Dislocated Shoulder (cont.)
What happens after reduction of a shoulder dislocation?
Examination
Once the shoulder has been reduced, the health-care provider will want to
reexamine the arm and make certain that no nerve or artery damage occurred
during the reduction procedure. Often, another X-ray is taken to reassess the
bones.
Immobilization
Significant damage occurs to the joint when the shoulder is dislocated. The
labrum and joint capsule have to tear, and there may be associated injuries to
the rotator cuff. These are the structures that lend stability to the shoulder
joint and since they are injured, the shoulder is at great risk to dislocate
again.
A sling or shoulder immobilizer may be used as a reminder not to use the arm.
This keeps the shoulder internally rotated up against the body. Recently, some
orthopedic surgeons have begun recommending immobilizing the shoulder in 10-20
degrees of external rotation with the arm held partially away from the body to
minimize future dislocation risk.
The length of time a sling is worn depends upon the individual patient. A
balance must be reached between immobilizing the shoulder to prevent recurrent
dislocation and losing range of motion if the shoulder has been kept still for
too long.
Pain control
Once the shoulder dislocation is reduced, much of the pain is resolved.
Ibuprofen is often recommended as an antiinflammatory medication. Narcotic pain
medication like codeine or hydrocodone may be prescribed for the short term.
Special situations/recurrent dislocations
In certain situations, dislocations may be reduced immediately. This is
especially true in the sports medicine arena, where a health-care provider may
reduce the dislocation on the field of play. This is a reasonable treatment
alternative because the care provider was able to see the injury occur, examine
the patient and come to the diagnosis, and then reduce the injury before muscles
spasm sets in.
Many patients experience shoulder subluxation or partial dislocation. These
are patients who have had previous dislocations and are aware that their
shoulder has dislocated again and then spontaneously reduced. They may choose
not to seek urgent or emergent care, but this situation should not be ignored.
Once a shoulder dislocates, it becomes unstable and more prone to future
dislocation and injury.
Next: What is appropriate follow-up following a shoulder dislocation? »
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