Dislocated Shoulder (cont.)

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What is appropriate follow-up following a shoulder dislocation?

Follow-up with a primary-care provider or orthopedic surgeon is advised after a shoulder dislocation. The decision as to when to begin range-of-motion exercises of the shoulder has to be individualized for each patient. In shoulder dislocations not associated with a fracture or other associated injury, younger patients may be kept immobilized for two to three weeks. In the elderly, this time frame may shrink to only a week because the risk of a frozen shoulder (a joint that becomes totally immobile) is markedly increased.

It may be necessary to get X-rays or a magnetic resonance imaging (MRI), depending upon the patient and the situation, to evaluate the extent of potential injury to the joint, including the bones, labrum, and cartilage.

Some patients may be candidates for surgery to prevent future dislocations. The decision depends upon the extent of damage to the joint and the type of activities in which the patient participates. This decision is individualized for each patient.

Physical therapy is an important component to return the shoulder joint to normal function. Therapy may include exercises to strengthen the muscles that surround the shoulder and to maintain range of motion of the shoulder joint.

The total rehabilitation and recovery time from a shoulder dislocation is about 12-16 weeks.

What are potential complications of a shoulder dislocation?

Fractures of the bones that make up the shoulder joint are a possible complication of shoulder dislocations. Up to 25% of patients will have an associated fracture. Not included in these numbers are the Hill-Sachs deformity that may occur in up to 75% of anterior shoulder dislocations.

Nerve damage is a potential complication. Most often, the circumflex axillary nerve is injured. The first sign of injury is numbness in a small patch distribution on the outside of the upper arm. This nerve often recovers spontaneously in a few weeks, but this is an important complication for the health-care professional to recognize since damage to the nerve may cause weakness of the deltoid muscle that helps move the shoulder.

Older patients who dislocate their shoulder may have rotator cuff injuries. The diagnosis may be difficult to make initially, and often the health-care professional will make the diagnosis during a follow-up visit.

Rare complications of shoulder dislocations include tearing of the axillary artery, the main artery that supplies blood to the arm and brachial plexus injury, in which the nerve bundle that attaches the arm nerves to the spinal cord is damaged. Both of these structures are located in the axilla or armpit and are potentially damaged by the initial dislocation or by attempts to reduce the dislocation.

REFERENCE:

Iannotti, J.P., and G.R. Williams. Disorders of the Shoulder: Diagnosis and Management. 2nd edition. Philadelphia: Lippincott Williams & Wilkins, 2007.


Medically Reviewed by a Doctor on 1/28/2014

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