Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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.
X-rays or magnetic resonance imaging (MRI) may be required, depending upon the
patient and the situation, to evaluate the extent of potential injury to the
joint.
Some patients may be a candidate for surgery to prevent future dislocations.
The decision depends upon the extent of damage to the joint and the type of
activity that the patient engages in. 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.
Total recovery from a shoulder dislocation usually takes 12-16 weeks.
What are potential complications of a shoulder dislocation?
Shoulder dislocations may be complicated by fractures of the bones that make
up the shoulder joint. 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 may be 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 provider to recognize since damage to the nerve may cause weakness
of the deltoid muscle that helps move the shoulder.
Rotator cuff injuries are commonly seen in older patients who dislocate their
shoulder. The diagnosis may be difficult to make initially and often is made in
follow-up visits with the health-care provider.
Rare complications of shoulder dislocation 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 these structures are located in the axilla or armpit and
are potentially damaged by the initial dislocation or by attempts to reduce the
dislocation.
Shoulders are the most common joint in the body to dislocate.
Approximately 25% of
shoulder dislocations have associated fractures.
Closed reduction, without the
need for surgery, is the most common initial treatment. Medications may be
required for sedation to help facilitate the reduction.
Immobilization with a
sling is important to decrease the risk of a repeat dislocation. First dislocations are immobilized in an external rotation position. Recurrent dislocations may be immobilized in a regular sling.
Early
follow-up is important to decide when to begin allowing shoulder motion.
Total
time of immobilization varies, and balance needs to exist between shoulder
stability and loss of motion and function from prolonged immobilization.
Uncomplicated rehabilitation and healing will allow return to normal function in
12-16 weeks.
REFERENCE:
Iannotti, J.P., and G.R. Williams. Disorders of the Shoulder: Diagnosis and Management. 2nd edition.
Philadelphia: Lippincott Williams & Wilkins, 2007.
Muscle cramps are involuntarily and forcibly contracted muscles that do not relax. Extremely common, any muscles that have voluntary control, including some organs, are subject to cramp. Since there is such variety in the types of muscle cramps that can occur, many causes and preventative medications are known. Stretching is the most common way to stop or prevent most muscle cramps.
A frozen shoulder (adhesive capsulitis) is when the shoulder joint experiences a significant loss in its range of motion due to inflammation, scarring, or injury. Treatment involves anti-inflammatory medication, cortisone injections, and physical therapy.
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