Dislocated Shoulder (cont.)

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.

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.

Last Editorial Review: 12/22/2010

Source: MedicineNet.com
http://www.medicinenet.com/dislocated_shoulder/article.htm