Should I X-ray after reduction?
For first time dislocators, they definitely need an x-ray, particularly if there was difficulty reducing the shoulder, a known fracture fragment prior to reduction attempt or documented neurovascular abnormalities. However for recurrent dislocators who have sustained no trauma and enjoyed an easy reduction there is probably not much to gain from another x-ray. And it makes them happy because they can get out of the Emergency Department and back home quickly!
Should I immobilise the shoulder after relocating? If so, how?
Standard treatment has traditionally consisted of immobilization in a broad arm sling or fashioning of the arm to the torso for three to six weeks.
The current evidence available shows no difference in recurrence rates with different periods of immobilization, from wearing a simple sling until comfortable, to full immobilization for one month.
Positioning the arm in external rotation may reduce the redislocation rate but is impractical for some patients.
What about physiotherapy?
Rehabilitation exercises may play a role in reducing the recurrence rate. The results of conservative management in reducing redislocation rates are poor.
When can they start using the shoulder again?
Provided there is no bony injury, most patients should be able to mobilise their arm when tolerated, using simple analgesia.
Does my patient need to see an orthopaedic surgeon?
If there is a bony or neurovascular injury then follow up with an orthopaedic surgeon is recommended. If a Bankart’s lesion in a young person is suspected, then MRI (or CT if unavailable) and early referral for a Bankart’s repair is appropriate.