Treatment for a Reduced Dislocated Shoulder

Initial Management After Reduction

Avoid the use of overhead pulleys during the initial recovery period as they encourage uncontrolled abduction which may worsen injury 1

If there are no contraindications, analgesics such as acetaminophen or ibuprofen can be used for pain relief 2
Intra-articular corticosteroid injections have shown significant effects on pain reduction 1
Subacromial corticosteroid injections may be beneficial when pain is related to injury or inflammation of the subacromial region 2
Botulinum toxin injections into the subscapularis and pectoralis muscles may be beneficial for cases with spasticity-related shoulder pain 2

Early physical therapy should begin after the immobilization period to restore function and prevent complications 1, 3
Rehabilitation should focus on gentle stretching and mobilization techniques, especially increasing external rotation and abduction 1, 2
Progressive strengthening of shoulder muscles, particularly the rotator cuff, is recommended 1
Neuromuscular re-education may be necessary if nerve injury is present 3
Functional electrical stimulation (FES) may be considered to improve shoulder lateral rotation 1

Healthcare staff, patients, and family should be educated on correct positioning and handling of the affected arm to prevent further injury 2, 4
Consider shoulder strapping or a sling to prevent trauma to the shoulder during recovery 1, 5
Monitor for signs of complex regional pain syndrome (shoulder-hand syndrome), which may require early intervention with oral corticosteroids 2
Regular assessment for neurological deficits is essential 3

Surgical intervention should be considered for patients with neurological deficits suggesting nerve involvement 3

Regular follow-up imaging should be limited to what will change management decisions 3
CT scan may be indicated to better characterize any associated fractures 3
MRI should be considered if there are concerns about soft tissue injuries or neurological involvement 3

Obtain at least three radiographic views—anteroposterior (AP) in both internal and external rotation plus an axillary or scapula‑Y view—to confirm a glenohumeral dislocation and to detect associated fractures in all patients presenting with an acute shoulder dislocation. 6
The axillary or scapula‑Y view is essential because reliance on AP views alone can lead to misclassification of dislocations. 7

Perform post‑reduction radiographs to verify successful relocation of the glenohumeral joint after closed reduction in every patient. 8

If a fracture is suspected or identified on plain films, obtain a non‑contrast CT scan; this imaging modality alters management decisions in approximately 41 % of proximal humeral fracture cases. 6
Order a non‑contrast MRI when there is clinical concern for rotator‑cuff pathology (particularly in patients older than 40 years), labral injury, or neurological deficits, to guide further treatment planning. 8

Do not rely solely on AP radiographs, as this can miss associated fractures; ensure inclusion of axillary or scapula‑Y views to provide a complete assessment. 7