Shoulder Dislocation Management Guidelines

Initial Post-Reduction Management

After successful reduction of a shoulder dislocation, the American College of Orthopedic Surgeons recommends beginning early physical therapy following a brief immobilization period, focusing on gentle mobilization and progressive strengthening to restore function while preventing recurrent instability 1
Avoid overhead pulleys during initial recovery as they encourage uncontrolled abduction that may worsen injury 1

Mandatory post-reduction radiographs must be obtained to confirm successful reduction and evaluate for fractures that may have been obscured by the dislocation, according to the American College of Radiology 2, 3
Post-reduction imaging should include AP views plus axillary or scapula-Y view, as recommended by the American College of Radiology 2
For young patients (<35 years), obtain MRI without contrast or MR arthrography to evaluate for labral tears, capsular injuries, and bone loss that predict recurrence, as suggested by the Journal of the American College of Radiology and the American College of Orthopedic Surgeons 2, 4

Critical post-reduction neurovascular examination is mandatory, particularly evaluating axillary nerve function and vascular integrity, according to the American College of Orthopedic Surgeons 2
Regular assessment for neurological deficits is essential throughout follow-up, as recommended by the American College of Orthopedic Surgeons 1
Consider CT angiography if vascular compromise is suspected, especially with associated proximal humeral fractures, as suggested by the American College of Orthopedic Surgeons 2

First-line pain management should include acetaminophen or ibuprofen if no contraindications exist, as recommended by the American College of Orthopedic Surgeons 1
Intra-articular corticosteroid injections demonstrate significant pain reduction effects, according to the American College of Orthopedic Surgeons 1

Begin early physical therapy immediately after immobilization period to restore function and prevent complications, as recommended by the American College of Orthopedic Surgeons 1
Focus on gentle stretching and mobilization techniques, especially increasing external rotation and abduction, according to the American College of Orthopedic Surgeons 1

Surgical intervention should be considered for patients with neurological deficits suggesting nerve involvement, as recommended by the American College of Orthopedic Surgeons 1

Limit follow-up imaging to what will change management decisions, as suggested by the American College of Orthopedic Surgeons 1
CT scan may be indicated to better characterize associated fractures, according to the American College of Orthopedic Surgeons 1
MRI should be considered if concerns exist about soft tissue injuries or neurological involvement, as recommended by the American College of Orthopedic Surgeons 1

Never overlook associated rotator cuff tears, especially in patients over 40 years or with high-energy trauma mechanisms, as warned by the American College of Orthopedic Surgeons 2
Do not delay reduction attempts, as delays increase neurovascular complications, according to the American College of Orthopedic Surgeons 2
Do not miss posterior dislocations by relying on AP views alone—always obtain axillary or scapula-Y views, as recommended by the American College of Radiology and the American College of Orthopedic Surgeons 2, 3