Post-reduction care for an anterior shoulder dislocation

Siamak Moayedi, MD
19th Nov 2020

Great post-reduction care for an anterior shoulder dislocation includes four important aspects:

  1. A physical exam
  2. An x-ray exam
  3. Re-dislocation prevention
  4. Follow-up care

 

Physical signs of a successful shoulder reduction 

There are three clues that you have successfully reduced a shoulder:

  1. The patient will have an immediate decrease in pain. 
  2. The shoulder will look normal again. 
  3. The patient can reach across their chest and touch their other shoulder.  

Physical signs for a successful shoulder reduction: Multi-component image of relieved patient, normal shoulder, and patient touching opposite shoulder. Cartoons.

Figure 1. Physical signs of a successful shoulder reduction. The patient will have an immediate decrease in pain, the shoulder will look normal again, and the patient can reach across their chest and touch their other shoulder. 

If your patient had reduced sensation over their deltoid before the reduction (e.g., axillary nerve injury), they have a 90% recovery rate after reduction. However, it’s a good idea to have them follow up with an orthopedist.

 

X-ray confirmation of successful shoulder reduction

It’s a good idea to get post-reduction x-rays to show that at the time of discharge, the shoulder was back in. Because of all the tears and stretching that lead to the initial dislocation, the shoulder is at a higher risk of re-dislocating.

X-ray confirmation of successful shoulder reduction: X-rays of a dislocated and reduced shoulder. Images. 

Figure 2. X-ray of a right shoulder before and after successful shoulder reduction. 

 

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How to prevent re-dislocation of the shoulder

To prevent re-dislocation, adduct and internally rotate the shoulder before placing it in a sling. Then, use a strap to prevent external rotation and abduction. 

How to prevent re-dislocation of the shoulder: Male patient wearing a sling with a strap. Cartoon.

Figure 3. How to prevent re-dislocation of the shoulder. Use a sling with a strap to prevent external rotation and abduction in patients who have dislocated their shoulder. 

 

Follow-up care

The incidence of rotator cuff injury is almost 40%, so it is important to follow up with an orthopedist for all shoulder dislocations.

Generally, patients older than 60 should follow up in five days and start physical therapy to avoid future shoulder stiffness. Younger patients will usually be immobilized for three weeks and can follow up in one to two weeks. 

Great job! You’re well on your way to perfecting post-reduction care for a shoulder dislocation. 

 

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Recommended reading

  • Alkaduhimi, H, van der Linde, JA, Willigenburg, NW, et al. 2017. A systematic comparison of the closed shoulder reduction techniques. Arch Orthop Trauma Surg137: 589–599. PMID: 28251280
  • Cunningham, N. 2003. A new drug free technique for reducing anterior shoulder dislocations. Emerg Med (Fremantle)15: 521–524. PMID: 144992071
  • Marinelli, M and de Palma, L. 2009. The external rotation method for reduction of acute anterior shoulder dislocations. J Orthop Traumatol10: 17–20. PMID: 19384630
  • Sayegh, FE, Kenanidis, EI, Papavasiliou KA, et al. 2009. Reduction of acute anterior dislocations: a prospective randomized study comparing a new technique with the Hippocratic and Kocher methods. J Bone Joint Surg Am91: 2775–2782. PMID: 19952238
  • Stafylakis, D, Abrassart, S, and Hoffmeyer, P. 2016. Reducing a shoulder dislocation without sweating. The Davos technique and its results. Evaluation of a nontraumatic, safe, and simple technique for reducing anterior shoulder dislocations. J Emerg Med50: 656–659. PMID: 26899512