Shoulder Dislocation Treatment

Surgical treatment of a shoulder dislocation is most often recommended for patients who have recurrent, or repeat, shoulder dislocations. In some patients, surgery may be recommended after a first shoulder dislocation. Can shoulder dislocation be effectively treated without surgery?

The Problem With Nonsurgical Treatment of Shoulder Dislocations

Most shoulder dislocations are anterior shoulder dislocations, meaning the ball is pushed out it front of the socket. About 95% of shoulder dislocations are anterior. In patients who sustain this type of shoulder dislocation, the most common injury in the shoulder is called a Bankart lesion. The "Bankart lesion" means that ligaments that help to hold the shoulder in proper position have been damaged.

The Bankart lesion occurs in over 90% of patients with an anterior shoulder dislocation. When the ligament is torn in patients with this Bankart lesion, the shoulder is not held as tightly in position.

Can the Bankart lesion heal without surgery?
Yes. In fact, it will always heal. The problem is, that it does not heal in the right position. The ligament tends to heal in a position that does not help to hold the shoulder in the proper position.

Usual Nonoperative Treatment of Shoulder Dislocations

The usual treatment of an anterior shoulder dislocation is to place the patient in a sling for a few weeks to allow the swelling and inflammation around the shoulder to subside. Thereafter, progressive exercises are started until the patient is able to resume their usual activities.

The sling that is used to treat most shoulder dislocations holds the shoulder in internal rotation. This means that the shoulder is turned inwards, and the forearm is held against the body. When the shoulder is held in internal rotation the ligament that is torn (the Bankart lesion) is often held in a non-anatomic position. When it heals, it tends to heal in an improper position. In some patients, especially younger patients, healing of the ligament in this position may lead to repeat shoulder dislocations.

Immobilization of Shoulder Dislocations in External Rotation

Research out of Japan has shed light on the treatment of shoulder dislocations with the shoulder held in external rotation. When the shoulder is held in external rotation the ligament is brought into a more normal position, and may heal in this proper position. The idea behind immobilization in external rotation is that if the ligament heals in the proper position, then repeat shoulder dislocations will be less likely.

• Pros of External Rotation Immobilization
  
  • Nonoperative, and therefore no complications that are seen with surgery.

  • Repeat shoulder dislocations may be less likely, as has been shown in some early studies.

• Cons of External Rotation Immobilization
  
  • Very awkward position to hold the arm--can be difficult to manage with normal daily activities.

  • It is unclear if the ligament heals with the proper tension--we know it is in a better position, but it still may not function normally.

Immobilization in external rotation of shoulder dislocations may be appropriate for some people. It is important that the external rotation brace be properly configured--the arm should be held tightly against the side, and the forearm should be pointing away from the body. Many patients (and some doctors) confuse abduction immobilizers (shoulder immobilizers with a pillow in the armpit) with an external rotation immobilizer. These are not the same, and similar results of treatment should not be expected.

Last updated: 03/20/2006

References:

• Itoi, E, et al. "A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study." J Shoulder Elbow Surg. 2003 Sep-Oct;12(5):413-5.