Determining the appropriate treatment depends on a number of factors including exactly what was damaged in the shoulder, how many dislocations have occurred, age of the patient, activities or sports performed, and other factors. You will need to discuss with your doctor the most appropriate treatment for your situation.
Repositioning the Dislocation:
Once the should dislocation is back in place, repeat x-rays are performed to ensure it is indeed in the correct position, and to evaluate for other injuries such as fractures. Patients are placed in a sling to rest the shoulder and referred to their orthopedic surgeon for further management.
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 commonly torn (the Bankart tear) when the shoulder dislocates, is held in an abnormal position. When the ligament heals, it tends to heal in this improper position. In some patients, especially younger athletes, healing of the ligament in this position may lead to repeat shoulder dislocations.
Immobilization in External Rotation:
Immobilization in external rotation is cumbersome and difficult to perform. It is important that the external rotation brace be properly configured--the upper 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. While this treatment is exciting in concept, most patients cannot comply with the brace, and therefore this treatment is seldom used.
Again, while physical therapy is often used, and extremely helpful in regaining strength and mobility, this has not been shown to lower the chance of having a second dislocation. The most common treatment recommendation is to try therapy after a first dislocation, and if a second dislocation occurs, to proceed with surgery.
Braces can help to prevent the shoulder from being placed into a position in which a dislocation is possible. While they cannot prevent all shoulder dislocations, these braces can reduce the overall chance of shoulder dislocations in athletes.
The major problem with bracing, is that athletes who participate in sports often have difficulty wearing the brace and competing effectively. Braces are especially cumbersome in athletes who overhead function (such as throwing) is critical for their effectiveness. Therefore, most athletes are unable to return to their sport while wearing a shoulder dislocation brace.
Surgery for Shoulder Dislocations:
Surgery is performed to repair the structures that normally hold the shoulder in position. The most common damage is to the ligaments in the front of the shoulder joint. Surgery to repair these ligaments is called a Bankart repair.
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.Owens BD, et al. "Management of Mid-season Traumatic Anterior Shoulder Instability in Athletes J Am Acad Orthop Surg August 2012 ; 20:518-526.