Closed Reduction (Shoulder)
A shoulder dislocation may be treated at the scene of the injury, however, treatment at a hospital is a much safer option. If a trainer or experienced medical provider is nearby, then a shoulder dislocation can usually be easily reduced immediately after the injury and before muscles have gone into spasm. At that point in time, the shoulder dislocation can usually be reduced with some basic manipulation.
It is important to remember that there are inherent complications of a shoulder dislocation, and additional complications of attempting to reduce a dislocated shoulder. Therefore, if there are signs of unusual circumstances or if trained medical personnel are not readily available, reduction of the shoulder dislocation should be left to the trained hands at a hospital.
There are a variety of methods available to return the shoulder to its normal position. Once the patient arrives at the emergency room, they will receive either intravenous (IV) sedation or a local injection prior to the reduction procedure.
In general, the goal of reduction is to effectively manipulate the bones to allow them to gently slide back into the correct position without causing further damage to the shoulder joint.
Once the dislocated shoulder is back in place, X-rays are taken to confirm that the shoulder is in the correct position and to check for other injuries such as fractures. Patients are then placed in a sling to rest and protect the shoulder from further injury, and then referred to an orthopaedic surgeon for further management.
Once an individual sustains a shoulder dislocation, they are much more likely to have a recurrence. This is due to the fact that when a dislocation occurs, the shoulder ligaments are torn, and the shoulder joint has been rendered less stable. In most cases, a patient should be examined by their orthopaedic physician. The examiner will look for signs of injury to the ligaments of the shoulder—specifically, a Bankart lesion. In addition, the attending physician will order specific tests to evaluate for shoulder instability. An MRI examination may be obtained to check for the Bankart lesion. Commonly, the MRI is done with dye injected into the joint. If such ligament damage is discovered, a decision must be made whether or not to proceed with surgical treatment.
If a patient has repeat shoulder dislocations, surgical treatment is often recommended. In some cases, surgery may be prescribed for patients suffering a shoulder dislocation for the first time.