Traditional internal rotation immobilization: standard of care for decades
External rotation immobilization hypothesis: better labral apposition on glenoid rim
Current evidence: external rotation may reduce recurrence but evidence remains evolving
Duration: 2-4 weeks for comfort; longer immobilization does not reduce recurrence
Patient Discharge Instructions
copy discharge instructions
What happened to your shoulder
Your shoulder dislocated — the ball of your upper arm bone came out of its socket
The shoulder was put back in place (reduced) in the Emergency Department
X-rays confirmed the shoulder is back in normal position
Sling instructions
Wear the sling for 2-4 weeks for comfort
Remove the sling for bathing and gentle pendulum exercises as directed
Do not lift objects with the affected arm until cleared by orthopedics
Keep the arm in the sling when sleeping initially if comfortable
Medications
Acetaminophen 500-1000 mg every 6-8 hours as needed for pain (maximum 3000 mg per day)
Ibuprofen 400-600 mg every 6-8 hours with food as needed
Apply ice pack wrapped in towel to shoulder for 20 minutes, 3-4 times per day for 48-72 hours
Activity restrictions
No contact sports, overhead activities, or heavy lifting until cleared by your orthopedic surgeon
Avoid positions that put the arm out to the side and rotate it outward
Driving: do not drive until cleared by your orthopedic surgeon and pain-free
Follow-up appointments
Orthopedic surgeon appointment within 1-2 weeks
Bring any prior shoulder X-rays or MRI to your follow-up appointment
Physiotherapy referral likely at your orthopedic appointment
Return to Emergency Department immediately if
Increasing numbness, tingling, or weakness in the arm or hand
Loss of pulse, cold fingers, or blue discoloration of the fingers
Worsening pain despite taking medications
Feeling of shoulder slipping out of place again
Fever greater than 38.5 degrees Celsius
Swelling or wound changes if skin was broken
Important counseling points
Recurrence risk is high in young patients (up to 51% if aged 15-20 years)
Each recurrent dislocation causes additional damage to the bone and soft tissue
Discuss surgical stabilization options with your orthopedic surgeon at follow-up
Rehabilitation and physiotherapy are essential for full recovery and preventing recurrence
References
Guidelines and Key Sources
Simon LM, Nguyen V, Ezinwa NM. Acute Shoulder Injuries in Adults. American Family Physician. 2023
PMID: 37192075
Comprehensive clinical review of diagnosis and management
Gonai S, Miyoshi T, da Silva Lopes K, Gilmour S. An Umbrella Review of Systematic Reviews for Assessment and Treatment of Acute Shoulder Dislocation. American Journal of Emergency Medicine. 2025
PMID: 39442380
Umbrella review supporting intra-articular lidocaine and biomechanical techniques
Braun C, McRobert CJ. Conservative Management Following Closed Reduction of Traumatic Anterior Dislocation of the Shoulder. Cochrane Database of Systematic Reviews. 2019
Cochrane review: recurrence rates by age, immobilization evidence
Sithamparapillai A, Grewal K, Thompson C, Walsh C, McLeod S. Intra-Articular Lidocaine Versus Intravenous Sedation for Closed Reduction. CJEM. 2022
PMID: 36181665
Meta-analysis supporting intra-articular lidocaine equivalence to IV sedation
Jin H, Zhang G, Chen S, et al. Surgical Treatment Is Superior to Conservative Options in Preventing Recurrence of First-Time Anterior Shoulder Dislocation in Adolescents and Adults Under 40 Years of Age. Arthroscopy. 2025
PMID: 40939903
Network meta-analysis supporting early surgical stabilization in young patients
Baden DN, Visser MFL, Roetman MH, et al. Effects of Reduction Technique Without Sedation. European Journal of Trauma and Emergency Surgery. 2023
PMID: 36856781
Meta-analysis of biomechanical reduction techniques without sedation
Imaging and Bone Loss Guidelines
Laur O, Ha AS, Bartolotta RJ, et al. ACR Appropriateness Criteria Acute Shoulder Pain: 2024 Update. Journal of the American College of Radiology. 2025
Imaging algorithm for acute shoulder pain including dislocation
MRI and CT indications following shoulder dislocation
Provencher MT, Midtgaard KS, Owens BD, Tokish JM. Diagnosis and Management of Traumatic Anterior Shoulder Instability. Journal of the American Academy of Orthopaedic Surgeons. 2021
PMID: 33275397
Bone loss thresholds, off-track Hill-Sachs, surgical indications
Hettrich CM, Magnuson JA, Baumgarten KM, et al. Predictors of Bone Loss in Anterior Glenohumeral Instability. American Journal of Sports Medicine. 2023
PMID: 36939180
Glenoid bone loss predictors and thresholds
Rutgers C, Verweij LPE, Priester-Vink S, et al. Recurrence in Traumatic Anterior Shoulder Dislocations Increases Prevalence of Hill-Sachs and Bankart Lesions. KSSTA. 2022
PMID: 34988633
Progressive bone loss with each recurrent dislocation
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