Nonaccidental trauma consideration when history inconsistent
Orthopedics follow-up for recurrent instability risk
Background
Epidemiology
Epidemiology facts
Anterior dislocation as most common subtype
Posterior dislocation as uncommon subtype
Inferior dislocation as rare subtype
Higher recurrence risk in adolescents and young adults
Pathophysiology
Mechanism and lesions
Anterior dislocation injury patterns
Bankart lesion risk
Hill-Sachs lesion risk
Posterior dislocation injury patterns
Reverse Hill-Sachs lesion risk
Posterior labral injury risk
Inferior dislocation injury patterns
Capsuloligamentous disruption risk
Neurovascular stretch injury risk
Therapeutic Considerations
Therapeutic rationale
Early reduction benefit
Pain relief
Skin protection
Neurovascular decompression
Immobilization tradeoffs
Comfort and short-term stability benefit
Stiffness risk with prolonged immobilization
Rehabilitation goals
Restore range of motion
Strengthen rotator cuff and scapular stabilizers
Reduce recurrent instability risk
Evidence framing
Class I recommendation for urgent reduction with neurovascular compromise
ACEP Level B framework for procedural sedation safety elements
Patient Discharge Instructions
Copy discharge instructions
Discharge instructions
Sling use
Wear continuously except hygiene and exercises as instructed
Sleep with sling if painful without it
Pain control plan
Acetaminophen dosing per label
NSAID dosing per label if allowed
Opioid short course only if required
Ice and elevation
Ice 15 to 20 minutes at a time
Keep arm supported on pillows when resting
Activity restrictions
No lifting with injured arm
Avoid abduction and external rotation until cleared
Follow-up
Orthopedics or sports medicine appointment within 1 week
Earlier follow-up if fracture, elderly, or persistent weakness
Return to ED now
Increasing pain despite medication
New numbness or weakness
Cool, pale, or blue hand
Increasing swelling or tightness
Recurrent dislocation sensation
Fever or redness with severe joint pain
References
Clinical guidelines and evidence sources
Reference list
AAOS patient and clinician education resources on shoulder instability
American Shoulder and Elbow Surgeons resources on shoulder instability and recurrent dislocation
ACEP clinical policy and guideline resources for procedural sedation and analgesia in the ED
Quebec Decision Rule publications and summaries for shoulder dislocation radiography
Orthopedic and sports medicine reviews on Bankart and Hill-Sachs lesion management
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.