After sustaining a dislocation or subluxation, the main priority is repositioning the shoulder back into place. The following step is a conservative treatment approach focused on healing, symptom reduction, and rehabilitation.
- Closed reduction – During this procedure, the physician moves and rotates the arm so that the humerus slides back into the glenoid cavity. Though patients may experience discomfort, shoulder pain drastically subsides after the bones are correctly realigned.
- Shoulder immobilization – Patients must wear a sling for a few weeks after closed reduction to keep the joint still and promote healing. Stretching and moving the shoulder during this period may lead to repeat injuries.
- Pain relief medication – Physicians will prescribe pain relievers and anti-inflammatories to address discomfort, lingering symptoms, and swelling. Caution is advised with more potent medicine known to lead to chronic consumption. NSAIDs such as ibuprofen, aspirin, or naproxen can also be prescribed for pain relief over a more extended period.
- Rehabilitation – If the shoulder is responsive to a limited course of treatment, physicians may recommend a series of light exercises to gradually restore the shoulder's range of motion and increase muscle strength.
Despite conservative treatment, some patients may continue experiencing shoulder instability or joint looseness. Activity modification may be recommended if instability results from specific activities. Surgical treatment is usually recommended for patients that require increased shoulder mobility like athletes or heavy laborers or if dislocations continue reoccurring.
Surgical Treatment Options
Subluxations don't usually require surgery, which is an option meant to address more severe injuries such as dislocations and damage to associated structures like bones, ligaments, tendons, and cartilage. Depending on the injury's severity, physicians may recommend open shoulder or arthroscopic surgery.
- Open Shoulder Surgery is recommended if the shape of the bones is affected or if weakness and discomfort persist following less invasive interventions. It involves the operating physician accessing the joint through a sizeable incision above the shoulder to repair damaged ligaments, tendons, the labrum, or address bone damage. Surgeons may address bone loss due to repeated dislocations with grafts from the patient's bones (usually from the top of the hip), which gradually fuse with the shoulder socket providing stability.
- Arthroscopic Surgery is a minimally intrusive procedure mostly recommended to tighten ligaments and tendons that have been torn or stretched, reattach the cartilaginous labrum to the shoulder socket, or clean out bone fragments. Physicians make small incisions around the shoulder, allowing access to a thin arthroscope to visualize the shoulder's interior and narrow surgical tools to carry out the operation. This procedure is preferred for its shorter time span, lower costs, and fewer complications or scarring.
Both types of interventions are performed under general anesthesia, with nerve blocking agents providing regional pain relief for up to 12-24 hours. After the incisions are closed and stitched, the operation is complete, and patients can begin focusing on healing. Arthroscopic surgery is performed on an outpatient basis allowing individuals to return home on the same day, but open shoulder surgery may require a stay in the hospital overnight.
