All dislocations need to be reduced quickly, usually with sedation and analgesia. If it cannot be reduced, then it needs to go to theatre to be reduced and an appropriate surgery performed repair the damaged structures.
Non-operative management of reduced shoulder dislocations involves pain medication and anti-inflammatories, a sling initially for comfort, and a dedicated rotator cuff rehabilitation program through physiotherapy. Patients with reduced dislocations then need to be risk assessed according to their risk of redislocation. Generally speaking, the younger and more active the patient, the greater the need for operative intervention. Older patients with shoulder dislocations have more often torn their rotator cuff off in the process, and the dislocation is not the primary problem that needs surgical repair.
Operative management of shoulder dislocations usually includes a shoulder arthroscopy to assess other intracapsular injuries, followed by definitive management of the instability. This may be achieved through an arthroscopic labral repair, where the risk of redislocation is not significant. In those where the risk of redislocation is high, a Laterjet or coracoid transfer procedure is performed to hold the humeral head in place.
Postoperative care involves pain management, a sling for comfort for 6 weeks and then a shoulder rehabilitation program to regain strength and range.