Shoulder > Shoulder Dislocation > Treatments

   Sling and Physical Therapy

Hospital Recovery

After a successful closed reduction of a dislocated shoulder, most patients have the affected shoulder and upper extremity placed in a sling, which holds your arm in a bent position across your chest, and an ice pack may be used to reduce pain and swelling. You probably will feel mild to moderate pain. While in the emergency room, your physician will prescribe pain medications that may be administered intravenously, intramuscularly, or orally. You will be discharged with a prescription for oral pain medications. You should wear the sling as prescribed by your orthopedic surgeon. Physicians generally recommend wearing the sling at all times except during daily hygiene for two to eight weeks. Remember to avoid moving your injured shoulder. Almost all shoulder dislocations followed by closed reduction heal better initially when the shoulder is immobilized for a period of time. It may be difficult to function at home with one arm in the sling, and you may be on prescription-strength painkillers. You should have someone available to take you home from the emergency room. In some cases, you will also need someone to help you with certain activities of daily living that require the use of two hands.

After a shoulder dislocation followed by closed reduction, you will need to take steps to reduce the pain and inflammation in the shoulder. Rest, icing, and anti-inflammatory painkillers, such as ibuprofen or aspirin, can ease pain and swelling, and immobilizing the shoulder will decrease pain and promote healing of damaged soft-tissues of the shoulder. Here is what you can expect and how you can cope with a sling immobilizing your shoulder:

   The first concern is to monitor swelling for the first 48 hours while wearing your sling. Physicians generally prescribe ice packs to be applied as much as possible during the first few days after the injury to decrease pain and swelling.

   You should wear the sling as prescribed by your orthopedic surgeon. Physicians generally recommend wearing the sling at all times except for daily hygiene for between two and eight weeks. Remember to avoid moving your injured shoulder. Almost all shoulder dislocations followed by closed reduction heal better initially when the shoulder is immobilized for a period of time.

   When your shoulder starts to heal, your physician may recommend that you remove the sling for short periods to perform some light, early-motion exercises.

   You should move your fingers and hands in the sling as much as possible to help circulate blood.

   If you develop a rash or irritated skin around your sling, call your physician.

   If you notice any abnormal wear or discomfort, contact your physician as early as possible. In general, do not try to "grin and bear it" if discomfort does not go away within a few days.

   Rehabilitation can usually begin within a few weeks after the injury, but you should visit your physician a week or two after the injury for a routine check-up. Until cleared by your physician, you should keep the shoulder immobilized in the sling.

   The sling may make it difficult to use the hand of the injured shoulder. Some people may need to take about six weeks off from work after a shoulder dislocation, depending on how much they rely on the immobilized arm.

After about two or three weeks of immobilization, your physician usually refers you to a physical therapist to begin rehabilitation exercises. Successful rehab may take between four and six months to complete. The first stage of physical therapy usually involves passive motion exercises with the assistance of your physical therapist. Most patients begin with forward motion in the shoulder. Because your arm has been held across your chest for weeks, rotating or turning the shoulder outward may be painful and difficult when rehabilitation begins, particularly externally rotation. With the shoulder held in place, you usually begin strengthening your wrist and elbow by flexing and extending your hand and arm. After two to four weeks, you may be able to start moving your hand, arm, and shoulder with the assistance of the therapist. Usually within eight weeks, your therapist can start adding resistance to your exercises with weights or elastic bands. After eight weeks, many patients can rotate their shoulders outward with little pain and rotator cuff strengthening exercises can begin. The four muscles in the rotator cuff generally should be made stronger than they were before the injury to properly support and stabilize your shoulder. When your rotator cuff muscles are strong enough to withstand stress, rehab tends to become more activity oriented. Sport-specific exercises and coordination drills help prepare you to return to sports and activities. Non-contact sports, like tennis and swimming, can often be resumed within four months. Contact sports should usually not be resumed until at least six months after a shoulder dislocation. Depending on your specific situation your physician may prescribe a modification to the above regimen.

The best way to prevent multiple shoulder dislocations is to make the shoulder strengthening exercises you learned in rehabilitation part of your everyday routine. After you suffer an initial dislocation, your shoulder may be more vulnerable to instability. The natural integrity of the socket may not be strong enough to withstand the force of contact sports or repeated overhead motion. You may have to rely much more on the muscles in the rotator cuff (supraspinatus, infraspinatus, subscapularis, and the teres minor), lower neck, and upper back to hold your shoulder in place. Remember to warm up your shoulders before physical exercise by rotating your arms in different directions. Depending on the severity of your dislocation and the success of your rehabilitation program, your physician may recommend that you avoid contact sports or risky, high-speed activities. In general, your shoulder can become healthy and stable after a dislocation, but you may need to be cautious of activities that could result in accidental collisions or falls. You should wear shoulder pads during contact sports. Your physician can recommend the best types of protective gear for your shoulders.

Nearly all shoulder dislocations can be initially treated without surgery by closed reduction (putting the humeral head back into the glenoid socket) and then immobilizing the shoulder in a removable sling for four to eight weeks.

Once the diagnosis of a dislocated shoulder has been made, your physician will proceed to reduce your dislocated shoulder. This reduction is performed after you have been given pain medications, sedatives, and muscle relaxants to alleviate your pain, calm you down, and relax your muscles so that the reduction is able to be performed as easily as possible for both you and your physician. The reduction is performed by stabilizing your torso and gently manipulating your upper extremity so that the humeral head can be guided back to the glenoid. Depending on the extent of damage to the soft-tissue structures of the shoulder, your age, and activity demands, non-operative treatment with an emphasis on physical therapy may sufficiently strengthen your shoulder to return to activities without surgery.