Shoulders

Non-surgical Management of the Unstable Shoulder

Usually, the doctor or general practitioner will recommend resting your injured shoulder and applying ice packs 3-4 times daily. A sling may or may not be recommended because experimental trials have shown that there is no difference in re-dislocation rates between patients allowed normal movement and others whose arm was immobilised in a sling or some other device for 3-4 weeks

Your doctor may suggest some gentle exercises to gradually increase the shoulder's range of motion. These start with passive movements where the arm is moved by another person, progressing to active-assisted, and then to active movements made by the patient alone. Rehabilitation is best if based on the principle of progressive resistance and avoidance of aggravating factors.

After the pain and swelling are under control, the doctor may give you a program to strengthen your shoulder. The reported success rates of shoulder strengthening protocols for the management of multidirectional instability are better than those reported for unidirectional instability.

For recurrent unidirectional instability, non-surgical management based on exercise programs has generally had a poor success rate. Only 12 of 74 people (16%) with recurrent unidirectional shoulder instability had good or excellent results from an exercise program.

Younger patients, who have had surgical treatment following a single episode of anterior shoulder instability, have had much better functional results following an exercise program than others who did not have surgery. In adolescents with unstable shoulders, non-surgical management is insufficient to produce good results. In one study, up to 94% of 10-20 year olds relying on non-surgical management for their unstable shoulder re-dislocated. In another study, virtually all the adolescent patients, having an average age of 13 years, re-dislocated.

Warning:

These matters are complex and unique to each individual. Always seek expert advice with the assistance of your general practitioner.