Ways to prevent repeat dislocations.

• Position: Shoulder Injuries

Prompt and appropriate treatment of a dislocated shoulder--when the head of the upper arm bone (humerus) completely is knocked out of the shoulder socket (glenoid)--can minimize risk for future dislocations as well as the effects of related bone, muscle, and nerve injuries, according to a literature review appearing in the Journal of the American Academy of Orthopaedic Surgeons.

The shoulder has the greatest range of motion of any joint in the human body and is the most common site for a full or partial dislocation. Shoulder dislocations are classified as "traumatic" or "atraumatic." Up to 96% of dislocations are traumatic, occurring most often during contact sports or when someone falls onto an outstretched hand. Atraumatic dislocations--when the shoulder starts to slip part way out without trauma--can cause limited shoulder movement in multiple directions.

Shoulder dislocations account for upwards of 200,000 emergency department visits in the U.S., although some patients choose to reset the joint without any medical assistance.

"We do not recommend self-setting of shoulder dislocations," says Richelle Takemoto, an orthopaedic surgeon with Kauai Medical Clinic/Wilcox Memorial Hospital, Lihue, Hawaii. Takemoto and her coauthors recommend immediate medical attention for a dislocated shoulder that includes radiographic images before and after reduction (resetting of the shoulder) to check for related fractures and other musculoskeletal injuries.

The cause of injury, the presence of an associated fracture and/or nerve injury, and the difficulty in resetting the shoulder all contribute to a patient's outcome. "Acute shoulder dislocations can be effectively managed by closed reduction maneuvers," explans lead study author Thomas Youm, clinical assistant professor,

New York University Hospital for Joint Diseases. "There are a plethora of...