Monitoring
Shoulder dislocation
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Patients under 25 years of age should be referred to an orthopaedic surgeon to consider further intervention (i.e., possible arthroscopic or open repair), as this age group is at significant risk of recurrence and has been reported to have a better outcome after primary repair by an orthopaedic surgeon. Patients should have routine follow-up with an orthopaedic surgeon and begin physiotherapy. If significant pain and inability to raise the arm remains 3 to 4 weeks after the reduction, a high suspicion for rotator cuff tear merits an MRI evaluation.
Finger dislocation
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Any finger dislocation should be followed up by a hand surgeon to ensure appropriate management and to monitor rehabilitation. Patients may or may not need occupational therapy to assist in range of motion and prevent stiffness of the joint.
Patellar dislocation
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Outpatient referral is appropriate after a dislocation has been reduced to evaluate presence of instability, assess the range of motion, and implement a therapy programme if necessary.
Elbow dislocation
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Patients with simple dislocations should have routine follow-up with an orthopaedic surgeon to evaluate presence of instability, assess the range of motion, and implement a therapy programme if necessary.
Patient Instructions
Shoulder dislocation
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There appears to be no difference between early mobilisation and immobilisation following a shoulder dislocation. However, it is common to place the arm in a sling for comfort. [25] [54] Immobilisation should be for no longer than 3 to 4 weeks to avoid adhesive capsulitis. All patients should avoid impact activities. Pain permitting, patients should be encouraged to begin range of motion activities. [Milne C. Patient information sheet: shoulder dislocation]
Finger dislocation
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For simple stable dislocations that concentrically reduce, patients should be instructed to wear their splints only until the pain subsides. Pain permitting, the patient should buddy tape the affected finger and begin an active range of motion.
Patellar dislocation
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Patients should be immobilised in a knee immobiliser for 10 to 14 days with emphasis on early mobilisation as pain permits to limit arthrofibrosis. [New England Musculoskeletal Institute: patellar dislocation] Crutches should be used until the patient can walk relatively pain free, and the knee immobiliser should be kept in place until strength improves and symptoms abate. Moderate quadriceps strengthening should begin when the patient is comfortable. [10] [26] [28]
Elbow dislocation
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Patients who sustain a simple dislocation should be splinted initially but instructed to remove the splint when pain permits.
