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Shoulder pain - Management
Basis for recommendation

Acute dislocation

  • CKS recommends immediate referral if acute dislocation is suspected because of the need for radiography and expertise for reduction of the dislocation. A New Zealand guideline on the diagnosis and management of soft tissue shoulder injuries and related disorders suggests [NZGG, 2004]:
    • Pre-reduction radiography is recommended in people older than 40 years of age.
    • Post-reduction radiography is recommended for all people with an acute first-time dislocation, to confirm the reduction and assess for bony injury.
    • Only clinicians with appropriate expertise should reduce anterior or posterior dislocations.

Recurrent dislocation

  • A New Zealand guideline on the diagnosis and management of soft tissue shoulder injuries and related disorders advises that people with recurrent dislocation should be referred to an orthopaedic specialist to evaluate the need for surgical stabilization [NZGG, 2004].

Instability

  • A New Zealand guideline on the diagnosis and management of soft tissue shoulder injuries and related disorders suggests that multidirectional instability should be diagnosed, managed, and investigated by an orthopaedic specialist, and that if a comprehensive rehabilitation programme does not improve function, surgery may be considered [NZGG, 2004]. Two reviews also suggest early referral, especially for athletes [Burbank et al, 2008; Mitchell, 2008]. Feedback from an expert reviewer also suggested referral for physiotherapy.
  • Evidence from a systematic review [Gibson et al, 2004] consistently showed poorer outcomes after conservative management compared with surgical management, especially in people younger than 30 years of age.

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