Non-Operative — Acute Glenohumeral Joint Dislocation (Non-Operative)

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Shoulder immobilizer worn at all times except during exercises Phase I (age-based duration: <20 yrs 4 wks, 20-30 yrs 2-3 wks, >30 yrs 10 days-2 wks); immobilizer discontinued Phase II

Key Restrictions

Avoid provocative positions risking recurrent instability, avoid shoulder abduction/ER, avoid shoulder extension throughout Phases I-II; suspend treatment and refer back to office if subluxation/dislocation signs occur; no heavy lifting or sports activity Phase III

Timeline & Phases

Phase I, Protection Phase (0-4 wks): minimize pain/inflammation, regain passive motion, pain medication and ice as needed, shoulder immobilizer at all times except exercises (age-based duration per protocol), Codman's pendulum (15 sec progressing to 3-5 min, 4-6x/day), passive forward flexion (hand to mouth, forehead, top of head, 4-6x/day 10-15 reps), passive abduction permitted, active elbow/wrist/finger ROM, ball squeezes, tabletop activities, avoid provocative positions/abduction/ER/extension, suspend treatment if instability signs occur; Phase II, Motion Phase (5-8 wks): regain full active ROM, avoid reinjury, re-establish stability, continue Phase I exercises supervised by PT, discontinue immobilizer, active-assisted forward flexion/abduction progressing to AROM, overhead pulley (passive to active progression), shoulder flexion/abduction/IR isometrics, shoulder shrug, elbow flexion isometrics, continue avoiding provocative positions/abduction/ER/extension; Phase III, Strengthening Phase (9-12 wks): maintain full painless ROM, continue RTC/scapular stabilizer/deltoid strengthening, isometrics all planes, isotonic theraband strengthening (progressive resistance and repetitions, emphasis on resisted ER/IR), isotonic free weights up to 3 lbs, shoulder shrug with weight progression, push-up progression (wall to table to kneeling to floor to seated), additional RTC/scapular exercises at PT discretion, avoid provocative positions/reinjury/heavy lifting/sports activity

Notes

OSMS Rehabilitation Guidelines; non-operative management of acute glenohumeral dislocation with age-based immobilization duration (younger patients immobilized longer due to higher recurrence risk); labeled internally as 'Protocol R1'