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Key points

  • Chronic dislocation of the shoulder should be suspected in patients with shoulder pain and decreased range of motion in the context of dementia, alcoholism, obesity, seizure disorders, or multiple trauma.
  • A patient with a posterior dislocation is most comfortable in a standard sling and should be fully evaluated.
  • A quality axillary lateral radiograph is necessary to rule out dislocation.
  • Closed reduction of a chronic shoulder dislocation after 3 weeks can be very difficult, and open reduction should be considered.
  • Extensive bone loss should be addressed to improve postoperative stability.
  • Posterior dislocations result in anteromedial humeral head impaction injuries, and anterior dislocations can cause both posterolateral humeral impaction injuries and anteroinferior glenoid bone loss.
  • Arthroplasty should be considered in patients with greater than 50% humeral head destruction, preexisting arthritis, and low functional status.

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