Medication Summary
Shoulder dislocations are extremely painful events. If relocation is not accomplished within an hour, anesthesia via conscious sedation is necessary in the emergency department setting. Medications for this technique are not discussed in this article.
Oral narcotic analgesics are reasonable for a period of days, but prolonged use is categorically inappropriate.
Analgesics
Class Summary
Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma. A 3- or 4-day supply of hydrocodone or similar opioid analgesic should be provided following shoulder relocation.
Hydrocodone and acetaminophen (Lortab, Norco, Vicodin)
Drug combination for moderate to severe pain.
Hydrocodone and ibuprofen (Vicoprofen, Ibudone, Xylon)
Drug combination for short-term (< 10 d) relief of moderate to severe acute pain.
Oxycodone and acetaminophen (Endocet, Percocet, Primlev)
The combination of oxycodone and acetaminophen is used for the relief of moderate to severe pain.
Oxycodone (Oxaydo, OxyContin, Roxicodone)
Oxycodone is indicated for the relief of moderate to severe pain.
Tramadol (ConZip, Ultram, Ultram ER)
Tramadol inhibits ascending pain pathways, altering the patient’s perception of and response to pain. It inhibits the reuptake of norepinephrine and serotonin.
Codeine and acetaminophen (Tylenol #3, Tylenol #4)
Acetaminophen and codeine combintation is used for the treatment of mild to moderate pain.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Class Summary
NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may also exist, such as leukotriene synthesis inhibition, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions. During rehabilitation, shoulder discomfort may interfere with sleep or basic ADLs. Oral NSAIDs should decrease the discomfort. NSAIDs do not speed recovery and should not be used to accelerate physical therapy goals.
Ibuprofen (Motrin, Caldolor, Advil, Provil)
Drug of choice for mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Naproxen (Naprosyn, Anaprox DS, Naprelan, Aleve)
For mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.
Ketoprofen
For mild to moderate pain and inflammation. Small initial doses are indicated in small and elderly patients and in those with renal or liver disease.
Doses >75 mg do not increase the therapeutic effects. Administer high doses with caution and closely observe the patient for response.
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Anterior dislocation.
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Normal shoulder.
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Shoulder dislocation, Part 1.
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Shoulder dislocation, Part 2.
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Shoulder dislocation, Part 3.
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Shoulder dislocation, Part 4.
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Shoulder dislocation, Part 5.
