British Elbow and Shoulder Society practice guidelines: Rehabilitation following traumatic anterior shoulder dislocation (post-operative and non-operative care).

Abstract

Background: Traumatic anterior shoulder dislocation is common and carries a high risk of recurrence. Rehabilitation is central to management following both surgical and non-surgical treatment. However, consistency in rehabilitation practice and continuity of care are lacking. The British Elbow and Shoulder Society (BESS) therefore commissioned the development of guidelines for post-operative and non-operative rehabilitation.

Methods: This guideline was developed through a multi-staged process that combined a UK national survey, Delphi consensus, evidence synthesis, and a final expert workshop. The post-operative guideline was based on a BESS best-practice framework, while the non-operative guideline was informed by the ARTISAN intervention development methodology, with both organised into phase-based protocols.

Results: The process produced aligned rehabilitation protocols comprising five sequential phases: (1) Acute protection and education (0-3 weeks), (2) Movement and early strengthening (3-6 weeks), (3) Progressive strengthening (6-12 weeks), and (4) Return to sport (>12 weeks) and (5) high-level function. Key guidance following surgical treatment included sling use after surgery, initiation of through-range resisted exercise, and criteria-based progression to contact sport. The non-operative pathway mirrored these phases, with earlier sling weaning.

Conclusion: Through a rigorous process, BESS has established pragmatic, evidence-informed rehabilitation guidelines for traumatic anterior shoulder dislocation, promoting consistent, safe, and adaptable patient-centred care across both operative and non-operative management.