If I dislocated my shoulder, and it needed to be put back in place in the emergency room, what is the appropriate treatment afterwards, and is surgery ever advisable?

Usually a period of immobilization in a sling is the next step--to allow pain to diminish and to allow the soft tissue swelling/trauma to settle down. In order to fully dislocate your shoulder in the front, the capsule and ligaments tear. In most cases, conservative treatment will be successful, and this includes the possibility of needing some physical therapy to help get motion back and to rehabilitate the muscles around the shoulder. The addition of "inferential muscle stimulation" and neuromuscular control techniques, which improve proprioception, are invaluable. It is unusual that an MRI be performed acutely, however, in certain situations this is indicated--to rule out a rotator cuff tear or to evaluate the pathology, should acute repair be contemplated.
 
This raises the question of indications for acute repair in a 1st time dislocator. In that light, favorable results reported by Dr Arciero after performing such acute treatment on West Point cadets in the 1990's have led many to assume that acute surgery must be performed in high caliber athletes (or the like) to eliminate a near 90% prevalence of redislocation. However, as with many studies, these studies were not designed to provide a "high level of evidence". In other words, we cannot truly say what the redislocation risk is---but it is certainly higher if physical exan shows apprehension, and lower if exam shows good range of motion, strength and stability. Please see the "PDF"  at the bottom of the article on "Treatment of shoulder dislocation" which describes a prospective study. This article can be found under Popular Shoulder Topics- "Shoulder Dislocation". This seems to indicate that acute surgery will result in "unnecessary" surgery in 30-50% of cases!
Thus, it may be best to make a decision regarding acute surgery after one's first dislocation with full consideration of what your shoulder exam is like---not merely on the basis of an MRI----which will always be abnormal after such an injury.

When treating the 1st time dislocator conservatively, a sling is often recommended for a week or so. Though some research has suggested that a position of "external rotation" better positions the ligaments for healing, wearing a simple sling, with the shoulder in internal rotation, remains the most common practice. It's worth noting also--that the PDF mentioned above shows no difference between those who wore a sling and those who did not!
 To summarize, although arthroscopic repair has been suggested acutely, particularly in high demand athletes, conservative treatment is by and large the norm since recurrent dislocations occur in less than 50% of cases; so in short, operating on all first time dislocators would be operating on several patients who would never have had another dislocation or episode of instability. However, when a dislocation occurs in people younger than 40, recurrence is a risk, and if a recurrent dislocation occurs, surgery may then be recommended. In the not too distant past, NBA basketball star Dwyane Wade opted for nonoperative treatment---and he has done very well. If a dislocation occurs after age 40, we need to be less concerned about recurrence, and more concerned about whether the rotator cuff may have torn as a result.

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