Controversies in the Management of the First Time Shoulder Dislocation

Abstract

Background:Traditionally, initial management of first anterior shoulder dislocations consists of reduction of the glenohumeral joint followed by a period of immobilization and subsequent physical therapy to recover shoulder range of motion and strength. This traditional approach in management is now controversial due to the high rate of recurrence. The aim of this paper is to review and discuss the literature about the global management of patients presenting with first-time traumatic anterior glenohumeral dislocation, analyzing the factors that affect shoulder instability after the first episode of dislocation. Methods:Scientific publications about the management of first-time shoulder dislocations are reviewed. Pubmed is used for that and no limit in the year of publication are stablished. These papers and their conclusions are discussed. Results:Younger patients, patient´s activities and the kind of injury are the most important factors related to the shoulder instability after a first time traumatic dislocation. Authors that recommend surgical treatment after the first episode of dislocation argue that the possibilities of recurrence are high and therefore surgery should be performed before its occurrence. Other authors, however, argue that surgical treatment is demanding, and keep in mind that complications, such as recurrence, stiffness and pain after surgery, are still present. Conclusion:Currently, there is still no consensus in the literature with regard to the management of first episode of shoulder dislocation. It is necessary to analyze carefully every individual case to manage them more or less aggressive to obtain the best result in our practice.

MPFL reconstruction results in lower redislocation rates and higher functional outcomes than rehabilitation: a systematic review and meta-analysis

“…However, several other orthopedic trials have demonstrated that despite rehabilitation being the safe option, it may not always be the best option. Specifically, patients with acute first‐time shoulder dislocations were historically treated nonoperatively [2]. Nevertheless, in recent years we have been seeing a shift in the management of these patients towards early arthroscopic stabilization largely due to the publication of high‐level evidence supporting early surgical intervention [18].…”

Conservative or surgical management for that shoulder dislocation?

“…A common approach to the care of a patient after a glenohumeral joint dislocation is to place the patient's shoulder in a sling for comfort, with permitted pain-free isometric exercise along with passive and assisted elevation up to 100°. 16 This is followed by a nonaggressive rehabilitation protocol for 2 months until full recovery, which includes progressive range of motion, strength, proprioception, and return to functional activities. 16 More aggressive return-to-play protocols with accelerated timelines and functional progression have been studied, including in a multicenter observational study that followed 45 contact intercollegiate athletes prospectively after in-season anterior glenohumeral instability.…”

“…16 This is followed by a nonaggressive rehabilitation protocol for 2 months until full recovery, which includes progressive range of motion, strength, proprioception, and return to functional activities. 16 More aggressive return-to-play protocols with accelerated timelines and functional progression have been studied, including in a multicenter observational study that followed 45 contact intercollegiate athletes prospectively after in-season anterior glenohumeral instability. Thirty-three of 45 (73%) athletes returned to sport for either all or part of the season after a median 5 days lost from competition, with 12 athletes (27%) successfully completing the season without recurrence.…”

Treatment of first-time traumatic anterior shoulder dislocation: the UK TASH-D cohort study

“…3,[38][39][40] In younger patients, rates of recurrence as high as 92-96% have been reported. 6 An incidence study of shoulder instability among athletes at a US military academy showed that 85% experienced a recurrent event within a 9-month period. 7 A systematic review showed that there were some limited data to support primary surgery following a first-time TASD in young adults engaged in demanding physical activities (i.e.…”