First-time anterior shoulder dislocations: has the standard changed?

Abstract

The traditional treatment of a first-time anterior shoulder dislocation of reduction and a period of immobilisation should be challenged. The purpose of this review is to assimilate and present the current literature on acute anterior shoulder instability. This involves consideration of the pathoanatomy, natural history and the more recent evaluation of treatment outcomes, which appropriately incorporate quality of life measures in addition to recurrences. There is ample evidence to consider primary stabilisation as an option for treatment in the high-risk group, less than 25 years of age.

Anterior shoulder instability: a review of pathoanatomy, diagnosis and treatment

“…In people younger than 25 years of age, the recurrence rate following conservative management has been reported to be between 60 and 90% [37]. Therefore, there is an increasing trend to treating this group of patients operatively, even after their first traumatic anterior shoulder dislocation [38][39][40]. Contraindications to surgical treatment may include brachial plexus and axillary nerve injuries, deltoid dysfunction and infections [14].…”

First-time anterior shoulder dislocations: should they be arthroscopically stabilised?

“…Age at the time of initial dislocation has been found to be the most important factor for recurrence of instability. (8) Gumina and Postacchini reported a recurrence rate of 22% (mean follow-up period of seven years) in 545 consecutive patients with anterior shoulder dislocations who were conservatively treated. (23) Hovelius et al's study, which examined the results of conservative treatment in primary anterior shoulder dislocations over a followup period of 25 years, found a recurrence rate of 72% in patients aged 12-22 years, 56% in patients aged 23-29 years and 27% in patients older than 30 years.…”

“…(7) Other lesions that may be associated with traumatic anterior dislocations include bony Hill-Sachs lesions, superior labral tears from anterior to posterior (SLAP), capsular tears, rotator cuff tears and glenoid rim fractures. (8) In a study evaluating first-time traumatic dislocations in young patients, Taylor and Arciero (9) documented that 97% of their patients had Bankart lesions with no gross evidence of capsular injury. They also noted that 89% of their patients had Hill-Sachs lesions, although the lesions were small and did not appear to significantly affect stability on arthroscopic evaluation.…”

“…continued apprehension, failure to return to work or sport, quality of life and development of posttraumatic osteoarthritis) are also crucial in assessing the outcomes of treatment. (8) Many authors have studied the factors associated with recurrent instability. Age at the time of initial dislocation has been found to be the most important factor for recurrence of instability.…”

“…In Boone et al's literature review on the pathoanatomy of first-time anterior dislocation, early surgical repair was advocated in young patients less than 25 years old. (8) In Speigl et al's study, (38) a different treatment algorithm was applied for acute glenoid rim fractures caused by first-time traumatic anterior shoulder dislocations, i.e. surgery was performed if the patient had a bony Bankart lesion > 5%, while conservative treatment was employed in all other cases.…”