Management of primary anterior shoulder dislocations: a narrative review

Abstract

The recurrence rate following acute anterior shoulder dislocations is high, particularly in young, active individuals. The purpose of this paper is to provide a narrative overview of the best available evidence and results with regards to diagnostic considerations, comorbidities, position of immobilization, surgical versus conservative management, and time to return to play for the management of primary anterior shoulder dislocations. Three independent reviewers performed literature searches using PubMed, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials and systematic reviews meeting inclusion criteria from 1930 to April 2019 were appraised and discussed with the intent to consolidate the best available evidence with regards to lowering recurrence rates. A majority of studies support early surgical intervention for individuals between 21 and 30 years of age following primary shoulder dislocations, as this group is particularly susceptible to recurrence. Conservative treatment plans favor 1-3 weeks of immobilization in internal rotation, followed by rehabilitation. Surgical methods are associated with longer time to return to play, but lower recurrence rates. Return to play time is best determined on an individualized basis, when subjective and objective function of both shoulders is determined to be symmetric. This paper broadly summarizes the best available evidence for the management of primary anterior shoulder dislocations. There remains a need for randomized studies to determine ideal long-term treatment following conservative or surgical management, as general timelines for returning to play following injury remain vague.

The Shoulder Instability: An Overview

“…20 Multiple studies have shown that surgical treatment is beneficial for the treatment of first-time dislocation in young males. 21,22 No consensus has been reached regarding the position and duration of immobilization in traumatic anterior instability. Shoulder immobilization in the external rotation will help to oppose the torn anteroinferior labrum to the glenoid better than the conventional position of internal rotation.…”

Manejo y tratamiento no quirúrgico de la luxación de hombro

“…En general, las radiografías antes de reducir el hombro no son necesaria a menos que se cumpla una de las siguientes tres condiciones: paciente mayor de 40 años, luxación por primera vez y mecanismo traumático de la lesión. Las radiografías estándar para ayudar con los diagnósticos iniciales, o en la evaluación posterior a la reducción, son las siguientes: radiografía anteroposterior en rotación neutral externa e interna, radiografía lateral en el plano escapular y una proyección axilar (1).…”

“…KEYWORDS: shoulder; shoulder dislocation; rotation e336 Revista Médica Sinergia Vol. 5 (1), Enero 2020 -ISSN:2215-4523 / e-ISSN: http://revistamedicasinergia.com…”

“…En particular, los hombres jóvenes y activos menores de 30 años tienen un mayor riesgo de inestabilidad recurrente. Casi la mitad (48.6%) de todas las luxaciones de hombro ocurren en pacientes de 15 a 29 años, con la tasa más alta de luxaciones recurrentes (64%) encontrado en los pacientes menores de 30 años (1). El hombro es la articulación que más frecuentemente se luxa en el cuerpo humano.…”

Luxação do Ombro em Jogador de Futebol Profissional

“…A articulação do ombro é a articulação com maior arco de movimento do corpo humano, pelas suas caraterísticas anatómicas 1 , em que a sua geometria permite grande mobilidade articular, à custa de diminuição da estabilidade intrínseca. 2 A luxação anterior do ombro (LAO) ocorre habitualmente após uma queda (58,8%), em casa (47,7%) ou no desporto recreativo (34.5%) 3 , particularmente em desportos de contacto e de colisão. 4 É a luxação mais frequente de entre as grandes articulações, constituindo 90% de todas as luxações do ombro, bastante mais frequentes que as luxações posteriores ou inferiores.…”