Natural History of Anterior Shoulder Instability

Abstract

Background:The shoulder is the most complex joint in the body. The large freedom of motion in this joint is the main cause of instability. Instability varies in its degree, direction, etiology and volition and there is a large spectrum of conditions. Methods:Based on literature research and also in our own experience, we propose to elucidate the reader about the natural history of instability and its importance for the appropriate management of this pathology, by answering the following questions:What happens in the shoulder after the first dislocation? Which structures suffer damage? Who are the patients at higher risk of recurrence? How does the disease evolve without treatment? Will surgical treatment avoid future negative outcomes and prevent degenerative joint disease? Who should we treat and when?Results:80% of anterior-inferior dislocations occur in young patients. Recurrent instability is common and multiple dislocations are the rule. Instability is influenced by a large number of variables, including age of onset, activity profile, number of episodes,delay between first episode and surgical treatment.Conclusion:Understanding the disease and its natural evolution is determinant to decide the treatment in order to obtain the best outcome. It is crucial to identify the risk factors for recurrence. Delay in surgical treatment, when indicated, leads to worse results. Surgical technique should address the type and severity of both soft tissue and bone lesions, when present.

Latarjet Procedure for Anterior Glenohumeral Instability: Early Postsurgical Complications for Primary Coracoid Transfer Versus Revision Coracoid Transfer After Failed Prior Stabilization

“…Arthroscopic Bankart repair is a less invasive procedure with lower complication rates than open bone transfer surgery. 2,7,20,22 There are important patient-specific factors that are evaluated by the surgeon that help to determine the initial recommendation for arthroscopic Bankart repair, open Bankart repair, or the Latarjet procedure to address anterior shoulder instability. In our study, we found a complication rate of 16.7% in the primary Latarjet group.…”

“…Anterior shoulder dislocations occur in approximately 2% of the population, with 80% of these occurring in young patients. 26 Recurrent instability and functional shoulder impairment have been shown to develop in up to 92% of these adolescent patients, 7,22,30,33 with young male athletes being at the highest risk for recurrence. 2,24,30 Aside from acute pain, functional impairment, and instability, these patients are now at an increased risk for developing long-term degenerative arthritis, which is correlated with the number of recurrent episodes of dislocation.…”

Management of the First-time Traumatic Anterior Shoulder Dislocation

“…The general consensus in the literature is that young males who are involved in contact sports are at significantly higher risk for recurrent instability than the general population. 11,44) There may be an interaction between sex and other risk factors, such as age or mechanism of injury. For example, young males may be more likely to sustain an instability event during contact sports.…”

“…However, some studies have reported that younger patients who are involved in contact or collision sports, or those who require occupationally require the overhead use of the arm, are more likely to have re-dislocation of the shoulder than their less active counterparts or older persons. 11,44) Sachs et al 50) recommended immediate surgical stabilization in young males who practice contact sports with persistent pain or instability, despite a period of initial conservative treatment in the first-time dislocation.…”

Shoulder Instability. Current Concepts and Controversies

“…The second part is focused in anterior instability with four reviews of the natural history [ 9 ], management alternatives of bone defects [ 10 , 11 ] and soft tissues [ 12 ] in instability and a fifth over the failed shoulder instability patient [ 13 ]. Three “controversies” papers focus in specially disputed topics: management of the first shoulder dislocation [ 14 ], open or arthroscopic procedures [ 15 ] and associated procedures during Bankart repair [ 16 ].…”