Surgical versus non-surgical treatment for acute anterior shoulder dislocation

BESS/BOA Patient Care Pathways

“…A Cochrane review comparing nonsurgical and surgical management for acute anterior shoulder dislocation demonstrated a relative risk reduction of 0.2 (95% confidence interval ¼ 0.11 to 0.33) in the surgical group. 42 Of note, half of the patients randomized to conservative management opted for subsequent surgical intervention. .…”

Surgical versus conservative treatment for acute first-time anterior shoulder dislocation: the evidence

“…The Cochrane systematic review [8] underlined that there are more favorable results among surgically treated patients, with a significantly lower risk of subsequent instability. The functional outcome among surgically treated patients was better than after conservative treatment for active young patients with acute shoulder dislocation, even if different functional assessment measures were used.…”

“…In 2004, Handoll and Almaiyah published an updated version to their Cochrane systematic review [8] which aimed to identify and evaluate the most appropriate treatment for first-time anterior dislocation of the shoulder. The authors identified 11 randomized and quasi-randomized trials; of these 5 were included and 6 were excluded.…”

“…A first-time anterior dislocation of the shoulder can commonly result in a variety of soft tissue injuries such as the Bankart lesion (an anterior labrum avulsion), the Hill Sachs lesion (humeral head compression fracture) and subscapularis muscle disorders [7,8]. The anterior capsulolabral complex is the most important passive anterior stabilizer of the glenohumeral joint; the high recurrence rate after conservative management correlates with failure of the labrum lesion to heal in an anatomical position [7].…”

“…Traditionally, surgical treatments have been reserved for cases of chronic recurrent instability [8], but the high rate of recurrence observed in young active patients has opened a new controversy on the surgical management of first-time traumatic shoulder anterior dislocation in this category of patients. The cause for these controversies is if surgical stabilization can significantly reduce the rate of recurrence and give an improved quality of life.…”