Conservative management of first-time traumatic anterior shoulder dislocation

Benedikt Schliemann,Markus Scheibel,Dominik Seybold,Marvin Minkus

doi:10.1007/s11678-021-00626-z

Benedikt Schliemann, Markus Scheibel + Show 2 more

Open Access

https://doi.org/10.1007/s11678-021-00626-z

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Abstract

AbstractTraumatic anterior shoulder dislocation is a common injury in young and active patients and the proper treatment is still a matter of debate. The recurrence rate after conservative management remains high and, therefore, primary surgical intervention is sometimes recommended in very young patients whose risk of recurrences is highest. Immobilization in external rotation, first described by Itoi, is a promising conservative option as it provides adequate labral reduction and low recurrence rates. Recent meta-analyzes could not unequivocally demonstrate its superiority over internal rotation immobilization. However, biomechanical and early clinical results show a better effect on reduction of the labrum and lower recurrence rates for immobilization in a combination of abduction/external rotation than for external rotation alone. The present article aims to provide an overview of the conservative management of first-time traumatic shoulder dislocation in order to provide the treating physician or surgeon with the best current evidence as a basis for developing the appropriate treatment strategy for the patient.

Highlights

Recurrent instability after first-time traumatic anterior shoulder dislocation is still a major concern after both conservative and operative treatment
The most recent reviews on the topic come to different conclusions: while the Cochrane review by Braun and McRobert could not provide evidence thatexternal rotation is superior, the most recent meta-analysis found that external rotation immobilization significantly reduces the recurrence rate in patients older than20 years ofage [11, 30]
The recurrence rate after conservative management remains high and, primary surgical intervention is sometimes recommended in very young patients whose risk of recurrences is highest

Summary

Introduction

Recurrent instability after first-time traumatic anterior shoulder dislocation is still a major concern after both conservative and operative treatment. Half of the studies report better results and lower recurrence rates for the external rotation group, whereas the other half did not find any advantage for external over internal rotation immobilization. The most recent reviews on the topic come to different conclusions: while the Cochrane review by Braun and McRobert could not provide evidence thatexternal rotation is superior, the most recent meta-analysis found that external rotation immobilization significantly reduces the recurrence rate in patients older than years ofage [11, 30]. It must be mentioned that the only study that compared internal rotation immobilization with combined immobilization in abduction/external rotation showed the most obvious difference in the recurrence rate, favoring abduc-

20–40 Years subgroup

Findings

Compliance with ethical guidelines