Controversies in the Management of the First Time Shoulder Dislocation.

José Luis Avila Lafuente,Santos Moros Marco,José Manuel García Pequerul

doi:10.2174/1874325001711011001

Abstract

Background:Traditionally, initial management of first anterior shoulder dislocations consists of reduction of the glenohumeral joint followed by a period of immobilization and subsequent physical therapy to recover shoulder range of motion and strength. This traditional approach in management is now controversial due to the high rate of recurrence. The aim of this paper is to review and discuss the literature about the global management of patients presenting with first-time traumatic anterior glenohumeral dislocation, analyzing the factors that affect shoulder instability after the first episode of dislocation.Methods:Scientific publications about the management of first-time shoulder dislocations are reviewed. Pubmed is used for that and no limit in the year of publication are stablished. These papers and their conclusions are discussed.Results:Younger patients, patient´s activities and the kind of injury are the most important factors related to the shoulder instability after a first time traumatic dislocation. Authors that recommend surgical treatment after the first episode of dislocation argue that the possibilities of recurrence are high and therefore surgery should be performed before its occurrence. Other authors, however, argue that surgical treatment is demanding, and keep in mind that complications, such as recurrence, stiffness and pain after surgery, are still present.Conclusion:Currently, there is still no consensus in the literature with regard to the management of first episode of shoulder dislocation. It is necessary to analyze carefully every individual case to manage them more or less aggressive to obtain the best result in our practice.

Highlights

Shoulder dislocation is the most frequent large joint dislocation in the human body, with an incidence of 1,7% (8, 2-17 cases per 100000 people per year) [1]
Physicians that recommend surgical treatment after the first episode of dislocation argue that the possibilities of recurrence are high and surgery should be performed before its occurrence
There is still no consensus in the literature with regard to the global management of patients presenting with first-time traumatic anterior dislocation of the shoulder

Summary

Introduction

Shoulder dislocation is the most frequent large joint dislocation in the human body, with an incidence of 1,7% (8, 2-17 cases per 100000 people per year) [1]. The initial management of a patient with a first episode of anterior shoulder dislocation is the reduction of the glenohumeral joint, followed by immobilization in a “safe position” for three weeks This is followed by a period of physical therapy in order to recover shoulder range of motion and strength. Initial management of first anterior shoulder dislocations consists of reduction of the glenohumeral joint followed by a period of immobilization and subsequent physical therapy to recover shoulder range of motion and strength. This traditional approach in management is controversial due to the high rate of recurrence. The aim of this paper is to review and discuss the literature about the global management of patients presenting with first-time traumatic anterior glenohumeral dislocation, analyzing the factors that affect shoulder instability after the first episode of dislocation

Objectives

Results

Conclusion