Doit-on opérer toutes les luxations gléno-humérales antérieures ?

Abstract

About 50% of primary anterior shoulder dislocations that had been treated non-operatively will recur whereas 50% will not or will become stable over time. Three weeks of immobilization of the arm in external rotation seems to decrease the recurrence rate. An adapted therapy with muscle strengthening can also decrease this rate. However, young patient age and high-energy activities are factors associated with recurrence. Furthermore, recurrent anterior shoulder instability is associated with the development of arthropathy whatever the initial treatment. Surgical stabilization after an initial anterior shoulder dislocation decreases the recurrence rate. But there is no medical justification to operate systematically all primary anterior shoulder dislocation because half of them will never recur over time. However, in a selected population of patient younger than 25 years of age, with high-energy activities, an immediate surgical stabilization can be proposed to decrease the recurrence rate and the risk of degenerative changes.