On-Field Management of the Acute Anterior Glenohumeral Dislocation

Abstract

Background: Glenohumeral dislocations are prevalent injuries in an athletic population, and proper, acute on-field management remains a topic of debate among health care professionals. Objective: Firstly, to provide a systematic approach to the on-field management of acute anterior glenohumeral dislocations for on-field health care professionals. Secondly, to present current methods of reduction, including a description of the safest and most efficacious methods. Methods: Based on the current literature, an overview of the relevant anatomy, mechanisms of injury, and associated injuries is provided. In addition, systematic guidelines for on-field management of acute glenohumeral dislocations are provided. Results: The glenohumeral joint remains the most commonly dislocated joint in the body. Anterior dislocations comprise 90% to 98% of all glenohumeral dislocations. Despite a variety of described methods of reduction, there remains a lack of high-level evidence reporting the efficacy of each. To date, there is no position statement or consensus regarding the acute management of glenohumeral dislocations, creating discontinuity among health care professionals. Conclusion: A systematic approach in management of the acute anterior glenohumeral dislocation is paramount. Method of reduction and position of immobilization should be dependent on physician and patient comfort, respectively. Reduction is safest in patients aged > 40 years with no neurovascular compromise, and when minimal attempts are performed.