First-time Anterior Shoulder Dislocation Research Articles

Patient Specific Factors Affecting the Decision for Surgery for a First Time Anterior Shoulder Dislocation (SS-09)

Introduction Recurrent instability following a first-time anterior shoulder dislocation (FTASD) is very common and approaches 100% in some reports. Arthroscopic stabilization can decrease the rate of recurrent instability and improve outcomes, but the decision for surgery remains complex. Multiple patient and provider specific factors exist that affect this treatment algorithm. In this paper, we examine the interaction of these complex factors and provide threshold values at which either surgery or non-operative treatment is preferred. Methods A Markov Monte Carlo decision model comparing non-operative versus surgical treatment for a FTASD was constructed using TreeAge Pro (Williamstown, MA, 2007). Four health states were incorporated into the model: initial dislocation, stable shoulder, recurrent instability and revision stabilization. Input parameters included patient-specific variables (age, gender, activity level, time lost from work or sport, and coping with instability) and physician-specific variables such as success of surgery as well as outcome probabilities and effectiveness. Values were derived from the literature or estimated by expert opinion where necessary. The primary outcome, treatment-related quality of life years, was calculated based upon the Western Ontario Shoulder Instability index (WOSI). Specific factors examined were age, gender, time lost from work or sport, surgical success rate, activity level and ability to cope with instability. Multivariate sensitivity analyses were performed to identify key variables that influenced the preferred treatment strategy. Results Surgery for a FTASD was preferred for all men age 15-35 and for women age 30 and younger. For high-risk patients such as overhead athletes, surgery was preferred for all men age 15-35 and women age 33 and younger. Non-operative management was preferred when the relative risk of dislocation after surgery rises above 0.7 and 0.5, for men and women, respectively. Non-operative management was preferred for men with an unstable shoulder when they were comfortable with a 14 point drop in WOSI score or when the WOSI benefit of surgery lasted 2.1 years or less. For women these values were 8 WOSI points and 3.6 years. Time lost from work or sport strongly effected the decision for surgery. This relationship is displayed in Figure 1, a two-way sensitivity analysis of time lost from work or sport against age at first dislocation. Conclusion Surgery for a first time anterior shoulder dislocation resulted in improved outcomes (WOSI) for all men and women under age 30 and was therefore the preferred treatment. Beyond age 30, patient and provider specific factors exerted strong influences on the decision for surgery. Our study clarified the relationship among these factors and indicated threshold values at which surgery resulted in improved outcomes. These thresholds could potentially be useful for guiding clinical decision-making, designing future studies, or benchmarking.

Comparison of arthroscopic treatment with conservative treatment for acute first-time traumatic anterior shoulder dislocation in a high-demand population

Abstract Purpose To compare the outcome of primary arthroscopic stabilization with that of nonoperative treatment for acute first-time traumatic anterior shoulder dislocation in a highly active military population at 5- to 7-year follow-up. Methods The patients in this prospective, nonrandomized study comprised 64 highly active military personnel with a first episode of traumatic anterior shoulder dislocation that occurred during the period January 2001 to July 2004. The patients were offered an arthroscopic procedure or nonoperative treatment. The average age was 22 years (range, 17–29 years). A total of 25 patients were treated by nonoperative methods and 39 patients underwent acute arthroscopic repair with metallic suture anchor fixation. Outcome was evaluated based on the Western Ontario Shoulder Instability Index score, the Disabilities of the Arm, Shoulder and Hand score, range of motion, and return to active duty. The mean follow-up was 71 months (range, 60–84 months). Results In the nonoperative group, 92% suffered a redislocation between 5 and 18 months (average, 10 months). In the operative group, only two patients (5.1%) suffered a redislocation 1 year after surgery. There were no surgical complications. In addition, there was no statistical difference in range of motion of injured sites between the two groups. Conclusions Primary arthroscopic stabilization leads to a significantly lower rate of recurrence of shoulder dislocations than nonoperative treatment in high-demand populations. In addition, there is no significant difference of recurrence rate and functional outcome between the surgical group and the nonoperative groups with recurrent dislocation undergoing arthroscopic stabilization at the final follow up.

A predictive model of shoulder instability after a first-time anterior shoulder dislocation

Management of a first-time anterior shoulder dislocation (FTASD) involves important clinical and policy decisions. Predictive disease modeling can improve the quality of information disseminated in treatment discussions. In this paper, we describe a general-purpose, publicly available model and illustrate its potential as a tool for management of a FTASD. A Markov decision model of the natural history of a FTASD was constructed. Outcome probabilities and effectiveness were derived from the literature or estimated by expert opinion where necessary. Outcomes were the Western Ontario Shoulder Instability index (WOSI) and the probability of a patient experiencing recurrent instability, undergoing surgical stabilization, and having a stable shoulder at 10years. The model was both internally and externally validated. Outcomes were examined for specific cases. The model was effectively externally validated against two studies, a Swedish prospective cohort of Hovelius et al and Botonni et al's military cohort. It can produce detailed outcome predictions for individuals; eg, an 18-year-old man has a 77% risk of dislocation in year 1 and a 32% chance of having a stable shoulder in 10 years. Detailed and specific information about prognosis is critical in the management of a FTASD. Disease modeling lends itself well to these needs and allows improved shared decision-making. Our model was externally validated and can predict specific outcomes. As a publically available resource, it will allow physicians to accurately predict the expected outcome of treatment based on covariates, patient demographics, and their own surgical success rates.

First-time anterior shoulder dislocations: has the standard changed?

The traditional treatment of a first-time anterior shoulder dislocation of reduction and a period of immobilisation should be challenged. The purpose of this review is to assimilate and present the...

Systematic Review of Rehabilitation Versus Operative Stabilization for the Treatment of First-Time Anterior Shoulder Dislocations

Context:Primary anterior shoulder dislocation is a frequent injury in young active patients. Traditionally, conservative nonoperative primary treatment has been advocated for a majority of first-time dislocators, whereas operative stabilization has been reserved for recurrent dislocators or those involved in strenuous physical activity. Currently, no consensus exists on whether to treat a first-time anterior shoulder dislocation surgically.Objective:(1) To provide clinical recommendations regarding the therapeutic intervention for first-time anterior shoulder dislocators and (2) to determine if there is sufficient Level 1 or 2 evidence available for the establishment of a uniform, optimal treatment protocol.Data Sources:A systematic review of prospective randomized controlled trials with human participants was performed. PubMed, the Cochrane Database of Systematic Reviews, and secondary references were appraised for studies published between 1994 and 2009.Study Selection:Inclusion criteria were English-language Level 1 or 2 studies involving the treatment of primary anterior shoulder dislocation. Exclusion criteria included non-English-language articles; Level 3, 4, or 5 studies; and studies examining treatment of recurrent/posterior shoulder dislocation or diagnoses other than primary anterior shoulder dislocations.Data Extraction:Each author conducted an independent quality appraisal of the included studies, identifying strengths, weaknesses, and biases, then reached consensus regarding their values.Results:Five randomized controlled trials were included, and they supported the use of operative management in a focused population. No long-term follow-up data were available describing the effects of surgical intervention or the development of osteoarthritis. Each study design had weaknesses that decreased the validity of the findings.Conclusions:While limited, the available evidence from randomized controlled trials supports operative stabilization as a reasonable alternative to nonoperative treatment for primary acute shoulder dislocation in young, active adults participating in highly demanding physical activities. Recommendations on the optimal surgical intervention cannot be provided. There is no conclusive evidence available to determine whether operative stabilization or conservative rehabilitation is superior for other patient or injury types.

Treatment of Pediatric Shoulder Instability

Anterior shoulder dislocation is the most common form of shoulder dislocation and is generally seen in adolescents participating in contact or collision sports among the pediatric age group. Age is the most important denominator for predicting the recurrence. In civilian/adult population, the treatment is generally conservative. However, there are emerging data to support stabilization surgery for the first-time traumatic anterior shoulder dislocation in the active adolescent patients. Traumatic posterior shoulder dislocations are rare, and can be easily missed on radiographs. Treatment is generally conservative. Multidirectional instability occurs in pediatric overhead athlete with generalized ligamentous laxity. A lengthy rehabilitation program involving shoulder girdle and periscapular strengthening is the mainstay of treatment.

Die Ruhigstellung der Schulter in Außenrotation nach traumatischer Erstluxation – Was kann man seinen Patienten zumuten? Eine retrospektive Patientenbefragung

Immobilisation in external rotation has become a new option in the therapy of the traumatically dislocated shoulder. Brace comfort and patient's satisfaction with this kind of conservative treatment are evaluated in a retrospective survey. 34 patients with a traumatic first-time anterior shoulder dislocation were immobilised in an external rotation brace for three weeks. Afterwards they were asked to complete a questionnaire regarding brace comfort and how they managed their daily life with one arm immobilised in external rotation. 29 questionnaires could be evaluated. 26 patients (90%) were satisfied with the new therapy. 24 patients (83%) would prefer the conservative treatment in an external rotation brace in case of another dislocation under similar circumstances. The impact of the brace therapy on daily live was reasonable. 79% of the patients (23) wore the brace more than 20 hours daily (average 22 hours, min.15, max. 24 hours). Despite the uncomfortable arm position during immobilisation the therapy in an external rotation brace showed a high acceptance. In addition to previous results regarding reposition of the labroligamentous complex it appears to be proven a suitable therapy for first-time traumatic anterior shoulder dislocation.

Neer Award 2008: Arthropathy after primary anterior shoulder dislocation–223 shoulders prospectively followed up for twenty-five years

Shoulder dislocation may cause arthropathy, but the natural history of this evolution is not well described. We therefore conducted a radiographic follow-up 25 years after the primary shoulder dislocation. A prospective Swedish multicenter study (1978-1979) included 257 shoulders in 255 patients (age, 12-40 years) with a first-time anterior shoulder dislocation. After 25 years, 227 patients (229 shoulders) were alive and had follow-up. Radiographic imaging was performed in 223 shoulders (97%). Shoulders were normal in 44%. Arthropathy was mild in 29%, moderate in 9%, and severe in 17%. Of the shoulders without a recurrence, 18% had moderate/severe arthropathy. The corresponding figures were 39% for shoulders that recurred once or more (without surgery) and 26% (16 of 62) for surgically stabilized shoulders. Seven of 221 patients (7 of 223 shoulders) were considered alcoholic at 25 years and all had severe arthropathy (P < .001). Other factors that correlated with moderate/severe arthropathy were age older than 25 years at primary dislocation (P = .01) and primary dislocation caused by high-energy sports activity (P = .009). Shoulders that had not recurred had less arthropathy than shoulders classified as recurrent (P = .047) or stabilized over time (P = .007). Sixty-two surgically stabilized shoulders had less arthropathy than those that became stable over time (P = .047). Mild arthropathy at 10 years was associated with moderate/severe arthropathy at 25 years in 19 of 30 shoulders (63%) compared with 13 of 146 (9%) classified as normal at 10 years (P < .001). Joint incongruence at 10 years was associated with moderate/severe arthropathy at 25 years (P = .001). Age at primary dislocation, recurrence, high-energy sports, and alcohol abuse were factors associated with the development of arthropathy. Also shoulders without a recurrence were associated with arthropathy.

How much external rotation is needed for immobilizing acute anterior shoulder dislocation in external rotation?

Introduction Immobilization in external rotation after a first-time traumatic anterior shoulder dislocation has been shown to improve the position of the labroligamentous lesion. The purpose of the present study was to determine, with the use of MRI, the effect of 15° and 30° external rotation braces on the position of the labral lesion.

Which labral lesion can be best reduced with external rotation of the shoulder after a first-time traumatic anterior shoulder dislocation?

Immobilization in external rotation after a first-time traumatic anterior shoulder dislocation has been shown to improve the position of the labroligamentous lesion relative to the glenoid rim. The purpose of the present study was to evaluate the effect of the external rotation position of the shoulder on different types of labroligamentous lesions in patients with first-time traumatic anterior shoulder dislocation by using MRI. We performed a standardized MRI in internal and external rotation of the shoulder after initial reduction in 34 patients with a first-time traumatic anterior shoulder dislocation. Labroligamentous lesions were classified as Bankart, Perthes, or nonclassifiable. Four distinct grades were used to classify the amount of plastic deformation of the anterior labroligamentous structures. The position of the labrum was defined relative to the tip of the glenoid rim by measuring the dislocation and separation. In all patients, dislocation and separation of the labrum relative to the rim of the glenoid were significantly improved in shoulders in the external rotation position compared to those in the internal rotation position. We observed 15 Bankart, 15 Perthes, and 4 non-classifiable lesions. No HAGL or GLAD lesions were found. Fourteen patients showed a plastic deformation grade I, 16 showed grade II, 3 showed grade III, and 1 showed grade IV. In regression analysis, the odds ratio was 1.100 for the type of lesion and 1.660 for the grade of plastic deformation. Perthes lesions (with an intact anterior scapular periosteum) and grade I plastic deformations showed the best labral reduction on the external rotation MRI. Placing the shoulder in external rotation after a first-time traumatic shoulder dislocation, significantly improves the position of the labroligamentous lesion on the glenoid rim. Perthes lesions that showed a low grade of plastic deformation displayed better reduction in external rotation and then compared to Bankart or other lesions that showed a high grade of plastic deformation. In conclusion, immobilization of the shoulder after a first-time traumatic shoulder dislocation is most effective in patients with Perthes lesions that show low grade plastic deformation.

The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients

This study evaluated the surgical outcomes of young active patients with arthroscopic Bankart repair within 1 month after first-time anterior shoulder dislocation. From July 2002-October 2004, patients presented with first-time traumatic anterior shoulder dislocation and treated with arthroscopic stabilization within 1 month of injury were retrospectively reviewed. Magnetic resonance imaging and computed tomography were performed before the operation in all cases. Cases with contralateral shoulder multidirectional instability or glenoid bone loss of more than 30% on preoperative computed tomography on the injury side were excluded. All patients were treated with arthroscopic Bankart repair, using metallic suture anchors or soft tissue bio-absorbable anchors by a same group of surgeons and followed the same rehabilitation protocol. Recurrence, instability signs, range of motion, WOSI score, Rowe score and complications were assessed. Thirty-eight patients were recruited: the average age was 21 (16-30). All patients had definite trauma history. Radiologically, all patients had Bankart/Hill-Sachs lesion. All the operations were done within 1 month after injury (6-25 days). The average hospital stay was 1.2 days (1-5 days). The average follow-up was 28 months (24-48 months). There were two cases of posttraumatic re-dislocation (5.2%). The average external rotation lag was 5 degrees (0-15) in 90 degrees shoulder abduction when compared with contralateral side. 95% of patients had excellent or good Rowe score. The average WOSI score was 83%. There was one case of transient ulnar nerve palsy and one case of superficial wound infection. This study concluded that immediate arthroscopic Bankart repair with an accelerated rehabilitation program is an effective and safe technique for treating young active patients with first-time traumatic anterior shoulder dislocation.

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

Acute anterior dislocation of the shoulder is a common injury associated with a high rate of recurrence in young active men. Management of traumatic anterior shoulder dislocation aims to restore range of motion, to reduce the risk of recurrence and to assure an improved quality of life with a stable and painless shoulder. It includes conservative and surgical-open or arthroscopic treatment, followed by rehabilitation. No clear consensus has been reached on the best management, surgical or conservative, to adopt in first-time anterior shoulder dislocation. The aim of this review was to collect and evaluate the scientific evidence supporting the effectiveness of immediate surgical treatment versus immobilization and rehabilitation for first-time traumatic anterior shoulder dislocation. There is some evidence to support primary surgery in young active patients with an acute first traumatic shoulder dislocation, in order to reduce the risk of recurrence, but there is no evidence for the best surgical technique or best conservative approach, nor is there information regarding the best treatment in other categories of patients.

Open Repair Reduced Recurrent Dislocation More Than Conservative Treatment After Traumatic Anterior Shoulder Dislocation

Question: In patients with traumatic anterior shoulder dislocation, how do open repair and conservative treatment compare for long-term recurrence rates? Design: Randomized (allocation concealed, unblinded)*, controlled trial with 10-year follw-up. Setting: 13 hospitals in Denmark. Patients: 76 patients who were 15 to 39 years of age (mean age, 22 y; 82% men) with an acute first-time traumatic anterior shoulder dislocation confirmed by radiography, no previous shoulder problems, and no fracture of the greater tuberosity. All patients underwent arthroscopy within the first week of injury. 75 patients were available for 10-year follow-up. Intervention: Patients were allocated to surgery (open Bankart repair) (n = 37) or conservative treatment (n = 39). Open repair was performed by exposing the subscapularis tendon through a deltopectoral split, cutting the capsule and tendon, and repairing the Bankart lesion with use of Mitek anchors (DePuy Mitek, Raynham, Massachusetts). The capsule and tendon were closed end to end, and the shoulder was immobilized in a fixed sling for 2 days. Conservative treatment consisted of immobilization of the shoulder in a fixed sling for 2 days, directly after arthroscopy. All patients had a nonfixed sling for 1 week and then followed identical rehabilitation programs. Main outcome measures: Recurrent dislocation and 10-year assessment of results based on the Oxford Self-Assessment Shoulder Score. Main results: At 24 months, fewer patients who received surgery sustained a recurrent anterior dislocation than did patients who received conservative treatment (Table). At 10 years, the difference in dislocation rates between surgery and conservative treatment was maintained (Table). 69% of patients who had surgery reported good or excellent results according to the Oxford Shoulder Score, whereas 74% of conservatively treated patients reported unsatisfactory results. Conclusion: In patients with traumatic anterior shoulder dislocation, open repair resulted in fewer recurrent dislocations than did conservative treatment.

Primary Repair Versus Conservative Treatment of First-Time Traumatic Anterior Dislocation of the Shoulder: A Randomized Study With 10-Year Follow-up

The purpose of this study was to compare long-term results after surgical and conservative primary treatment of first-time traumatic anterior shoulder dislocation. Arthroscopic diagnosis after first-time traumatic anterior shoulder dislocation was performed, and in cases of a Baker type 1, 2, or 3 lesion, patients were randomized either to conservative treatment with a fixed sling for 1 week followed by a rehabilitation program or to open repair with a similar rehabilitation program. In this study 76 patients (14 female and 62 male patients), aged 15 to 39 years, were randomized to surgical repair (n = 37) or conservative treatment (n = 39). Of the patients, 6.6% had Baker type 1 lesions, 13.2% had type 2 lesions, and 80.3% had type 3 lesions. After a minimum of 2 years' follow-up, 56% had recurrence after conservative treatment and 3% after open repair (P < .005). Among nondislocators, 39% in the conservative group and 7% in the repair group had a positive apprehension test. When evaluated after 10 years by use of the Oxford self-assessment score, 72% of patients in the surgical group had good or excellent results. Of the conservatively treated patients, 75% had unsatisfactory results because of recurrence, instability, and pain or stiffness. Arthroscopic evaluation after first-time anterior shoulder dislocation revealed a Baker type 2 or 3 lesion in 93.5% of patients. At 2 years' follow-up, 21 (54%) of the conservatively treated patients had recurrence, as compared with 1 patient with recurrence (3%) after open surgical repair. After 8 years, a further 3 patients in the conservatively treated group had redislocations, 1 had subjective instability, and 4 had pain or stiffness, resulting in 74% having unsatisfactory results according to the Oxford score. Of the patients who had surgical repair, 72% had good or excellent results after 10 years. Because open repair produces superior results compared with conservative treatment, we recommend that the surgeon consider performing primary repair in active patients to reduce the risk of recurrence. Level I, high-quality prospective, randomized controlled trial.

Survey Of The Management Of Acute Traumatic Unilateral First-Time Anterior Shoulder Dislocation (AFSD) Among Orthopaedic Surgeons In USA

Aim: To identify the current trend in managing acute traumatic first-time anterior shoulder dislocation (AFSD) among orthopaedic surgeons in USA and to draw comparisons with previous UK study1. Design: Postal Questionnaire among Orthopaedic Surgeons in Northern America. Method: 200 questionnaires were sent out to a random list of active members of The American Orthopaedic Society for Sports Medicine (AOSSM) throughout USA. Questions were laid out in two 'workgroups'. Basic demographic data such as type of practice and surgical specialisation were recorded. In 'Workgroup One' questions regarding method and duration of immobilisation were analysed. In 'Workgroup Two', two case scenarios stratified by age, were analysed to look into the 'postreduction' management, focusing on trend in technique of stabilisation employed. Results: The response rate was 55% (109 of 200). 26 percent of respondents derived from academic practices and the remaining 74% of respondents were from privatised institution. Majority of the respondents were regarded as 'surgeons with special interest in sports medicine' (87 of 109, 80%). This was followed by 'shoulder and elbow surgeons' and 'general orthopaedic surgeons' (12% and 8% respectively). The most popular choice of immobilisation was internal rotation (72.5%). However, 24.8% of respondents preferred the external rotation method for immobilisation as advocated by Itoi et al. The mean duration of immobilisation was 2.5 weeks (1/2 weeks to 8 weeks, Std Deviations 1.2weeks). 42.2% (46 of 109) of respondents would perform an immediate arthroscopic stabilisation in young, fit patients presenting with this type of injury. On the other hand, an overwhelming majority of the respondent opted for non-operative management in older patient presented with this problem (98%). The current trend of management in the young, active age group comprised of arthroscopic stabilisation using suture anchors, followed by immobilisation in internal rotation for average 3-4 weeks and return to sports/work at average 5 months post-surgery. Conclusion: This survey revealed variations among orthopaedic surgeons in managing AFSD on the 'front-line' within USA. There are also observational differences between the findings of this and the UK study previously published. There is a need to address the issue of immobilisation technique. Majority of surgeons used age as a criterion in determining definitive management for this injury. The current trend in managing AFSD in young and active patient who presented with AFSD is arthroscopic stabilisation using suture anchors.

Survey of the Management of Acute Traumatic First-Time Anterior Shoulder Dislocation Among Trauma Clinicians in the UK

The aim of this work was to survey how acute traumatic first-time anterior shoulder dislocation (AFSD) is managed among trauma clinicians in UK using a postal questionnaire. A total of 150 questionnaires were sent out to active consultant members of the British Trauma Society in the UK. Questions were laid out in two 'workgroups'. In Workgroup One, an assortment of questions was included regarding choices and methods of analgesia, methods of monitoring used, methods of reduction, and position of immobilisation. In Workgroup Two, three different case scenarios were analysed to look into the 'post-reduction' management. The response rate was 60%. Of respondents, 22% have a local protocol for managing AFSD. Almost all respondents recommended pre- and post-reduction X-rays as standard practice. Most respondents favoured systemic analgesia and sedation with airways' monitoring, as opposed to intra-articular anaesthesia (68 versus 9). Eighty-four respondents advocated immobilisation in internal rotation compared to six in external rotation. Only 19% (16 of 84) of respondents would perform an immediate arthroscopic stabilisation in young, fit patients presenting with this type of injury. This survey revealed variations among trauma clinicians in managing AFSD on the 'front-line'. There is a need to address the issue of intra-articular analgesia, immobilisation technique and management of AFSD in the young patient with regards to immediate surgical intervention. We suggest that these issues be revised and clarified, ideally in a randomised, controlled, clinical trial prior to the introduction of a protocol for managing this problem.

Diagnostik und Therapie der vorderen Erstluxation der Schulter

Eine detaillierte Anamneseerhebung und seitenvergleichende klinische Untersuchung beider Schultergelenke sind die entscheidenden klinischen Kriterien zur Differenzierung zwischen einer traumatischen und atraumatischen Schulterluxation. Das Therapiespektrum nach Erstluxation der Schulter reicht von der rein funktionellen Therapie über die Ruhigstellung im Gilchrist-Verband bis zu arthroskopischen oder offenen Stabilisierungsoperationen. Junge Patienten (< 30 Jahre) nach einer traumatischen Erstluxation durch adäquates Trauma, mit unidirektionaler Instabilität, dem Nachweis einer Hill-Sachs-Läsion und sportlicher Aktivität sollten bei Therapiewunsch bereits nach der Erstluxation einer operativen Stabilisierung zugeführt werden. Das Operationsprinzip besteht in einer Refixation des abgerissenen Labrum glenoidale und des anterioren Anteils des inferioren glenohumeralen Bandes am vorderen Glenoidrand. Die Entwicklung arthroskopischer Operationsverfahren ist inzwischen soweit fortgeschritten, dass die Rekonstruktion des traumatisch abgelösten Kapsel-Labrum-Komplexes am Glenoidrand mit verschiedenen Nahttechniken realisierbar ist. Bei Abrissfrakturen des Glenoids (knöcherne Bankart-Läsion) besteht, bedingt durch den Verlust der Gelenkfläche, eine hohe Gefahr der Reluxation. Eine offene Refixation des Bankart-Fragments mittels Schraubenosteosynthese ist die Therapie der Wahl.

Arthroscopic observation of capsulolabral reduction after shoulder dislocation

The standard treatment for most first-time anterior shoulder dislocations is reduction and immobilization. This places the arm in a position of adduction and internal rotation. We question whether this position assists or hinders reduction of a displaced capsulolabral injury (Bankart lesion). This study examined the pathology present after traumatic first-time anterior shoulder dislocations and looked at the reduction of the Bankart lesion in internal and external rotation. A series of 25 patients with Bankart lesions were identified who underwent arthroscopy at a mean of 10.5 days after first-time anterior shoulder dislocations. We found that there is wide variation in pathology after anterior dislocation. In 23 of 25 patients in whom the capsulolabral complex was detached (Bankart lesion), we found that external rotation of the arm improved the reduction of the labrum (92%). We conclude that in patients with a displaced Bankart lesion, the standard treatment of immobilization in internal rotation may hinder anatomic healing of this injury.

A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young: a five-year follow-up study

A prospective arthroscopic study was conducted on 31 patients with an acute first-time anterior shoulder dislocation (AFASD). The patients were aged between 16 and 39 years. The mean age was 24 years. None had a history of shoulder problems. All were evaluated after 1, 2, and 5 years. The Constant score, Rowe score, recurrence rate, and instability rate were evaluated, as well as patient satisfaction and sports participation. We conclude that after a prolonged follow-up, an increase in the instability rate in young patients with AFASD may become apparent. The overall instability rate was 55% (17/31) after 5-year follow-up. In patients aged younger than 18 years the instability rate was 71% (5/7). Age was the only predictive factor in shoulder instability. The mean Rowe score was 87 (range, 57-100; SD, 14). Three patients had undergone a stabilization operation at the 5-year follow-up. The intraarticular pathology found at arthroscopy was not predictive of shoulder instability. We could not find a correlation between sporting activities and shoulder instability. On the basis of our results, it appears unlikely that arthroscopic lavage reduces redislocation rates after AFASD in the young patient.

Fracture of the coracoid process, the greater tuberosity, and the glenoid rim after acute first-time anterior shoulder dislocation: A case report

J Shoulder Elbow Surg 2001;10:489-92.