Controversies in the Management of the First Time Shoulder Dislocation

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.

Keywords: Arthroscopy; First dislocation; Instability; Review; Shoulder dislocation; Treatment.

Fig. (1)

Arthroscopic view of a chronic Bankart lesion with affected capsular tissue.

Fig. (2)

Arthroscopic view of a small bony Bankart lesion.

Fig. (3)

Arthroscopic view of a chronic large humeral Hill-Sachs lesion.

Fig. (4)

Arthroscopic view of a enganging Hill-Sachs lesion.

Fig. (5)

Arthroscopic view of an acute glenohumeral capsular tear after first-time shoulder dislocation.

Fig. (6)

Arthroscopic view of an acute Bankart lesion after first-time shoulder dislocation.

Fig. (7)

Arthroscopic view of an acute bony Bankart lesion previous to the repair.

Fig. (8)

Arthroscopic view of an acute bony Bankart lesion after the repair by a Sugaya technique.

Fig. (9)

Arthroscopic view of an acute bony Bankart lesion at the end of the previous Sugaya procedure.