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Review
. 2025 Feb 21;122(4):89-95.
doi: 10.3238/arztebl.m2024.0254.

Traumatic Anterior Shoulder Dislocation: Epidemiology, Diagnosis, and Treatment

Anna Patricia Goth  1 , Alexander Klug, Georg Gosheger, Mirkka Lynn Hiort, Doruk Akgün, Kristian Nikolaus Schneider
Affiliations
Review

Traumatic Anterior Shoulder Dislocation: Epidemiology, Diagnosis, and Treatment

Anna Patricia Goth et al. Dtsch Arztebl Int. .

Abstract

Background: Traumatic anterior shoulder dislocation is the most common type of joint dislocation, with an incidence of 11 to 29 per 100 000 persons per year. Controversy still surrounds the recommendations for treatment and the available procedures for surgical stabilization.

Methods: This review is based on pertinent publications (2014-2024) that were retrieved by a selective search in the PubMed and Google Scholar databases. Meta-analyses and ran - domized controlled trials (RCTs) with evidence levels I and II were included.

Results: The typical injury mechanism is forcible external rotation and abduction of the arm. The diagnosis is established by x-ray, which may be supplemented by magnetic resonance imaging (MRI) for the assessment of soft-tissue structures. The indication and type of surgical treatment depends on the patient's age, sex, activity level, and concomitant injuries. For purely soft-tissue injuries, arthroscopic Bankart repair is an established treatment, with reported significant reduction in the rate of recurrent instability after follow-up periods of up to 12 years. An accompanying bony injury of the dorsal humeral head (Hill-Sachs lesion), depending on its extent, may be an indication for the arthroscopic Remplissage procedure: this can lower the rate of recurrence, but it can also cause a postoperative restriction of external rotation. In cases of chronic instability, an arthroscopic or open Latarjet procedure and bone grafting can be per formed to augment the ventral glenoid articular surface. These procedures have likewise been reported to yield low rates of recurrent instability, but also higher complication rates.

Conclusion: The treatment of shoulder dislocation should be individually tailored. Although the reported results are promising, the evidence base remains weak. Prospective studies with larger case numbers are needed so that clear treatment algorithms can be established.

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Figures

Figure 1
Figure 1
Anterior shoulder dislocation with bony Bankart lesion, Hill-Sachs lesion of the posterior humeral head, and capsule elongation
Figure 2
Figure 2
Apprehension test. The examiner stands behind the patient. The arm is held in 60° abduction and simultaneous external rotation. The examiner applies pressure to the humeral head from dorsal to ventral. The test is then repeated in 90° and 120° abduction. The test is positive if the patient tenses the shoulder muscles in response to pressure on the humeral head or is unable to bring the arm in the required position out of fear.
Figure 3
Figure 3
On-track Hill-Sachs lesion with an associated bony Bankart lesion.
Figure 4
Figure 4
Off-track Hill-Sachs lesion with an associated bony Bankart lesion. The humeral head bone defect is larger than the contact surface of the glenoid fossa.
Figure 5
Figure 5
Latarjet procedure with transfer of the coracoid process to the anterior glenoid rim as a therapeutic option for a glenoid defect and chronic traumatic shoulder instability
See this image and copyright information in PMC

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