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Singapore Med J 2014; 55(10): 511-516; http://dx.doi.org/10.11622/smedj.2014132
First-time anterior shoulder dislocations: should they be arthroscopically stabilised?
Sedeek SM, Bin Abd Razak HR, Ee G, Tan A
Correspondence: Dr Sedeek Mohamed Sedeek, sedeeko2000@hotmail.com
ABSTRACT
The glenohumeral joint is inherently unstable because the large humeral head articulates with the small shadow glenoid fossa. Traumatic anterior dislocation of the shoulder is a relatively common athletic injury, and the high frequency of recurrent instability in young athletes after shoulder dislocation is discouraging to both the patient and the treating physician. Management of primary traumatic shoulder dislocation remains controversial. Traditionally, treatment involves initial immobilisation for 4–6 weeks, followed by functional rehabilitation. However, in view of the high recurrence rates associated with this traditional approach, there has been an escalating interest in determining whether immediate surgical intervention can lower the rate of recurrent shoulder dislocation, improving the patient’s quality of life. This review article aims to provide an overview of the nature and pathogenesis of first-time primary anterior shoulder dislocations, the widely accepted management modalities, and the efficacy of primary surgical intervention in first-time primary anterior shoulder dislocations.
Keywords: arthroscopic Bankart repair, conservative treatment, dislocation, shoulder
Singapore Med J 2014; 55(10): 511-516; http://dx.doi.org/10.11622/smedj.2014132
REFERENCES
| 1. Shah AS, Karadsheh MS, Sekiya JK. Failure of operative treatment for glenohumeral instability: etiology and causes. Arthroscopy 2011; 27:681?94. http://dx.doi.org/10.1016/j.arthro.2010.11.057 | ||||
| 2. Turkel SJ, Panio MW, Marshall JL, Girgis FG. Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg Am 1981; 63:1208-17. PMid:7287791 | ||||
| 3. Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am 1978; 60:1-16. PMid:624747 | ||||
| 4. Wheeler JH, Ryan JB, Arciero RA, Molinari RN. Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes. Arthroscopy 1989; 5:213-7. http://dx.doi.org/10.1016/0749-8063(89)90174-6 | ||||
| 5. Pevny T, Hunter RE, Freeman JR. Primary traumatic anterior shoulder dislocation in patients 40 years of age and older. Arthroscopy 1998; 14:289?94. http://dx.doi.org/10.1016/S0749-8063(98)70145-8 | ||||
| 6. Chahal J, Marks PH, Macdonald PB, et al. Anatomic Bankart repair compared with nonoperative treatment and/or arthroscopic lavage for first-time traumatic shoulder dislocation. Arthroscopy 2012; 28:565-75. http://dx.doi.org/10.1016/j.arthro.2011.11.012 | ||||
| 7. Robinson CM, Dobson RJ. Anterior instability of the shoulder after trauma. J Bone Joint Surg Br 2004; 86:469-79. http://dx.doi.org/10.1302/0301-620X.86B4 | ||||
| 8. Boone JL, Arciero RA. First-time anterior shoulder dislocations: has the standard changed? Br J Sports Med 2010; 44:355-60. http://dx.doi.org/10.1136/bjsm.2009.062596 | ||||
| 9. Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 1997; 25:306-11. http://dx.doi.org/10.1177/036354659702500306 | ||||
| 10. Baker CL, Uribe JW, Whitman C. Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am J Sports Med 1990; 18:25-8. http://dx.doi.org/10.1177/036354659001800104 | ||||
| 11. Antonio GE, Griffith JF, Yu AB, et al. First-time shoulder dislocation: High prevalence of labral injury and age-related differences revealed by MR arthrography. J Magn Reson Imaging 2007; 26:983-91. http://dx.doi.org/10.1002/jmri.21092 | ||||
| 12. Pollock RG, Wang VM, Bucchieri JS, et al. Effects of repetitive subfailure strains on the mechanical behavior of the inferior glenohumeral ligament. J Shoulder Elbow Surg 2000; 9:427-35. http://dx.doi.org/10.1067/mse.2000.108388 | ||||
| 13. Buscayret F, Edwards TB, Szabo I, et al. Glenohumeral arthrosis in anterior instability before and after surgical treatment: incidence and contributing factors. Am J Sports Med 2004; 32:1165-72. http://dx.doi.org/10.1177/0363546503262686 | ||||
| 14. Griffith JF, Antonio GE, Yung PS, et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. AJR Am J Roentgenol 2008; 190:1247-54. http://dx.doi.org/10.2214/AJR.07.3009 | ||||
| 15. Wallace WA, Hellier M. Improving radiographs of the injured shoulder. Radiography 1983; 49:229-33. PMid:6635156 | ||||
| 16. Chandnani VP, Yeager TD, DeBerardino T, et al. Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol 1993; 161:1229-35. http://dx.doi.org/10.2214/ajr.161.6.8249731 | ||||
| 17. Kuhn JE. Treating the initial anterior shoulder dislocation--an evidence-based medicine approach. Sports Med Arthrosc 2006; 14:192-8. http://dx.doi.org/10.1097/01.jsa.0000212328.25345.de | ||||
| 18. Hovelius L, Augustini BG, Fredin H, et al. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 1996; 78:1677-84. PMid:8934481 | ||||
| 19. Simonet WT, Cofield RH. Prognosis in anterior shoulder dislocation. Am J Sports Med 1984; 12:19-24. http://dx.doi.org/10.1177/036354658401200103 | ||||
| 20. Kiviluoto O, Pasila M, Jaroma H, Sundholm A. Immobilization after primary dislocation of the shoulder. Acta Orthop Scand 1980; 51:915-9. http://dx.doi.org/10.3109/17453678008990894 | ||||
| 21. Seybold D, Schliemann B, Heyer CM, Muhr G, Gekle C. Which labral lesion can be best reduced with external rotation of the shoulder after a first-time traumatic anterior shoulder dislocation? Arch Orthop Trauma Surg 2009; 129:299-304. http://dx.doi.org/10.1007/s00402-008-0618-6 | ||||
| 22. Itoi E, Hatakeyama Y, Sato T, et al. Immobilization in external rotation after shoulder dislocation reduces the risk of recurrence. A randomized controlled trial. J Bone Joint Surg Am 2007; 89:2124-31. http://dx.doi.org/10.2106/JBJS.F.00654 | ||||
| 23. Gumina S, Postacchini F. Anterior dislocation of the shoulder in elderly patients. J Bone Joint Surg Br 1997; 79:540-3. http://dx.doi.org/10.1302/0301-620X.79B4.7497 | ||||
| 24. Hovelius L, Olofsson A, Sandström B, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. a prospective twenty-five-year follow-up. J Bone Joint Surg Am 2008; 90:945-52. http://dx.doi.org/10.2106/JBJS.G.00070 | ||||
| 25. Sachs RA, Lin D, Stone ML, Paxton E, Kuney M. Can the need for future surgery for acute traumatic anterior shoulder dislocation be predicted? J Bone Joint Surg Am 2007; 89:1665-74. http://dx.doi.org/10.2106/JBJS.F.00261 | ||||
| 26. Wintzell G, Haglund-Akerlind Y, Ekelund A, et al. Arthroscopic lavage reduced the recurrence rate following primary anterior shoulder dislocation. A randomised multicentre study with 1-year follow-up. Knee Surg Sports TraumatolArthrosc 1999; 7:192-6. http://dx.doi.org/10.1007/s001670050146 | ||||
| 27. Robinson CM, Jenkins PJ, White TO, Ker A, Will E. Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder. A randomized, double-blind trial. J Bone Joint Surg Am 2008; 90:708-21. http://dx.doi.org/10.2106/JBJS.G.00679 | ||||
| 28. Valentin A, Winge S, Engström B. Early arthroscopic treatment of primary traumatic anterior shoulder dislocation. A follow-up study. Scand J Med Sci Sports 1998; 8:405-10. http://dx.doi.org/10.1111/j.1600-0838.1998.tb00459.x | ||||
| 29. Law BK, Yung PS, Ho EP, Chang JJ, Chan KM. The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients. Knee Surg Sports TraumatolArthrosc 2008; 16:188-93. http://dx.doi.org/10.1007/s00167-007-0453-2 | ||||
| 30. Bottoni CR, Wilckens JH, DeBerardino TM, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med 2002; 30:576-80. PMid:12130413 | ||||
| 31. Kirkley A, Werstine R, Ratjek A, Griffin S. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation. Arthroscopy 2005; 21:55-63. http://dx.doi.org/10.1016/j.arthro.2004.09.018 | ||||
| 32. Jakobsen BW, Johannsen HV, Suder P, Søjbjerg JO. Primary repair versus conservative treatment of first-time traumatic anterior dislocation of the shoulder: a randomized study with 10-year follow-up. Arthroscopy 2007; 23:118-23. http://dx.doi.org/10.1016/j.arthro.2006.11.004 | ||||
| 33. Yanmis I, Tunay S, Kömürcü M, et al. Outcomes of acute arthroscopic repair and conservative treatment following first traumatic dislocation of the shoulder joint in young patients. Ann Acad Med Singapore 2003; 32:824-7. PMid:14716954 | ||||
| 34. Edmonds G, Kirkley A, Birmingham TB, Fowler PJ. The effect of early arthroscopic stabilization compared to nonsurgical treatment on proprioception after primary traumatic anterior dislocation of the shoulder. Knee Surg Sports TraumatolArthrosc 2003; 11:116-21. PMid:12664205 | ||||
| 35. Kirkley A, Griffin S, Richards C, Miniaci A, Mohtadi N. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder. Arthroscopy 1999; 15:507-14. http://dx.doi.org/10.1053/ar.1999.v15.015050 | ||||
| 36. Baumgarten KM, Wright RW. Ease of tying arthroscopic knots. J Shoulder Elbow Surg 2007; 16:438-42. http://dx.doi.org/10.1016/j.jse.2006.10.013 | ||||
| 37. Barber FA, Ryu RK, Tauro JC. Should first time anterior shoulder dislocations be surgically stabilized? Arthroscopy 2003; 19:305-9. http://dx.doi.org/10.1053/jars.2003.50085 | ||||
| 38. Spiegl UJ, Ryf C, Hepp P, Rillmann P. Evaluation of a treatment algorithm for acute traumatic osseous Bankart lesions resulting from first time dislocation of the shoulder with a two year follow-up. BMC Musculoskelet Disord 2013; 14:305. http://dx.doi.org/10.1186/1471-2474-14-305 | ||||