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

Background Shoulder dislocations are the most common joint dislocations seen in emergency departments. Most traumatic cases are anterior and cause recurrent dislocations. Management options include surgical and conservative treatments. There is a lack of evidence about which method is most effective after the first traumatic anterior shoulder dislocation (TASD). Objectives To produce UK age- and sex-specific incidence rates for TASD. To assess whether or not surgery within 6 months of a first-time TASD decreases re-dislocation rates compared with no surgery. To identify clinical predictors of recurrent dislocation. Design A population-based cohort study of first-time TASD patients in the UK. An initial validation study and subsequent propensity-score-matched analysis to compare re-dislocation rates between surgery and no surgery after a first-time TASD. Prediction modelling was used to identify potential predictors of recurrent dislocation. Setting UK primary and secondary care data. Participants Patients with a first-time TASD between 1997 and 2015. Interventions Stabilisation surgery within 6 months of a first-time TASD (compared with no surgery). Stabilisation surgery within 12 months of a first-time TASD was also carried out as a sensitivity analysis. Main outcome measure Re-dislocation rate up to 2 years after the first TASD. Methods Eligible patients were identified from the Clinical Practice Research Datalink (CPRD) (1997–2015). Accuracy of shoulder dislocation coding was internally validated using the CPRD General Practitioner questionnaire service. UK age- and sex-specific incidence rates for TASD were externally validated against rates from the USA and Canada. A propensity-score-matched analysis using linked CPRD and Hospital Episode Statistics (HES) data compared re-dislocation rates for patients aged 16–35 years, comparing surgery with no surgery. Multivariable Cox regression models for predicting re-dislocation were developed for the surgical and non-surgical cohorts. Results Shoulder dislocation was coded correctly for 89% of cases in the CPRD [95% confidence interval (CI) 83% to 95%], with a ‘primary’ dislocation confirmed for 76% of cases (95% CI 67% to 85%). Far fewer patients than expected received stabilisation surgery within 6 months of a first TASD, leading to an underpowered study. Around 20% of re-dislocation rates were observed for both surgical and non-surgical patients. The sensitivity analysis at 12 months also showed little difference in re-dislocation rates. Missing data on risk factors limited the value of the prediction modelling; however, younger age, epilepsy and sex (male) were identified as statistically significant predictors of re-dislocation. Limitations Far fewer than the expected number of patients had surgery after a first-time TASD, resulting in an underpowered study. This and residual confounding from missing risk factors mean that it is not possible to draw valid conclusions. Conclusions This study provides, for the first time, UK data on the age- and sex-specific incidence rates for TASD. Most TASD occurs in men, but an unexpected increased incidence was observed in women aged > 50 years. Surgery after a first-time TASD is uncommon in the NHS. Re-dislocation rates for patients receiving surgery after their first TASD are higher than previously expected; however, important residual confounding risk factors were not recorded in NHS primary and secondary care databases, thus preventing useful recommendations. Future work The high incidence of TASD justifies investigation into preventative measures for young men participating in contact sports, as well as investigating the risk factors in women aged > 50 years. A randomised controlled trial would account for key confounders missing from CPRD and HES data. A national TASD registry would allow for a more relevant data capture for this patient group. Study registration Independent Scientific Advisory Committee (ISAC) for the Medicines and Healthcare Products Regulatory Agency (ISAC protocol 15_0260). Funding The National Institute for Health Research Health Technology Assessment programme.

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Conservative management of first-time traumatic anterior shoulder dislocation

Obere Extremität ◽

10.1007/s11678-021-00626-z ◽

2021 ◽

Author(s):

Benedikt Schliemann ◽

Marvin Minkus ◽

Dominik Seybold ◽

Markus Scheibel

Keyword(s):

Conservative Management ◽

Shoulder Dislocation ◽

External Rotation ◽

Young Patients ◽

Clinical Results ◽

Current Evidence ◽

Anterior Shoulder Dislocation ◽

Recurrence Rates ◽

Traumatic Anterior Shoulder Dislocation ◽

First Time

AbstractTraumatic anterior shoulder dislocation is a common injury in young and active patients and the proper treatment is still a matter of debate. The recurrence rate after conservative management remains high and, therefore, primary surgical intervention is sometimes recommended in very young patients whose risk of recurrences is highest. Immobilization in external rotation, first described by Itoi, is a promising conservative option as it provides adequate labral reduction and low recurrence rates. Recent meta-analyzes could not unequivocally demonstrate its superiority over internal rotation immobilization. However, biomechanical and early clinical results show a better effect on reduction of the labrum and lower recurrence rates for immobilization in a combination of abduction/external rotation than for external rotation alone. The present article aims to provide an overview of the conservative management of first-time traumatic shoulder dislocation in order to provide the treating physician or surgeon with the best current evidence as a basis for developing the appropriate treatment strategy for the patient.

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Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2018-000447 ◽

2019 ◽

Vol 5 (1) ◽

pp. e000447 ◽

Cited By ~ 7

Author(s):

Margie K Olds ◽

Richard Ellis ◽

Priya Parmar ◽

Paula Kersten

Keyword(s):

Shoulder Dislocation ◽

Univariate Analysis ◽

Recurrent Dislocation ◽

Multivariate Logistic Regression Model ◽

Anterior Shoulder Dislocation ◽

Predictive Tool ◽

Recurrent Instability ◽

Significant Difference ◽

Traumatic Anterior Shoulder Dislocation ◽

First Time

ObjectiveTo develop a multivariate tool that would predict recurrent instability after a first-time traumatic anterior shoulder dislocation.MethodsParticipants (aged 16–40 years) were recruited across New Zealand into a prospective cohort study. Baseline data were collected during a telephone interview and through examination of radiology records. Variables associated with recurrent instability were selected for the multivariate logistic regression model using backwards selection (p<0.10). Coefficients for those variables retained in the model were used to develop the predictive tool.ResultsAmong the 128 participants, 36% had redislocated at least once in the first 12 months. Univariate analysis showed an increased likelihood of recurrent dislocation with bony Bankart lesions (OR=3.65, 95% CI 1.05 to 12.70, p=0.04) and participants who had: not been immobilised in a sling (OR = 0.38, 95% CI 0.15 to 0.98, p=0.05), higher levels of shoulder activity (OR=1.13, 95% CI 1.01 to 1.27, p=0.03), higher levels of pain and disability (OR=1.03, 95% CI 1.01 to 1.06, p=0.02), higher levels of fear of reinjury (OR=1.12, 95% CI 1.01 to 1.26, p=0.04) and decreased quality of life (OR=1.01, 95% CI 1.00 to 1.02, p=0.05). There was no significant difference in those with non-dominant compared with dominant shoulder dislocations (p=0.10) or in those aged 16–25 years compared with 26–40 years (p=0.07).ConclusionSix of seven physical and psychosocial factors can be used to predict recurrent shoulder instability following a first-time traumatic anterior shoulder dislocation.

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First time traumatic anterior shoulder dislocation: Will it always result in recurrent shoulder dislocation in all patients?

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.04.3227 ◽

2020 ◽

Vol 27 (04) ◽

pp. 695-699

Author(s):

Faaiz Ali Shah ◽

Mian Amjad Ali ◽

Naeemullah

Keyword(s):

Shoulder Joint ◽

Shoulder Dislocation ◽

Rehabilitation Program ◽

Monthly Interval ◽

Anterior Shoulder Dislocation ◽

Number Of Patients ◽

Traumatic Anterior Shoulder Dislocation ◽

Recurrent Shoulder Dislocation ◽

First Time

Objectives: To determine the frequency of recurrent shoulder dislocation after first time traumatic anterior shoulder dislocation treated non operatively. Study Design: Prospective observational cohort study. Setting: Department of Orthopedics and Traumatology Lady Reading Hospital Peshawar. Period: 25th May 2011 to 25th December 2018. Material & Methods: Patients of all ages and both gender with first time. Traumatic anterior shoulder dislocation meeting the inclusion criteria were included in the study. In the included subjects shoulder joint was relocated under general anesthesia and immobilized in a poly sling for four weeks followed by supervised physiotherapy and rehabilitation program without any surgical stabilization of the shoulder joint. All these patients were instructed for follow up at monthly interval or before if recurrence occurred. Results: A total of 52 patients with mean age 35±9.4 years (range 16-55 years) were enrolled in our study. Male patients were 43(82.6%) while female patients were 9(17.3%). Right sided dislocation was noted in 38(73%) and left in 14(26.9%). Recurrent shoulder dislocation was reported in 32(61.5%) patients during a minimal follow up period of three years. Most (46.8%, n=15) of the patients with recurrent shoulder dislocation were 30 years of age or below. Conclusion: First time traumatic anterior shoulder dislocation treated non operatively not always result in recurrent shoulder dislocation in all patients. However a large number of patients and particularly younger patients suffered recurrence.

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Do Articular-Sided Partial-Thickness Rotator Cuff Tears After a First-Time Traumatic Anterior Shoulder Dislocation in Young Athletes Influence the Outcome of Surgical Stabilization?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118781311 ◽

2018 ◽

Vol 6 (6) ◽

pp. 232596711878131

Author(s):

Madis Rahu ◽

Jüri-Toomas Kartus ◽

Elle Põldoja ◽

Kirsti Pedak ◽

Ivo Kolts ◽

...

Keyword(s):

Surgical Treatment ◽

Rotator Cuff ◽

Shoulder Dislocation ◽

Clinical Results ◽

Rotator Cuff Tears ◽

Anterior Shoulder Dislocation ◽

Young Athletes ◽

Bony Bankart ◽

Traumatic Anterior Shoulder Dislocation ◽

First Time

Background: Because of the high risk for redislocations after a first-time traumatic anterior shoulder dislocation with conservative treatment, recent publications have recommended early arthroscopic intervention, especially for young athletes. Concomitant rotator cuff tendon damage may occur when the shoulder dislocates; however, its presence and influence on clinical results have not been well described in this patient category. Hypothesis: In opposition to current opinion, a substantial number of articular-sided partial-thickness rotator cuff tears (APTRCTs) would be found at surgery after a first-time traumatic anterior shoulder dislocation in young athletes. However, the impact of these injuries on 2-year postoperative results would be negligible. Study Design: Cohort study; Level of evidence, 3. Methods: Sixteen male patients (mean age, 21 years [range, 16-25 years]) with a first-time traumatic anterior shoulder dislocation without bony Bankart lesions were included in this study. The indications for surgical treatment were age less than 25 years and being active in collision or contact sports at a competitive level. Arthroscopic surgery was performed at a mean 7.8 days (range, 2-14 days) after injury. Rowe and American Shoulder and Elbow Surgeons (ASES) scores as well as range of motion were evaluated at a minimum 2 years after an arthroscopic Bankart procedure, and a comparison of the clinical results between patients with and without APTRCTs was conducted. Results: An anterior-inferior capsulolabral injury was found in all patients. There were no bony Bankart lesions. An APTRCT was found in 9 of the 16 patients. At 2 years after surgical treatment, there were no significant differences between the patients with and without APTRCTs in terms of the Rowe score (90.0 and 87.1, respectively; P = .69) and ASES score (94.6 and 90.4, respectively; P = .67). Conclusion: APTRCTs were found in the superior part of the shoulder joint after a first-time traumatic anterior shoulder dislocation in a majority of young male athletes treated with surgical stabilization. There were no significant differences found between patients with and without APTRCTs in terms of the Rowe and ASES scores at 2 years after surgical treatment.

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