FUNCTIONAL OUTCOME AND RISK OF RECURRENT INSTABILITY AFTER PRIMARY TRAUMATIC ANTERIOR SHOULDER DISLOCATION IN YOUNG PATIENTS

2006 ◽  
Vol 88 (11) ◽  
pp. 2326-2336 ◽  
Author(s):  
C. MICHAEL ROBINSON ◽  
JONATHAN HOWES ◽  
HELEN MURDOCH ◽  
ELIZABETH WILL ◽  
CATRIONA GRAHAM
Keyword(s):  
Functional Outcome ◽  
Shoulder Dislocation ◽  
Young Patients ◽  
Anterior Shoulder Dislocation ◽  
Recurrent Instability ◽  
Traumatic Anterior Shoulder Dislocation

scholarly journals Conservative management of first-time traumatic anterior shoulder dislocation

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.

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

2019 ◽  
Vol 5 (1) ◽  
pp. e000447 ◽  
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.

Outcome of Immobilization in External Rotation Position after Closed Reduction in Traumatic Anterior Shoulder Dislocation

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Suraj Bidary ◽  
Suresh Pandey ◽  
Roshani Aryal ◽  
Prabal KC ◽  
Kushal Bhattarai ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Closed Reduction ◽  
Shoulder Dislocation ◽  
External Rotation ◽  
Anterior Dislocation ◽  
Anterior Shoulder Dislocation ◽  
Easy Method ◽  
Cross Sectional ◽  
Traumatic Anterior Shoulder Dislocation

Background: As documented in many studies, anterior shoulder dislocation can be effectively immobilized in both external and internal rotation positions, with favorable outcomes. However, controversy exists about the superiority of the technique of immobilization to achieve the reduced rate of redislocation. We conducted this study to assess the functional outcome of immobilization of shoulder in external rotation position after relocation in patients with acute anterior shoulder dislocation. Methods: This is hospital based cross-sectional study in total of 36 patients of primary anterior dislocation of shoulder. They were managed with closed reduction and immobilization in external rotation position and followed up for up to twelve months. Functional outcome (including re-dislocation rate) during each follow-up visit was assessed by using ROWE Score. Results: The mean age of the participants was 29.6±7.9 years (range: 17-44 years). Of them, 89.9% were male; and 55.6% were involved in risky jobs. Similarly, 50% of them sustained injury due to slip and fall, 72.2% presented to the hospital within 12 hours; and 69.4% had their right side involved. All the patients were compliant with treatment regime; 77.8% tolerated the brace well and the redislocation rate was 8.3%. ROWE score was found to be significantly increased between subsequent follow-up visits (p<0.05), except between six months and 12 months (p>0.05). Overall, ROWE score varied significantly across the total follow-up period (p<0.05). Conclusions: Immobilization in external rotation position in traumatic anterior shoulder dislocation was a simple and easy method of conservative treatment with good patient compliance, less incidence of re-dislocation and good functional outcome.

scholarly journals Management of the First-time Traumatic Anterior Shoulder Dislocation

2018 ◽  
Vol 21 (3) ◽  
pp. 169-175
Author(s):  
Sung Il Wang
Keyword(s):  
Elderly Patients ◽  
Shoulder Dislocation ◽  
Traumatic Event ◽  
Young Patients ◽  
Rotator Cuff Tears ◽  
Anterior Dislocation ◽  
Anterior Shoulder Dislocation ◽  
Careful Evaluation ◽  
Traumatic Anterior Shoulder Dislocation ◽  
First Time

Traumatic anterior dislocation of the shoulder is one of the most common directions of instability following a traumatic event. Although the incidence of shoulder dislocation is similar between young and elderly patients, most studies have traditionally focused on young patients due to relatively high rates of recurrent dislocations in this population. However, shoulder dislocations in older patients also require careful evaluation and treatment selection because they can lead to persistent pain and disability due to rotator cuff tears and nerve injuries. This article provides an overview of the nature and pathology of acute primary anterior shoulder dislocation, widely accepted management modalities, and differences in treatment for young and elderly patients.

scholarly journals Treatment of first-time traumatic anterior shoulder dislocation: the UK TASH-D cohort study

2019 ◽  
Vol 23 (18) ◽  
pp. 1-104
Author(s):  
Jonathan L Rees ◽  
Anjali Shah ◽  
Katherine Edwards ◽  
Maria T Sanchez-Santos ◽  
Danielle E Robinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Shoulder Dislocation ◽  
Recurrent Dislocation ◽  
Incidence Rates ◽  
Anterior Shoulder Dislocation ◽  
Traumatic Anterior Shoulder Dislocation ◽  
The Uk ◽  
First Time ◽  
Residual Confounding ◽  
Age And Sex

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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