Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Management of the First-time Traumatic Anterior Shoulder Dislocation

  • Wang, Sung Il (Department of Orthopaedic Surgery, Chonbuk National University Medical School, Research Insitute for Endocrine Sciences and Research Insitute of Clinical Medicine of Chonbuk National University-Biomedical Research Insitute of Chonbuk National University Hospital)
  • Received : 2018.07.03
  • Accepted : 2018.07.30
  • Published : 2018.09.01
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Abstract

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.

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References

  1. Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy. 2009;25(3):298-304. https://doi.org/10.1016/j.arthro.2008.12.007
  2. 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(1):55-63. https://doi.org/10.1016/j.arthro.2004.09.018
  3. Kirkley A, Griffin S, McLintock H, Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med. 1998;26(6):764-72. https://doi.org/10.1177/03635465980260060501
  4. Goss TP. Anterior glenohumeral instability. Orthopedics. 1988;11(1):87-95.
  5. Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am. 2010;92(3):542-9. https://doi.org/10.2106/JBJS.I.00450
  6. Robinson CM, Shur N, Sharpe T, Ray A, Murray IR. Injuries associated with traumatic anterior glenohumeral dislocations. J Bone Joint Surg Am. 2012;94(1):18-26. https://doi.org/10.2106/JBJS.J.01795
  7. Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am. 2006;88(11):2326-36. https://doi.org/10.2106/JBJS.E.01327
  8. Hovelius L, Olofsson A, Sandstrom 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(5):945-52. https://doi.org/10.2106/JBJS.G.00070
  9. Hovelius L, Eriksson K, Fredin H, et al. Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment. J Bone Joint Surg Am. 1983;65(3):343-9. https://doi.org/10.2106/00004623-198365030-00008
  10. McLaughlin HL, MacLellan DI. Recurrent anterior dislocation of the shoulder. II. A comparative study. J Trauma. 1967;7(2):191-201. https://doi.org/10.1097/00005373-196703000-00002
  11. Boone JL, Arciero RA. First-time anterior shoulder dislocations: has the standard changed? Br J Sports Med. 2010;44(5):355-60. https://doi.org/10.1136/bjsm.2009.062596
  12. 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(3):306-11. https://doi.org/10.1177/036354659702500306
  13. Baker CL, Uribe JW, Whitman C. Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am J Sports Med. 1990;18(1):25-8. https://doi.org/10.1177/036354659001800104
  14. Norlin R. Intraarticular pathology in acute, first-time anterior shoulder dislocation: an arthroscopic study. Arthroscopy. 1993;9(5):546-9. https://doi.org/10.1016/S0749-8063(05)80402-5
  15. Hintermann B, Gachter A. Arthroscopic findings after shoulder dislocation. Am J Sports Med. 1995;23(5):545-51. https://doi.org/10.1177/036354659502300505
  16. Pevny T, Hunter RE, Freeman JR. Primary traumatic anterior shoulder dislocation in patients 40 years of age and older. Arthroscopy. 1998;14(3):289-94. https://doi.org/10.1016/S0749-8063(98)70145-8
  17. Ribbans WJ, Mitchell R, Taylor GJ. Computerised arthrotomography of primary anterior dislocation of the shoulder. J Bone Joint Surg Br. 1990;72(2):181-5. https://doi.org/10.2106/00004623-199072020-00004
  18. Hawkins RJ, Bell RH, Hawkins RH, Koppert GJ. Anterior dislocation of the shoulder in the older patient. Clin Orthop Relat Res. 1986;(206):192-5.
  19. Gumina S, Postacchini F. Anterior dislocation of the shoulder in elderly patients. J Bone Joint Surg Br. 1997;79(4):540-3. https://doi.org/10.1302/0301-620X.79B4.7497
  20. Toolanen G, Hildingsson C, Hedlund T, Knibestol M, Oberg L. Early complications after anterior dislocation of the shoulder in patients over 40 years. An ultrasonographic and electromyographic study. Acta Orthop Scand. 1993;64(5):549-52. https://doi.org/10.3109/17453679308993690
  21. Shin SJ, Yun YH, Kim DJ, Yoo JD. Treatment of traumatic anterior shoulder dislocation in patients older than 60 years. Am J Sports Med. 2012;40(4):822-7. https://doi.org/10.1177/0363546511434522
  22. Atef A, El-Tantawy A, Gad H, Hefeda M. Prevalence of associated injuries after anterior shoulder dislocation: a prospective study. Int Orthop. 2016;40(3):519-24. https://doi.org/10.1007/s00264-015-2862-z
  23. Murthi AM, Ramirez MA. Shoulder dislocation in the older patient. J Am Acad Orthop Surg. 2012;20(10):615-22. https://doi.org/10.5435/JAAOS-20-10-615
  24. de Laat EA, Visser CP, Coene LN, Pahlplatz PV, Tavy DL. Nerve lesions in primary shoulder dislocations and humeral neck fractures. A prospective clinical and EMG study. J Bone Joint Surg Br. 1994;76(3):381-3.
  25. Gates JD, Knox JB. Axillary artery injuries secondary to anterior dislocation of the shoulder. J Trauma. 1995;39(3):581-3.
  26. Kelley SP, Hinsche AF, Hossain JF. Axillary artery transection following anterior shoulder dislocation: classical presentation and current concepts. Injury. 2004;35(11):1128-32. https://doi.org/10.1016/j.injury.2003.08.009
  27. Robinson CM, Dobson RJ. Anterior instability of the shoulder after trauma. J Bone Joint Surg Br. 2004;86(4):469-79. https://doi.org/10.1302/0301-620X.86B4
  28. Park MC, Blaine TA, Levine WN. Shoulder dislocation in young athletes: current concepts in management. Phys Sportsmed. 2002;30(12):41-8. https://doi.org/10.3810/psm.2002.12.580
  29. Wallace WA, Hellier M. Improving radiographs of the injured shoulder. Radiography. 1983;49(586):229-33.
  30. Palmer WE, Brown JH, Rosenthal DI. Labral-ligamentous complex of the shoulder: evaluation with MR arthrography. Radiology. 1994;190(3):645-51. https://doi.org/10.1148/radiology.190.3.8115604
  31. Waldt S, Burkart A, Imhoff AB, Bruegel M, Rummeny EJ, Woertler K. Anterior shoulder instability: accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries. Radiology. 2005;237(2):578-83. https://doi.org/10.1148/radiol.2372041429
  32. Orvets ND, Parisien RL, Curry EJ, et al. Acute versus delayed magnetic resonance imaging and associated abnormalities in traumatic anterior shoulder dislocations. Orthop J Sports Med. 2017;5(9):2325967117728019.
  33. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br. 1991;73(3):389-94.
  34. Kuhn JE. Treating the initial anterior shoulder dislocation: an evidence-based medicine approach. Sports Med Arthrosc Rev. 2006;14(4):192-8. https://doi.org/10.1097/01.jsa.0000212328.25345.de
  35. Paterson WH, Throckmorton TW, Koester M, Azar FM, Kuhn JE. Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. J Bone Joint Surg Am. 2010;92(18):2924-33. https://doi.org/10.2106/JBJS.J.00631
  36. Kiviluoto O, Pasila M, Jaroma H, Sundholm A. Immobilization after primary dislocation of the shoulder. Acta Orthop Scand. 1980;51(6):915-9. https://doi.org/10.3109/17453678008990894
  37. Simonet WT, Cofield RH. Prognosis in anterior shoulder dislocation. Am J Sports Med. 1984;12(1):19-24. https://doi.org/10.1177/036354658401200103
  38. Maeda A, Yoneda M, Horibe S, Hirooka A, Wakitani S, Narita Y. Longer immobilization extends the "symptom-free" period following primary shoulder dislocation in young rugby players. J Orthop Sci. 2002;7(1):43-7. https://doi.org/10.1007/s776-002-8413-9
  39. Itoi E, Hatakeyama Y, Kido T, et al. A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study. J Shoulder Elbow Surg. 2003;12(5):413-5. https://doi.org/10.1016/S1058-2746(03)00171-X
  40. Itoi E, Hatakeyama Y, Itoigawa Y, et al. Is protecting the healing ligament beneficial after immobilization in external rotation for an initial shoulder dislocation? Am J Sports Med. 2013;41(5):1126-32. https://doi.org/10.1177/0363546513480620
  41. 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(10):2124-31.
  42. Liu A, Xue X, Chen Y, Bi F, Yan S. The external rotation immobilisation does not reduce recurrence rates or improve quality of life after primary anterior shoulder dislocation: a systematic review and meta-analysis. Injury. 2014;45(12):1842-7. https://doi.org/10.1016/j.injury.2014.06.005
  43. Whelan DB, Kletke SN, Schemitsch G, Chahal J. Immobilization in external rotation versus internal rotation after primary anterior shoulder dislocation: a meta-analysis of randomized controlled trials. Am J Sports Med. 2016;44(2):521-32. https://doi.org/10.1177/0363546515585119
  44. Carpinteiro EP, Barros AA. Natural history of anterior shoulder instability. Open Orthop J. 2017;11:909-18. https://doi.org/10.2174/1874325001711010909
  45. Owens BD, Agel J, Mountcastle SB, Cameron KL, Nelson BJ. Incidence of glenohumeral instability in collegiate athletics. Am J Sports Med. 2009;37(9):1750-4. https://doi.org/10.1177/0363546509334591
  46. Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. Br J Sports Med. 2015;49(14):913-22. https://doi.org/10.1136/bjsports-2014-094342
  47. Levy O, Pritsch M, Rath E. An operative technique for recurrent shoulder dislocations in older patients. J Shoulder Elbow Surg. 1999;8(5):452-7. https://doi.org/10.1016/S1058-2746(99)90075-7
  48. Lee TQ, Dettling J, Sandusky MD, McMahon PJ. Age related biomechanical properties of the glenoid-anterior band of the inferior glenohumeral ligament-humerus complex. Clin Biomech (Bristol, Avon). 1999;14(7):471-6. https://doi.org/10.1016/S0268-0033(99)00007-8
  49. Rowe CR. Prognosis in dislocations of the shoulder. J Bone Joint Surg Am. 1956;38(5):957-77. https://doi.org/10.2106/00004623-195638050-00001
  50. 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(8):1665-74. https://doi.org/10.2106/JBJS.F.00261
  51. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am. 2000;82(1):35-46. https://doi.org/10.2106/00004623-200001000-00005
  52. Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006;88(8):1755-63. https://doi.org/10.2106/JBJS.E.00817
  53. Provencher MT, Bhatia S, Ghodadra NS, et al. Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am. 2010;92 Suppl 2:133-51. https://doi.org/10.2106/JBJS.J.00906
  54. Kaar SG, Fening SD, Jones MH, Colbrunn RW, Miniaci A. Effect of humeral head defect size on glenohumeral stability: a cadaveric study of simulated Hill-Sachs defects. Am J Sports Med. 2010;38(3):594-9. https://doi.org/10.1177/0363546509350295
  55. Chahal J, Leiter J, McKee MD, Whelan DB. Generalized ligamentous laxity as a predisposing factor for primary traumatic anterior shoulder dislocation. J Shoulder Elbow Surg. 2010;19(8):1238-42. https://doi.org/10.1016/j.jse.2010.02.005
  56. Kim DS, Yoon YS, Yi CH. Prevalence comparison of accompanying lesions between primary and recurrent anterior dislocation in the shoulder. Am J Sports Med. 2010;38(10):2071-6. https://doi.org/10.1177/0363546510371607
  57. Ozbaydar M, Elhassan B, Diller D, Massimini D, Higgins LD, Warner JJ. Results of arthroscopic capsulolabral repair: Bankart lesion versus anterior labroligamentous periosteal sleeve avulsion lesion. Arthroscopy. 2008;24(11):1277-83. https://doi.org/10.1016/j.arthro.2008.01.017
  58. Lee BG, Cho NS, Rhee YG. Anterior labroligamentous periosteal sleeve avulsion lesion in arthroscopic capsulolabral repair for anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc. 2011;19(9):1563-9. https://doi.org/10.1007/s00167-011-1531-z
  59. Berendes TD, Pilot P, Nagels J, Vochteloo AJ, Nelissen RG. Survey on the management of acute first-time anterior shoulder dislocation amongst Dutch public hospitals. Arch Orthop Trauma Surg. 2015;135(4):447-54. https://doi.org/10.1007/s00402-015-2156-3
  60. Riccio I, de Sire A, Latte C, Pascarella F, Gimigliano F. Conservative treatment of traumatic shoulder instability: a case series study. Musculoskelet Surg. 2015;99(2):133-7. https://doi.org/10.1007/s12306-015-0373-0
  61. Balke M, Shafizadeh S, Bouillon B, Banerjee M. Management of shoulder instability: the current state of treatment among German orthopaedic surgeons. Arch Orthop Trauma Surg. 2016;136(12):1717-21. https://doi.org/10.1007/s00402-016-2553-2
  62. Bottoni CR, Wilckens JH, DeBerardino TM, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, firsttime shoulder dislocations. Am J Sports Med. 2002;30(4):576-80. https://doi.org/10.1177/03635465020300041801
  63. 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. https://doi.org/10.1186/1471-2474-14-305
  64. Murray IR, Ahmed I, White NJ, Robinson CM. Traumatic anterior shoulder instability in the athlete. Scand J Med Sci Sports. 2013;23(4):387-405. https://doi.org/10.1111/j.1600-0838.2012.01494.x
  65. Bassett RW, Cofield RH. Acute tears of the rotator cuff. The timing of surgical repair. Clin Orthop Relat Res. 1983;(175):18-24.
  66. Porcellini G, Paladini P, Campi F, Paganelli M. Shoulder instability and related rotator cuff tears: arthroscopic findings and treatment in patients aged 40 to 60 years. Arthroscopy. 2006;22(3):270-6. https://doi.org/10.1016/j.arthro.2005.12.015
  67. Simank HG, Dauer G, Schneider S, Loew M. Incidence of rotator cuff tears in shoulder dislocations and results of therapy in older patients. Arch Orthop Trauma Surg. 2006;126(4):235-40. https://doi.org/10.1007/s00402-005-0034-0
  68. Hsu HC, Luo ZP, Cofield RH, An KN. Influence of rotator cuff tearing on glenohumeral stability. J Shoulder Elbow Surg. 1997;6(5):413-22. https://doi.org/10.1016/S1058-2746(97)70047-8
  69. Shubert DJ, Shubert SB. Reverse total shoulder arthroplasty for recurrent shoulder dislocation in an elderly patient: a case report. JBJS Case Connect. 2015;5(1):e2-5. https://doi.org/10.2106/JBJS.CC.N.00070