Journal of Clinical Orthopaedics | Vol 7 | Issue 1 | Jan-Jun 2022 | page: 47-52 | Abhay Narvekar, Nikhil Iyer, Nagraj Shetty, Shreya Joshi
Author: Abhay Narvekar , Nikhil Iyer , Nagraj Shetty , Shreya Joshi 
 Department of Orthopaedic and Arthroscopy surgeon, P D Hinduja National Hospital and Research Center, Mahim 400016, Global Hospital, Parel, Mumbai 400012, India
 Department of Orthopaedic and Arthroscopic Surgeon, Zen Multi-speciality Hospital, Chembur, Global Hospital, Parel, Reliance Hospital, Navi. Mumbai, India
 Department of Arthroscopy, Complex Knee and Shoulder Surgeon, Lilavati Hospital and Medical Research Centre, P D Hinduja, Khar, Max Nanavati Super-Speciality
hospital, Mumbai, India
 Department Orthopaedic and Arthroscopic Surgeon, Shushrusha Citizens Co-operative Hospital, Dadar, LifeCare Hospital, Sion, Mumbai, India
Address of Correspondence
Dr. Nikhil Iyer,
Consultant Orthopaedic and Arthroscopic Surgeon, Director ArthroSports Medical Service LLP.
OrthoCare Clinic, 603 Centerpoint, Opp. State Bank of India, Near Ambedkar garden, Chembur, Mumbai 400071, India.
Background: Instability following a traumatic shoulder dislocation is known to cause significant morbidity especially as ost-traumatic dislocations occur in young active patients. The management of this injury is still controversial. There is always a debate between those that recommend surgical stabilization following a 1st time dislocation (FTD) and those that prefer treating them conservatively. The aim of treatment following a dislocation is to manage the episode such that there is no threat of recurrence, there is a full functional recovery with no apprehension, and an ability to get back to the same level of sporting activity.
Purpose: The purpose of the study is to review the current literature and provide recommendations regarding management following FTD.
Design: Clinical overview, Perspective.
Methods: Review of literature using PUBMED, MEDLINE.
Results: The present thought process is towards Arthroscopic primary stabilization following 1st time post-traumatic dislocation in young active individuals with projected significant overhead activities.
Conclusion: Management of a patient following a FTD/subluxation has been the subject of debate for a long time. A number of factors have been studied and published such as age, sports participation, sex, pathological findings after the dislocation to enable the surgeon to decide on the management of this condition. Recurrence comes at a cost of increasing the instability with every episode of dislocation. More the instability before the surgical stabilization, more are the chances of either failure or the requirement of a salvage procedure like a Latarjet with its inherent high complication rate. But not every patient with FTD should warrant a surgical stabilization. A personalized approach is recommended and not a one size fits all approach.
Keywords: First time dislocator, microinstability, Bankart lesion, Latarjet
- Imhoff AB, Beitzel K, Voss A. Overview of the spectrum of instability in the very young: Evolving concepts. In: Shoulder Instability Across the Life Span. Berlin, Germany: Springer Science+Business Media; 2017. p. 3-5. Available from: https://www.link.springer.com/chapter/10.1007/978-3-662-54077-0_1 [Last accessed on 2022 Feb 07].
- Wheeler JH, Ryan JB, Arciero RA, Molinari RN. Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes. Arthroscopy 1989;5:213-7.
- 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.
- Norlin R. Intraarticular pathology in acute, first-time anterior shoulder dislocation: An arthroscopic study. Arthroscopy 1993;9:546-9.
- Carrazzone OL, Tamaoki MJ, Ambra LF, Neto NA, Matsumoto MH, Belloti JC. Prevalence of lesions associated with traumatic recurrent shoulder dislocation. Rev Bras Ortop 2011;46:281.
- Provencher MT, Frank RF, Gross DJ, Golijanin P. Normal and Pathological Anatomy of the Shoulder. Berlin, Germany: Springer Science+Business Media; 2015. p. 35-45. Available from: https://www.link.springer.com/chapter/10.1007/978-3-662-45719-1- [Last accessed on 2022 Feb 07].
- Seung-Ho K. Pathoanatomy of glenohumeral instability. In: Bain GI, Itoi E, Di Giacomo G, Sugaya H. editors. Normal and Pathological Anatomy of the Shoulder. Berlin, Heidelberg: Springer Berlin Heidelberg; 2015. p. 115-22.
- Pollock RG, Wang VM, Bucchieri JS, Cohen NP, Huang CY, Pawluk RJ, et al. Effects of repetitive subfailure strains on the mechanical behavior of the inferior glenohumeral ligament. J Shoulder Elbow Surg 2000;9:427-35.
- Urayama M, Itoi E, Sashi R, Minagawa H, Sato K. Capsular elongation in shoulders with recurrent anterior dislocation. Quantitative assessment with magnetic resonance arthrography. Am J Sports Med 2003;31:64-7.
- Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 2007;23:985-90.
- Thomas SC, Matsen FA. An approach to the repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability. J Bone Joint Surg Am 1989;71:506-13.
- O’Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 1990;18:449-56.
- McLaughlin HL, Maclellan DI. Recurrent anterior dislocation of the shoulder. II. A comparative study. J Trauma 1967;7:191-201.
- 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;88:2326-36.
- Bain G, Phadnis J, Itoi E, Di Giacomo G, Sugaya H, Sonnabend DH, et al. Shoulder crane: A concept of suspension, stability, control and motion. J ISAKOS 2019;4:63-70.
- Buss DD, Lynch GP, Meyer CP, Huber SM, Freehill MQ. Nonoperative management for in-season athletes with anterior shoulder instability. Am J Sports Med 2004;32:1430-3.
- Marans HJ, Angel KR, Schemitsch EH, Wedge JH. The fate of traumatic anterior dislocation of the shoulder in children. J Bone Joint Surg Am 1992;74:1242-4.
- Hovelius L, Olofsson A, Sandström B, Augustini BG, Krantz L, Fredin H, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. Aprospective twenty-five-year follow-up. J Bone Joint Surg Am 2008;90:945-52.
- Hovelius L, Eriksson K, Fredin H, Hagberg G, Hussenius A, Lind B, et al. Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment. J Bone Joint Surg Am 1983;65:343-9.
- Liavaag S, Brox JI, Pripp AH, Enger M, Soldal LA, Svenningsen S. Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence: A randomized controlled trial. J Bone Joint Surg Am 2011;93:897-904.
- Burkhart SS. Editorial commentary: Off-track hill-sachs lesions in adolescents with multiple anterior dislocations: The case for stabilizing adolescent first-time dislocators. Arthroscopy 2017;33:1762-3.
- Vaswani R, Gasbarro G, Como C, Golan E, Fourman M, Wilmot A, et al. Labral morphology and number of preoperative dislocations are associated with recurrent instability after arthroscopic Bankart repair. Arthroscopy 2020;36:993-9.
- Duethman NC, Bernard CD, Leland D, Wilbur RR, Krych AJ, Dahm DL, et al. Multiple instability events at initial presentation are the major predictor of failure of nonoperative treatment for anterior shoulder instability. Arthroscopy 2021;37:2432-9.
- Shin SJ, Ko YW, Lee J. Intra-articular lesions and their relation to arthroscopic stabilization failure in young patients with first-time and recurrent shoulder dislocations. J Shoulder Elbow Surg 2016;25:1756-63.
- Chahal J, Marks PH, MacDonald PB, Shah PS, Theodoropoulos J, Ravi B, et al. Anatomic Bankart repair compared with nonoperative treatment and/or arthroscopic lavage for first-time traumatic shoulder dislocation. Arthroscopy 2012;28:565-75.
- Jacobson ME, Riggenbach M, Wooldridge AN, Bishop JY. Open capsular shift and arthroscopic capsular plication for treatment of multidirectional instability. Arthroscopy 2012;28:1010-7.
- Hurley ET, Manjunath AK, Bloom DA, Pauzenberger L, Mullett H, Alaia MJ, et al. Arthroscopic bankart repair versus conservative management for first-time traumatic anterior shoulder instability: A systematic review and meta-analysis. Arthroscopy 2020;36:2526-32.
- Brophy R, Marx R. The Treatment of traumatic anterior instability of the shoulder: Nonoperative and surgical treatment. Arthroscopy 2008;25:298-304.
- Handoll HH, Almaiyah MA, Rangan A. Surgical versus non-surgical treatment for acute anterior shoulder dislocation. Cochrane Database Syst Rev 2004;2004:CD004325.
- Porcellini G, Campi F, Pegreffi F, Castagna A, Paladini P. Predisposing factors for recurrent shoulder dislocation after arthroscopic treatment. J Bone Joint Surg 2009;91:2537-42.
- Provencher CM, Midtgaard KS. Editorial commentary: Evidence to support surgical intervention for first-time shoulder instability: Stabilize them early! Arthroscopy 2020;36:2533-6.
- Mather RC, Orlando LA, Henderson RA, Lawrence JTR, Taylor DC. A predictive model of shoulder instability after a first-time anterior shoulder dislocation. J Shoul Elbow Surg 2011;20:259-66.
- Jakobsen B, Johannsen H, Suder P, Søjbjerg J. 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.
- Bottoni C, Wilckens J, De Berardino T, D’Alleyrand J, Rooney R, Harpstrite J, 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.
- Sheth U. Editorial commentary: Management of first-time anterior shoulder instability requires risk stratification and surgery for many, but not all. Arthroscopy 2021;37:2440-3.
|How to Cite this article: Narvekar A, Iyer N, Shetty N, Joshi S. A Clinical Overview of Management of First Time Anterior Shoulder Dislocation. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):47-52.|