Surgery May Be First-Line Option for First-Time Anterior Shoulder DislocationAccording to statistics, the shoulder is the most commonly dislocated joint in the human body, possibly because of the wide range of motion the joint provides, reducing the stability that other joints have. The anterior dislocation is the most common type of dislocation, making up almost 96 percent of shoulder dislocations. This is a dislocation that occurs at the front of the joint, rather than the back.
People who are most likely to experience a dislocated shoulders are young men (aged between 21 and 30 years) and older women (aged between 61 and 80 years). Unfortunately, once a shoulder has been dislocated, it is subject to being dislocated again later on, with less force than the original injury. Some statistics say that the chances of a second dislocation is as high as 94 percent.
Traditionally, first time anterior shoulder dislocations are treated conservatively, without surgery. Surgery is usually reserved for people who have heavy physical activities (for first time injuries) or for repeat dislocations. That being said, there does not seem to be any general agreement as to whether surgery would be beneficial after first time injuries for most people. The authors of this article wanted to determine clinical recommendations regarding how first-time anterior dislocations would be best treated and if there could be an optimal treatment protocol.
Researchers reviewed the medical literature for studies that were randomized controlled trials comparing operative with conservative treatment for primary anterior should dislocation. After excluding studies that were not appropriate, the researchers gathered six articles that described five randomized controlled trials, with one study being reported twice.
Results of the study found that all patients, except one, in two groups in the Kirkley trial were able to return to their pre-injury sports and/or activity levels. In two other studies, the Bottoni study and the Robinson trial saw both operative and conservatively treated patient return in equal numbers. However, one study, done by Wintzell, found that patients who had undergone surgery had only a 73.1 percent average rate of returning to previous levels of activity, while conservatively treated patients had a 65.2 percent rate.
The rates of repeat dislocations, an important aspect of the study, were lower in those who had undergone surgery Two studies found that when the shoulder did redislocate in the operated group, the length of time between treatment and repeat injury was longer than that of the length of time between conservative treatment and re-injury. This finding, however, was not consistent across all studies.
Upon reviewing the results of the published studies, the authors determined that there was not enough information to definitively recommend that surgery should be done on most first-time anterior shoulder dislocations. However, there was enough evidence to support surgery as a first-choice treatment if the patient has a heavily physical occupation or participates in sports activities.
Jonathan Godin, BA, and Jon K. Sekiya, MD. Systematic Review of Rehabilitation Versus Operative Stabilization for the TReatment of First-Time Anterior Shoulder Dislocations. In Sports Health. March/April 2010. Vol. 2. No. 2. Pp. 156-165.
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