This 10-year prospective multicenter study followed 247 primary anterior shoulder dislocations in patients aged 12–40 across 27 Swedish hospitals. It asked two questions: does immobilization type affect recurrence, and what are the long-term outcomes stratified by age and radiographic findings? It is the foundational natural history dataset for first-time anterior shoulder dislocation.
For decades, surgeons immobilized first-time dislocators for 3–6 weeks believing it reduced recurrence. This paper definitively refuted that: immobilization duration changed nothing, and age at dislocation was the only factor that consistently predicted who would need surgery.
When a 19-year-old presents with a first-time anterior dislocation, counsel them that roughly 1 in 3 patients their age will eventually need surgical stabilization — and that wearing a sling for an extra 3 weeks will not change that trajectory. A Hill-Sachs lesion on the initial film pushes that risk higher still.
When the patient is 35, the calculus shifts: only 1 in 11 will need surgery, spontaneous stabilization is plausible, and watchful waiting is well supported.
One underappreciated finding: 20% of shoulders developed radiographic arthropathy at 10 years regardless of recurrence history, suggesting the index dislocation event itself initiates articular damage. A point worth raising in long-term counseling.
This 10-year prospective multicenter study followed 247 primary anterior shoulder dislocations in patients aged 12–40 across 27 Swedish hospitals. It asked two questions: does immobilization type affect recurrence, and what are the long-term outcomes stratified by age and radiographic findings? It is the foundational natural history dataset for first-time anterior shoulder dislocation.
For decades, surgeons immobilized first-time dislocators for 3–6 weeks believing it reduced recurrence. This paper definitively refuted that: immobilization duration changed nothing, and age at dislocation was the only factor that consistently predicted who would need surgery.
When a 19-year-old presents with a first-time anterior dislocation, counsel them that roughly 1 in 3 patients their age will eventually need surgical stabilization — and that wearing a sling for an extra 3 weeks will not change that trajectory. A Hill-Sachs lesion on the initial film pushes that risk higher still.
When the patient is 35, the calculus shifts: only 1 in 11 will need surgery, spontaneous stabilization is plausible, and watchful waiting is well supported.
One underappreciated finding: 20% of shoulders developed radiographic arthropathy at 10 years regardless of recurrence history, suggesting the index dislocation event itself initiates articular damage. A point worth raising in long-term counseling.