Hovelius, J Bone Joint Surg Am 2008 - Nonoperative Treatment of Primary Anterior Shoulder Dislocation in Patients Forty Years of Age and Younger. A Prospective Twenty-Five-Year Follow-Up - Article Summary

Nonoperative Treatment of Primary Anterior Shoulder Dislocation in Patients Forty Years of Age and Younger. A Prospective Twenty-Five-Year Follow-Up

Hovelius, Sennerby, et al.·J Bone Joint Surg Am·2008·415 citations·Prospective cohort

Background

During 1978 and 1979, we initiated a prospective multicenter study to evaluate the results of nonoperative treatment of primary anterior shoulder dislocation. In the current report, we present the outcome after 25 years.

Methods

255 patients (257 shoulders) with an age of 12 to 40 years who had a primary anterior shoulder dislocation were managed with immobilization (achieved by tying the arm to the torso with use of a bandage) or without immobilization. All 227 living patients (229 shoulders) completed the follow-up questionnaire, and 214 patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Results

99 (43%) of 229 shoulders had not redislocated, and 17 (7%) redislocated once.
33 recurrent dislocations had become stable over time (14.4%), and 18 were considered to be still recurrent (7.9%).
62 shoulders (27%) had undergone surgery for the treatment of recurrent instability.
Immobilization after the primary dislocation did not change the prognosis.
Only 2 of 24 shoulders with a fracture of the greater tuberosity at the time of the primary dislocation redislocated (p < 0.001).
When shoulders with a fracture of the greater tuberosity were excluded, 44 (38%) of 115 shoulders in patients who had been 12 to 25 years of age at the time of the original dislocation and 16 (18%) of 90 shoulders in patients who had been 26 to 40 years of age had undergone surgical stabilization.
At 25 years, 14 (23%) of 62 shoulders that had undergone surgical stabilization were in patients who subsequently had a contralateral dislocation, compared with 7 (7%) of 99 shoulders in patients in whom the index dislocation had been classified as solitary (p = 0.01).
Gender and athletic activity did not appear to affect the redislocation rate; however, women had worse DASH scores than men did (p = 0.006).

Conclusions

After 25 years, half of the primary anterior shoulder dislocations that had been treated nonoperatively in patients with an age of 12 to 25 years had not recurred or had become stable over time.

Level of evidence: Prognostic Level I. Copyright remains with the authors and publisher.

Core

Nonoperative Treatment of Primary Anterior Shoulder Dislocation in Patients Forty Years of Age and Younger. A Prospective Twenty-Five-Year Follow-Up.

Hovelius, Sennerby, et al.J Bone Joint Surg Am2008415 citationsProspective cohort