This narrative review outlines the evaluation and management of chronic glenohumeral dislocations, defined as dislocations not recognized at the time of injury. It builds a treatment algorithm around two variables: the size of the humeral head impression fracture and the duration of dislocation. It covers both anterior and posterior dislocations, from nonsurgical care to arthroplasty.
The single most testable and clinically actionable point is that a chronic dislocation is a missed diagnosis, and the axillary view is your protection against it. When an elderly patient, a seizure patient, or a polytrauma patient has a stiff shoulder with fixed loss of external rotation, get a full trauma series including the axillary view before you label it a frozen shoulder.
Once the diagnosis is made, two numbers organize your thinking: defect size and time. Under 20% articular involvement you can often stabilize with soft tissue; 20 to 40% calls for head-preserving reconstruction; over 40% or a degenerated head pushes toward arthroplasty.
Remember that closed reduction is only reasonable within roughly 4 weeks, and a head locked on the glenoid is a hard contraindication. The evidence base here is level III to V, so these thresholds are expert-derived guidelines rather than proven cutoffs.
This narrative review outlines the evaluation and management of chronic glenohumeral dislocations, defined as dislocations not recognized at the time of injury. It builds a treatment algorithm around two variables: the size of the humeral head impression fracture and the duration of dislocation. It covers both anterior and posterior dislocations, from nonsurgical care to arthroplasty.
The single most testable and clinically actionable point is that a chronic dislocation is a missed diagnosis, and the axillary view is your protection against it. When an elderly patient, a seizure patient, or a polytrauma patient has a stiff shoulder with fixed loss of external rotation, get a full trauma series including the axillary view before you label it a frozen shoulder.
Once the diagnosis is made, two numbers organize your thinking: defect size and time. Under 20% articular involvement you can often stabilize with soft tissue; 20 to 40% calls for head-preserving reconstruction; over 40% or a degenerated head pushes toward arthroplasty.
Remember that closed reduction is only reasonable within roughly 4 weeks, and a head locked on the glenoid is a hard contraindication. The evidence base here is level III to V, so these thresholds are expert-derived guidelines rather than proven cutoffs.