Background:
Rarely, closed reduction cannot be achieved in patients with acute shoulder
dislocation, necessitating open management. A paucity of literature exists
regarding these cases.
Purpose:
To perform a systematic review on the mechanism, management, and outcome data
of acute irreducible shoulder dislocations.
Study Design:
Systematic review; Level of evidence, 4.
Methods:
A systematic review of the literature was performed using the Cochrane
Database of Systematic Reviews, the Cochrane Central Register of Controlled
Trials, PubMed, and MEDLINE between 2000 and 2020. Inclusion criteria were
as follows: human participants, acute irreducible shoulder dislocation
requiring open management, English language, and publication within the past
20 years. We excluded basic science articles, technique articles, reviews,
editorials, and studies of chronic shoulder dislocations or dislocations
with ipsilateral humeral shaft fractures.
Results:
Twelve articles fit the inclusion criteria and were considered for review.
All studies were single case reports (level 4 evidence). Ten of the 12
studies were of male patients. The direction of dislocation included 7
anterior/anteroinferior, 2 posterior, 1 inferior, 1 bilateral inferior, and
1 superolateral. Most dislocations were irreducible owing to a mechanical
block to reduction. The most common type of block was an incarcerated long
head of the biceps tendon, followed by interposition of 1 of the rotator
cuff tendons. The axillary and musculocutaneous nerves, displaced fracture
fragments, and Hill-Sachs and bony Bankart lesions were other causes of
blocks to reduction. Eleven patients were treated with open surgery, while 1
patient was treated arthroscopically. Procedures performed were dependent on
concurrent pathology. Final follow-up ranged from 6 weeks to 2 years, with
no repeat dislocation episodes reported. Complications after open reduction
included 1 case of brachial plexopathy (posterior cord) and 1 case of
musculocutaneous nerve palsy.
Conclusion:
There is a paucity of literature on the management of irreducible acute
shoulder dislocations. The most common irreducible dislocation found in this
systematic review was anterior with a mechanical block attributed to
interposition of the long head of the biceps tendon. When patients were
treated with an open or arthroscopic procedure, recurrence was low, with
none reporting recurrent dislocation in limited follow-up.
