Natural history of glenohumeral dislocation—revisited

Abstract

The purpose of this study was to evaluate the natural history of glenohumeral dislocation in young athletes. A review of the literature revealed a consensus of opinion that the dislocated shoulder should be immobilized from 3-6 weeks. However, a high recurrence rate could be expected. One hundred twenty-one patients with acute traumatic anterior dislocations were evaluated (average age-19 years). Methods of immobilization were shoulder immobilizers and slings and swaths. Sixty-two patients were immobilized and 56 (90%) of these suffered recurrent dislocation. Fifty-nine patients were not immobilized and 50 (85%) re-dislocated their shoulders. The length of immobilization had no effect on the recurrence rate. All re-dislocations occurred within 18 months of the initial injury. Seventy-nine patients were operated on for recurrent dislocation. With such a high recurrence rate in the athletic age group, the authors question if immobilization affects the prognosis.

Anterior instability of the shoulder after trauma

“…[2][3][4] Despite the numerous studies of the natural history after an initial traumatic anterior dislocation, the exact incidence of recurrent instability remains uncertain, 2,4,5 with rates quoted ranging from as low as 17% 6 to close to 100%. 2,[7][8][9][10] Many of the series which describe a high incidence have been drawn from selective populations, such as patients presenting to sports injury clinics and in military cadets, 7,11 and may therefore be unrepresentative of the general population. There may also be a substantial pool of individuals who never seek medical advice, either because they sustain an isolated dislocation, become occasional dislocators, or are relatively asymptomatic and do not want surgical intervention.…”

Recurrent anterior dislocation of the shoulder: Results of Eden-Hybbinette and Putti-Platt operations

“…A review of the earlier literature revealed a consensus of opinion that the primary dislocation of the shoulder should be immobilized from 3 to 6 weeks, but a high recurrence rate could still be expected. In a recent comparative study by Henry & Genung (1982), however, the length of the immobilization had no effect on the recurrence rate, and all the re-dislocations occurred within 18 months of the initial injury. Further, in the report by Cyprien et al (19831, Hovelius et al 1983).…”

Nonoperative rehabilitation for traumatic and atraumatic glenohumeral instability

“…The incidence of recurrent dislocation ranges from 17-96% with a mean of 67% in patient populations between the ages of 21-30 years old. 1,[5][6][7][8][9][10][11][12][13][14][15] Therefore, the rehabilitation program should progress cautiously in young athletic individuals. It should be noted that Hovelius et al 8,16,17 has demonstrated that the rate of recurrent dislocations is based on the patient's age and not affected by the length of post-injury immobilization.…”

“…In athletes involved in collision sports, the recurrence rates have been reported collision sports, the recurrence rates have been reported between 86-94%. 6,[40][41][42] …”