Prognosis in anterior shoulder dislocation

Abstract

All patients treated for a first-time anterior glenohumeral dislocation in Olmsted County, Minnesota, from 1970 through 1979 were identified. Of these 124 patients, 116 were available for study at a mean followup of 4.63 years (range 2 to 11). Of the 116 patients, 38 (33%) had recurrence of dislocation: 21 of the 32 (66%) patients less than 20 years old, 17 of the 43 (40%) patients 20 through 40 years old, and none of the 41 patients older than 40 years. Symptomatic instability remained a problem in 24 patients. Twenty-seven of 33 (82%) young athletes had recurrence of dislocation as compared with only 8 of 27 (30%) nonathletes of similar ages. Patients restricted from resuming sports participation for 6 weeks or more had significantly better results than those restricted for less than 6 weeks. The recurrence rate of dislocation is not as high as previously reported. However, the rate in athletes is much higher than that in nonathletes. Many patients continue to complain of symptomatic instability without actual redislocation. In our younger patients, we now advise immobilization for from 3 to 6 weeks, followed by extensive rehabilitation before return to athletic activity.

Shoulder Instability: Management and Rehabilitation

“…61,87 In one study of 21 patients (age range 4 to 16 years), 100% recurrence rates were reported for immobilization periods that included 0, 4, and 6 weeks in duration. 61 Another study of 116 patients (age range 14 to 96 years) reported an overall redislocation rate of 33% with no difference in recurrence for periods of immobilization between 0 and 6 weeks duration.…”

“…Data from Hovelius et al, 42 Marans et al, 61 McLaughlin et al, 65 Rowe, 84 and Simonet and Cofield. 87 have already dislocated can expect to dislocate again within 2 years of the initial injury. Younger and older subjects have a comparable incidence of primary shoulder dislocation ( Figure 1A).…”

“…Dislocation has been reported to recur in 66% to 100% of people aged 20 years or under, 13% to 63% of people aged between 20 and 40 years, and in 0% to 16% of people aged 40 years or older. 42,61,65,82,87 …”

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.…”

Cost Analysis of Failed Shoulder Stabilization

“…These studies noted a recurrence rate of 66 to 94% in patients younger than 20, and a recurrence rate of 40 to 74% in patients between 20 and 40. 7,15,20,26,35 More recently, Burkhart and DeBeer noted a 67% recurrence rate in patients with significant bone defects com pared to a 4% recurrence rate in patients with nonsigni ficant bone defects. 6 Boileau et al reported a 15.3% recurrent instability rate following arthroscopic Bankart repair.…”