Management of traumatic anterior shoulder dislocation in the 17- to 25-year age group: a dramatic evolution of practice

Abstract

Background: Anterior shoulder dislocation in the young patient is a common problem, yet there is no universal agreement on its management.

Methods: In this study, we comprehensively surveyed all members of the British Elbow and Shoulder Society (BESS) to ascertain their preferred methods of treating young patients with traumatic, anterior shoulder dislocation. We then repeated exactly the same survey 7 years later to find out whether practices had changed and if any consensus of opinion had been reached.

Results: The number of surgeons indicating their preferred stabilization procedure was arthroscopic more than quadrupled from only 16% in 2002 to 71% in 2009, while the numbers of those preferring an open technique fell in a correspondingly dramatic manner. The numbers who now potentially offer stabilization surgery to first-time dislocators virtually doubled from 35% to 68%. There was also a big rise in the use of magnetic resonance imaging (MRI) arthrograms as an investigation prior to surgery and in the use of bio-absorbable anchors during surgical stabilization. There remain, however, aspects of treatment and rehabilitation where little consensus exists.

Conclusion: Rarely in the history of orthopaedic surgery has such a dramatic and widespread change in operative technique occurred in such a short space of time. Rarer still has such a change been prospectively documented.