Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis

Br J Sports Med. 2018 Dec;52(23):1498-1506. doi: 10.1136/bjsports-2017-098539. Epub 2018 Jun 23.


Objective: To review and compare treatments (1) after primary traumatic shoulder dislocation aimed at minimising the risk of chronic shoulder instability and (2) for chronic post-traumatic shoulder instability.

Design: Intervention systematic review with random effects network meta-analysis and direct comparison meta-analyses.

Data sources: Electronic databases (Ovid MEDLINE, Cochrane Clinical Trials Register, Cochrane Database of Systematic Reviews, Embase, Scopus, CINAHL, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, DARE, HTA, NHSEED, Web of Science) and reference lists were searched from inception to 15 January 2018.

Eligibility criteria for selecting studies: Randomised trials comparing any interventions either after a first-time, traumatic shoulder dislocation or chronic post-traumatic shoulder instability, with a shoulder instability, function or quality of life outcome.

Results: Twenty-two randomised controlled trials were included. There was moderate quality evidence suggesting that labrum repair reduced the risk of future shoulder dislocation (relative risk 0.15; 95% CI 0.03 to 0.8, p=0.026), and that with non-surgical management 47% of patients did not experience shoulder redislocation. Very low to low-quality evidence suggested no benefit of immobilisation in external rotation versus internal rotation. There was low-quality evidence that an open procedure was superior to arthroscopic surgery for preventing shoulder redislocations.

Conclusions: There was moderate-quality evidence that half of the patients managed with physiotherapy after a first-time traumatic shoulder dislocation did not experience recurrent shoulder dislocations. If chronic instability develops, surgery could be considered. There was no evidence regarding the effectiveness of surgical management for post-traumatic chronic shoulder instability.

Keywords: meta-analysis; shoulder.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Humans
  • Joint Instability / prevention & control*
  • Joint Instability / therapy*
  • Network Meta-Analysis
  • Randomized Controlled Trials as Topic
  • Shoulder Dislocation / surgery*