Natural History of Anterior Shoulder Dislocation:

    - natural history:
            - young patient:
                   - when the patient's proximal humeral growth plate is open, there is upto 100% rate of redislocation;
                   - in young adults, the rate of redislocation ranges from 55 to 95%; 
                   - large humeral head defect is an independent risk factor;
                   - in the prospective randomized study by Kirkley A, et al (1999), the authors studied the effectiveness of traditional treatment with immediate arthroscopic stabilization in young patients who have sustained a first traumatic anterior dislocation of the shoulder;
                          - 40 skeletally mature patients younger than 30 years of age were randomly allocated to immobilization for 3 weeks followed by rehabilitation (group T) or arthroscopic stabilization (group S);
                          - at 24 months, there was a statistically significant difference in the rate of redislocation (T = 47%, S = 15.9%, P = .03);
                   - references: 
                          - Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder.
                          - Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment.
                          - Dislocations of the upper extremity in children.
                          - Anterior dislocation of the shoulder in teen-agers and young adults. Five-year prognosis.
                          - Contralateral shoulder instability following anterior repair. An epidemiological investigation.
                          - The fate of traumatic anterior dislocation of the shoulder in children.
                          - A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young: a five-year follow-up study.
                          - The prognosis following acute primary glenohumeral dislocation.
                          - Functional Outcome and Risk of Recurrent Instability After Primary Traumatic Anterior Shoulder Dislocation in Young Patients 
                          - Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. a prospective twenty-five-year follow-up. 
                          - Pathoanatomy of First-Time, Traumatic, Anterior Glenohumeral Subluxation Events 
                          - The Epidemiology, Risk of Recurrence, and Functional Outcome After an Acute Traumatic Posterior Dislocation of the Shoulder
            - older patient:
                   - high incidence of rotator cuff tear 
                   - references:
                          - Treatment of primary anterior shoulder dislocation in patients older than 40 years of age. Conservative versus operative.
                          - Anterior dislocation of the shoulder in the older patient.
                          - Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient.
                          - Recurrent dislocation of the shoulder after age fifty.




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, January 9, 2013 4:16 pm