- 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.