Early Surgical Stabilization of the Shoulder is recommended before Multiple Anterior Dislocations
ESSKA Academy. Yoshida M. May 11, 2018; 218033; FP22-1642
Masahito Yoshida
Masahito Yoshida
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Objectives: In a young population, the recurrence following an acute traumatic anterior shoulder dislocation has been reported following conservative treatment. Some surgeons recommend non-operative management following a first time shoulder dislocation. In addition, some patients fail to seek medical treatment following a first episode and do so after multiple dislocations. In these patients, the best chance for optimal surgical treatment may have been missed before an increased propensity for recurrent instability. The purpose of this study is to assess the kinematics of the glenohumeral joint following multiple anterior dislocations in order to quantify joint stability, and to evaluate the relationship between the number of dislocations and the propensity for recurrence.

Methods: Eight fresh-frozen cadaveric shoulders (age range 48 to 66 years) were dissected free of all soft tissue except the glenohumeral capsule. Each joint was mounted in a robotic testing system. To evaluate the function of the intact capsule, a simulated apprehension test was performed at 60 degrees of glenohumeral abduction and 60 degrees of external rotation. At this position, a 50 N anterior load was applied to the humerus, and the resulting joint kinematics were recorded. Each joint was then dislocated at 60 degrees of abduction and 60 degrees of external rotation by applying an anterior load to the humerus. The humerus was allowed to move until the anterior translation reached one half the maximum anterior-posterior width of the glenoid plus 10 mm. To evaluate the effect of the dislocation, a 50 N anterior load was applied to the shoulder and the resulting kinematics were recorded following 1, 2, 3, 4, 5 and 10 dislocations. To assess the propensity for recurrence of the dislocation, the anterior load required to achieve the dislocation was measured. A repeated-measures analysis of variance (ANOVA) was used to compare the kinematics and force required for dislocation following each dislocation. Statistical significance was set at p<0.05.

Results: The anterior force required for dislocation was significantly decreased between the intact shoulder and all subsequent dislocations (p<0.05). In addition, the anterior force required for dislocation was significantly decreased following the 4th dislocation compared to the 2nd dislocation. Anterior translation in response to an anterior load was statistically increased between the intact shoulder and all subsequent dislocations (p<0.05). Anterior translation was also significantly increased following the 3rd, 4th and 10th dislocations compared to after the 1st dislocation. (p<0.05)

Conclusions: The propensity for recurrent shoulder dislocation is significantly increased following a 1st dislocation. Additionally, the 2nd and 3rd dislocations are also important thresholds regarding further loss of anterior stability. Thus, early surgical stabilization following the first dislocation may be necessary to prevent a significant loss of anterior stability.

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