Shoulder stabilization versus immobilization for first-time anterior shoulder dislocation: A systematic review and meta-analysis of level 1 randomized controlled trials.
Belk JW, Wharton BR, Houck DA, Bravman JT, Kraeutler MJ, Mayer B, Noonan TJ, Seidi AJ, Frank RM, McCarty EC. Am J Sport Med. doi: 10.1177/03635465211065403
Recurrent instability after a shoulder dislocation is common, so surgical stabilization is recommended for young, active patients.
Anterior shoulder dislocations are among the most common shoulder injuries in athletes, and effective treatment is essential to decreasing the risk of recurrent dislocations. Historically, nonoperative immobilization has been the primary treatment for first-time dislocations. However, surgical stabilization is immerging as a more reliable method to reduce recurrent instability episodes and improve patient outcomes. We need to compare patient outcomes to determine the optimal treatment approach for different patient populations.
Belk and colleagues conducted a systematic review and meta-analysis of randomized-controlled trials that compared patient outcomes after nonoperative immobilization or surgical stabilization of first-time anterior shoulder dislocation.
After an initial search of three databases, the authors identified 1,957 studies. After removing duplicates and applying inclusion/exclusion criteria, only five studies remained eligible for systematic review and meta-analysis. Researchers manually reviewed each article to compare outcomes of range of motion, rates of recurrent instability, rates of subsequent surgery, and Western Ontario Shoulder Instability Index scores.
The participants were ~24 years old in the operative group (87% male) and ~23 years old in the nonoperative group (89% male). Participants who underwent surgical stabilization were less likely to experience recurrent instability episodes, had lower rates of subsequent surgery, and had better shoulder function (Western Ontario Shoulder Instability Index scores). Range of motion was not different between the two treatment approaches.
Risk factors for anterior shoulder dislocation include male sex, active lifestyle, and adolescent and young adult age groups. Based on this systematic review and meta-analysis, patients at high risk for recurrent dislocation would likely have improved shoulder function following operative treatment. However, more research is needed to determine the optimal treatment recommendation for patients at low risk of recurrent dislocation.
Surgical stabilization is the preferred treatment approach after an anterior shoulder dislocation to prevent recurrent instability. However, clinicians and patients should consider patient-specific implications before deciding on surgery.
Questions for Discussion
Does your clinical experience match these patient outcomes for surgical versus conservative treatment of shoulder dislocations? What factors would you consider when deciding whether to recommend surgical treatment?
Immobilization vs. Surgery – Is it Worth Going Under the Knife?
Decision Making in Treatment after a First Time Anterior Glenohumeral Dislocation-A Delphi Approach by the Neer Circle of the American Shoulder and Elbow Surgeons
Written by: Rebecca Rodriguez
Reviewed by: Steve Thomas