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.
Tokish JM, Kuhn JE, Ayers GD, Arciero RA, Burks RT, Dines DM, Duralde XA, ElAttrache NS, Millett PJ, St Pierre P, Provencher MT, Tibone JE, Ticker JB, Cordasco FA. J Shoulder Elbow Surg. 2020 Aug 25:S1058-2746(20)30684-4. doi: 10.1016/j.jse.2020.08.011. Epub ahead of print. PMID: 32858192.
The authors report areas of consensus among experts regarding the treatment of a patient with a first-time anterior glenohumeral dislocation. The expert panel considered athletes, including tactical athletes (i.e., active duty military), and nonathletes. The group reached consensus on recommending surgery in only 8 of 162 clinical scenarios. Factors that sometimes influenced the expert panel of surgeons to recommend surgery were the presence of meaningful bone loss and the end of a sports season, the presence of apprehension on exam, and age between 14 to 30 years. The group agreed on recommending nonoperative treatment in 22 of the clinical scenarios, especially when a person was a nonathlete lacking apprehension on exam and had no meaningful bone loss.