Treatment Following a First-Time Anterior Shoulder Dislocation: What Does the Evidence Tell Us?

Shoulder dislocations are an incredibly common orthopaedic injury. Although these injuries can affect patients of almost any age, those between 15 and 20 years of age have been identified as a population at risk. Aside from young age, male sex and participation in contact and overhead sports have also been identified as additional risk factors for these injuries. Despite the frequency with which shoulder dislocations occur, there is controversy regarding the optimal treatment algorithm following a first-time shoulder dislocation. Historically, patients were almost always treated with short-term immobilization followed by supervised physiotherapy and a gradual return to activity. More recent literature, however, suggests that many patients who undergo nonsurgical treatment following a first-time dislocation not only experience unacceptably high rates of recurrent instability but also have increased structural pathology resulting in more open and bony procedures than early surgical stabilization. However, there remains a subset of patients treated nonsurgically following a first-time dislocation who never experience recurrent instability and can return to sports or military service and other high shoulder-demand activities. It is important to provide a comprehensive framework for evaluating and treating the patient who sustains a first-time anterior shoulder dislocation. Special emphasis will be placed on the clinical evaluation of these individuals and an overview of the various treatment options available.