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Twenty-five Year Natural History of Shoulder Dislocation Treated Without Surgery

A group of orthopedic surgeons from Sweden started a study 25 years ago. They wanted to assess the results of nonoperative treatment for anterior shoulder dislocations. The patients in their study were all 40 years old or younger.

Most (80 per cent) were men. They all had their first anterior shoulder dislocation in 1978 or 1979. More than half were involved in a sports activity when the dislocation occurred.

Patients were divided into two nonoperative groups. The first group was immobilized with a bandage that held the arm against the front of the body. They kept the arm still in that position for at least three to four weeks.

The second group was placed in a sling that could be removed whenever they were comfortable enough to do so. Some of the patients in this group wore the sling a few days. Others wore it a week, two weeks, or three weeks.

Everyone in both groups was assessed after the shoulder dislocation using X-rays, an interview with the doctor, and a physical exam. The patients filled out a questionnaire that was used to measure their shoulder function. Level of athletic activity was also recorded. Follow-up occurred at two, five, ten, and 25 years.

The authors report that immobilization treatment was not linked with recurrent shoulder dislocations. Patients between the ages of 12 and 22 years were more likely to develop a second shoulder dislocation. The reason for this was not clear. There was no significant difference based on gender or activity levels.

According to the results of this study, immobilizing (or not immobilizing) a dislocated shoulder doesn't change the final outcome. There were no differences between the two treatment groups over time. First-time dislocations can be treated nonoperatively. Most stabilize on their own without surgical intervention.

References: Lennart Hovelius, MD, PhD, et al. Nonoperative Treatment of Primary Anterior Shoulder Dislocation in Patients Forty Years of Age and Younger. In The Journal of Bone and Joint Surgery. May 2008. Vol. 90-A. No. 5. Pp. 945-952.

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