What is the recommended treatment for recurrent left shoulder dislocation (recurrent anterior shoulder dislocation)?

From the Guidelines

For recurrent left shoulder dislocations, surgical intervention, specifically arthroscopic Bankart repair or the Latarjet procedure, is the recommended treatment to restore stability and prevent further dislocations, particularly in younger, active patients. This recommendation is based on the high recurrence rate of shoulder dislocations in this population, with studies suggesting that non-surgical management alone can result in recurrence rates of over 90% 53. The Latarjet procedure, which involves transferring bone to reinforce the shoulder socket, may be particularly beneficial for patients with significant glenoid bone loss, a common finding in up to 10% of patients with recurrent shoulder instability 1.

Key considerations in the treatment of recurrent left shoulder dislocations include:

• The direction of dislocation, with anterior dislocation being the most common 1
• The age of the patient, with younger patients more likely to have labroligamentous injury and persistent instability, and older patients more likely to have rotator cuff tears 1
• The presence of coexisting humeral avulsion of the glenohumeral ligament and significant glenoid bone loss, which can underscore the need for bone grafting to restore stability 1
• The importance of assessing both osseous and labroligamentous pathology in patients with shoulder dislocation or instability 1

In terms of post-surgical rehabilitation, patients typically wear a sling for 4-6 weeks followed by gradual rehabilitation for 4-6 months. It is essential for patients to avoid high-risk positions (arm abducted and externally rotated) during recovery and may need to modify certain activities permanently depending on their specific situation and treatment outcome. Glenoid morphology and bone loss can play a significant factor in recurrent shoulder dislocations, and surgical intervention can help address these underlying issues 1.

From the Research

Treatment Options for Recurrent Left Shoulder Dislocation

• Surgical intervention is often recommended for patients with recurrent shoulder dislocation, especially amongst younger, active patient populations 2.
• Bankart repair surgery has been shown to result in a large reduction in the risk of recurrent shoulder instability and subsequent stabilization surgery in both short- and long-term follow-up intervals 3.
• The optimal treatment of shoulder instability depends on the degree of instability and concomitant pathology involving the labrum, capsule, and bony anatomy of the glenoid and humeral head 2.

Comparison of Surgical and Conservative Management

• Bankart repair surgery has been compared to conservative management in several studies, with results showing that surgery lowers recurrent instability in the short and long term 3.
• However, surgical intervention failed to significantly improve the rate of return to sport when compared with conservative management 3.
• The financial burden associated with multiple shoulder dislocations and the potential cost savings of surgical stabilization have also been studied, with results suggesting that surgery can result in cost savings if it prevents 2-3 future shoulder dislocations resulting in ED visits 4.

Conservative Management

• Conservative management following closed reduction of traumatic anterior dislocation of the shoulder typically involves immobilization of the injured arm in a sling or brace for a few weeks, followed by exercises 5.
• The evidence for conservative management is limited, and the optimal immobilization duration, precise indications for immobilization, and optimal rehabilitation interventions are still unclear 5.
• Immobilization in external rotation has been compared to immobilization in internal rotation, but the evidence is insufficient to draw firm conclusions about whether one method is superior to the other 5.