What are the residuals from a prior shoulder dislocation (shoulder luxation)?

From the Guidelines

Residuals from prior shoulder dislocation should be evaluated with MRI shoulder without IV contrast or MR arthrography when physical examination and history suggest a prior dislocation event, or the presence of instability and radiographs are normal. This approach is supported by the American College of Radiology's appropriateness criteria for shoulder pain-traumatic, which recommends MRI shoulder without IV contrast or MR arthrography in such cases 1. The primary goal of evaluation is to assess labroligamentous injuries, such as Bankart or Hill-Sachs lesions, and guide further management.

Key considerations in the management of residuals from prior shoulder dislocation include:

• Rehabilitation focusing on rotator cuff and scapular stabilizer strengthening to improve dynamic stabilization
• Pain management with NSAIDs, such as ibuprofen or naproxen, for a limited period
• Surgical intervention, including Bankart repair or Latarjet procedure, for persistent instability or significant tissue damage
• Long-term complications, such as chronic instability, early osteoarthritis, and decreased range of motion, which can be mitigated with proper rehabilitation and management.

In terms of imaging, the American College of Radiology's guidelines recommend:

• Radiography of the shoulder as the initial study for traumatic shoulder pain
• MRI of the shoulder without IV contrast for nonlocalized shoulder pain and negative radiographs
• CT without IV contrast for characterizing fracture planes in cases of humeral head or neck fractures, or scapula fractures 1.

Overall, a comprehensive approach to managing residuals from prior shoulder dislocation involves careful evaluation, rehabilitation, and, when necessary, surgical intervention to minimize long-term complications and improve quality of life.

From the Research

Residuals from Prior Shoulder Dislocation

• Residual instability is a common issue after a shoulder dislocation, with a high rate of recurrence, particularly in young, active individuals 2.
• Studies have compared the outcomes of different treatment options, including Bankart repair, Latarjet procedure, and conservative management 3, 4, 5, 6.
• Bankart repair has been shown to reduce the risk of recurrent shoulder instability and subsequent stabilization surgery in both short- and long-term follow-up intervals 3.
• The Latarjet procedure has been found to confer a lower risk of recurrence and redislocation compared to Bankart repair, with better patient-reported outcomes and less restricted external-rotation motion 4, 5.
• Conservative management, including immobilization and rehabilitation, may be effective in reducing the risk of recurrence, but the optimal treatment approach remains controversial 2, 6.
• The choice of treatment should be individualized, taking into account factors such as age, activity level, and the presence of any comorbidities 2.
• Further research is needed to determine the ideal long-term treatment approach for patients with residual instability after a shoulder dislocation 2, 6.

Treatment Options

• Bankart repair: a surgical procedure that involves repairing the labrum and capsule to restore stability to the shoulder joint 3, 4, 5.
• Latarjet procedure: a surgical procedure that involves transferring the coracoid process to the anterior aspect of the glenoid to restore stability to the shoulder joint 4, 5.
• Conservative management: a non-surgical approach that involves immobilization, rehabilitation, and physical therapy to restore stability and function to the shoulder joint 2, 6.

Outcomes

• Recurrent shoulder instability: a common complication after a shoulder dislocation, which can be reduced with surgical treatment such as Bankart repair or Latarjet procedure 3, 4, 5.
• Patient-reported outcomes: measures of patient satisfaction, function, and quality of life, which can be improved with surgical treatment such as Latarjet procedure 4, 5.
• Return to sport: an important outcome for athletes, which can be influenced by the choice of treatment and the presence of any comorbidities 2, 6.