Zwichnięcie stawu ramiennego – Rokowania, prognozy i postęp choroby

Zwichnięcie stawu ramiennego
Rokowania, prognozy i postęp choroby

Zwichnięcie stawu ramiennego, zwłaszcza przednie, jest częstym urazem o zróżnicowanym rokowaniu zależnym od wielu czynników. Najistotniejszym prognostycznie jest wiek pacjenta – u osób w wieku 16-25 lat wskaźnik nawrotowości wynosi około 90%, podczas gdy u pacjentów ≥40 lat spada do 10-15%. Inne czynniki ryzyka to płeć męska, obecność uszkodzenia Bankarta, dominująca strona urazu, aktywność sportowa, hipermobilność stawów oraz wcześniejsze niestabilności barku. Modele matematyczne pozwalają oszacować ryzyko nawrotu w ciągu 12 miesięcy, uwzględniając m.in. wiek, uszkodzenie Bankarta, unieruchomienie oraz wskaźniki SPADI i TSK-11. Długoterminowo (25 lat) około 29% barków z dwoma nawrotami stabilizuje się, ale dwie trzecie pacjentów rozwija artropatię. Najwięcej nawrotów występuje w ciągu pierwszych 2 lat po urazie, a najczęstszą komplikacją jest właśnie nawrotowość spowodowana uszkodzeniem torebki stawowej i więzadeł.

Prognoza po zwichnięciu stawu ramiennego

Czynniki ryzyka nawrotowości zwichnięcia
Modele predykcyjne ryzyka nawrotu
Długoterminowe rokowanie
Komplikacje po zwichnięciu stawu ramiennego
Leczenie zachowawcze a rokowanie
Leczenie operacyjne a rokowanie
Powrót do aktywności
Diagnostyka i przewidywanie powikłań
Wskazania do edukacji pacjentów
Kolejne rozdziały

Prognoza po zwichnięciu stawu ramiennego

Zwichnięcie stawu ramiennego (w szczególności przednie zwichnięcie barku) stanowi jeden z częstszych urazów w obrębie tego stawu. Rokowanie po pierwszym zwichnięciu zależy od wielu czynników, zarówno fizycznych jak i psychospołecznych. Poniżej omówiono najważniejsze aspekty prognostyczne tego urazu oraz czynniki wpływające na ryzyko nawrotowości zwichnięcia stawu ramiennego.

Czynniki ryzyka nawrotowości zwichnięcia

Wiek pacjenta jest najważniejszym wskaźnikiem prognostycznym nawrotowości zwichnięć stawu ramiennego. Im młodszy wiek w momencie pierwszego urazu, tym większe prawdopodobieństwo wystąpienia kolejnych zwichnięć.¹ Badania wykazują, że wskaźnik nawrotowości wynosi około 90% jeśli pierwsze zwichnięcie nastąpi w wieku nastoletnim, natomiast u pacjentów w wieku 40 lat lub starszych, wskaźnik nawrotowości spada do 10-15%.²

Dalsze czynniki ryzyka nawrotowości obejmują:³⁴

Wiek 16-25 lat – grupa szczególnie narażona na nawrotowe zwichnięcia
Płeć męska – wykazuje umiarkowane do dużego ryzyko zarówno pierwszorazowego jak i nawrotowego zwichnięcia
Obecność uszkodzenia Bankarta (uszkodzenie kostne brzegu panewki)
Dominująca strona urazu
Uprawianie sportu
Hipermobilność stawów (szczególnie u mężczyzn)
Historia wcześniejszych niestabilności stawu ramiennego

³⁴

Modele predykcyjne ryzyka nawrotu

Opracowano modele matematyczne pozwalające przewidzieć ryzyko nawrotowego zwichnięcia po pierwszym urazie. Według badań, ryzyko nawrotu w ciągu 12 miesięcy można oszacować za pomocą następującego równania:⁵

Ryzyko nawrotu = 4,73 + 1,06 (wiek 16-25 lat) + 1,80 (uszkodzenie Bankarta) + 0,80 (dominująca strona) – 1,27 (unieruchomienie) + 0,03 (SPADI-Total) + 0,13 (TSK-11-Total)

Wskaźnik nawrotowości wynosi około 35,9% w pierwszym roku po urazie, przy czym największa nawrotowość występuje u osób w wieku 16-25 lat.⁶ Ważne jest uwzględnienie zarówno czynników fizycznych jak i psychospołecznych, takich jak strach przed ponownym urazem oraz poziom bólu i niepełnosprawności.⁷

Długoterminowe rokowanie

Badania długoterminowe (25-letnie) wskazują, że:⁸

Nawroty zwichnięć narastają do 10 lat od pierwszego urazu
Po 25 latach około 29% barków z dwoma nawrotami stabilizuje się z czasem
Prawie połowa wszystkich pierwszorazowych zwichnięć u osób w wieku 25 lat będzie wymagała operacji stabilizującej
Dwie trzecie pacjentów rozwinie różne stadia artropatii w ciągu 25 lat

⁸

Większość ponownych zwichnięć występuje w ciągu pierwszych 2 lat od pierwotnego urazu.⁹ Najczęstszą komplikacją ostrego zwichnięcia barku jest właśnie nawrotowość, która występuje z powodu rozciągnięcia i deformacji torebki stawowej oraz otaczających więzadeł podczas zwichnięcia.¹⁰

Komplikacje po zwichnięciu stawu ramiennego

Poza nawrotowością, częstymi komplikacjami po zwichnięciu stawu ramiennego są:¹¹

Złamania – najczęstszym typem jest uszkodzenie Hill-Sachsa (złamanie kompresyjne tylno-bocznej części głowy kości ramiennej). Opisano również złamania bliższego końca kości ramiennej, większego guza, wyrostka kruczego i wyrostka barkowego
Uszkodzenia stożka rotatorów – częstość tej komplikacji wzrasta z wiekiem i można jej oczekiwać u 30-35% pacjentów w wieku 40 lat lub starszych
Uszkodzenia nerwu pachowego – pacjenci z takimi urazami mogą oczekiwać pełnego powrotu do zdrowia w ciągu 3-6 miesięcy
Niestabilność barku spowodowana uszkodzeniem dolnego więzadła barkowo-ramiennego (IGHL)
Uszkodzenie Bankarta lub inne urazy przedniego obrąbka panewki
Uszkodzenie tętnicy pachowej lub splotu ramiennego
Ciała wolne w stawie

¹²¹¹

Leczenie zachowawcze a rokowanie

Przednie zwichnięcia barku są zwykle leczone za pomocą zamkniętej manualnej repozycji i okresu unieruchomienia (np. 6 tygodni), aby umożliwić odpowiednie gojenie torebki stawowej. Jednak czy znacząco zmienia to prawdopodobieństwo nawrotowego zwichnięcia, nie jest pewne.¹³ Badania sugerują, że wczesny ruch lub unieruchomienie po pierwotnym zwichnięciu dają takie samo długoterminowe rokowanie.¹⁴

Kluczem do udanego gojenia i prawidłowego funkcjonowania jest ustrukturyzowany program fizjoterapii mający na celu zmniejszenie zaniku mięśni i utrzymanie mobilności.¹⁵ Co istotne, pacjenci z pierwotnym zwichnięciem przednim barku (PASD) bez operacji i zgłaszającymi problemy z barkiem trzy-sześć tygodni po początkowym urazie nie mają mniejszego upośledzenia barku (samoocena lub obiektywne pomiary) niż pacjenci bez operacji z nawrotowym zwichnięciem (RASD).¹⁶ Obie te grupy pacjentów prezentują ogólnie słabą funkcję barku i wysoki lęk przed ponownym urazem, dlatego mają równe wskazania do leczenia niezależnie od liczby poprzednich zwichnięć.¹⁷

Leczenie operacyjne a rokowanie

Naprawa chirurgiczna nie jest wymagana w przypadku samego zwichnięcia, ale raczej w celu leczenia powikłań i powiązanych urazów.¹⁸ Jeśli pacjent jest młody i aktywny, szczególnie poniżej 30 roku życia, jest znacznie bardziej narażony na ponowne zwichnięcie barku i będzie miał lepsze długoterminowe wyniki przy leczeniu chirurgicznym.¹⁹²⁰

Ponowne zwichnięcie stawu ramiennego jest bardzo powszechne nawet po odpowiednim leczeniu, a niektóre badania zgłaszają wskaźniki nawrotowości przekraczające 70%. Wskaźniki nawrotowości znacznie się jednak różnią, a wiek pacjenta wydaje się odgrywać znaczącą rolę w określaniu tego wskaźnika.²¹

Powrót do aktywności

Istnieje pewna rozbieżność w zaleceniach dotyczących optymalnego czasu powrotu do aktywności po zwichnięciu stawu ramiennego:²²

Według niektórych badań pacjent powinien być bez bólu z symetryczną siłą łopatki przed powrotem, co zwykle następuje w ciągu 2-3 tygodni
Inne badania wykazały, że pacjenci, którzy wrócili przed upływem 6 tygodni, mieli znacznie gorsze wyniki niż pacjenci, którzy czekali ponad 6 tygodni

²²

Pacjenci zazwyczaj mogą wrócić do uprawiania sportu od 4 do 6 miesięcy po chirurgicznej korekcji przedniego zwichnięcia barku, a większość z nich jest w stanie osiągnąć poziom aktywności sprzed urazu.²³

Diagnostyka i przewidywanie powikłań

Kliniczne predyktory mogą pomóc w stratyfikacji ryzyka u pacjentów ze zwichnięciem barku na podstawie prawdopodobieństwa współistniejącego, klinicznie istotnego złamania.²⁴ Kliniczne reguły predykcyjne mogą pomóc zidentyfikować pacjentów, którzy mogliby bezpiecznie zrezygnować z radiografii przed zamkniętą repozycją zwichniętego barku.²⁵

Istniejące dowody sugerują, że kliniczne reguły predykcyjne mogą odgrywać rolę we wspieraniu wspólnego podejmowania decyzji po zwichnięciu barku, szczególnie w środowiskach przedszpitalnych i odległych, gdy przewidywane jest opóźnienie w obrazowaniu.²⁶ Zidentyfikowanie tej grupy mogłoby zmniejszyć koszty, ekspozycję na promieniowanie jonizujące i czas do repozycji stawu.²⁷

Wskazania do edukacji pacjentów

Istnieje możliwość edukacji pacjentów w szczególnych populacjach co do ich zwiększonego ryzyka wystąpienia niestabilności barku, szczególnie u młodych mężczyzn, którzy wydają się być bardziej narażeni na nawrotowe zwichnięcie barku.²⁸ W przypadku młodszych i aktywnych pacjentów, szczególnie poniżej 30 roku życia, zaleca się omówienie ryzyka i korzyści związanych z podejściem zachowawczym i chirurgicznym, ponieważ wykazano, że opcje chirurgiczne dają lepsze długoterminowe wyniki w tej populacji pacjentów poza młodymi nastolatkami.²⁹

Osiągnięcie najlepszych długoterminowych wyników w leczeniu pierwotnych przednich zwichnięć barku wymaga systematycznego podejmowania decyzji oraz indywidualnego podejścia do pacjenta, uwzględniającego wszystkie czynniki ryzyka i specyfikę danego przypadku.³⁰

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Materiały źródłowe

#1 Shoulder Dislocation: Practice Essentials, Epidemiology, Functional Anatomy
https://emedicine.medscape.com/article/93323-overview
Age at dislocation is the most important prognostic indicator for recurrence of shoulder dislocations. Younger age at initial injury increases the likelihood for future dislocation. The recurrence rate is thought to be 90% if the initial episode occurs in the teen years. In patients aged 40 years or older, the recurrence rate is 10-15%. Most redislocations occur within 2 years of the primary injury. Persons with axillary nerve injuries can be expected to recover completely within 3-6 months. […] The most common complication of an acute shoulder dislocation is recurrence. This complication occurs because the capsule and surrounding ligaments are stretched and deformed during the dislocation. Age is the most important indicator for prognosis; dislocations recur in approximately 90% of teenagers.
#2 Shoulder Dislocation: Practice Essentials, Epidemiology, Functional Anatomy
https://emedicine.medscape.com/article/93323-overview
Age at dislocation is the most important prognostic indicator for recurrence of shoulder dislocations. Younger age at initial injury increases the likelihood for future dislocation. The recurrence rate is thought to be 90% if the initial episode occurs in the teen years. In patients aged 40 years or older, the recurrence rate is 10-15%. Most redislocations occur within 2 years of the primary injury. Persons with axillary nerve injuries can be expected to recover completely within 3-6 months. […] The most common complication of an acute shoulder dislocation is recurrence. This complication occurs because the capsule and surrounding ligaments are stretched and deformed during the dislocation. Age is the most important indicator for prognosis; dislocations recur in approximately 90% of teenagers.
#3 Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation
https://pmc.ncbi.nlm.nih.gov/articles/PMC6407568/
To develop a multivariate tool that would predict recurrent instability after a first-time traumatic anterior shoulder dislocation. […] Six of seven physical and psychosocial factors can be used to predict recurrent shoulder instability following a first-time traumatic anterior shoulder dislocation. […] The rate of recurrent instability was 35.9% (46/128) at 1 year follow-up with the greatest recurrence in those aged 1625. […] At 12 months following their injury, 46 (35.9%) participants had an episode of recurrent instability. […] Risk of recurrence at 12 months was predicted using both physical and psychosocial factors in the following equation: Risk of recurrence=4.73 + 1.06 (ages 1625 years)+1.80 (bony Bankart lesions)+0.80 (dominant side affected) 1.27 (immobilised) +0.03 (SPADI-Total)+0.13 (TSK-11-Total).
#4 Risk Factors Associated with First Time and Recurrent Shoulder Instability: A Systematic Review | Published in International Journal of Sports Physical Therapy
https://ijspt.scholasticahq.com/article/116278-risk-factors-associated-with-first-time-and-recurrent-shoulder-instability-a-systematic-review
Male sex, participation in sport, hypermobility in males, and glenoid index demonstrated moderate to large risk associated with first time shoulder instability. […] Male sex, age 30 years, and history of glenohumeral instability with concomitant injury demonstrated moderate to large risk associated with recurrent shoulder instability. […] There may be an opportunity for patient education in particular populations as to their increased risk for suffering shoulder instability, particularly in young males who appear to be at increased risk for recurrent shoulder instability.
#5 Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation
https://pmc.ncbi.nlm.nih.gov/articles/PMC6407568/
To develop a multivariate tool that would predict recurrent instability after a first-time traumatic anterior shoulder dislocation. […] Six of seven physical and psychosocial factors can be used to predict recurrent shoulder instability following a first-time traumatic anterior shoulder dislocation. […] The rate of recurrent instability was 35.9% (46/128) at 1 year follow-up with the greatest recurrence in those aged 1625. […] At 12 months following their injury, 46 (35.9%) participants had an episode of recurrent instability. […] Risk of recurrence at 12 months was predicted using both physical and psychosocial factors in the following equation: Risk of recurrence=4.73 + 1.06 (ages 1625 years)+1.80 (bony Bankart lesions)+0.80 (dominant side affected) 1.27 (immobilised) +0.03 (SPADI-Total)+0.13 (TSK-11-Total).
#6 Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation
https://pmc.ncbi.nlm.nih.gov/articles/PMC6407568/
To develop a multivariate tool that would predict recurrent instability after a first-time traumatic anterior shoulder dislocation. […] Six of seven physical and psychosocial factors can be used to predict recurrent shoulder instability following a first-time traumatic anterior shoulder dislocation. […] The rate of recurrent instability was 35.9% (46/128) at 1 year follow-up with the greatest recurrence in those aged 1625. […] At 12 months following their injury, 46 (35.9%) participants had an episode of recurrent instability. […] Risk of recurrence at 12 months was predicted using both physical and psychosocial factors in the following equation: Risk of recurrence=4.73 + 1.06 (ages 1625 years)+1.80 (bony Bankart lesions)+0.80 (dominant side affected) 1.27 (immobilised) +0.03 (SPADI-Total)+0.13 (TSK-11-Total).
#7 Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation
https://pmc.ncbi.nlm.nih.gov/articles/PMC6407568/
This prospective cohort study reports the rate of recurrent instability in NZ within 1 year of an FTASD. […] A multivariate tool of age, bony Bankart lesion, immobilisation status, dominance of affected shoulder, fear of reinjury and pain and disability can be used to predict recurrent shoulder instability at 1 year.
#8 Primary anterior dislocation of the shoulder: long-term prognosis at the age of 40 years or younger – PubMed
https://pubmed.ncbi.nlm.nih.gov/26754859/
Purpose: We describe the long-term prognosis in 257 first-time anterior shoulder dislocations (255 patients, aged 12-40 years) registered at 27 Swedish emergency units between 1978 and 1979. […] Results: Early movement or immobilisation after the primary dislocation resulted in the same long-term prognosis. Recurrences increased up to 10 years of follow-up, but, after 25 years, 29 % of the shoulders with 2 recurrences appeared to have stabilised over time. […] Conclusion: Almost half of all first-time dislocations at the age of 25 years will have stabilising surgery and two-thirds will develop different stages of arthropathy within 25 years.
#9 Shoulder Dislocation: Practice Essentials, Epidemiology, Functional Anatomy
https://emedicine.medscape.com/article/93323-overview
Age at dislocation is the most important prognostic indicator for recurrence of shoulder dislocations. Younger age at initial injury increases the likelihood for future dislocation. The recurrence rate is thought to be 90% if the initial episode occurs in the teen years. In patients aged 40 years or older, the recurrence rate is 10-15%. Most redislocations occur within 2 years of the primary injury. Persons with axillary nerve injuries can be expected to recover completely within 3-6 months. […] The most common complication of an acute shoulder dislocation is recurrence. This complication occurs because the capsule and surrounding ligaments are stretched and deformed during the dislocation. Age is the most important indicator for prognosis; dislocations recur in approximately 90% of teenagers.
#10 Shoulder Dislocation: Practice Essentials, Epidemiology, Functional Anatomy
https://emedicine.medscape.com/article/93323-overview
Age at dislocation is the most important prognostic indicator for recurrence of shoulder dislocations. Younger age at initial injury increases the likelihood for future dislocation. The recurrence rate is thought to be 90% if the initial episode occurs in the teen years. In patients aged 40 years or older, the recurrence rate is 10-15%. Most redislocations occur within 2 years of the primary injury. Persons with axillary nerve injuries can be expected to recover completely within 3-6 months. […] The most common complication of an acute shoulder dislocation is recurrence. This complication occurs because the capsule and surrounding ligaments are stretched and deformed during the dislocation. Age is the most important indicator for prognosis; dislocations recur in approximately 90% of teenagers.
#11 Shoulder Dislocation: Practice Essentials, Epidemiology, Functional Anatomy
https://emedicine.medscape.com/article/93323-overview
Another common complication following dislocation is fracture. The most common type is a Hill-Sachs lesion or compression fracture of the posterior humeral head. Fractures of the proximal humerus, greater tuberosity, coracoid, and acromion have also been described. […] Rotator cuff tears also commonly occur as a result of shoulder dislocations, and the frequency of this complication increases with age. This complication can be expected in 30-35% of patients aged 40 years or older. Slow progression in return to active function following shoulder dislocation in a middle-aged patient should warrant a workup for a rotator cuff tear.
#12 Anterior shoulder dislocation | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/anterior-shoulder-dislocation?lang=us
Anterior shoulder dislocations are usually managed with closed manual reduction and a period of immobilization (e.g. 6 weeks) to allow adequate capsular healing, although whether this significantly changes the likelihood of recurrent dislocation is not certain. […] The key to successful healing and normal eventual function is a structured course of physiotherapy aimed at reducing muscle wasting and maintaining mobility. […] Surgical repair is not required for dislocation per se, but rather to treat complications and associated injuries which include: shoulder instability due to damage to the inferior glenohumeral ligament (IGHL), Hill-Sachs defect, Bankart lesion or other anterior glenolabral injuries, damage to the axillary artery, or brachial plexus, intraarticular loose body.
#13 Anterior shoulder dislocation | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/anterior-shoulder-dislocation?lang=us
Anterior shoulder dislocations are usually managed with closed manual reduction and a period of immobilization (e.g. 6 weeks) to allow adequate capsular healing, although whether this significantly changes the likelihood of recurrent dislocation is not certain. […] The key to successful healing and normal eventual function is a structured course of physiotherapy aimed at reducing muscle wasting and maintaining mobility. […] Surgical repair is not required for dislocation per se, but rather to treat complications and associated injuries which include: shoulder instability due to damage to the inferior glenohumeral ligament (IGHL), Hill-Sachs defect, Bankart lesion or other anterior glenolabral injuries, damage to the axillary artery, or brachial plexus, intraarticular loose body.
#14 Primary anterior dislocation of the shoulder: long-term prognosis at the age of 40 years or younger – PubMed
https://pubmed.ncbi.nlm.nih.gov/26754859/
Purpose: We describe the long-term prognosis in 257 first-time anterior shoulder dislocations (255 patients, aged 12-40 years) registered at 27 Swedish emergency units between 1978 and 1979. […] Results: Early movement or immobilisation after the primary dislocation resulted in the same long-term prognosis. Recurrences increased up to 10 years of follow-up, but, after 25 years, 29 % of the shoulders with 2 recurrences appeared to have stabilised over time. […] Conclusion: Almost half of all first-time dislocations at the age of 25 years will have stabilising surgery and two-thirds will develop different stages of arthropathy within 25 years.
#15 Anterior shoulder dislocation | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/anterior-shoulder-dislocation?lang=us
Anterior shoulder dislocations are usually managed with closed manual reduction and a period of immobilization (e.g. 6 weeks) to allow adequate capsular healing, although whether this significantly changes the likelihood of recurrent dislocation is not certain. […] The key to successful healing and normal eventual function is a structured course of physiotherapy aimed at reducing muscle wasting and maintaining mobility. […] Surgical repair is not required for dislocation per se, but rather to treat complications and associated injuries which include: shoulder instability due to damage to the inferior glenohumeral ligament (IGHL), Hill-Sachs defect, Bankart lesion or other anterior glenolabral injuries, damage to the axillary artery, or brachial plexus, intraarticular loose body.
#16 Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2444-0
Patients with non-operated traumatic PASD do not have less shoulder impairment (self-reportedly or objectively measured) than patients with RASD. […] Generally, both groups present with poor shoulder function and high fear of re-injury, and therefore have equal indications for receiving treatment regardless of number of previous dislocations. […] Non-operated patients with a traumatic primary anterior shoulder dislocation (PASD) and self-reported shoulder trouble three-six weeks after initial injury do not have less shoulder impairment (self-reportedly or objectively measured) than non-operated patients with recurrent (second-fifth time) anterior shoulder dislocation (RASD) and self-reported shoulder trouble three-six weeks after their latest shoulder dislocation event.
#17 Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2444-0
Patients with non-operated traumatic PASD do not have less shoulder impairment (self-reportedly or objectively measured) than patients with RASD. […] Generally, both groups present with poor shoulder function and high fear of re-injury, and therefore have equal indications for receiving treatment regardless of number of previous dislocations. […] Non-operated patients with a traumatic primary anterior shoulder dislocation (PASD) and self-reported shoulder trouble three-six weeks after initial injury do not have less shoulder impairment (self-reportedly or objectively measured) than non-operated patients with recurrent (second-fifth time) anterior shoulder dislocation (RASD) and self-reported shoulder trouble three-six weeks after their latest shoulder dislocation event.
#18 Anterior shoulder dislocation | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/anterior-shoulder-dislocation?lang=us
Anterior shoulder dislocations are usually managed with closed manual reduction and a period of immobilization (e.g. 6 weeks) to allow adequate capsular healing, although whether this significantly changes the likelihood of recurrent dislocation is not certain. […] The key to successful healing and normal eventual function is a structured course of physiotherapy aimed at reducing muscle wasting and maintaining mobility. […] Surgical repair is not required for dislocation per se, but rather to treat complications and associated injuries which include: shoulder instability due to damage to the inferior glenohumeral ligament (IGHL), Hill-Sachs defect, Bankart lesion or other anterior glenolabral injuries, damage to the axillary artery, or brachial plexus, intraarticular loose body.
#19 Management of primary anterior shoulder dislocations: a narrative review | Sports Medicine – Open | Full Text
https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-019-0203-2
If a patient is young and active, particularly under the age of 30, they are far more likely to dislocate the shoulder and, if not a young adolescent, will have superior long-term results with surgical management. […] Re-dislocation of the glenohumeral joint is very common even after appropriate treatment, with some studies reporting recurrence rates exceeding 70%. However, rates of recurrence vary greatly, and patient age seems to play a significant role in the determination of that rate. […] A study by Watson et al. agrees with this, noting the general consensus that the patient should be pain free with symmetric scapular strength before returning, generally occurring within 2-3 weeks. However, this notion has been challenged by a study that showed patients who returned before 6 weeks had significantly poorer outcomes than patients who waited over 6 weeks to return.
#20 Management of primary anterior shoulder dislocations: a narrative review | Sports Medicine – Open | Full Text
https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-019-0203-2
Patients are typically able to return to sport anywhere from 4 to 6 months following surgical correction of an anterior shoulder dislocation and most are able to achieve pre-injury activity level. […] Achieving the best long-term results when managing primary anterior shoulder dislocations requires a systematic series of decisions. […] If a patient is young and active, particularly under the age of 30, they are far more likely to redislocate the shoulder. For this population, we suggest discussing the risks and benefits of conservative versus surgical approaches with patients, as surgical options have been shown to have superior long-term results in this patient population outside of young adolescents.
#21 Management of primary anterior shoulder dislocations: a narrative review | Sports Medicine – Open | Full Text
https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-019-0203-2
If a patient is young and active, particularly under the age of 30, they are far more likely to dislocate the shoulder and, if not a young adolescent, will have superior long-term results with surgical management. […] Re-dislocation of the glenohumeral joint is very common even after appropriate treatment, with some studies reporting recurrence rates exceeding 70%. However, rates of recurrence vary greatly, and patient age seems to play a significant role in the determination of that rate. […] A study by Watson et al. agrees with this, noting the general consensus that the patient should be pain free with symmetric scapular strength before returning, generally occurring within 2-3 weeks. However, this notion has been challenged by a study that showed patients who returned before 6 weeks had significantly poorer outcomes than patients who waited over 6 weeks to return.
#22 Management of primary anterior shoulder dislocations: a narrative review | Sports Medicine – Open | Full Text
https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-019-0203-2
If a patient is young and active, particularly under the age of 30, they are far more likely to dislocate the shoulder and, if not a young adolescent, will have superior long-term results with surgical management. […] Re-dislocation of the glenohumeral joint is very common even after appropriate treatment, with some studies reporting recurrence rates exceeding 70%. However, rates of recurrence vary greatly, and patient age seems to play a significant role in the determination of that rate. […] A study by Watson et al. agrees with this, noting the general consensus that the patient should be pain free with symmetric scapular strength before returning, generally occurring within 2-3 weeks. However, this notion has been challenged by a study that showed patients who returned before 6 weeks had significantly poorer outcomes than patients who waited over 6 weeks to return.
#23 Management of primary anterior shoulder dislocations: a narrative review | Sports Medicine – Open | Full Text
https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-019-0203-2
Patients are typically able to return to sport anywhere from 4 to 6 months following surgical correction of an anterior shoulder dislocation and most are able to achieve pre-injury activity level. […] Achieving the best long-term results when managing primary anterior shoulder dislocations requires a systematic series of decisions. […] If a patient is young and active, particularly under the age of 30, they are far more likely to redislocate the shoulder. For this population, we suggest discussing the risks and benefits of conservative versus surgical approaches with patients, as surgical options have been shown to have superior long-term results in this patient population outside of young adolescents.
#24 Clinical predictors of fracture in patients with shoulder dislocation: systematic review of diagnostic test accuracy studies | Emergency Medicine Journal
https://emj.bmj.com/content/40/5/379
Clinical predictors can help risk stratify patients with a shoulder dislocation based on the likelihood of a concomitant clinically significant fracture. […] Clinical prediction rules can help identify patients that could safely forgo radiography before closed reduction of a dislocated shoulder. […] This systematic review suggests there is a subgroup of patients with shoulder dislocations for whom radiographs may be safely omitted before closed reduction. Identifying this group could reduce costs, exposure to ionising radiation and time to joint reduction. […] The existing evidence suggests that clinical prediction rules may have a role in supporting shared decision making after shoulder dislocation, particularly in the pre-hospital and remote environments when delay to imaging is anticipated.
#25 Clinical predictors of fracture in patients with shoulder dislocation: systematic review of diagnostic test accuracy studies | Emergency Medicine Journal
https://emj.bmj.com/content/40/5/379
Clinical predictors can help risk stratify patients with a shoulder dislocation based on the likelihood of a concomitant clinically significant fracture. […] Clinical prediction rules can help identify patients that could safely forgo radiography before closed reduction of a dislocated shoulder. […] This systematic review suggests there is a subgroup of patients with shoulder dislocations for whom radiographs may be safely omitted before closed reduction. Identifying this group could reduce costs, exposure to ionising radiation and time to joint reduction. […] The existing evidence suggests that clinical prediction rules may have a role in supporting shared decision making after shoulder dislocation, particularly in the pre-hospital and remote environments when delay to imaging is anticipated.
#26 Clinical predictors of fracture in patients with shoulder dislocation: systematic review of diagnostic test accuracy studies | Emergency Medicine Journal
https://emj.bmj.com/content/40/5/379
Clinical predictors can help risk stratify patients with a shoulder dislocation based on the likelihood of a concomitant clinically significant fracture. […] Clinical prediction rules can help identify patients that could safely forgo radiography before closed reduction of a dislocated shoulder. […] This systematic review suggests there is a subgroup of patients with shoulder dislocations for whom radiographs may be safely omitted before closed reduction. Identifying this group could reduce costs, exposure to ionising radiation and time to joint reduction. […] The existing evidence suggests that clinical prediction rules may have a role in supporting shared decision making after shoulder dislocation, particularly in the pre-hospital and remote environments when delay to imaging is anticipated.
#27 Clinical predictors of fracture in patients with shoulder dislocation: systematic review of diagnostic test accuracy studies | Emergency Medicine Journal
https://emj.bmj.com/content/40/5/379
Clinical predictors can help risk stratify patients with a shoulder dislocation based on the likelihood of a concomitant clinically significant fracture. […] Clinical prediction rules can help identify patients that could safely forgo radiography before closed reduction of a dislocated shoulder. […] This systematic review suggests there is a subgroup of patients with shoulder dislocations for whom radiographs may be safely omitted before closed reduction. Identifying this group could reduce costs, exposure to ionising radiation and time to joint reduction. […] The existing evidence suggests that clinical prediction rules may have a role in supporting shared decision making after shoulder dislocation, particularly in the pre-hospital and remote environments when delay to imaging is anticipated.
#28 Risk Factors Associated with First Time and Recurrent Shoulder Instability: A Systematic Review | Published in International Journal of Sports Physical Therapy
https://ijspt.scholasticahq.com/article/116278-risk-factors-associated-with-first-time-and-recurrent-shoulder-instability-a-systematic-review
Male sex, participation in sport, hypermobility in males, and glenoid index demonstrated moderate to large risk associated with first time shoulder instability. […] Male sex, age 30 years, and history of glenohumeral instability with concomitant injury demonstrated moderate to large risk associated with recurrent shoulder instability. […] There may be an opportunity for patient education in particular populations as to their increased risk for suffering shoulder instability, particularly in young males who appear to be at increased risk for recurrent shoulder instability.
#29 Management of primary anterior shoulder dislocations: a narrative review | Sports Medicine – Open | Full Text
https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-019-0203-2
Patients are typically able to return to sport anywhere from 4 to 6 months following surgical correction of an anterior shoulder dislocation and most are able to achieve pre-injury activity level. […] Achieving the best long-term results when managing primary anterior shoulder dislocations requires a systematic series of decisions. […] If a patient is young and active, particularly under the age of 30, they are far more likely to redislocate the shoulder. For this population, we suggest discussing the risks and benefits of conservative versus surgical approaches with patients, as surgical options have been shown to have superior long-term results in this patient population outside of young adolescents.
#30 Management of primary anterior shoulder dislocations: a narrative review | Sports Medicine – Open | Full Text
https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-019-0203-2
Patients are typically able to return to sport anywhere from 4 to 6 months following surgical correction of an anterior shoulder dislocation and most are able to achieve pre-injury activity level. […] Achieving the best long-term results when managing primary anterior shoulder dislocations requires a systematic series of decisions. […] If a patient is young and active, particularly under the age of 30, they are far more likely to redislocate the shoulder. For this population, we suggest discussing the risks and benefits of conservative versus surgical approaches with patients, as surgical options have been shown to have superior long-term results in this patient population outside of young adolescents.