First Anterior Dislocation: Conservative Treatment

  • Robert Pełka
  • Wojciech Marek


This chapter summarizes what we know so far about a first anterior shoulder dislocation and what can be done after the dislocation has happened. The main focus is on conservative treatment of different age groups. All recommendations are made from existing surveys and publications concerning first dislocations.


  1. 1.
    Liavaag S, Svenningsen S, Reikerås O, Enger M, Fjalestad T, Pripp AH, Brox JI. The epidemiology of shoulder dislocations in Oslo. Scand J Med Sci Sports. 2011;21(6):e334–40.CrossRefGoogle Scholar
  2. 2.
    Kroner K, Lind T, Jensen J. The epidemiology of shoulder dislocations. Arch Orthop Trauma Surg. 1989;108(5):288–90.CrossRefGoogle Scholar
  3. 3.
    Nordqvist A, Petersson CJ. Incidence and causes of shoulder girdle injuries in an urban population. J Shoulder Elb Surg. 1995;4(2):107–12.CrossRefGoogle Scholar
  4. 4.
    Simonet WT, Melton LJ III, Cofield RH, Ilstrup DM. Incidence of anterior shoulder dislocation in Olmsted County, Minnesota. Clin Orthop Relat Res. 1984;186:186–91.Google Scholar
  5. 5.
    Owens BD, Agel J, Mountcastle SB, Cameron KL, Nelson BJ. Incidence of glenohumeral instability in collegiate athletics. Am J Sports Med. 2009;37(9):1750–4.CrossRefGoogle Scholar
  6. 6.
    Owens BD, Dawson L, Burks R, Cameron KL. Incidence of shoulder dislocation in the United States military: demographic considerations from a high-risk population. J Bone Joint Surg Am. 2009;91(4):791–6.CrossRefGoogle Scholar
  7. 7.
    Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am. 2010;92(3):542–9.CrossRefGoogle Scholar
  8. 8.
    Hovelius L. Incidence of shoulder dislocation in Sweden. Clin Orthop Relat Res. 1982;166:127–31.Google Scholar
  9. 9.
    Chalidis B, et al. Has the management of shoulder dislocation changed over time? Int Orthop (SICOT). 2007;31:385–9.CrossRefGoogle Scholar
  10. 10.
    Baker CL. Intraarticular pathology in acute, first-time anterior shoulder dislocation: an arthroscopic study. Arthroscopy. 1994;10(4):478–9.CrossRefGoogle Scholar
  11. 11.
    Sachs RA, Lin D, Stone ML, et al. Can the need for future surgery for acute traumatic anterior shoulder dislocation be predicted? J Bone Joint Surg Am. 2007;89:1665–74.CrossRefGoogle Scholar
  12. 12.
    Habermeyer P, Gleyze P, Rickert M. Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study. J Shoulder Elb Surg. 1999;8:66–74.CrossRefGoogle Scholar
  13. 13.
    Buscayret F, Edwards TB, Szabo I, et al. Glenohumeral arthrosis in anterior instability before and after surgical treatment: incidence and contributing factors. Am J Sports Med. 2004;32:1165–72.CrossRefGoogle Scholar
  14. 14.
    Griffith JF, Antonio GE, Yung PS, et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. AJR Am J Roentgenol. 2008;190:1247–54.CrossRefGoogle Scholar
  15. 15.
    Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa M, Wakabayashi I, Kobayashi M. A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study. J Shoulder Elb Surg. 2003;12(5):413–5.CrossRefGoogle Scholar
  16. 16.
    Itoi E, et al. Immobilization in external rotation after shoulder dislocation reduces the risk of recurrence. A randomized controlled trial. J Bone Joint Surg Am. 2007;89:2124–31.CrossRefGoogle Scholar
  17. 17.
    Whelan DB, Lichtfeld R, Wambolt E, Dainty KN. External rotation immobilization for primary shoulder dislocation: a randomized controlled trial. Clin Orthop Relat Res. 2014;472(8):2380–6.CrossRefGoogle Scholar
  18. 18.
    Liavaag S, Brox JI, Pripp AH, Enger M, Soldal LA, Svenningsen S. Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence: a randomized controlled trial. J Bone Joint Surg Am. 2011;93(10):897–904. Epub 2011 Apr 15CrossRefGoogle Scholar
  19. 19.
    Dickens JF, Owens BD, Cameron KL, Kilcoyne K, Allred CD, Svoboda SJ, Sullivan R, Tokish JM, Peck KY, Rue JP. Return to play and recurrent instability after in-season anterior shoulder instability: a prospective multicenter study. Am J Sports Med. 2014;42(12):2842–50. Epub 2014 Nov 5CrossRefPubMedGoogle Scholar
  20. 20.
    Aronen JG, Regan K. Decreasing the incidence of recurrence of first time anterior shoulder dislocations with rehabilitation. Am J Sports Med. 1984;12:283–91.CrossRefGoogle Scholar
  21. 21.
    Robinson CM, Howes J, Murdoch H, et al. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am. 2006;88:2326–36.CrossRefGoogle Scholar
  22. 22.
    Hovelius L, Olofsson A, Sandström B, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. A prospective twenty-five-year follow-up. J Bone Joint Surg Am. 2008;90:945–52.CrossRefGoogle Scholar
  23. 23.
    Olds M, Donaldson K, Ellis R, Kersten P. Among children of 18 years old and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors. Br J Sports Med. 2016;50(18):1135–41. Scholar
  24. 24.
    Shymon SJ, Roocroft J, Edmonds EW. Traumatic anterior instability of the pediatric shoulder: a comparison of arthroscopic and open Bankart repairs. J Pediatr Orthop. 2015;35(1):1–6.CrossRefGoogle Scholar
  25. 25.
    Gigis I, Heikenfeld R, Kapinas A, Listringhaus R, Godolias G. Arthroscopic versus conservative treatment of first anterior dislocation of the shoulder in adolescents. J Pediatr Orthop. 2014;34(4):421–5. Scholar
  26. 26.
    Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. Bone Joint Surg Am. 2006;88(11):2326–36.CrossRefGoogle Scholar
  27. 27.
    Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy. 2009;25(3):298–304.CrossRefGoogle Scholar
  28. 28.
    Chahal J, Marks P, MacDonald P, Shah P, Theodoropoulos J, Ravi B, Whelan D. Anatomic Bankart repair compared with nonoperative treatment and/or arthroscopic lavage for first-time traumatic shoulder dislocation. Arthroscopy. 2012;28(4):565–75.CrossRefGoogle Scholar
  29. 29.
    Longo UG, Loppini M, Rizzello G, Ciuffreda M, Maffulli N, Denaro V. Management of primary acute anterior shoulder dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy. 2014;30(4):506–22. Level IVCrossRefGoogle Scholar
  30. 30.
    Kirkley A, Werstine R, Ratjek A, Griffin S. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation. Arthroscopy. 2005;21(1):55–63.CrossRefGoogle Scholar
  31. 31.
    Atoun E, Narvani A, Even T, Dabasia H, Van Tongel A, Sforza G, Levy O. Management of first-time dislocations of the shoulder in patients older than 40 years: the prevalence of iatrogenic fracture. J Orthop Trauma. 2013;27(4):190–3. Scholar
  32. 32.
    Pevny T, Hunter RE, Freeman JR. Primary traumatic anterior shoulder dislocation among patients 40 years of age and older. Arthroscopy. 1998;14(3):289–94.CrossRefGoogle Scholar
  33. 33.
    Wenner SM. Anterior dislocation of the shoulder in patients over 50 years of age. Orthopedics. 1985;8(9):1155–7.PubMedGoogle Scholar
  34. 34.
    Riccio I, de Sire A, Latte C, Pascarella F, Gimigliano F. Conservative treatment of traumatic shoulder instability: a case series study. Musculoskelet Surg. 2015;99(2):133–7. Epub 2015 May 16CrossRefPubMedGoogle Scholar
  35. 35.
    Spiegl UJ, Ryf C, Hepp P, Rillmann P. Evaluation of a treatment algorithm for acute traumatic osseous Bankart lesions resulting from first time dislocation of the shoulder with a two year follow-up. BMC Musculoskelet Disord. 2013;14:305. Scholar

Copyright information

© ESSKA 2020

Authors and Affiliations

  • Robert Pełka
    • 1
  • Wojciech Marek
    • 1
  1. 1.NZOZ Ortopedia Opole/GłuchołazyOpolePoland

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