traumatic first time shoulder dislocation: surgery vs non-operative treatment

Management of first shoulder dislocation following reduction remains controversial. the two main options are immobilisation and arthroscopic stabilisation. the aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (oa), the effects of delaying surgery and the optimal method of immobilisation. extensive literature review was performed looking for previous publication addressing 4 points. i) natural history of primary shoulder dislocation ii) effect of surgical intervention on natural history iii) risk of long term osteoarthritis with and without surgical intervention iv) immobilisation techniques post reduction. individuals younger than 25 years old are likely to re-dislocate with non-operative management. surgery reduces risk of recurrent instability. patients with recurrent instability appear to be at a higher risk of oa. those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop oa than those with recurrent instability. delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. recent studies have failed to match the preliminary outcomes associated with external rotation braces. defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity.