L. Hovelius et al., PRIMARY ANTERIOR DISLOCATION OF THE SHOULDER IN YOUNG-PATIENTS - A 10-YEAR PROSPECTIVE-STUDY, Journal of bone and joint surgery. American volume, 78A(11), 1996, pp. 1677-1684
Two hundred and forty-five patients who had had 247 primary anterior d
islocations of the shoulder were followed for ten years in a multicent
er study at twenty-seven Swedish hospitals. The ages of the patients a
t the time of the dislocation ranged from twelve to forty years. The p
atients were assigned to one of three treatment groups: immobilization
with the arm tied with a bandage to the torso for three to four weeks
after reduction of the dislocation; use of a sling, which was discont
inued after the patient was comfortable; or immobilization for various
durations. At the ten-year follow-up evaluation, no additional disloc
ation had occurred in 129 shoulders (52 per cent). Recurrent dislocati
on necessitating operative treatment had developed in fifty-eight shou
lders (23 per cent): thirty-four (34 per cent) of the ninety-nine shou
lders in patients who were twelve to twenty-two years old, sixteen (28
per cent) of the fifty-seven shoulders in patients who were twenty-th
ree to twenty-nine years old, and eight (9 per cent) of the ninety-one
shoulders in patients who were thirty to forty years old. Twenty-four
(22 per cent) of the shoulders that had had at least two recurrences
during the first two or five years seemed to have stabilized spontaneo
usly without operative intervention at ten years. Dislocation of the c
ontralateral shoulder occurred in association with sixteen (16 per cen
t) of the ninety-nine shoulders in patients who were twelve to twenty-
two years old, twelve (21 per cent) of the fifty-seven shoulders in pa
tients who were twenty-three to twenty-nine years old, and only three
(3 per cent) of the ninety-one shoulders in patients who were thirty t
o forty years old. The type and duration of the initial treatment had
no effect on the rate of recurrence. Radiographs, made for 185 shoulde
rs at the time of the primary dislocation, demonstrated an evident Her
modsson (Hill-Sachs) lesion in ninety-nine shoulders (54 per cent); th
is finding was associated with a significantly worse prognosis with re
gard to recurrence than was no evident lesion (p < 0.04). Radiographs
made for 208 shoulders at the ten-year follow-up examination were eval
uated for post-dislocation arthropathy. Twenty-three shoulders (11 per
cent) had mild arthropathy and eighteen (9 per cent) had moderate or
severe arthropathy. Some of the shoulders that had arthropathy had had
no recurrence.