PRIMARY ANTERIOR DISLOCATION OF THE SHOULDER IN YOUNG-PATIENTS - A 10-YEAR PROSPECTIVE-STUDY

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.