CURRENT TREATMENT CONCEPTS FOR SHOULDER I NSTABILITY - RESULTS OF A COUNTRYWIDE SURVEY

The object of the study was to evaluate the management of patients wit h acute or recurrent shoulder instabilities. Therefore all trauma, gen eral surgery, and orthopaedic departments in Germany were ask to compl ete a standardized evaluation form; completed questionnaires were retu rned from 880 institutions treating shoulder instabilities. Questions were asked about the diagnostic imaging techniques used and about cons ervative and operative treatment. In addition, the treatment regimens that would be followed for two typical patients were asked for. In pat ients with shoulder instabilities the following diagnostic imaging tec hniques were used: X-ray (97.1%), ultrasound (61.3%), CT (29.1%), arth ro-CT (26.2%), MRI (13.3%), arthrography (24.1%), and arthroscopy (30. 6%). After the first traumatic dislocation the average period of immob ilization was 2.2 weeks. Immobilization was achieved with a sling in 2 .0%, with a Desault bandage in 38.8%, with a Gilchrist bandage in 72.7 %, and with a cast in 4.2% of cases. Open surgical stabilization was p erformed according to Bankart (30%), Eden-Hybinette (28.6%), Weber (Os teotomy) (27.1%), Lange (15.5%), Putti-Platt (13.6%), and other proced ures (Magnusson-Stack, Bristow) only occasionally. The average period of immobilization after open surgery was 3.0 weeks. Arthroscopic stabi lization techniques were applied by 7.5%. In a 19-year-old handball pl ayer stabilization would be performed immediately after the first trau matic dislocation in 9.2% of the institutions; in 34.4% the patient wo uld not be operated on, and in 56.3% the shoulder would be stabilized after the third redislocation. A 45-year-old recreational athlete woul d be operated on immediately after the first traumatic dislocation in 1.6% of responding institutions while in 38.6% such a patient would no t undergo surgery and in 46.9% he or she would be operated on after th e third redislocation. In summary, in most departments invasive diagno stic arthroscopy is used prior to such noninvasive diagnostic modaliti es as MRI. Besides the Bankart procedure various other procedures are in use, which seem to be more frequently followed by redislocation. In most institutions little difference was made in the treatment regimen s proposed for the young active athlete and the older recreational ath lete after a first dislocation.