The glenohumeral joint of the shoulder is the most commonly dislocated joint in the human body. Anterior dislocation of the shoulder is commonly seen in accident and emergency (A&E) and trauma clinic. Acute dislocation is a surgical emergency and demands urgent relocation.
The first, and by far the largest group are young adult men who have sustained high-energy injuries to the shoulder. The second group are older patients who have been injured with a much lower level of violence. In older patients, the dislocation usually proves to be an isolated event. Failure to reduce a dislocated shoulder successfully within the first 24 hours carries the risk that it will be impossible to achieve a stable closed reduction.
The main patho mechanism of anterior shoulder dislocation is a functional deficiency of the anterior capsular mechanism, especially the inferior glenohumeral ligament-labrum complex. The most common cause of functional deficiency of the inferior glenohumeral ligament-labrum complex is detachment of that complex from the anterior aspect of the glenoid (a Bankart lesion).
The arm is usually held in an abducted and externally rotated position. There is loss of the normal contour of the deltoid and the acromion is prominent posteriorly and laterally. The humeral head itself may well be palpable anteriorly.
There is no consensus on the optimum technique for reduction of the dislocated shoulder. Success of any one technique is likely to be dependent on the familiarity of the surgeon and the choice of analgesia
Ideally, all dislocated joints would be reduced under general anaesthetic with adequate analgesia and muscle relaxation.
After the initial period of immobilisation, the patient begins supervised physiotherapy exercises to prevent glenohumeral joint contracture followed by dynamic exercises to develop dynamic stabilisers of the shoulder and improve proprioception in the joint.
Even with optimum management, many patients will go on to develop recurrent dislocation and these must be investigated and treated appropriately.
In those patients who suffer recurrent dislocation, arthroscopic visualisation of the shoulder joint would now be regarded as the gold standard diagnostic technique
Open surgical repair involves a substantial incision with slower recovery times than arthroscopic repair.
Return to sport is permissible when range of motion and strength are near normal.
Osteoarthritis is a common long term sequela to anterior shoulder dislocation