[Acute anterior instability of the shoulder: short- and mid-term outcome after conservative treatment].
OBJECTIVE
We assessed short and mid-term outcome after emergency care for acute anterior instability of the shoulder.


METHODS
Between October 1990 and May 1996, 233 shoulders (206 anteromedial dislocations, 21 dislocations with spontaneous reduction, and 6 painful shoulders with unknown instability) were treated, mainly orthopedically. The series included 165 men and 68 women, mean age 42 years (range 13-95 years). One hundred fifty-eight practiced sports more or less regularly (73% of the 216 patients) and a sports accident was involved in 121 cases (52.8%). Besides the usual lesions secondary to bone displacement, there were 51 fracture-avulsions of the greater tuberosity, 7 major fractures of the anteroinferior border of the glenoid cavity, 2 fractures of the coracoid process, 10 nerve lesions (6 axillary nerve palsies and 4 partial palsies of the brachial plexus) and 10 rotator cuff tears. Orthopedic reduction was performed in the emergency room in all patients with a dislocated shoulder (82%). Immobilization, elbow to body, was prescribed for 8 to 15 days. Sixteen patients (6.8%) underwent surgery during the days following reduction, 8 for displaced fracture of the greater tuberosity, 7 for important fracture of the glenoid cavity and 1 for avulsion of the rotator cuff.


RESULTS
Patient files (n=210) or phone interviews (n=185) were used to assess outcome. Mean follow-up was 38 months (12 - 72 months). All nerve lesions regressed within a few weeks without sequelae. We had 6 cases of retractile capsulitis and 4 cases of reflex dystrophy that regressed totally in 3 to 6 months. Recurrent dislocation was observed in 52 cases (24.7% recurrence rate) with 29 occurring within one year (55.8%). Among the 145 other shoulders, 84 recovered completely (58%), 52 were occasionally bothersome (36%), 8 exhibited repeated subdislocation (5.5%) and one remained pseudoparalytic. Among the factors favoring recurrence, we found patient age (higher risk in younger subjects) and lack of rehabilitation (p<0.05).


CONCLUSIONS
Acute anterior dislocation of the shoulder is frequent, but emergency surgical repair is rarely needed (15 cases in our series, 6.9%). Mid-term recurrence is not as frequent as is often thought, warranting the choice of first intention orthopedic care. Our findings demonstrated that emergency surgery is not indicated in most cases of anterior shoulder instability, even with the arthroscopic approach, especially since the results of this method remain unclear.
Saragaglia
D
D
Service de Chirurgie Orthopédique et de Traumatologie du Sport, CHU de Grenoble, Hôpital Sud, BP 185, 38130 Echirolles.
Picard
F
F
Le Bredonchel
T
T
Moncenis
C
C
Sardo
M
M
Tourne
Y
Y
D000059:Accidents / Q000706:statistics & numerical data; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001265:Athletic Injuries / Q000150:complications; D001915:Braces; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012307:Risk Factors; D017678:Sex Distribution; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome