title: Primary anterior dislocation of the shoulder: long-term prognosis at the age of 40 years or younger.
abstract: OBJECTIVE
  We describe the long-term prognosis in 257 first-time anterior shoulder dislocations (255 patients, aged 12-40 years) registered at 27 Swedish emergency units between 1978 and 1979.
  
  
  METHODS
  Half the shoulders were immobilised for 3-4 weeks after repositioning. Follow-ups were performed after two (questionnaire), five (questionnaire), 10 (questionnaire and radiology) and 25 (questionnaire and radiology) years in 227 patients (229 shoulders). Twenty-eight patients died during the 25 years of observation.
  
  
  RESULTS
  Early movement or immobilisation after the primary dislocation resulted in the same long-term prognosis. Recurrences increased up to 10 years of follow-up, but, after 25 years, 29 % of the shoulders with ≥2 recurrences appeared to have stabilised over time. Arthropathy increased from 9 % moderate to severe and 11 % mild at 10 years, to 34 % moderate to severe and 27 % mild after 25 years. Alcoholics had a poorer prognosis with respect to dislocation arthropathy (P < 0.001). Age <25 years and/or bilateral instability represent a poorer prognosis, where stabilising surgery is necessary in every second shoulder. Fracture of the greater tuberosity means a good prognosis, and we have found no evidence that athletic activity, gender, a Hill-Sachs lesion and minor rim fractures had any prognostic impact. During the 25 years in which these patients were followed, 28/255 died (11 %), representing a mortality rate (SMR) that was more than double that of the general Swedish population (P < 0.001).
  
  
  CONCLUSIONS
  Almost half of all first-time dislocations at the age of <25 years will have stabilising surgery and two-thirds will develop different stages of arthropathy within 25 years.
authors.affiliation: Orthopedic Department, Gävle Hospital, Lasarettsvägen 1, SE-801 88, Gävle, Sweden. hovelius@swipnet.se.
authors.forename: Lennart
authors.initials: L
authors.lastname: Hovelius
authors.affiliation: Elisabethsjukhuset, Geijersgatan 10, SE-752 26, Uppsala, Sweden. hans.rahme@telia.com.
authors.forename: Hans
authors.initials: H
authors.lastname: Rahme
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Dislocation; Dislocation arthropathy; Long-term prognosis; Shoulder