Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study.

Two hundred and forty-five patients who had had 247 primary anterior dislocations of the shoulder were followed for ten years in a multicenter study at twenty-seven Swedish hospitals. The ages of the patients at the time of the dislocation ranged from twelve to forty years. The patients 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 discontinued after the patient was comfortable; or immobilization for various durations. At the ten-year follow-up evaluation, no additional dislocation had occurred in 129 shoulders (52 per cent). Recurrent dislocation necessitating operative treatment had developed in fifty-eight shoulders (23 per cent): thirty-four (34 per cent) of the ninety-nine shoulders in patients who were twelve to twenty-two years old, sixteen (28 per cent) of the fifty-seven shoulders in patients who were twenty-three 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 spontaneously without operative intervention at ten years. Dislocation of the contralateral shoulder occurred in association with sixteen (16 per cent) 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 patients 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 to forty years old. The type and duration of the initial treatment had no effect on the rate of recurrence. *No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study. tOrthopedic Department, Gavle Hospital, 801 87 Gavle, Sweden. ^Orthopedic Department, Regionsjukhuset, 701 85 Orebro, Sweden. SOrthopedic Department, Malmo Allmanna sjukhus, 214 01 Malmo, Sweden. 10rthopedic Department, Karlstad Hospital, 651 85 Karlstad, Sweden. tOrthopedic Department, University Hospital, 581 85 Linkoping, Sweden. **Orthopedic Department, Falun Hospital, 791 82 Falun, Sweden. Radiographs, made for 185 shoulders at the time of the primary dislocation, demonstrated an evident Hermodsson (Hill-Sachs) lesion in ninety-nine shoulders (54 per cent); this finding was associated with a significantly worse prognosis with regard to recurrence than was no evident lesion (p < 0.04). Radiographs made for 208 shoulders at the tenyear follow-up examination were evaluated for postdislocation 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. We previously described the two and five-year results of treatment of primary anterior dislocation in 257 shoulders (255 patients). The same cohort constitutes the basis for the present study, with the duration of follow-up extended to ten years for 247 shoulders (245 patients). (Nine patients died and one was lost to follow-up.) This prospective clinical and radiographic study was performed to provide additional information with regard to the results of treatment of primary anterior dislocation of the shoulder in younger patients (those twelve to forty years old). Materials and Methods In 1977, one of us (L. H.) initiated a prospective study to evaluate the results of treatment of primary anterior dislocation of the glenohumeral joint in patients who were forty years old or less. Twenty-seven Swedish hospitals participated in the study. After reduction with manipulation, the dislocations were treated either with immobilization with the arm tied with a bandage to the torso for three to four weeks (group 1) or with the limb held in a sling until the patient was comfortable (group 2). At the larger institutions, the patients were assigned randomly to these two groups on the basis of the date of the injury. At each of the smaller institutions, they were assigned randomly to only one method of treatment. Early in the study, a third group (group 3) was established; this group included twenty patients who could not follow the assigned protocol, ten who had received inaccurate instructions, two who were alcoholics, three who had had reduction of the dislocation more than twenty-four hours VOL. 78 -A , NO. 11, NOVEMBER 1996 1677 1678 L. HOVELIUS, B. G. AUGUST1NI, H. FREDIN,