Treating the initial anterior shoulder dislocation--an evidence-based medicine approach

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Evidence-Based Medicine

Background:

• Anterior shoulder dislocation is a common injury.
• Optimal treatment strategies require clear evidence-based guidelines.

Purpose of the Study:

• To present the best available evidence for managing initial anterior shoulder dislocations.
• To guide clinical decision-making for effective treatment and recovery.

Main Methods:

• Systematic review of existing literature.
• Analysis of evidence levels (Level 1 to 5) for various treatment modalities.

Main Results:

• No definitive best method for shoulder reduction identified; recommendations based on low-level evidence.
• Intra-articular lidocaine offers comparable reduction success to IV sedation with fewer complications and shorter ER times (Level 1).
• Postreduction immobilization in external rotation may decrease recurrence (Level 2), while internal rotation does not (Level 1).
• Arthroscopic surgery significantly lowers recurrence rates compared to nonoperative management (Level 1).
• Limited data exist for safe return-to-play criteria; expert opinion suggests near-normal strength/motion and sport-specific activity readiness, with ongoing recurrence risk.

Conclusions:

• Intra-articular lidocaine is a favorable option for shoulder dislocation reduction.
• Arthroscopic surgery shows promise in reducing recurrence after dislocation.
• Further research is needed to establish clear return-to-play guidelines for athletes.