Operative versus nonoperative treatment of acute shoulder dislocation in the athlete

The purpose of this manuscript is to review evaluation and treatment techniques in patients with glenohumeral instability with specific attention to treatment of anterior shoulder dislocation. Scrutiny of the best available evidence reveals that: 1) there is little quality evidence to advocate one reduction technique over another, 2) premedication with intra-articular lidocaine is preferred over intravenous narcotics and benzodiazepine, 3) recurrence rates are age related and may be associated with higher energy injuries, but other predictors of recurrence are not clear, 4) post-reduction immobilization in internal rotation does not affect recurrence, 5) post-reduction immobilization in external rotation appears to decrease recurrence, 6) arthroscopic or open repair decreases recurrence compared with nonoperative treatment, 7) recurrence after arthroscopic repair using transglenoid sutures or staples is higher compared with open repair, 8) recurrence after arthroscopic repair with suture anchors is comparable with open repair in treatment of isolated Bankart lesions, and 9) further research is needed to clarify risk factors that predict recurrence in order to assist the clinician in deciding upon operative versus nonoperative treatment.