Outcomes of Chronic Anterior Shoulder Dislocation Treatment: A Systematic Review

TL;DR

This systematic review examines treatment outcomes for chronic anterior shoulder dislocation, a rare condition with limited evidence-based guidance.

Contribution

The study provides a systematic review and treatment algorithm for managing chronic anterior shoulder dislocations.

Findings

Operative treatment showed better functional outcomes compared to nonoperative approaches.

There is a lack of Level 1 evidence and no definitive treatment superiority in the literature.

Chronic shoulder dislocation management remains understudied compared to acute instability.

Abstract

Chronic anterior shoulder dislocation, defined as a glenohumeral dislocation that remains unreduced for at least three weeks, is a rare yet debilitating condition marked by progressive soft tissue contractures, bone loss, and altered joint stability. This review aims to provide a systematic review of the literature and a proposed treatment algorithm for this injury pattern.

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. We performed a search of PubMed, Excerpta Medica database (Embase), Google Scholar, and Cochrane Database of Systematic Reviews electronic databases to retrieve articles published from January 1974 to December 2024. We included studies of patients treated both nonoperatively and operatively for chronic or neglected anterior shoulder dislocations, defined as lasting three weeks or longer. The initial search result provided 427 studies to be assessed. Seventeen papers were included in this systematic review following meticulous screening. There were 242 patients, consisting of 100 males and 142 females, managed for chronic anterior shoulder dislocation across all of the studies, with a weighted mean age of 58.4 ± 13 years. This study has three therapy groups: an untreated cohort, a closed reduction percutaneous pinning cohort, and an operative cohort, by way of open reduction and bone block procedures, soft tissue procedures, or arthroplasty. The untreated group and the closed reduction percutaneous pinning group had lower complication rates but worse functional results compared to the operated group of patients.

Management of chronic anterior shoulder dislocations has been overlooked as compared to management of acute shoulder instability, with no definitive guidance for the orthopedic community to aid the aging population affected by this devastating condition. Despite the procedures outlined in the literature, none have demonstrated superiority in terms of positive outcomes. There is a deficiency of Level 1 studies regarding this condition.

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