Management of first‐time shoulder dislocations: A survey of sport medicine physician perceptions

TL;DR

This study explores how sports medicine physicians worldwide manage first-time shoulder dislocations, highlighting treatment trends and the influence of personal experience versus guidelines.

Contribution

The study identifies global management strategies for first-time shoulder dislocations and factors influencing treatment choices among sports medicine physicians.

Findings

Immobilization followed by physical therapy is the most common management strategy for FTSDs.

Geographic differences exist in imaging preferences, with North Americans favoring radiography and Europeans preferring MRI.

Surgical decisions are most influenced by bony injury, patient age, and sports participation.

Abstract

The purpose of this study was to survey sport medicine physicians globally to evaluate how they treat patients with a first‐time shoulder dislocation (FTSD), specifically exploring the most common management strategies, the evidence or guidelines guiding these decisions, and the influence of demographic factors on these strategies and perceptions.

A cross‐sectional survey was developed and distributed globally from 14 October 2024 through 22 March 2025 to sport medicine physicians involved in the management of shoulder instability. The questionnaire assessed respondents' demographics, preferred management strategies for FTSDs, and perceptions regarding the evidence supporting various treatment approaches. Descriptive statistics were used to summarize the data, and regression analyses were conducted to explore associations between demographic variables and management practices and perceptions.

A total of 326 respondents completed the survey, predominantly fellowship‐trained orthopaedic surgeons from North America and Europe. The most common management strategy was immobilization for 1–3 weeks, followed by physical therapy incorporating strengthening and proprioception exercises. Imaging practices varied geographically, with North American respondents preferring radiographic assessment and Europeans favouring magnetic resonance imaging at initial presentation. Surgical management or consideration for surgical intervention was most influenced by the presence of bony injury (81%), patient age (69%) and participation in contact sports (63%). Younger physicians favoured arthroscopic stabilization, while older respondents leaned towards open approaches.

While variability in the management of FTSDs persists, the results of this study demonstrate emerging trends towards consensus on critical factors for consideration in the management of such patients. However, despite the prevalence of guideline‐based management, a substantial proportion of respondents, particularly those over 55 years old, continue to base their practices on personal experience and training rather than standardized protocols. The development and dissemination of evidence‐based guidelines remain essential to standardize clinical practices and optimize patient outcomes.

Level IV.

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