Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 2, pp 330–342 | Cite as

Primary anterior dislocation of the shoulder: long-term prognosis at the age of 40 years or younger

  • Lennart Hovelius
  • Hans Rahme



We describe the long-term prognosis in 257 first-time anterior shoulder dislocations (255 patients, aged 12–40 years) registered at 27 Swedish emergency units between 1978 and 1979.


Half the shoulders were immobilised for 3–4 weeks after repositioning. Follow-ups were performed after two (questionnaire), five (questionnaire), 10 (questionnaire and radiology) and 25 (questionnaire and radiology) years in 227 patients (229 shoulders). Twenty-eight patients died during the 25 years of observation.


Early movement or immobilisation after the primary dislocation resulted in the same long-term prognosis. Recurrences increased up to 10 years of follow-up, but, after 25 years, 29 % of the shoulders with ≥2 recurrences appeared to have stabilised over time. Arthropathy increased from 9 % moderate to severe and 11 % mild at 10 years, to 34 % moderate to severe and 27 % mild after 25 years. Alcoholics had a poorer prognosis with respect to dislocation arthropathy (P < 0.001). Age <25 years and/or bilateral instability represent a poorer prognosis, where stabilising surgery is necessary in every second shoulder. Fracture of the greater tuberosity means a good prognosis, and we have found no evidence that athletic activity, gender, a Hill–Sachs lesion and minor rim fractures had any prognostic impact. During the 25 years in which these patients were followed, 28/255 died (11 %), representing a mortality rate (SMR) that was more than double that of the general Swedish population (P < 0.001).


Almost half of all first-time dislocations at the age of <25 years will have stabilising surgery and two-thirds will develop different stages of arthropathy within 25 years.


Shoulder Dislocation Long-term prognosis Dislocation arthropathy 


  1. 1.
    Arciero RA, Wheeler JH, Ryan JB, McBride JT (1994) Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 22:589–594CrossRefPubMedGoogle Scholar
  2. 2.
    Aronen JG, Regan K (1994) Decreasing the incidence of recurrence of first time anterior shoulder dislocations with rehabilitation. Am J Sports Med 12:283–291CrossRefGoogle Scholar
  3. 3.
    Atroshi I, Gummesson C, Andersson B, Dahlgren E, Johansson A (2000) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire. Reliability and validity of the Swedish version evaluated in 176 patients. Acta Ortop Scand 71:613–618CrossRefGoogle Scholar
  4. 4.
    Biebl R (1935) Behandlung und Prognose frischer Schulterluxationen. Arch Orthop Trauma Surg 1:381–396Google Scholar
  5. 5.
    Boileau P, Mercier N, Old J (2010) Arthroscopic Bankart–Bristow–Latarjet (2B3) procedure: how to do it and tricks to make it easier and safe. Orthop Clin North Am 41:381–392CrossRefPubMedGoogle Scholar
  6. 6.
    Buss DD, Lynch GP, Meyer CP, Huber SM, Freehill MQ (2004) Nonoperative management for in-season athletes with anterior shoulder instability. Am J Sports Med 32:1430–1433CrossRefPubMedGoogle Scholar
  7. 7.
    DeBerardino TM, Arciero RA, Taylor DC, Uhorchak JM (2001) Prospective evaluation of arthroscopic stabilization of acute, initial anterior shoulder dislocations in young athletes. 2–5-year follow-up. Am J Sports Med 29:586–592PubMedGoogle Scholar
  8. 8.
    Eden R (1918) Zur operation der habituellen schulter luxation unter Mitteilung eines neuen Verfahrens bei Abriss am inneren Pfannenrande. Deutsche Z Chir 144:269–280CrossRefGoogle Scholar
  9. 9.
    Finestone A, Milgrom C, Radeva-Petrova DR, Rath E, Barchilon V, Beyth S, Jaber S, Safran O (2009) Bracing in external rotation for traumatic anterior dislocation of the shoulder. J Bone Joint Surg 91-B:918–921CrossRefGoogle Scholar
  10. 10.
    Flury MP, Goldhan J, Holzmann P, Simmen BR (2007) Does weber’s rotation osteotomy induce degenerative joint disease at the shoulder in the long run? J Shoulder Elbow Surg 6:735–741CrossRefGoogle Scholar
  11. 11.
    Gordins V, Hovelius L, Sandström B, Rahme H, Bergström U (2015) Risk of arthropathy after the Bristow-Latarjet repair: a radiologic and clinical 33–35 years of follow-up of thirty-one shoulders. J Shoulder Elbow Surg 24:691–699CrossRefPubMedGoogle Scholar
  12. 12.
    Henry JH, Genung JA (1982) Natural history of glenohumeral dislocation—revisited. Am J Sports Med 10:135–137CrossRefPubMedGoogle Scholar
  13. 13.
    Hermodsson IR (1934) Studien über die traumatischen und habituellen schulterverrenkungen nach vorn und nach unten. Acta Radiol (Stockholm) Suppl 20:1–173Google Scholar
  14. 14.
    Hill HA, Sachs MD (1940) The grooved defect of the humeral head. A frequently unrecognized complication of dislocations of the shoulder joint. Radiology 35:690–700CrossRefGoogle Scholar
  15. 15.
    Hoelen M, Burgers A, Rozing P (1990) Prognosis of primary anterior shoulder dislocation in young adults. Arch Orthop Trauma Surg 110:51–54CrossRefPubMedGoogle Scholar
  16. 16.
    Hovelius L (1978) Shoulder dislocation in Swedish ice-hockey players. Am J Sports Med 6:373–377CrossRefPubMedGoogle Scholar
  17. 17.
    Hovelius L (1982) Anterior dislocation of the shoulder. A clinical study on incidence, prognosis and operative treatment with the Bristow-Latarjet procedure. Thesis 139, Linköping University, Linköping, SwedenGoogle Scholar
  18. 18.
    Hovelius L (1982) Incidence of shoulder dislocation in Sweden. Clin Orthop Relat Res 166:127–131PubMedGoogle Scholar
  19. 19.
    Hovelius L, Eriksson K, Fredin H, Hagberg G, Hussenius Å, Lind B, Thorling J, Weckström J (1983) Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment. J Bone Joint Surg 65A:343–349Google Scholar
  20. 20.
    Hovelius L, Lind B, Thorling J (1983) Primary dislocation of the shoulder. Factors affecting the 2-year prognosis. Clin Orthop Relat Res 176:181–185PubMedGoogle Scholar
  21. 21.
    Hovelius L, Åkermark C, Albrektsson B, Berg E, Körner L, Lundberg B, Wredmark T (1983) Bristow-Latarjet procedure for recurrent anterior dislocation of the shoulder. A 2–5 year follow-up study on the results of 112 cases. Acta Orthop Scand 54:284–290CrossRefPubMedGoogle Scholar
  22. 22.
    Hovelius L (1987) Anterior dislocation of the shoulder in teen-agers and young adults. 5-year prognosis. J Bone Joint Surg Am 69:393–399PubMedGoogle Scholar
  23. 23.
    Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J (1996) Primary anterior dislocation of the shoulder in young patients. A 10-year prospective study. J Bone Joint Surg Am 78:1677–1684PubMedGoogle Scholar
  24. 24.
    Hovelius L, Sandström B, Saebö M (2006) One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder. Study II. The evolution of dislocation arthropathy. J Shoulder Elbow Surg 15:279–289CrossRefPubMedGoogle Scholar
  25. 25.
    Hovelius L, Nilsson J-Å, Nordqvist A (2007) Increased mortality after anterior shoulder dislocation. 255 patients aged 12–40 years followed for 25 years. Acta Orthop Scand 78:822–826CrossRefGoogle Scholar
  26. 26.
    Hovelius L, Saebö M (2008) Documentation of dislocation arthropathy of the shoulder. Area index”; A better method to objectify the humeral osteophyte? J Shoulder Elbow Surg 17:197–201CrossRefPubMedGoogle Scholar
  27. 27.
    Hovelius L, Olofsson A, Sandström B, Augustini B-G, Krantz L, Fredin H et al (2008) Nonoperative treatment of primary anterior shoulder dislocation in patients 40 years of age or younger. A prospective 25 year follow-up. J Bone Joint Surg Am 90A:945–952CrossRefGoogle Scholar
  28. 28.
    Hovelius L, Saeboe M, Neer Award 2008 (2009) Arthropathy after primary anterior shoulder dislocation, 223 shoulders prospectively followed for 25 years. J Shoulder Elbow Surg 18:339–347CrossRefPubMedGoogle Scholar
  29. 29.
    Hudak PL, Amdi PC, Bombardier C (1996) Development of an Upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). Am J Ind Med 29:602–608CrossRefPubMedGoogle Scholar
  30. 30.
    Hybbinette S (1932) De la transplantation d’un fragment osseux pour rémédier aux luxations récidivantes de l´épaule; constations et résultats opératoires. Acta Chir Scand 71:411–443Google Scholar
  31. 31.
    Itoi E, Hatakeyama Y, Kidr T, Sato T, Minagawa H, Wakabayashi I, Kobayashi M (2003) A new method of immobilization after traumatic anterior dislocation of the shoulder. A preliminary study. J Shoulder Elbow Surg 12:413–415CrossRefPubMedGoogle Scholar
  32. 32.
    Kazar E, Relovszky E (1969) Prognosis of primary dislocation of the shoulder. Acta Orthop Scand 40:216–224CrossRefPubMedGoogle Scholar
  33. 33.
    Kirkley A, Werstine R, Ratjek A, Griffin S (2005) Prospective randomized clinical trial comparing the effective of immediate arthroscopic stabilization versus immobilization rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation. Arthroscopy 21:55–63CrossRefPubMedGoogle Scholar
  34. 34.
    Liavaag S, Brox JI, Pripp AH, Enger M, Soldal LA, Svenningsen S (2011) Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence. J Bone Joint Surg Am 93:1–8CrossRefGoogle Scholar
  35. 35.
    McLaughlin HL, MacLellan DI (1967) Recurrent anterior dislocation of the shoulder. II. A comparative study. J Trauma 7:191–201CrossRefPubMedGoogle Scholar
  36. 36.
    Malgaigne JF (1855) Traité des fractures et des Luxations. J B, Ballière, ParisGoogle Scholar
  37. 37.
    Milgrom C, Mann G, Finestone A (1998) A prevalence study of recurrent shoulder dislocation in young adults. J Shoulder Elbow Surg 6:621–624CrossRefGoogle Scholar
  38. 38.
    Nordqvist A, Petersson CJ (1995) Shoulder girdle injuries in an urban population. J Shoulder Elbow Surg 4:107–112CrossRefPubMedGoogle Scholar
  39. 39.
    Olsson C, Nordquist A, Pettersson C (2003) Increased mortality after fracture of the surgical neck of the humerus. A case-control study of 253 patients with a 12-year follow-up. Acta Orthop Scand 74(6):709–712CrossRefGoogle Scholar
  40. 40.
    Pollock R, Flatow E (1996) Classification and evaluation. In: Bigliani L (ed) The unstable shoulder by the American Academy of Orthopaedic Surgeons: ISBN 0-89203-120-4 pp 25–36Google Scholar
  41. 41.
    Robinson M, Howes J, Murdock H, Will E, Graham C (2006) Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am 88:2326–2336CrossRefPubMedGoogle Scholar
  42. 42.
    Rowe C (1956) Prognosis in dislocation of the shoulder. J Bone Joint Surg Am 38:957–977PubMedGoogle Scholar
  43. 43.
    Rowe C, Patel D, Southmayd WW (1978) The Bankart procedure. A long term end-result study. J Bone Joint Surg Am 65:1–16Google Scholar
  44. 44.
    Rowe C (1988) Dislocations of the shoulder. In: Rowe C (ed) The shoulder. Churchill Livingstone, New York, pp 165–291Google Scholar
  45. 45.
    Ryf C, Matter P (1993) Erstmalige traumatische Schulterluxation. Prospektive Studie. Z Unfall Chir Versicherungsmed Suppl 1:204–212Google Scholar
  46. 46.
    Samilson R, Prieto V (1983) Dislocation arthropathy of the shoulder. J Bone Joint Surg Am 65:456–460PubMedGoogle Scholar
  47. 47.
    Simonet WT, Cofield RH (1985) Prognosis in anterior shoulder dislocation. Am J Sports Med 12:19–24CrossRefGoogle Scholar
  48. 48.
    te Slaa RL, Brand R, Marti RK (2003) A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young. A 5-year follow-up study. J Shoulder Elbow Surg 12:529–534CrossRefGoogle Scholar
  49. 49.
    Thomas S, Matsen F (1989) An approach to the repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability. J Bone Joint Surg Am 71:506–513PubMedGoogle Scholar
  50. 50.
    Wintzell G, Haglund-Åkerlind Y, Nowak J, Larsson S (1999) Arthroscopic lavage compared with nonoperative treatment for traumatic anterior shoulder dislocation. A 2 year follow-up of a prospective randomized study. J Shoulder Elbow Surg 8:399–402CrossRefPubMedGoogle Scholar

Copyright information

© European Union 2016

Authors and Affiliations

  1. 1.Orthopedic DepartmentGävle HospitalGävleSweden
  2. 2.ElisabethsjukhusetUppsalaSweden

Personalised recommendations