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

Knee Surgery, Sports Traumatology, Arthroscopy volume 24, pages 330–342 (2016)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

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Authors and Affiliations

  1. Orthopedic Department, Gävle Hospital, Lasarettsvägen 1, SE-801 88, Gävle, Sweden

    Lennart Hovelius

  2. Elisabethsjukhuset, Geijersgatan 10, SE-752 26, Uppsala, Sweden

    Hans Rahme

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  1. Lennart Hovelius
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Correspondence to Lennart Hovelius.

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Hovelius, L., Rahme, H. Primary anterior dislocation of the shoulder: long-term prognosis at the age of 40 years or younger. Knee Surg Sports Traumatol Arthrosc 24, 330–342 (2016). https://doi.org/10.1007/s00167-015-3980-2

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Keyword

  • Shoulder
  • Dislocation
  • Long-term prognosis
  • Dislocation arthropathy