Acute first-time shoulder dislocation

The shoulder is the most frequently dislocated joint in the human body, anterior dislocation being the most common variant. For stability, the glenohumeral joint relies on both static and dynamic restraints and dislocation often results in damage to these restraints. For example, antero-inferior capsulolabral complex damage often occurs as a result of anterior dislocations (a ‘Bankart lesion’) and impaction of the dislocated humeral head against the rim of the antero-inferior glenoid can result in a postero-lateral humeral head defect (the ‘Hill–Sachs lesion’). Prompt reduction of the dislocation is necessary to relieve pain and reduce the risk of complications, and should be performed as soon as possible in the emergency department, or in the operating theatre in cases with an associated shoulder fracture. Subsequent treatment of the dislocation is aimed at restoring function of the shoulder and minimizing the risk of recurrent instability. Non-surgical treatment is the conventional method of management after a successful closed reduction and involves immobilization of the affected shoulder for between 3 and 6 weeks coupled with, or followed by, physiotherapy. Young age at the time of the first anterior dislocation is associated with a high rate of recurrence and there is growing evidence that primary arthroscopic stabilization significantly reduces the rate of recurrent instability. This article outlines the current management strategies for dealing with this acute traumatic injury.