Recurrent anterior shoulder dislocation

Disease Description (Causes and Symptoms)

• Definition summary: A condition in which the humeral head repeatedly dislocates anteriorly (recurrent anterior shoulder dislocation). It occurs when joint stability decreases due to damage to or laxity of the labrum (cartilage), ligaments, or joint capsule surrounding the joint.
• Main causes and pathophysiology:
  • Initial anterior dislocation caused by trauma (such as falling or having the arm pulled) → injury to the labrum (Bankart lesion), joint capsule and ligaments, or bone loss (anterior glenoid defect, Hill‑Sachs lesion).
  • The younger the patient is at the time of the initial episode, particularly in their teens or young adulthood, the higher the risk of recurrence. In people aged 50–60 or older, associated fractures or rotator cuff tears are more likely than recurrent dislocation.
• Main symptoms:
  • Difference in arm length (deformity due to malposition), severe pain (initially), swelling and bruising, and restricted joint movement.
  • A feeling of instability or apprehension that the shoulder may dislocate again when rotating the arm outward (external rotation) or when raising the arm to 90° and rotating it backward (the position used to pitch a baseball).
  • With repeated dislocations, the shoulder may dislocate even during light movements or while sleeping.
• Warning symptoms (urgent signs): Loss of the pulse in the wrist or arm, persistent loss of sensation, or decreased muscle strength (suggesting nerve or vascular injury).

Treatment Methods

• Acute phase (immediately after dislocation)
  • Closed reduction should be performed as soon as possible. If reduction is delayed, muscle spasms may make reduction difficult.
  • A neurovascular (pulse, sensation, and muscle strength) reassessment after reduction is essential.
  • Control pain with analgesics (NSAIDs, and short-term opioids if necessary).
  • Imaging tests: plain X‑ray (to confirm dislocation and check for associated fractures) → MRI if necessary (to assess the labrum, ligaments, and soft tissue), and CT (to assess bone loss).
• Conservative treatment
  • Immobilize the arm with a sling or similar device after reduction (generally recommended for 2–3 weeks; adjusted according to the patient’s age and severity of injury).
  • Gradual rehabilitation: initially, pain control and gentle joint and muscle exercises → gradual recovery of ROM → strengthening (particularly focusing on the levator scapulae and rotator cuff).
  • Return to sports should be decided after stability has been restored and sufficient strength and function have returned.
• Surgical treatment (when dislocation is recurrent or structural damage is clearly present)
  • Labral repair (arthroscopic Bankart repair): the most common procedure for typical anterior instability.
  • Latarjet (bone grafting) or open bone fixation: when there is substantial anterior glenoid defect (bone loss).
  • Capsular shift or other stabilization procedures.
  • Postoperative rehabilitation: light exercise is usually possible starting 3 months after surgery (e.g., swimming at 3 months; throwing activities are recommended at approximately 6 months—timing varies depending on the patient’s condition).
• Prevention and management of complications
  • Increased risk of nerve injury (particularly axillary nerve injury), articular cartilage damage, chronic instability, and arthritis due to surgery or repeated dislocations.
• Lifestyle management and precautions
  • Do not attempt forceful reduction during the acute phase (refer to a medical professional).
  • Follow the rehabilitation program diligently to restore strength and joint stability.
  • Consult about the need for surgical stabilization when returning to high-risk sports (throwing or contact sports).

Checklist Before an Outpatient Visit (Including Examples of Items to Bring and Questions)

• Items to bring
  • A list of currently used medications (including anticoagulants) and a history of allergies.
  • The time of the accident and treatment (exact time), and records of initial treatment (whether reduction was performed and emergency-room treatment).
  • Original copies or CDs of previous imaging studies (X‑ray, MRI, or CT), if available.
  • Notes recording the frequency and type of symptoms (when and in what position the shoulder dislocates, whether there is pain, and changes in sensation or movement).
  • Information about occupation and activity level (type of sport and experience) and the primarily used arm (dominant arm).
• Key information to tell the doctor during the outpatient visit
  • Age at first occurrence and number of episodes (timing of the first dislocation and frequency of recurrence).
  • Mechanism of dislocation (fall, external force, etc.) and associated symptoms (numbness or vascular symptoms).
• Examples of questions to prepare before the outpatient visit (questions for the patient to ask)
  • "Has sensation in my arm remained since the last reduction?"
  • "I brought the imaging studies (CT/MRI) taken previously. Please check whether there is any bone loss."

Examples of General Questions to Ask the Doctor

• How likely is this condition to stabilize with nonsurgical treatment?
• If surgery is recommended, which surgical method do you recommend, and what are its advantages and disadvantages?
• What are the risk of recurrence and the prognosis after surgical and nonsurgical treatment?
• How long will rehabilitation take, and when can I expect to return to daily activities, work, and sports?
• What are the risks of surgical complications (infection, nerve injury, joint stiffness, etc.), and how are they managed?

Examples of Condition-Specific Questions

• I am a young athlete. When would you recommend surgery to reduce the risk of recurrence after the first dislocation?
• A glenoid defect (or Hill‑Sachs lesion) was found on CT/MRI. Which surgical options should be considered depending on its size?

(Note: According to the clinical information provided, reduction should be performed as soon as possible, immobilization and rehabilitation for 2–3 weeks after reduction are recommended, and postoperative rehabilitation generally aims for light exercise starting at 3 months and throwing activities at approximately 6 months.)