Management of First-Time Shoulder Dislocation in the Contact Athlete.pdfVIP

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Management of First-Time Shoulder Dislocation in the Contact Athlete.pdf

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Management of First-Time Shoulder Dislocation in the Contact Athlete.pdf

Management of First-Time Shoulder Dislocation in the Contact Athlete Michael A. Donohue, MD,* Alaina M. Brelin, MD,* and Lance E. LeClere, MD? First-time anterior shoulder dislocation in the contact and collision athlete represents a treatment challenge for the orthopaedic surgeon, especially if the athlete is in season. Treatment starts with immediate on-?eld management and transitions to a thorough history and physical examination off the ?eld. Plain ?lm and advanced imaging then help to guide the orthopaedic surgeon in the shared decision-making process. The decision to return an athlete to play in the same season carries a high risk of repeat dislocation or instability, and the surgeon must not only counsel the athlete on this but also protect the athlete from returning before safe to do so. The optimal surgical treatment—arthroscopic vs open vs bone block— remains controversial as well. Historically, open Bankart repair and stabilization has shown a decreased risk of recurrence compared with arthroscopic, but the current literature has support for either options. Additionally, some authors now advocate open osseous augmentation procedures as having the lowest recurrence rates. This article explores the decisionmaking process from ?rst clinic contact through clinical management. Oper Tech Sports Med 24:236-241 Published by Elsevier Inc. KEYWORDS shoulder, dislocation, contact, collision, athlete, management Introduction The glenohumeral joint is one of the most commonly dislocated joints in the body with an overall incidence rate of 23.9 per 100,000 person-years.1,2 Dislocations are most commonly anterior and result from a traumatic event. The inherent instability of the joint is owing to minimal bony restraints and reliance on soft tissue stabilizers.3 Nevertheless, anatomical features are not the only contributors to the high rate of instability injuries. Several patient demographic factors have been identi?ed as increasing the risk for injury and recurrent ev