Best treatment for dislocated shoulder unclear

NEW YORK (Reuters Health) - When an athlete dislocates a shoulder, the jury is still out on the best mode of treatment, the authors of a new research review conclude.

Shoulder dislocation occurs when the top of the upper arm bone detaches from the socket in the shoulder bone. Once this injury occurs, a person is at greater risk for having it again.

In the September-October issue of Current Sports Medicine Reports, Drs. Charles L. Cox and John E. Kuhn of Vanderbilt University Medical Center in Nashville, Tennessee reviewed the scientific literature on both surgical and nonsurgical treatment of shoulder dislocation in an attempt to identify how best to treat it.

There are more than 24 published techniques for reducing shoulder dislocations, or putting the arm bone back in the shoulder socket without surgery, Cox and Kuhn note.

When the reduction is done early, before muscles begin to spasm, giving the athlete pain medication beforehand isn't necessary, they add. But if the reduction is done later, data shows, injecting local anesthetic into the joint is just as effective as giving a patient intravenous sedation, and produces fewer complications, according to the researchers.

Because no reduction technique has been shown to be better than another, the researchers say, "the treating clinician should learn two to three techniques and gain experience with each."

In about half of cases where an athlete has non-surgical reduction of a dislocated shoulder, Cox and Kuhn found, the injury will occur again. Immobilizing the joint so that the arm can't rotate internally can help patients be more comfortable, but will not affect recurrence risk, they add; however, preventing external rotation of the arm as well as internal rotation as the joint heals may indeed prevent recurrence.

Several studies show that reinjury is less likely when shoulder dislocation is treated with surgery, the researchers found, although the best surgical approach remains unclear.

At present, they advise, it can be concluded that patients who undergo arthroscopic repair using sutures or staples to hold the joint in place will have a higher rate of recurrence than patients who undergo open surgery, while arthroscopy using suture anchors -- devices that fix the sutures to bone -- has a recurrence rate similar to that of open surgery.

Based on the review, Cox and Kuhn conclude, the decision on whether a shoulder dislocation should be treated with surgery depends on a patient's likelihood of having a recurrence of the injury, when in the season the athlete's injury occurs, and what the patient prefers.

SOURCE: Current Sports Medicine Reports, September-October 2008.