Treatment of chronic anterior shoulder dislocations
Limited goal surgery
BACKGROUND: Chronic anterior shoulder dislocations are encountered relatively frequently in KwaZulu-Natal, South Africa. Various surgical options exist to treat these injuries; however, the reported results of such interventions are not uniformly favourable. There remains the opinion that such cases are perhaps best treated with 'skilful neglect'.
METHODS: We present a combined case series of chronic anterior shoulder dislocations treated surgically. Patients were identified retrospectively using departmental databases and their case files, available X-rays, CT scans and MRI scans were reviewed. Surgical outcome was assessed using range of movement, change in pain severity, the Oxford Shoulder Instability Score, the Rowe and Zarins score, as well as a patient satisfaction score.
RESULTS: Twenty-six patients were included in the study. The average duration of dislocation was 9 months (range 2 weeks to 7 years). The most common reason for chronicity was delayed presentation to clinic or hospital (nine patients). A Hill-Sachs lesion was present in 20 patients, and a pseudo-glenoid was often encountered in dislocations present for more than 4 weeks (16 of 23 patients). Three supraspinatus ruptures and four biceps tears were encountered, while neurological injury was uncommon (two patients). Surgical treatment included open reduction (one patient), open reduction and Latarjet (15 patients), hemi-arthroplasty (two patients), hemi-arthroplasty and Latarjet (three patients) and reverse total shoulder arthroplasty (five patients). Eighteen patients were available for clinical review. Regardless of the type of surgery done, postoperative range of motion and surgical outcome scores were generally poor. Despite this, most patients (16 of 18 patients) were satisfied with their outcome due to reduction in pain. Two patients were dissatisfied, due to re-dislocation.
CONCLUSION: Surgical treatment of chronic anterior shoulder dislocation results in limited improvement in range of motion and overall shoulder function. However, high patient satisfaction levels and significant improvement in pain levels can be expected. Patients should be counselled pre-operatively regarding this 'limited goal surgery'.