Surgical versus non-surgical treatment for acute anterior shoulder dislocation

Hdl Handle:
http://hdl.handle.net/10149/92042
Title:
Surgical versus non-surgical treatment for acute anterior shoulder dislocation
Authors:
Handoll, H. H. G. (Helen); Al-Maiyah, M. A. (Mohammed)
Affiliation:
University of Teesside
Citation:
Handoll, H. H. G., Al-Maiyah, M. A. and Rangan, A. (2004) 'Surgical versus non-surgical treatment for acute anterior shoulder dislocation', The Cochrane Database of Systematic Reviews; 1
Publisher:
Wiley-Blackwell
Journal:
The Cochrane Database of Systematic Reviews
Issue Date:
2004
URI:
http://hdl.handle.net/10149/92042
DOI:
10.1002/14651858.CD004325.pub2
Abstract:
Background: Acute anterior dislocation is the commonest type of shoulder dislocation. Subsequently, the shoulder is less stable and more susceptible to redislocation, especially in active young adults. Objectives: To compare surgical versus non-surgical treatment for acute anterior dislocation of the shoulder. Search strategy: The authors searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (14 August 2009), The Cochrane Library (2009, Issue 3), MEDLINE (1950 to August 2009), EMBASE (1980 to August 2009), trial registration databases, conference proceedings and reference lists of articles. Selection criteria: Randomised or quasi-randomised controlled trials comparing surgical with conservative interventions. Data collection and analysis: Both authors independently selected trials, assessed methodological quality and extracted data. Where appropriate, results were pooled. Main results: The four included studies involved 163 participants, mainly active young adult males. All had had a primary (first time) traumatic anterior shoulder dislocation. Methodological quality was variable. All participants of one trial returned to active military duty. Two trials respectively reported similar numbers with reduced sports participation or non return to previous activities. The other, an inadequately reported, trial found significantly fewer people in the surgical group failed to attain previous levels of sports activity. Pooled results from all four trials showed that subsequent instability, either redislocation or subluxation, was statistically significantly less frequent in the surgical group (risk ratio 0.25, 95% confidence interval 0.14 to 0.44). This result remained statistically significant (risk ratio 0.32, 95% confidence interval 0.17 to 0.59) for the three trials reported in full. Half (17/33) of the conservatively treated patients with shoulder instability in these three trials opted for subsequent surgery. Different, mainly patient rated, functional assessment measures for the shoulder were recorded in these trials. The results were more favourable, usually statistically significantly so, in those treated surgically. The only complication reported was a septic joint in a surgically treated patient. There was no information on shoulder pain, long-term complications or resource use. Authors' conclusions: Limited evidence supports primary surgery for young adults, usually male, engaged in highly demanding physical activities who have sustained their first acute traumatic shoulder dislocation. There is no evidence available to determine which treatment is better for other patient groups. Sufficiently powered, good quality, well reported randomised trials are required that compare surgical treatment with conservative treatment for these injuries, including in people at lower risk of recurrence. Long-term surveillance of outcome, looking at shoulder disorders including osteoarthritis is also required.
Type:
Article
Language:
en
Keywords:
surgical; non-surgical; treatment; acute anterior shoulder dislocation; male; adults; shoulder dislocation
ISSN:
1469-493X
Rights:
In return for the grant of the licence, the author(s) shall have the following rights: The right to post the review as an electonic file on the author's own website and/or the author's institution's website, using the PDF version of the Review available in the Cochrane Database of Systematic Reviews. [Advice from CEO of The Cochrane Collaboration]
Citation Count:
0 [Scopus, 12/02/2010]

Full metadata record

DC FieldValue Language
dc.contributor.authorHandoll, H. H. G. (Helen)en
dc.contributor.authorAl-Maiyah, M. A. (Mohammed)en
dc.date.accessioned2010-02-12T16:28:23Z-
dc.date.available2010-02-12T16:28:23Z-
dc.date.issued2004-
dc.identifier.citationThe Cochrane Database of Systematic Reviews; 1en
dc.identifier.issn1469-493X-
dc.identifier.doi10.1002/14651858.CD004325.pub2-
dc.identifier.urihttp://hdl.handle.net/10149/92042-
dc.description.abstractBackground: Acute anterior dislocation is the commonest type of shoulder dislocation. Subsequently, the shoulder is less stable and more susceptible to redislocation, especially in active young adults. Objectives: To compare surgical versus non-surgical treatment for acute anterior dislocation of the shoulder. Search strategy: The authors searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (14 August 2009), The Cochrane Library (2009, Issue 3), MEDLINE (1950 to August 2009), EMBASE (1980 to August 2009), trial registration databases, conference proceedings and reference lists of articles. Selection criteria: Randomised or quasi-randomised controlled trials comparing surgical with conservative interventions. Data collection and analysis: Both authors independently selected trials, assessed methodological quality and extracted data. Where appropriate, results were pooled. Main results: The four included studies involved 163 participants, mainly active young adult males. All had had a primary (first time) traumatic anterior shoulder dislocation. Methodological quality was variable. All participants of one trial returned to active military duty. Two trials respectively reported similar numbers with reduced sports participation or non return to previous activities. The other, an inadequately reported, trial found significantly fewer people in the surgical group failed to attain previous levels of sports activity. Pooled results from all four trials showed that subsequent instability, either redislocation or subluxation, was statistically significantly less frequent in the surgical group (risk ratio 0.25, 95% confidence interval 0.14 to 0.44). This result remained statistically significant (risk ratio 0.32, 95% confidence interval 0.17 to 0.59) for the three trials reported in full. Half (17/33) of the conservatively treated patients with shoulder instability in these three trials opted for subsequent surgery. Different, mainly patient rated, functional assessment measures for the shoulder were recorded in these trials. The results were more favourable, usually statistically significantly so, in those treated surgically. The only complication reported was a septic joint in a surgically treated patient. There was no information on shoulder pain, long-term complications or resource use. Authors' conclusions: Limited evidence supports primary surgery for young adults, usually male, engaged in highly demanding physical activities who have sustained their first acute traumatic shoulder dislocation. There is no evidence available to determine which treatment is better for other patient groups. Sufficiently powered, good quality, well reported randomised trials are required that compare surgical treatment with conservative treatment for these injuries, including in people at lower risk of recurrence. Long-term surveillance of outcome, looking at shoulder disorders including osteoarthritis is also required.en
dc.language.isoenen
dc.publisherWiley-Blackwellen
dc.rightsIn return for the grant of the licence, the author(s) shall have the following rights: The right to post the review as an electonic file on the author's own website and/or the author's institution's website, using the PDF version of the Review available in the Cochrane Database of Systematic Reviews. [Advice from CEO of The Cochrane Collaboration]en
dc.subjectsurgicalen
dc.subjectnon-surgicalen
dc.subjecttreatmenten
dc.subjectacute anterior shoulder dislocationen
dc.subjectmaleen
dc.subjectadultsen
dc.subjectshoulder dislocationen
dc.titleSurgical versus non-surgical treatment for acute anterior shoulder dislocationen
dc.typeArticleen
dc.contributor.departmentUniversity of Teessideen
dc.identifier.journalThe Cochrane Database of Systematic Reviewsen
ref.citationcount0 [Scopus, 12/02/2010]en
or.citation.harvardHandoll, H. H. G., Al-Maiyah, M. A. and Rangan, A. (2004) 'Surgical versus non-surgical treatment for acute anterior shoulder dislocation', The Cochrane Database of Systematic Reviews; 1-
All Items in TeesRep are protected by copyright, with all rights reserved, unless otherwise indicated.