The Journal of Bone and Joint Surgery (American). 2008;90:945-952.
doi:10.2106/JBJS.G.00070
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Nonoperative Treatment of Primary Anterior Shoulder Dislocation in Patients Forty Years of Age and Younger

A Prospective Twenty-five-Year Follow-up

Lennart Hovelius, MD, PhD1, Anders Olofsson, MD1, Björn Sandström, MD1, Bengt-Göran Augustini, MD2, Lars Krantz, MD3, Hans Fredin, MD, PhD4, Bo Tillander, MD, PhD5, Ulf Skoglund, MD6, Björn Salomonsson, MD7, Jan Nowak, MD, PhD8 and Ulf Sennerby, MD9

1 Department of Orthopedics, Gävle Hospital, S-801 87 Gävle, Sweden. E-mail address for L. Hovelius: hovelius{at}swipnet.se
2 Läkargruppen AB, Box 344, S-70146 Örebro, Sweden
3 Orthopedic Department, Högalidssjukhuset, S-5758 Eksjö, Sweden
4 Läkargruppen St Petri, Hamng 4, S-21122 Malmö, Sweden
5 Department of Orthopedics, University Hospital, S-58185 Linköping, Sweden
6 Department of Orthopedics, Karlstad Hospital, S-65185 Karlstad, Sweden
7 Department of Orthopedics, Danderyd Hospital, S-18288 Danderyd, Sweden
8 Department of Orthopedics, Samariterhemmet, S-85125 Uppsala, Sweden
9 Department of Orthopedics, Nordfjord Hospital, N-6771 Nordfjord, Norway
Investigation performed at the Department of Orthopedics, Division of Surgery and Perioperative Science, Umeå University Hospital, Umeå, Sweden, as well as at the participating hospitals and clinics

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: During 1978 and 1979, we initiated a prospective multicenter study to evaluate the results of nonoperative treatment of primary anterior shoulder dislocation. In the current report, we present the outcome after twenty-five years.

Methods: Two hundred and fifty-five patients (257 shoulders) with an age of twelve to forty years who had a primary anterior shoulder dislocation were managed with immobilization (achieved by tying the arm to the torso with use of a bandage) or without immobilization. All 227 living patients (229 shoulders) completed the follow-up questionnaire, and 214 patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Results: Ninety-nine (43%) of 229 shoulders had not redislocated, and seventeen (7%) redislocated once. Thirty-three recurrent dislocations had become stable over time (14.4%), and eighteen were considered to be still recurrent (7.9%). Sixty-two shoulders (27%) had undergone surgery for the treatment of recurrent instability. Immobilization after the primary dislocation did not change the prognosis. Only two of twenty-four shoulders with a fracture of the greater tuberosity at the time of the primary dislocation redislocated (p < 0.001). When shoulders with a fracture of the greater tuberosity were excluded, forty-four (38%) of 115 shoulders in patients who had been twelve to twenty-five years of age at the time of the original dislocation and sixteen (18%) of ninety shoulders in patients who had been twenty-six to forty years of age had undergone surgical stabilization. At twenty-five years, fourteen (23%) of sixty-two shoulders that had undergone surgical stabilization were in patients who subsequently had a contralateral dislocation, compared with seven (7%) of ninety-nine shoulders in patients in whom the index dislocation had been classified as solitary (p = 0.01). Gender and athletic activity did not appear to affect the redislocation rate; however, women had worse DASH scores than men did (p = 0.006).

Conclusions: After twenty-five years, half of the primary anterior shoulder dislocations that had been treated nonoperatively in patients with an age of twelve to twenty-five years had not recurred or had become stable over time.

Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.


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