First-time traumatic anterior shoulder dislocation: Approach for the primary health care physician

Abstract

Traumatic anterior shoulder dislocation is a very common injury encountered in emergency rooms as well as in the primary health care  physician’s office. This injury occurs either in the setting of competitive or recreational sports injuries or as a high-energy injury during a  fall or a road traffic accident. Common complications such as a recurrent dislocation can be predicted, monitored and prevented. Early  appropriate treatment of associated cuff tears or fractures is associated with improved outcomes. There is a plethora of literature on the  assessment and management of the primary anterior shoulder dislocation in specialised fields such as sports medicine, orthopaedic  surgery and shoulder surgery. These studies are often highly technical, addressed to a particular subset of readers and often deal with  one aspect of the management of the injury. This narrative aims to provide the reader with a simplified, evidence-based assessment and  management approach for the first-time acute anterior shoulder dislocation. Emphasis is on closed reduction techniques, position and  duration of immobilisation, and return to activities of life or sports. Risk factors for recurrence and other indications for primary referral  to the orthopaedic surgeon are discussed. Other forms of shoulder instability such as posterior shoulder dislocation, inferior dislocation  and multidirectional instability will not be the focus of this narrative.