Shoulder arthroscopy: part I Is it justifiable after acute first-time anterior shoulder dislocation?

ABSTRACT

We reported on 34 young labor men, mean age 31.4 years with high physical demands who sustained first-time anterior dislocation of the shoulder. All were treated initially with closed reduction and immobilization, followed by shoulder therapy programs. Despite this, patients still suffered episodes of pain, discomfort and/or insecurity and feelings of joint being out on performing a particular activity. MRI was done for all cases, then, arrangement was made for arthroscopic evaluation some weeks to few months after primary treatment. The pathologic findings at arthroscopy divided the cases into 5 groups capsular tears only in 5 patients; 4 [11.8%] of them [G1] the tear was defined at the glenoid attachment - in the rest one [2.9%] it was at the humeral insertion [G2]. Capsular tears associated with partial labral detachment [G3] in 9 [26.5%], capsular tears and complete labral detachment [G4] in 17 [50.0%], and complex injury [G5] in the remaining [8.8%] shoulders that demonstrated full labral detachment from the glenoid, frank tearing and fraying of the capsular structure which was seen as well avulsed from the labrum. No bony Bankart lesions, or mid-capsular tears were defined. The decision, based on the literature review [1-4-5-8-12-13-14-15-17-18-32] was to continue conservative treatment and observation for the 5 patients suffered capsular tears, but, an arthroscopic repair was an option in our mind for the 4 shoulders with glenoid capsular detachment, and an open surgery for the humeral avulsion of the glenohumeral ligament. While the option for the fifth group of cases was open shoulder stabilization procedures. The third, and fourth groups of cases including 26 shoulders were considered as an ideal candidates for arthroscopic treatment. This study emphasizes that a systemic arthroscopic examination of the glenohumeral joint is not only more confirmatory, defining the exact pathologic anatomy associated with first-time anterior shoulder dislocation, but as well how best in patient selection, and decision making