Mechanism of Injury:

Anterior shoulder dislocation resulting from trauma to the abducted and externally rotated arm.

Subjective Symptoms:

Acutely, patients complain of significant pain with the inability to internally rotate the arm. Often requires a manual reduction by a physician. In between episodes of subluxation or dislocation, patients may complain of persistent pain and a sense that the shoulder will dislocate again with the arm abducted and externally rotated.

Objective Signs:

Positive apprehension test recreating the sense of instability with the arm abducted and externally rotated with a decrease in the patient's symptoms with a posteriorly directed force on the proximal humerus (i.e., the relocation maneuver). May be associated with a rotator cuff tear in older individuals and axillary nerve injury.

Natural History:

Younger patients engaged in high risk activities (overhead athletes, collision athletes, and laborers) with a high incidence of recurrent instability. Older patients have a significantly lower risk of recurrent instability, but may complain of symptoms due to rotator cuff pathology.

Nonsurgical:

Following closed reduction, short-term immobilization followed by physical therapy. Treatment of chronic instability requires strengthening of the rotator cuff and scapular stabilizers.

Surgical:

1) Arthroscopic Bankart repair
2) Arthroscopic Bankart repair with heat shrinking capsullorhaphy
3) Open Bankart repair with capsular shift

Nonsurgical:

8-12 weeks

Avoid overhead activities

Surgical:

16-20 weeks

Avoid overhead activities