First-time Glenohumeral Dislocations: Current Evidence and Considerations in Clinical Decision Making

Background: Glenohumeral dislocation is the most common orthopedic injury, especially among young and active athletes. Due to its wide range of motion, the glenohumeral joint is the most commonly dislocated major joint, making it susceptible to dislocation during traumatic events, particularly when the arm is in an abducted and externally rotated position. Anterior dislocations comprise the majority of cases, with an incidence rate of approximately ۲۳.۹ per ۱۰۰,۰۰۰ individuals per year. This study discusses the most effective treatment strategies for shoulder dislocations, their implications for long-term outcomes, including the risk of recurrent instability and arthritis. Methods: The study reviews existing evidence on the management of glenohumeral dislocations by analyzing the literature from ۲۰۱۰ to ۲۰۲۱ regarding treatment approaches, focusing on several key questions: the natural history following an initial shoulder dislocation, the impact of surgical versus nonsurgical treatment on recurrence rates, and potential long-term consequences such as osteoarthritis. Data were collected from various studies assessing both conservative management—typically involving closed reduction and immobilization—and surgical interventions like arthroscopic Bankart repair. The review also considered factors influencing recurrence rates, including age at dislocation, participation in high-energy sports, and pre-existing conditions such as generalized ligamentous laxity. Results: Analysis showed that the natural history of first-time shoulder dislocations is characterized by a high risk of recurrent instability, with rates varying from ۱۴% to ۱۰۰%, significantly influenced by the patient’s age and activity level. Younger patients (under ۳۰) demonstrated higher recurrence rates (approximately ۶۰%) with conservative treatment compared to those who underwent initial surgical stabilization (۱۹%). Furthermore, factors such as significant bony lesions (e.g., Hill-Sachs or Bankart lesions) were associated with increased recurrence rates even after surgical intervention. The review indicated that while nonsurgical management can be effective for many patients, primary surgical stabilization may reduce the risk of future instability and related complications like osteoarthritis, particularly in high-demand populations. Conclusion: Consequently, managing first-time glenohumeral dislocations requires careful consideration of individual patient factors and injury characteristics. While conservative treatment may be sufficient for some patients, early surgical intervention is recommended for younger individuals or those at high risk for recurrent instability. The findings emphasize the importance of personalized treatment strategies to optimize outcomes and minimize long-term complications like osteoarthritis. Ongoing research is also essential to refine management protocols and improve the understanding of the natural history of these injuries.