The mechanism of shoulder dislocation can vary depending on the forces generated in different sports activities. Understanding injury mechanisms in sports can help guide preventative strategies.

Shoulder dislocation can result from a variety of mechanisms unique to different sports. Understanding the common injury patterns in each sport allows for targeted preventative interventions and technique modifications to help reduce risk.

Shoulder dislocation refers to displacement of the humeral head from its normal anatomical position. While prompt treatment is recommended, some patients may present late or leave shoulder dislocations untreated. This can lead to long term complications.

Shoulder dislocations that are left untreated lead to short and long term consequences like recurrent instability, loss of function, arthritis, neruopraxia, vascular compromise, and bone loss. Prompt reduction followed by a period of immobilization is imperative to minimize these potential complications. Most patients require rehabilitation to restore range of motion and strength. Surgical stabilization may be warranted for young patients or those with high functional demands. Regular follow up is important to monitor for residual issues after a shoulder dislocation.

While the principles of initial management are similar, there are some key differences in the nonoperative treatment approach for shoulder dislocation between adults and pediatric patients.

While immobilization, physical therapy, activity modification, and return to sport criteria share similarities between pediatrics and adults, there are also important differences in nonoperative treatment approaches that recognize age-related factors. Understanding these nuanced distinctions can optimize rehabilitation and outcomes for each population after shoulder dislocation.

The anterior labrum in the shoulder is commonly torn or detached during traumatic dislocations resulting in instability. When nonoperative treatment fails, surgical repair of the labrum may be warranted.

Arthroscopic Bankart repair has become a common procedure to treat recurrent anterior shoulder instability. This minimally invasive technique aims to restore function and prevent recurrence.

Arthroscopic Bankart repair is an effective and minimally invasive technique to treat recurrent shoulder instability, with high patient outcomes and return to play rates. Appropriate patient selection is key.

Open Bankart repair involves surgical reattachment of the torn anteroinferior labrum to treat recurrent shoulder dislocations.

Open Bankart repair is an effective treatment for recurrent anterior shoulder instability, allowing predictable restoration of function and return to athletics with low recurrence rates.

Both isolated labral repair and labral repair combined with remplissage can effectively treat anterior shoulder instability. The addition of the remplissage procedure aims to augment stability in certain situations.

Adding remplissage to a Bankart repair is a viable option for anterior instability with coexisting Hill-Sachs lesions or mild glenoid bone loss. Outcomes are comparable or superior to isolated Bankart repair alone when appropriately indicated.

The Latarjet procedure involves transferring the coracoid process to the anterior glenoid to augment bony defects in revision settings of recurrent shoulder instability.

The Latarjet procedure is an effective revision option for treating recurrent anterior shoulder instability even in high-risk patients, albeit with some range of motion limitations.

Glenoid bone loss is a common complication of anterior shoulder dislocation and instability. It can lead to recurrent instability after arthroscopic Bankart repair. Operative treatment options aim to restore the native glenoid anatomy and provide a stable glenohumeral articulation.

Accurate assessment of glenoid bone loss is critical for surgical planning and decision making. The glenoid bare spot method, inverted pear glenoid method, and CT scan with 3D reconstruction are commonly used assessment techniques. CT scan provides the most accurate evaluation of location and magnitude of bone loss. Greater than 25% glenoid bone loss as measured on CT scan is considered significant and may require bone augmentation procedures.

In patients with recurrent anterior instability and significant glenoid bone loss (>20-25%), isolated arthroscopic Bankart repair results in high failure rates up to 67%. Operative treatment is indicated in these patients to restore glenoid concavity and treat bone loss.

1. Bone grafting
Autologous iliac crest bone graft has been the historical method to reconstruct anterior glenoid bone loss. The Latarjet procedure uses an iliac crest bone block along with the attached coracoidProcess to stabilize anterior glenohumeral dislocations. The Bristow procedure uses only the coracoid tip. Potential drawbacks include graft resorption, graft fracture, and graft nonunion.

2. Allograft reconstruction
Tricortical iliac crest allograft reconstruction avoids donor site morbidity of autologous grafts. Union rates over 90% have been reported. Precise graft contouring and placement are critical to success.

3. Anatomic glenoid reconstruction
Anatomic glenoid reconstruction with distal tibial osteoarticular allograft transplantation is an emerging technique. It provides anatomic restoration of the glenoid arcs and curvature. Long-term outcomes are still forthcoming.

4. Bone augmentation with arthroscopic stabilization
Remplissage adds posterior Hill-Sachs bone grafting to arthroscopic Bankart repair to limit engagement. Relative over-constraint of the shoulder is a potential risk.

In patients with significant glenoid bone loss, operative management provides reliable restoration of glenoid anatomy and shoulder stability. Accurate preoperative assessment of bone loss is essential to guide appropriate treatment. Both bone grafting and allograft reconstructions have shown good short and mid-term outcomes. Anatomic reconstruction techniques aim to fully restore native glenoid anatomy and curvature. Further research is needed on long-term patient outcomes and comparison between different surgical options. Surgeon experience and careful patient selection remain critical factors for success.

Hill-Sachs lesions are bony defects of the posterolateral humeral head that occur in association with anterior shoulder dislocations. They can engage the anterior glenoid rim leading to recurrent instability. Operative treatment aims to prevent engagement and glenohumeral joint locking.

The size, orientation and location of Hill-Sachs lesions significantly affect the risk of engagement with the glenoid. Lesions oriented parallel with the glenoid equator are more likely to engage. Lesions involving 20-40% of the humeral head diameter have the highest risk of engagement. Accurate sizing of Hill-Sachs lesions is critical to guide management decisions.

Hill-Sachs lesions involving more than 25% of the humeral head are less likely to remain reduced after arthroscopic Bankart repair alone. Engaging lesions with significant bone loss often require operative stabilization to prevent recurrent instability.

1. Remplissage
Posterior capsulodesis and infraspinatus tenodesis converts the Hill-Sachs lesion into an extra-articular defect. Good clinical outcomes have been reported, but modest loss of external rotation commonly occurs.

2. Humeral head bone grafting
Autograft or allograft reconstruction of large Hill-Sachs lesions prevents engagement. Graft integration and postoperative outcomes are less predictable than remplissage.

3. Osteochondral allograft transplantation
Osteochondral allografts can anatomically reconstruct large Hill-Sachs defects. Donor-site morbidity is avoided, but graft availability and long-term graft survival are concerns.

4. Humeral head rotational osteotomy
Rotational osteotomy of the proximal humerus increases the intact articular arc and eliminates engagement. Appropriate osteotomy position can be difficult to determine preoperatively.

5. Partial humeral head resurfacing
Prosthetic humeral head resurfacing provides another option for large engaging lesions. The intact articular surface is preserved, but partial humeral head replacements may have higher failure rates.

The optimal surgical approach depends on Hill-Sachs lesion size, engagement risk, and other patient factors. Good outcomes have been achieved with both remplissage and bone grafting techniques. Anatomic Hill-Sachs reconstruction and prosthetic solutions are emerging options. Further comparative studies are needed to determine best practices. Careful patient selection and technical execution remain paramount for successful outcomes.

Physical therapy is a critical component of recovery after arthroscopic anterior labral repair. Controlled rehabilitation protects the repair while restoring range of motion and strength. Optimal physical therapy protocols continue to evolve as surgical techniques and implants improve.

The early phase focuses on maintaining the integrity of the labral repair. Sling immobilization is commonly used for 3-6 weeks along with gentle pendulum and passive range of motion (ROM) exercises.[1] Elbow, wrist and hand ROM is encouraged to reduce stiffness. Submaximal isometrics help minimize muscle atrophy.

Gradual active assisted and active ROM exercises commence around 6 weeks postoperatively.[2] Motion progresses to restore functional ROM while avoiding excessive translation and rotation. Strengthening targets the rotator cuff, deltoid and scapular stabilizers. Low load, high repetition rotator cuff and scapular exercises are beneficial.

Resisted rotator cuff strengthening continues, incorporating therabands and light free weights.[3] Higher intensity strengthening begins around 12 weeks, progressing gradually to avoid overloading healing tissues. Sport or activity-specific programs are designed around the patient’s functional goals.

Intervals or highly repetitive actions are generally avoided for 4-6 months after labral repair.[4] Contact and collision sports may require an even longer recovery period before full clearance. Functional testing helps confirm sport readiness along with patient-reported outcomes.

Controlled tension and graded progression are key principles during all phases of recovery and return to activity. Frequent assessment ensures therapies target current impairments while avoiding overstressing healing tissues. Patients must be an active participant in the rehabilitation process.

Current physical therapy protocols allow early protected ROM while limiting stress on repaired labral tissue. Progressive strengthening restores muscle performance and dynamic stability. Criteria-based advancement provides individualized rehabilitation to safely achieve patient goals. Further research is warranted to optimize post-operative rehabilitation as surgical techniques continue to evolve.

Both adolescent and adult patients are at risk for recurrent instability after an initial anterior shoulder dislocation. However, the rates and risk factors for recurrence may differ between skeletally immature patients and adults.

Pediatrics patients have a very high recurrence risk after first-time dislocation, with rates reported between 50-100%. The highest risk is seen in teenagers undergoing their adolescent growth spurt. Recurrence rates in adults are lower, averaging around 26% across multiple studies.

1. Pediatric patients
Younger age, open physes, and joint hyperlaxity increase the risk of recurrent instability in pediatric patients. Hill-Sachs lesions are less important predictors as these patients can compensate well and remain stable despite humeral head defects.

2. Adult patients
Key risk factors for recurrence in adults include larger Hill-Sachs lesions, glenoid bone loss, activity level, and hyperlaxity/collisions sports. Non-operative management has a high failure rate in adults with these characteristics.

3. Age
Younger patient age at initial dislocation is the most significant risk factor for recurrence in all populations. The highest risk is seen in teenage athletes.

Immobilization in a sling or brace can reduce recurrence risk in pediatrics, but surgical stabilization is frequently required. Prompt surgical treatment provides more reliable stabilization in high risk adults and adolescents.

Younger patients, especially teenagers, face the highest risk of recurrence after initial shoulder dislocation. Pediatric patients have different pathoanatomic risk factors compared to adults. Recognizing these differences can guide appropriate treatment algorithms to minimize instability recurrence for all age groups.

Shoulder instability is a common condition, especially among young athletes participating in contact sports. The Bankart lesion, an injury to the anterior labrum and glenoid, is the most frequent cause of recurrent shoulder instability.1 Surgical stabilization is often required after failed conservative management. The two most common surgical techniques are open Bankart repair and arthroscopic Bankart repair. This review will examine the evidence for these procedures in adults and children.

Open Bankart repair has been considered the gold standard treatment for shoulder instability. During an open procedure, an incision is made on the front of the shoulder to visualize the damaged labrum. The detached labrum is reattached to the glenoid rim using suture anchors.

Several studies have shown excellent outcomes with open Bankart repair in adults. Recurrence rates are generally less than 5%. Low recurrence rates are also achieved in adolescent patients. Open repair allows direct visualization and secure labral repair. However, disadvantages include increased surgical morbidity, longer recovery time, and stiffness compared to arthroscopic techniques.

With advancements in arthroscopic shoulder surgery, arthroscopic Bankart repair has gained popularity. Small incisions allow placement of a camera and instruments inside the joint. The labrum is repaired to the glenoid using suture anchors similar to the open technique.

In adults, multiple randomized trials and meta-analyses have compared open versus arthroscopic Bankart repair. No significant differences were found in recurrence rates, return to sports, or functional outcomes. Arthroscopic repair results in less pain, faster recovery, and fewer complications compared to open repair.

However, in adolescents and children, open Bankart repair may result in lower recurrence rates compared to all-arthroscopic fixation techniques. The open procedure allows more secure labral repair in younger patients with ligamentous laxity. Further comparative studies are needed to define the optimal treatment by age group.

Both open and arthroscopic Bankart repair are effective procedures with low recurrence rates in adults. Arthroscopic repair offers advantages of minimally invasive surgery. In adolescents and children, open repair may result in lower recurrence rates compared to arthroscopic fixation. Patient age, ligamentous laxity, and surgeon experience should guide treatment decisions. Further randomized trials comparing these techniques are warranted.