I regularly review newly published, high-quality medical research and share patient-focused summaries explaining what the evidence means in everyday practice. These updates are intended to support informed discussions and shared decision-making, while recognising that treatment should always be tailored to the individual.
At the heart of my practice is Shared Decision-Making. Whether we pursue conservative management (Plan A) or surgical intervention (Plan B), the goal is to create a tailored treatment plan that aligns with your lifestyle, values, and functional goals.
Prepared by:
Prof. Bijay Singh
Consultant Orthopaedic Surgeon – Upper Limb, Trauma & Sports Injury
Shoulder | Elbow | Wrist | Hand
Visiting Professor Canterbury Christchurch University & AIIMS Raipur
NHS Appointments:
Spire Alexandra Hospital: 01634 – 687166
Medway NHS Trust: 01634 – 976749
Spire Alexandra Hospital
Medway NHS Trust
What happens in a shoulder dislocation?
In an anterior shoulder dislocation, the ball of the shoulder joint slips out the front of the socket. The stabilizing tissues may be stretched or torn, increasing the risk of future dislocations.
Treatment options
- Nonoperative treatment
- Short period in a sling
- Supervised physiotherapy, Focus on strength and stability
- Early arthroscopic stabilization surgery
- Keyhole surgery to repair torn stabilizing tissues
- Structured rehabilitation afterwards
What did the study look at?
Khalik et al. (2024) performed a systematic review and meta-analysis to compare early surgery with nonoperative treatment after a first-time shoulder dislocation.
- 34 studies included, 2222 shoulder dislocations analysed
- 5 randomized controlled trials comparing early surgery vs immobilisation
- Mean follow-up: about 59 months (almost 5 years)
- Primary outcomes: redislocation, instability, and need for further surgery
Key findings from the analysis
- Early arthroscopic stabilization significantly reduced re-dislocation rates.
- Lower shoulder instability in patients treated surgically after the first dislocation.
- Lower rates of subsequent stabilization surgery compared with those initially treated nonoperatively.
- Patients stabilized after the first dislocation did better than those who had surgery only after recurrent dislocations.
Professor Singh’s commentary
This study shows a significant reduction in further dislocations in patients who undergo surgery after the first dislocation, compared with those who have surgery only after repeated dislocations. The rates of revision surgery and further instability were also lower.
Prof. Singh generally manages first-time dislocations with supervised physiotherapy. The decision about surgery depends on the patient’s expectations, activity level, and sporting demands.
For a professional sportsperson, early surgery may be appropriate, whereas a recreational athlete may do very well without an operation.
Reference
Khalik M et al. Arthroscopic stabilization surgery for first-time anterior shoulder dislocations: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery, 2024.
