CPD Articles

First-time traumatic anterior shoulder dislocation: Approach for the primary health care physician

Ntambue Kauta, James Porter, Mubashir A. Jusabani, Stefan Swanepoel
South African Family Practice | Vol 65, No 1 : Part 4| a5744 | DOI: https://doi.org/10.4102/safp.v65i1.5744 | © 2023 Ntambue Kauta, James Porter, Mubashir A. Jusabani, Stefan Swanepoel | This work is licensed under CC Attribution 4.0
Submitted: 13 March 2023 | Published: 26 June 2023

About the author(s)

Ntambue Kauta, Division of Orthopaedic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Department of Orthopaedic Surgery, Mitchels Plain Hospital, Metro Health Services, Western Cape Government: Health and Wellness, Cape Town, South Africa
James Porter, Division of Family Medicine, Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, False Bay Hospital, Metro Health Services, Western Cape Government: Health and Wellness, Cape Town, South Africa
Mubashir A. Jusabani, Division of Orthopaedic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Department of Orthopaedic Surgery, Mitchels Plain Hospital, Metro Health Services, Western Cape Government: Health and Wellness, Cape Town, South Africa
Stefan Swanepoel, Division of Orthopaedic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Department of Orthopaedic Surgery, Mitchels Plain Hospital, Metro Health Services, Western Cape Government: Health and Wellness, Cape Town, South Africa

Abstract

Traumatic anterior shoulder dislocation is a very common injury encountered in emergency rooms as well as in the primary health care physician’s office. This injury occurs either in the setting of competitive or recreational sports injuries or as a high-energy injury during a fall or a road traffic accident. Common complications such as a recurrent dislocation can be predicted, monitored and prevented. Early appropriate treatment of associated cuff tears or fractures is associated with improved outcomes. There is a plethora of literature on the assessment and management of the primary anterior shoulder dislocation in specialised fields such as sports medicine, orthopaedic surgery and shoulder surgery. These studies are often highly technical, addressed to a particular subset of readers and often deal with one aspect of the management of the injury. This narrative aims to provide the reader with a simplified, evidence-based assessment and management approach for the first-time acute anterior shoulder dislocation. Emphasis is on closed reduction techniques, position and duration of immobilisation, and return to activities of life or sports. Risk factors for recurrence and other indications for primary referral to the orthopaedic surgeon are discussed. Other forms of shoulder instability such as posterior shoulder dislocation, inferior dislocation and multidirectional instability will not be the focus of this narrative.

Keywords

primary health care; shoulder; anterior dislocation; traumatic; treatment; immobilisation

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