A new study has come to a surprising conclusion about shoulder dislocations.
A new study has found that way too many people are getting surgery after dislocating their shoulder, when they really shouldn’t.
Only severe dislocations are likely to benefit from surgery, but in cases where patients dislocate their acromio-clavicular joint — the most common shoulder dislocation — they should wear a sling but don’t need surgery, according to a UPI report.
Surgery can be pretty invasive for a dislocation, and may involve using plates and screws to reconnect the joint. But the research found that a dislocation of the AC join would be better off being treated by a sling and rehabilitation, and the results would actually be better with fewer complications.
Dr. Michael McKee, who is an orthopedic surgeon with St. Michael’s Hospital, said in a statement: “For severe AC joint dislocations, surgery is the common practice, but there’s not much evidence to suggest this is actually the best treatment. … The main advantages of surgery are that the joint is put back in place and the shoulder appears more symmetrical and pleasing to the eye. The long-term implications of surgery for AC joint dislocation remain unclear when compared to non-operative treatment.”
The study involved 83 patients who had dislocated AC joints, with about half electing for surgery and the other half going the alternate route. The researchers found that patients who did not have surgery had more mobility in their shoulders at their six-week and three-month exams, and 75 percent of them were back at work after that three month period, compared to just 43 percent of those who had gotten surgery.
Also, seven of the 40 who had gotten surgery had major complications, such as an infection or a losse plate. The nonsurgical group had just two major complications, and in both cases it involved a fall during the recovery.
However, nonsurgical patients were more likely to complain about how their shoulders looked. That is an important factor to consider, but people thinking about surgery should still realize the downsides of electing to go under the knife.
The findings were published in the Journal of Orthopedic Trauma. The abstract is posted below:
Objective: To perform a randomized clinical trial of operative versus nonoperative treatment of acute acromio-clavicular (AC) joint dislocations using modern surgical fixation and both patient-based and surgeon-based outcome measures to determine which treatment method was superior.
Design: Prospective, randomized.
Patients/Participants: Eight-three patients with acute (<28 days from the time of injury) complete (grade III, IV, and V) dislocations of the AC joint.
Intervention: Patients were randomized to operative repair with hook plate fixation versus nonoperative treatment (operative repair, 40; nonoperative treatment, 43).
Main Outcome Measurements: Disabilities of the Arm, Shoulder and Hand (DASH) score at 1 year after injury. Assessment also included a complete clinical assessment, evaluation of the constant score, and a radiographic evaluation at 6 weeks, and at 3, 6, 12, and 24 months.
Results: There were no demographic differences between the 2 groups, and the mechanisms of injury were similar between the 2 groups. The DASH scores (a disability score, lower score is better) were significantly better in the nonoperative group at 6 weeks (operative, 45; nonoperative, 31; P = 0.014) and 3 months (operative, 29; nonoperative, 16; P = 0.005). There were no significant differences between the groups at 6 months (operative, 14; nonoperative, 12; P = 0.442), 1 year (operative, 9; nonoperative, 9; P = 0.997), or 2 years (operative, 5; nonoperative, 6; P = 0.439) after injury. Constant scores were similar (better scores in the nonoperative group at 6 weeks, 3 months, and 6 months; P = 0.0001; and no difference thereafter). Although radiographic results were better in the operative group, the reoperation rate was significantly lower in the nonoperative group (P < 0.05).
Conclusions: Although hook plate fixation resulted in superior radiographic alignment, it was not clinically superior to nonoperative treatment of acute complete dislocations of the AC joint. The nonoperative group had better early scores, although both groups improved from a significant level of initial disability to a good or excellent result (mean DASH score, 5–6; mean constant score, 91–95) at 2 years. At present, there is no clear evidence that operative treatment with the currently available hook plate improves short-term outcome for complete AC joint dislocations.
Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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