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Pediatric and adolescent anterior shoulder instability: clinical management of first-time dislocators

Lin, Kenneth M.a; James, Evan W.a; Spitzer, Eladb; Fabricant, Peter D.a

doi: 10.1097/MOP.0000000000000566
ORTHOPEDICS: Edited by Daniel W. Green

Purpose of review The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and clinical management of pediatric and adolescent patients following a first-time shoulder dislocation.

Recent findings Shoulder instability is becoming increasingly common as pediatric and adolescent patients engage in earlier organized sports competition. Recommended treatment following a first-time glenohumeral dislocation event in adolescents depends on several factors, but surgical stabilization is becoming more frequently performed. Surgical indications include bony Bankart lesion, ALPSA lesion, bipolar injury (e.g. Hill–Sachs humeral head depression fracture) or off-season injury in an overhead or throwing athlete. Complications following surgical treatment are rare but most commonly are associated with recurrent instability. Young children (eg. open proximal humerus growth plate), individuals averse to surgery, or in-season athletes who accept the risk of redislocation may complete an accelerated rehabilitation program for expedited return to play in the absence of the structural abnormalities listed above.

Summary Following a first-time dislocation event in pediatric and adolescent patients, a detailed discussion of the risks and benefits of nonoperative versus operative management is critical to match the recommended treatment with the patient's injury pattern, risk factors, and activity goals.

aPediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, USA

bAssaf Harofeh Medical Center, Be’er Ya’akov, Israel

Correspondence to Peter D. Fabricant, MD, MPH, Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.

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