Assessing Healthcare Inequities in Shoulder Dislocation Management and Outcomes

Abstract

Introduction

The inherent instability of the glenohumeral joint and the lesions it produces are major contributors to shoulder pain. As one of the most commonly treated sports injuries, shoulder dislocations have benefited from significant advancements in arthroscopic techniques and rehabilitative approaches to restore joint function. However, despite these improvements, research on disparities in the management and outcomes of shoulder dislocations remains limited. Our objective was to comprehensively analyze the existing health inequities related to shoulder dislocation to better understand the complex interplay between healthcare access barriers and disparities in treatment outcomes.

Methods

A systematic review was conducted using PubMed, including studies published between 2000 and 2023 examining disparities in shoulder dislocation management. Keywords included “shoulder dislocation,” “shoulder instability,” “healthcare disparities,” “insurance status,” “race/ethnicity,” and “access to care.” Of 233 initially identified studies, 12 met inclusion criteria. Data were extracted on patient demographics, surgical rates, time to surgery, and post-surgical outcomes.

Results

Barriers to surgical management, prolonged time to surgery, and delays in diagnosis and access to care for shoulder dislocation were associated with public insurance status and racial minority groups. Additionally, publicly insured patients were more likely to be readmitted or experience postoperative complications. Shoulder instability was associated with minority race, male sex, and older age, with Black and Asian patients experiencing more significant pathology and lower post-surgical baseline activity levels. At the same time, socioeconomic factors like insurance status and community distress influenced preoperative severity.

Discussion/Conclusion

Systemic inequities in healthcare access continue to impact the management and outcomes of shoulder dislocations, particularly among patients with public insurance and lower socioeconomic status. Despite Medicaid expansion, access to orthopedic care remains limited due to low provider reimbursement rates, administrative burdens, and higher appointment refusal rates for Medicaid patients. Expanding Federally Qualified Health Centers (FQHCs) and increasing Medicaid reimbursement have shown potential to address these barriers, but more systemic reforms should be considered. Standardized treatment protocols and improved access to specialty care may help close the gap in surgical intervention rates and postoperative outcomes. Addressing such disparities requires further research into targeted policy solutions and healthcare models that improve accessibility, streamline treatment pathways, and ensure equitable care for all patients.