Does earlier investigation of first-time traumatic shoulder dislocation lead to a reduction in the rate of recurrent dislocations?

Background: The British Elbow and Shoulder Society (BESS) introduced national guidance for first-time traumatic shoulder instability in 2015. The aim of this case-control study was to evaluate the effect on re-dislocation rate following adoption of their imaging protocol in our department in 2016.

Method: We included patients >16 years old with first traumatic shoulder dislocations between: January 2013 to December 2013 and January 2016 to September 2016 (pre-guidance) and October 2016 to December 2019 (post-guidance). Clinical records were analysed to determine imaging and surgery rates, respective lag times and re-dislocation rates. Follow-up was set at 4 years.

Results: The study comprised 144 pre-guidance and 342 post-guidance patients. MRI arthrograms performed in < 25 s increased from 26.2% to 68.2% (p  <  0.001), with lag times reduced (p = 0.061). Ultrasound scans performed in > 40 s increased from 42.6% to 60.1% (p  <  0.05), with a significant lag time reduction (p  <  0.001). Time to surgery decreased from 432 to 249 days. Overall re-dislocations decreased from 14.6% to 8.5% (p  <  0.05), and mean dislocations from 1.33 to 1.14 (p = 0.028). In < 25 s, percentage of ≥3 dislocations decreased from 19.0% to 3.03% (p = 0.005).

Conclusions: BESS guideline implementation has resulted in increased rates of imaging and reduced lag times to imaging and surgery. Re-dislocations rates have significantly decreased.