Shoulder Dislocation: Forget Surgery?

According to a new study in the Journal of Orthopaedic Trauma, patients who are treated non-surgically have fewer complications and return to work sooner.

“For severe AC [acromioclavicular] joint dislocations, surgery is the common practice but there’s not much evidence to suggest this is actually the best treatment, ” said Michael McKee, M.D. an orthopedic surgeon with St. Michael’s Hospital in Toronto, Ontario, in the October 22, 2015 news release.

The study involved 83 patients with moderate to severe AC joint dislocations who received either plate-and-screws surgery followed by rehabilitation or non-surgical treatment with sling and rehabilitation. Those not undergoing surgery showed greater mobility than the surgical patients at follow-up sessions six weeks and three months after their injury. There were no significant differences between the groups at six months, one year or two years after their injury.

“Three months after the initial injury, more than 75% of the patients who did not have AC joint surgical repair were able to return to work, whereas only 43% of those who underwent surgery were back at work, ” said Dr. McKee.

“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, ” said Dr. McKee. “The long-term implications of surgery for AC joint dislocation remain unclear when compared to non-operative treatment.”

As indicated in the news release, “Because the non-operative patients did not have the dislocation put back into place with surgery, they were more likely to be dissatisfied with the appearance of their shoulder compared to the group who’d received surgery. After one year, five per cent of the surgical patients reported dissatisfaction with the appearance of their shoulder compared to 16% of the non-surgical patients. That gap widened after the second year, when more than 21% of non-surgical patients had issues, compared to four per cent of those who’d received surgical repair.”

Dr. McKee told OTW, “The biggest surprise to me was the fact that patients treated with surgical stabilization did not improve more quickly than those treated non-operatively. In our other studies, for example of clavicle fractures, the surgical group showed dramatically better improvement early, compared to non-operative treatment. There is obviously an intrinsic difference to how the body recovers from an AC joint injury.”

“I think surgeons will use this information properly. We don’t say you should never operate, we simply say that in the short term, the operation provided little benefit and should not be performed routinely. However, there are some specific circumstances where it may be warranted. In general, our study supports a non-operative approach to this particular shoulder injury.”