MINIMUM 5 YEAR FOLLOW-UP MRI IMAGING OF SINGLE ANTERIOR SHOULDER DISLOCATIONS.

Abstract

To identify any shoulder joint pathology on MRI of young patients (< 35 yrs) with a single simple antero- inferior dislocation of the shoulder at minimum 5-year follow-up.

Patients aged 16–35 years with a single antero-inferior shoulder dislocation with a minimum 5-year (range5–9 yrs) follow-up were identified. A history of recurrent dislocation or surgery excluded patients from study. Ethical approval was obtained and identified patients were asked to volunteer for clinical review and have an MRI scan. Shoulders were clinically examined, noting specifically any signs/symptoms of rotator cuff pathology or instability. All shoulders were imaged with a 1.5 Tesla open MRI scan to assess any pathology.

In a 5-year period (1994–1998), 349 patients sustained an antero-inferior dislocation. 251 were in patients aged 35 years or less. 136 of these were excluded either due to recurrent dislocations. 62 patients were lost to follow-up of 53 eligible patients 7 could attend for study. Only one patient had a positive anterior apprehension sign but he did not have any symptoms of instability in his daily activities or sport. The only abnormality demonstrated on MRI was of a united greater tuberosity fracture in one shoulder. The glenolabral and bicipitolabral complexes were normal in all shoulders imaged.

Bankart lesions, both bony and labral, are known to be associated with recurrent anterior shoulder dislocations.This study has shown no shoulder joint pathology on MRI at minimum 5-year follow-up in young patients who have sustained a single antero-inferior shoulder dislocation, confirming that labral pathology seems to be important in recurrent dislocations. Further study to image more patients is underway. These results indicate that acute imaging of dislocated shoulders may be useful to help predict young patients who are unlikely to re-dislocate and thus unlikely to require surgery.