Chronic Shoulder Dislocations

Chronic Shoulder Dislocations 

Mel Herbert MD interviews James Webley MD 

• A patient presents for a chronic shoulder dislocation. You try to reduce it but are unsuccessful, so you decide to try again. Is this a good idea? 
• In 1941, a French orthopedist named Calvet described the reduction of 91 chronic anterior shoulder dislocations, and 68 of them had arterial ruptures. Half of those patients died. Later textbooks said that reduction of chronic shoulder dislocations should only be attempted in the operating room by an orthopedist, with a vascular surgeon on call. 
• Calvet, E et al. [Dislocations of the shoulder and vascular lesions.] (in French). J Chir (Paris) 1941; 58: 337-346. 
• In 2012, Verhaegen reported two cases of axillary artery rupture in patients with reduction of a chronic shoulder dislocation. One of the patients had only been dislocated for about 12 weeks. Verhaegen F, et al. Chronic anterior shoulder dislocation: aspects of current management and potential complications. Acta Orthop Belg. 2012 Jun;78(3):291-5. PMID: 22822566. 
• We all need to know about this. We see a lot of patients with shoulder dislocations of unknown duration and frequently will try to reduce them and see what happens. Is this a bad idea? Yes. 
• Chronic shoulder dislocation can result in adhesions between the displaced humerus and the artery. When you attempt to reduce it, it puts traction on the artery and can to lead to rupture. This is more common in older patients. 
• What is considered chronic? About 3-4 weeks. 
• Sahajpal DT, et al. Chronic glenohumeral dislocation. J Am Acad Orthop Surg. 2008 Jul;16(7):385-98. PMID: 18611996. A review of the literature showed that of 50 chronic dislocations treated by closed reduction, only 27 patients had good results; these were reduced within 4 weeks of dislocation. 
• If patients have a chronic dislocation, there is no reason to relocate it in the Emergency Department. Call your orthopedic surgeon.