On-Field Management of the Acute Anterior Glenohumeral Dislocation

Authors:

Grant E Norte, Angela West, Michael Gnacinski, Olivier A van der Meijden, Peter J Millett

Abstract:

Glenohumeral dislocations account for nearly 50% of all joint dislocations, and have been reported to be more common than any other diarthrodial joint injury. In 2010, the incidence of glenohumeral dislocations presenting to emergency departments in the United States was estimated at 23.9 per 100,000 person-years. Younger male patients appeared to have a higher risk of sustaining a dislocation, with a significant portion occurring during sport or recreation.

Surveys among the high school and college athletic populations have shown that certain sports carry a higher risk of glenohumeral dislocations and shoulder injuries in general. These sports include basketball, soccer, wrestling, and football. Among high school athletes, glenohumeral dislocations and shoulder separations combined accounted for approximately 24% of all shoulder injuries, corresponding with 55,000 glenohumeral dislocations per year nationwide. The majority of dislocations are anterior, accounting for 90% to 98% of all occurences.

During an athletic event, it is paramount that the responding medical personnel be familiar with the potential complexity of the injury in order to act in a systematic manner and optimize patient care. Time, prolonged pain, potential for increased injury, and fear are commonly associated with delayed treatment and emergency department visits, and add to the importance of having trained medical personnel available on-site for early intervention.

The original descriptions of the glenohumeral dislocation and reduction techniques can be dated back 2000 years. However, there remains discontinuity within the literature regarding appropriate management of these injuries. The athletic trainer is commonly the first medical professional to examine the patient following an injury. Currently, there is no consensus or National Athletic Trainers’ Association (NATA) position statement outlining the standard for on- field care of glenohumeral dislocations, leaving a gap within formal athletic training education curricula. Furthermore, a joined consensus statement in 2008 by the American Academy of Orthopaedic Surgeons (AAOS) and American Orthopaedic Society for Sports Medicine (AOSSM), among others, lacked thorough guidelines for the approach and treatment of glenohumeral dislocations.

To date, no authors have outlined a systematic approach in managing the on-field acute anterior glenohumeral dislocation. The aims of this article are 1) to provide a systematic approach for health care professionals, outlining what should be included in the on-field management of these injuries, and 2) to present current methods of reduction, describing the safest and most efficacious methods.

For the complete study: On-Field Management of the Acute Anterior Glenohumeral Dislocation

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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On-Field Management of the Acute Anterior Glenohumeral Dislocation

Authors:

Abstract:

About the Author: Peter Millett, MD