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.