The most common form of shoulder dislocation -- acromio-clavicular joint dislocation -- is often treated with surgery, however a new study suggests it may not be necessary except for severe dislocations.
Researchers found patients who dislocate their AC joint but wear a sling and undergo rehabilitation rather than going under the knife recover faster and experience far fewer complications while they heal. Surgical correction of the injury involves reconnecting the joint using a plate and screws.
There was no significant difference between patients who had surgery and those who didn't, suggesting fewer patients require a surgical procedure to fix the injury.
"For severe AC joint dislocations, surgery is the common practice, but there's not much evidence to suggest this is actually the best treatment," said Dr. Michael McKee, an orthopedic surgeon with St. Michael's Hospital, in a press release. "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. The long-term implications of surgery for AC joint dislocation remain unclear when compared to non-operative treatment."
Researchers recruited 83 patients with dislocated AC joints, treating 40 with surgery and the other 43 without it.
The non-surgical patients had more mobility of their shoulders at six-week and three-month exams and 75 percent of them returned to work after three months. In the group of patients who had surgical repair, only 43 percent of patients returned to work after three months.
Additionally, seven of the 40 surgical patients had major complications, including a loose plate or an infection, and seven others had minor complications such as numbness. In the nonsurgical group, there were two major complications, both caused by falls during recovery that made the injury worse.
More nonsurgical patients complained about the look of their healed shoulders -- more than 21 percent -- as compared with only four percent of patients who had surgery.
"While satisfaction with appearance of the shoulder should be a consideration, I believe surgeons should think twice before recommending surgery for an AC joint dislocation -- regardless of the severity," said Dr. McKee. "Patients who forgo surgery return to work sooner, experience less disability during the first months after injury and have fewer complications."