Posterior shoulder dislocation: Systematic review and treatment algorithm

Purpose: Posterior shoulder dislocations (PSDs) comprise a small subset of shoulder dislocations, and there are few evidence-based treatment protocols and no actual algorithm for the treatment of PSDs available in the literature. This article provides a systematic review of the literature, as well as an overview of clinical and radiologic diagnostic techniques, and presents an algorithm for treatment of PSDs, including minimally invasive treatment options. Methods: For a systematic review of current literature, a systematic search was performed in the Medline and Cochrane databases. Journal articles published between January 1940 and June 2010 were taken into account. Studies that only existed as abstracts were not included in the analysis. Broad exclusion criteria consisted of radiologic reports, review articles, case reports, and technical notes. Refined exclusion criteria consisted of a minimum of 4 patients with PSDs operated on by the same surgical technique and clinical outcome documented by a functional shoulder score. Results: The final set of articles for evaluating closed or open techniques included 5 prospective case series and 6 retrospective studies. Within this group, there was no study with a level of evidence higher than Level IV. We present a descriptive comparison of these studies because of the heterogeneity and/or number of patients and the level of evidence. Case reports illustrate the different surgical approaches according to the literature. Conclusions: PSDs are still a challenge for the treating physician. There are few articles available about PSDs in evidence-based literature, with a limited number of cases. Our algorithm provides guidelines for decision making including minimally invasive treatment options according to the available literature. Level of Evidence: Level IV, systematic review of Level IV studies.