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We will be studying patients who suffer with traumatic shoulder dislocations and seeing if there is any benefit to them of having shoulder surgery after their first dislocation compared to having non-operative treatments such as physiotherapy in preventing further problems.

This is a commissioned study by the HTA to answer the following treatment uncertainty: ‘Is surgical repair more clinically effective for the treatment of first-time traumatic anterior shoulder dislocation than conservative care? This question is being asked because shoulder joint dislocations are the most common joint dislocations seen in hospital A+E departments and it is still not known if people are best treated after one dislocation with surgery.

Background

Traumatic anterior shoulder dislocation (TASD) is when the humeral head (top end of the arm bone at the shoulder) is forced out of the shoulder socket frontwards. This can happen after sport injuries or falls and is most common in younger patients. The injury is very painful and the shoulder often stays dislocated until it is reduced or put back in hospital. This type of injury often causes the joint to remain unstable and more dislocations can occur. In some people these dislocations are very frequent and can even occur during sleep. The two main ways of treating this problem are physiotherapy and surgery. Traditionally physiotherapy has been used first and surgery used if the physio does not work. However, in recent years patients are more frequently being treated with surgery as the risk or further dislocation without surgery is considered to be high. While surgical treatment has become more common, researchers and doctors still don t know which patients are best treated with physiotherapy and which patients are best treated first with surgery. Because dislocations cause so much pain, stress and disability, it is important to know if surgery after one dislocation is worthwhile in preventing further problems.

STUDY DESIGN

We will be using advanced statistical techniques to examine the data in two large national healthcare databases that will allow us to study the association between surgical treatment (compared to no surgery) and recurrent dislocation rates following a first episode of traumatic anterior shoulder dislocation in young adults.  We also plan to identify clinical predictors to inform which patients will get recurrent dislocations.  This will hopefully allow us to write national guidelines for doctors and patients about which is the best treatment option for different people suffering with this common problem.

To do this we have put together a research team with expertise in shoulder dislocation and expertise in studying these two databases. The team has used this method of database analysis before including the advanced statistical methods that need to be used. To further ensure this database can be successfully used for this purpose, we plan to first test the coding of shoulder dislocations in the CPRD database by performing an initial validation (or testing) study for 9 months. If this is successful it means we have a high chance of then answering the research question with a full analysis of the linked CPRD and HES databases which will take another 18 months.

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