DOES ACHIEVING BESS GUIDELINES FOR THE MANAGEMENT OF FIRST TIME ANTERIOR SHOULDER DISLOCATION RESULT IN BETTER MANAGEMENT FOR ALL PATIENTS?

MLT Jayatilaka, M Argyropoulos R Parmar, I Guisasola , M Kent, MG Smith, J Gibson, P Brownson

Background: Traumatic dislocation of the glenohumeral joint is the most common joint dislocation. Our aim was to evaluate and improve our unit’s management of this patient group.

Method: An audit of management of 36 consecutive first time anterior shoulder dislocation patients, prior to the creation of a shoulder instability clinic, was performed from February to October 2016. A patient pathway was created based on the BESS guidelines. This was administered through the Virtual fracture clinic and a new weekly shoulder instability clinic. This clinic was staffed with shoulder consultants, had immediate access to ultrasound scans and specialist physiotherapists. The audit cycle was repeated from March to September 2017 yielding 22 patients.

Results: The results showed improvement in adherence to the BESS guidelines. Early referral for physiotherapy went from 78% to 91% . 100% of patients from 72% had an appointment to see an upper limb consultant within 6 weeks. All patients undergoing arthroscopic stabilization had this within 6 months in comparison to 1 patient in the 1^st cycle. 78% from 0% of patients over 40 years of age had an USS at their first clinic appointment and cuff repair surgery was performed at a mean of 7.7 weeks when required. We found a high non-attendance rate in those aged below 40. 100% of patients aged 25 – 40 did not attend follow up and 83% of the sub 25 age group did not attend follow up.

Conclusion: The combination of VFC and an instability clinic lead to improvements in recommended early management of the first-time anterior shoulder dislocation. However, this has resulted in a waste of resource particularly in the 25 – 40 age group. We recommend that this age group should be managed primarily with physiotherapy and referral into a specialist clinic only if required.