Non-operative Management of First-Time Shoulder Dislocations: Cross-Sectional Survey of Physiotherapists’ Perceptions

Abstract Purpose: The shoulder is the most vulnerable joint to dislocation because of its anatomical structure and range of motion. The prevalence of shoulder dislocation underscores the importance of proper care and injury prevention strategies to maintain stability and functionality. This study aimed to describe the current perceptions of physiotherapists on the management of first-time shoulder dislocations (FTDs) and their perspectives on current evidence to guide optimal care. Method: A cross-sectional online survey with 29 questions was distributed to the memberships of the Canadian Physiotherapy Association, Sport Physiotherapy Canada, the American Society of Shoulder and Elbow Therapists, and the European Society for Shoulder and Elbow Rehabilitation. Results: Data from 102 respondents revealed that 58.8% were unaware of published clinical practice guidelines for FTD management. Awareness increased with more years of clinical experience; those with over 10 years of experience demonstrated greater awareness (57.9%) than those with less experience (16.1%). Almost half perceived there to be insufficient evidence (49%) and protocols (47%) to guide non-operative treatment of an FTD. Conclusions: This study highlights that there is no clear consensus among physiotherapists on an evidence-based management of FTDs. Improving knowledge dissemination and professional training could bridge the gap between evidence-based practice and clinical implementation. Résumé Objectif : l’épaule est l’articulation la plus vulnérable à une dislocation en raison de sa structure anatomique et de son amplitude de mouvement. La prévalence de dislocations de l’épaule fait ressortir l’importance des soins appropriés et des stratégies de prévention des blessures pour maintenir la stabilité et la fonctionnalité. Cette étude vise à décrire les perceptions actuelles des physiothérapeutes au sujet de la prise en charge des premières dislocations de l’épaule (PDÉ) et leurs points de vue sur les données probantes à jour pour orienter les soins optimaux. Méthodologie : les membres de l’Association canadienne de pédiatrie, de Physiothérapie du sport du Canada, de l’American Society of Shoulder and Elbow Therapists et de la European Society for Shoulder and Elbow Rehabilitation ont reçu un sondage transversal en ligne de 29 questions. Résultats : les données des 102 répondants ont révélé que 58,8 % d’entre eux n’étaient pas au courant des directives cliniques publiées sur la prise en charge des PDÉ. Plus ils avaient de l’expérience clinique, plus ils en étaient informés. Ceux qui avaient plus de dix ans d’expérience étaient plus au courant (57,9 %) que ceux qui en avaient moins (16,1 %). Près de la moitié trouvait que les données probantes (49 %) et les protocoles (47 %) n’étaient pas suffisants pour orienter le traitement non opératoire des PDÉ. Conclusions : cette étude démontre l’absence de consensus évident entre les physiothérapeutes sur la prise en charge fondée sur des données probantes des PDÉ. L’amélioration de la diffusion du savoir et de la formation professionnelle pourrait corriger l’écart entre les pratiques fondées sur des données probantes et la mise en œuvre clinique. Lay Summary Shoulder dislocations are very common injuries, especially in athletes and people who are active. After a first-time shoulder dislocation, treatment can either involve surgery or non-surgical care, such as physiotherapy. Surgery is often recommended for young athletes as they are at higher risk for re-dislocation, while primary non-surgical care is usually preferred for non-athletes. However, there is little agreement on the best way to manage these injuries without surgery. This study surveyed 102 physiotherapists from North America and Europe to learn about their views and practices. Most physiotherapists reported that patients with first-time dislocations are usually treated without surgery. Yet, nearly half of respondents felt that there is not enough research evidence or clear treatment guidelines to guide non-surgical care. Awareness of existing guidelines was also low, especially among less experienced physiotherapists. Overall, the study found that physiotherapists lack a consistent, evidence-based approach to managing first-time shoulder dislocations. The results highlight a need for better education, clearer guidelines, and improved sharing of research findings to ensure that patients receive the best possible care.