الفهرس 
Relevant anatomy and biomechanicsOnly 14 pages are availabe for public view
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Abstract
The shoulder, by virtue of its anatomy and biomechanics, is one of the most unstable and frequently dislocated joints in the body, accounting for nearly 50% of all dislocations. (1,2,3) And by arthroscopic analysis for gross pathological changes and after lesser important microscopicexamination ,there is no doubt that , detachments of the capsulolabral complex (Bankart lesion) from the glenoid rim and scapular neck is the main obvious finding in nearly all cases of acute anterior traumatic shoulder dislocation (21,44,46,61,98) .
After non difficult diagnosis and emergency reduction of cases of acute anterior traumatic shoulder dislocation, the definitive management was a very debatable issue for long period of time and to lesser extent, now it is still (3,4,56,119,143). The previously reported prevalence of recurrent instability after non-operative treatment for
uncomplicated first‐time shoulder dislocations in younger individuals has varied) , with rates ranging from <25% (106,110 to close to 100% (28,46,89,100).
These differences may be partially explained by the difficulty of obtaining adequate follow up in young patients, many of whom are undergraduates or professionals who
default from follow‐up, if they move away from the area where they were first treated.
Differences in the study populations may also account for some of the variation in the
reported rates of instability (90,97,98,106). In most of studies they found, that age and sex were the most important factors in determining the risk of recurrent instability (63,67,110,119,122) .There is no doubt that the risk of recurrent instability in patient who are>40 years of age is low and we can say that it reach near 0% at 60 to 70 years of age, so non operative treatment is the treatment of choice to that age group. But with youngerages, the risk of recurrence is rising, reaching the peak in 12‐22 year’s age group(3,4,15,18,58).It also was noticeable that the predicted risk of recurrent instability in female patients was lower at all ages, reaching the age at which the risk was equivalent (50%) ten years earlier than male patients (i.e., seventeen compared with twenty seven years). The beneficial effects of early interventions designed to reduce the risk of recurrent instability are therefore more likely to be greater in younger male patients with a
primary dislocation, whereas a wait‐and‐see policy may be more appropriate for olderfemale patients (3,28,44,46).The risk of recurrent instability was highest within the first
two years after the initial dislocation and then reached a plateau. An instability‐free
period of two years after a primary dislocation can therefore justifiably be regarded as a
landmark in the treatment of the patient, at which time he or she may be counseled that the likelihood that a recurrent dislocation will develop is low (4,72,89) . A variety of other
patient and injury‐related risk factors has been associated with an increased risk of
recurrent instability after a dislocation (90,97,98). In particular, it has often been suggested
that athletes are at greater risk of instability than non-athletes (22,27,28) .
.In most of studies, most individuals who were active in sports were males who
were less than twenty‐five years old, and, although all three of these factors were
associated with an increased risk on univariate analysis, only age and sex remained
independently predictive when they were considered together in a multivariate analysis.
Restricting survival analysis to males who were less than twenty‐five years old
revealed that 77% of the 120 athletes had recurrent instability develop by the end of the
second year compared with 81% of the thirty‐five non-athletes. By the end of the fifth
year, both groups had an 85% probability of recurrent instability. So it appeared that
participation in sports has a minor effect on the risk of recurrent instability (106,110), which our study is underpowered to detect. However, a much larger prospective cohort study would be required to definitively resolve this issue (61,67,72,85,89).