ShoulderImmobilization in external rotation combined with abduction reduces the risk of recurrence after primary anterior shoulder dislocation
Section snippets
Study design and setting
We conducted a prospective, randomized, controlled, clinical trial, called Shoulder Stabilizing Support (3S), to compare 2 nonsurgical treatments. Between October 2011 and March 2013, 135 consecutive patients with primary anterior dislocation of the shoulder were screened for inclusion in the study. The study was performed at the emergency department (ED) of a university-affiliated urban hospital that is a regional level II trauma center with annual census of 68,000 ED visits.
The study was
Results
The study screened 135 patients for inclusion; of these, 102 patients (91 males and 11 females) with the diagnosis of primary anterior dislocation of the shoulder were included.
Enrollment, treatment allocation, follow-up, and data analysis of all participants are summarized in Fig. 2. The mean ± standard deviation age was 35.7 ± 8.9 years. There were 72 (70.6%) right-sided dislocations and 30 (29.4%) left-sided dislocations. The etiologies of dislocations were sport activities for 69 patients
Discussion
Dislocations of the shoulder joint are common medical conditions in an ED practice.2 Among nonsurgical interventions, immobilization in adduction and internal rotation after anterior dislocation of shoulder has been applied for more than 2000 years, since the era of Hippocrates.9 This method persists broadly in ED settings and orthopedic clinics20, 22, 34; however, the redislocation rate is 68% to 94%, especially in young individuals and active athletes treated with this technique.1, 21, 31, 35
Conclusions
Immobilization in 15° of abduction and 10° of external rotation for 3 weeks reduced the relative risk of recurrence of a primary anterior shoulder dislocation compared with the risk associated with conventional immobilization in adduction and internal rotation. However, this beneficial treatment was associated with higher proportion of noncooperative patients than the conventional treatment.
Accordingly, owing to the effectiveness of abducted and externally rotated stabilization, this method
Acknowledgment
The authors acknowledge Abdollah Asadollahi and Mohammad Ghashami for their contributions to perform the brace preparation and application.
Disclaimer
The investigation was financially supported by a grant from Shahid Beheshti University of Medical Sciences, Iran (No. 16X-03B-76349).
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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Cited by (46)
Immobilization in external rotation versus internal rotation after shoulder dislocation: A meta-analysis of randomized controlled trials
2020, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :Seven trials [10,21–24,30,31] reported participant losses. Selective reporting was difficult to assess, and trial protocols were unavailable in 10 trials [20,10,21,23–29]. All trials were generally assessed low in quality and contained the risk of bias, suggesting future studies might influence the results in this meta-analysis and require revising the conclusion.
Immobilization in external rotation after primary shoulder dislocation reduces the risk of recurrence in young patients. A randomized controlled trial
2020, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :Over the last few years, studies with conflicting evidences have investigated the effect of immobilization in IR or ER among patients with first-time anterior shoulder dislocation. Itoi et al. [7] and Heidari et al. [13] concluded to a lower risk of recurrence with immobilization in ER for three weeks when compared to the traditional immobilization in a sling. On the contrary, Finestone et al. [14], Whelan et al. [15] and Liavaag et al. [11] found no significant benefit in the recurrence rate when comparing both types of immobilization.
Immobilization in external rotation after primary shoulder dislocation reduces the risk of recurrence in young patients. A randomized controlled trial
2020, Revue de Chirurgie Orthopedique et TraumatologiqueThe position of sling immobilization influences the outcomes of anatomic total shoulder arthroplasty: a randomized, single-blind, prospective study
2018, Journal of Shoulder and Elbow SurgeryEpidemiology of glenohumeral dislocation and subsequent instability in an urban population
2018, Journal of Shoulder and Elbow SurgeryClosed Treatment of Shoulder Dislocations
2018, Operative Techniques: Shoulder and Elbow Surgery
The Shahid Beheshti University of Medical Sciences (SUMS) Research Ethics Committee approved this study (Study No. SB-104).