Shoulder
Immobilization in external rotation combined with abduction reduces the risk of recurrence after primary anterior shoulder dislocation

https://doi.org/10.1016/j.jse.2014.01.018Get rights and content

Background

We aimed to compare the effectiveness of immobilization in abduction and external rotation vs immobilization in adduction and internal rotation after primary anterior dislocation of the shoulder.

Methods

The study randomized 102 patients (age range, 15-55 years) with the diagnosis of primary anterior dislocation of the shoulder to receive immobilization in adduction and internal rotation (AdIR, n = 51) using sling and swathe bandage or immobilization in abduction and external rotation (AbER, n = 51) with a stabilizer brace. Patients received a rehabilitation program 3 weeks after the intervention.

Results

After a 24-month follow-up, 33.3% in the AdIR group and 3.9% in the AbER group had recurrence (P < .001). The difference in the recurrence rate was greater in the subgroup aged between 31 and 40 years (44.8% in the AdIR group and 3.8% in the AbER group, P < .001). Ten patients in the AbER group (19.6%) and 3 in the AdIR group (5.8%) discontinued shoulder immobilization before 3 weeks (P = .03). In patients without recurrence, the anterior apprehension test was positive in 6 of 34 in the AdIR group (17.6%) and in 4 of 49 in the AbER group (8.1%, P = .19).

Conclusions

Immobilization with the shoulder joint in abduction and external rotation is an effective method to reduce the risk of recurrence after primary anterior shoulder dislocations and should be preferred to the traditional method of immobilization in adduction and internal rotation in clinical practice.

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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      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.

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    The Shahid Beheshti University of Medical Sciences (SUMS) Research Ethics Committee approved this study (Study No. SB-104).

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