Position and Duration of Immobilization After Primary Anterior Shoulder Dislocation

Paterson, William H.; Throckmorton, Thomas W.; Koester, Michael; Azar, Frederick M.; Kuhn, John E.
December 2010
Journal of Bone & Joint Surgery, American Volume;12/15/2010, Vol. 92-A Issue 18, p2924
Academic Journal
Background: Immobilization after closed reduction has long been the standard treatment for primary anterior dislocation of the shoulder. To determine the optimum duration and position of immobilization to prevent recurrent dislocation, a systematic review of the relevant literature was conducted. Methods: Of 2083 published studies that were identified by means of a literature review, nine Level-I and Level-II studies were systematically reviewed. The outcome of interest was recurrent dislocation. Additional calculations were performed by pooling data to identify the ideal length and position (external or internal rotation) of immobilization. Results: Six studies (including five Level-I studies and one Level-II study) evaluated the use of immobilization in internal rotation for varying lengths of time. Pooled data analysis of patients younger than thirty years old demonstrated that the rate of recurrent instability was 41% (forty of ninety-seven) in patients who had been immobilized for one week or less and 37% (thirty-four of ninety-three) in patients who had been immobilized for three weeks or longer (p = 0.52). An age of less than thirty years at the time of the index dislocation was significantly predictive of recurrence in most studies. Three studies (including one Level-I and two Level-II studies) compared recurrence rates with immobilization in external and internal rotation. Analysis of the pooled data demonstrated that the rate of recurrence was 40% (twenty-five of sixty-three) for patients managed with conventional sling immobilization in internal rotation and 25% (twenty-two of eighty-eight) for those managed with bracing in external rotation (p = 0.07). Conclusions: Analysis of the best available evidence indicates there is no benefit of conventional sling immobilization for longer than one week for the treatment of primary anterior shoulder dislocation in younger patients. An age of less than thirty years at the time of injury is significantly predictive of recurrence. Bracing in external rotation may provide a clinically important benefit over traditional sling immobilization, but the difference in recurrence rates did not achieve significance with the numbers available.


Related Articles

  • Arthroscopic treatment of acute acromioclavicular joint dislocation by coracoclavicular ligament augmentation. Liu, Xudong; Huangfu, Xiaoqiao; Zhao, Jinzhong // Knee Surgery, Sports Traumatology, Arthroscopy;May2015, Vol. 23 Issue 5, p1460 

    Purpose: Coracoclavicular (CC) ligament augmentation has been a method to treat acromioclavicular (AC) joint dislocation in recent years. The purpose of this paper is to describe our arthroscopic CC ligament augmentation technique in treating type III and V acute AC joint dislocations and to...

  • Surgical management of chronic, unreduced anterior dislocation of the shoulder. Ozkan, Korhan; Unay, Koray; Cift, Hakan; Kadioglu, Baris; Turhan, Yalcın; Eceviz, Engin // European Journal of Orthopaedic Surgery & Traumatology;Dec2010, Vol. 20 Issue 8, p657 

    Chronic old unreduced anterior dislocations are extremely rare. We report a case of 75-year-old lady who was seen in policlinic with the symptoms of severe pain and limited shoulder range of motion in which radiographies revealed anteroinferior missed shoulder dislocation. Open reduction with...

  • Management of Primary Anterior Shoulder Dislocations Using Immobilization. Smith, Brent I.; Bliven, Kellie C. Huxel; Morway, Genoveffa R.; Hurbanek, Jason G. // Journal of Athletic Training (Allen Press);May2015, Vol. 50 Issue 5, p550 

    An abstract of the article "Management of Primary Anterior Shoulder Dislocations Using Immobilization," by Brent I. Smith and colleagues is presented.

  • Open and Closed Kinetic Chain Exercises Improve Shoulder Joint Reposition Sense Equally in... Rogol, Ian M.; Ernst, Gregory // Journal of Athletic Training (National Athletic Trainers' Associ;Oct-Dec98, Vol. 33 Issue 4, p315 

    Provides information on a study that compared the effects of open and closed kinetic chain exercise on shoulder joint reposition sense. Methodology; Results of the study; Discussion.

  • Bilateral traumatic anterior dislocation of the Shoulder - A rare case report. Grover, Amit; Nagaraj, Prashanth; Gadi, Daksh; Singh, Inderjit // International Journal of Biological & Medical Research;2014, Vol. 5 Issue 4, p4618 

    Introduction: Shoulder is the most common joint to dislocate in the human body. Bilateral shoulder dislocations are very rare and occur following seizures and electrocution and are usually of posterior type. Bilateral traumatic anterior shoulder dislocation is a very rare entity with very few...

  • Incapacity of work after arthroscopic Bankart repair. Kraus, Tobias; Freude, Thomas; Fiedler, Sebastian; Schröter, Steffen; Stöckle, Ulrich; Ateschrang, Atesch; Kraus, Tobias M; Schröter, Steffen; Stöckle, Ulrich // Archives of Orthopaedic & Trauma Surgery;Oct2015, Vol. 135 Issue 10, p1429 

    Background and Introduction: The incapacity with respect to work following anterior-inferior shoulder dislocation and subsequent Bankart repair has not been previously examined. The objective of this study was to examine a patient's incapacity according to the classification by the...

  • Modified Boytchev procedure for treatment of recurrent anterior dislocation of shoulder. Garg, Anant Kumar; Ayan, Saankritya; Keshari, Vikas; Kundu, Debi; Mukhopadhyay, Kiran Kumar; Acharyya, Biplab // Indian Journal of Orthopaedics;Jul/Aug2011, Vol. 45 Issue 4, p336 

    Background: More than 200 different operations have been described for the treatment of recurrent anterior dislocation of shoulder. The Modified Boytchev procedure employs rerouting of the detached tip of coracoid process with its attached conjoined tendon (short head of biceps and...

  • Open Bankart Repair for the Treatment of Anterior Shoulder Instability without Substantial Osseous Glenoid Defects. Moroder, Philipp; Odorizzi, Marco; Pizzinini, Severino; Demetz, Ernst; Resch, Herbert; Moroder, Peter // Journal of Bone & Joint Surgery, American Volume;9/2/2015, Vol. 97 Issue 17, p1398 

    Background: Neglected osseous glenoid defects are thought to be one of the reasons for the reported high rates of recurrent instability at long-term follow-up after Bankart repair. We hypothesized that open Bankart repair for the treatment of anterior glenohumeral instability in the absence of a...

  • The Bankart Procedure: An Unrealized Expectation for Long-Term Shoulder Stability. Warner, Jon J. P. // Journal of Bone & Joint Surgery, American Volume;9/2/2015, Vol. 97 Issue 17, pe61.1 

    The author discusses the results of the study "Open Bankart Repair for the Treatment of Anterior Shoulder Instability without Substantial Osseous Glenoid Defects: Results After a Minimum Follow-up of Twenty Years" conducted by Dr. Philipp Moroder and colleagues. He comments on the researchers'...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics