Immobilisation following traumatic anterior glenohumeral joint dislocation: a literature review

Traumatic anterior dislocations of the shoulder are common and disabling injuries, in young and old alike. For centuries, the means of managing this injury has been to immobilise the affected shoulder after reduction, for up to 8 weeks, in an adducted and internally rotated position. The aim of this literature review is to assess whether traumatic anterior shoulder dislocations should be immobilised; for how long should they be immobilised; and whether the position of immobilisation affects outcomes. An electronic literature search was performed of the databases AMED, Cinahl, Embase, Medline (using Ovid), PEDro and Pubmed, from their inceptions to February 2005. Human clinical trials, written in English, which could assist in answering the research questions, were included. Sixteen (of 168) papers met the inclusion criteria and were reviewed. The review suggests that it remains unclear whether patients with traumatic primary anterior shoulder dislocations should be immobilised, or for how long. Similarly, it remains uncertain whether patients should be immobilised in internal, or external rotation. Much of this uncertainty is due to the limited size of the evidence base, which exhibited numerous methodological weaknesses (e.g. small sample sizes, no control groups, not evaluating findings against statistical tests). Recommendations are made to develop the evidence base.