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External rotation immobilization for primary shoulder dislocation: a randomized controlled trial.

Daniel B Whelan1, Robert Litchfield, Elizabeth Wambolt

  • 1Department of Surgery, St Michael's Hospital and University of Toronto, 55 Queen Street East (800), Toronto, ON, M5C 1R6, Canada, wheland@smh.ca.

Clinical Orthopaedics and Related Research
|January 4, 2014
PubMed
Summary
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Immobilization in external rotation did not reduce recurrent instability after primary anterior shoulder dislocation compared to traditional sling use. Quality of life scores also showed no significant difference between the two treatment methods.

Area of Science:

  • Orthopedics
  • Sports Medicine
  • Traumatology

Background:

  • Traditional treatment for anterior shoulder dislocations involves internal rotation immobilization.
  • Emerging evidence suggests external rotation immobilization may reduce recurrent instability.
  • This study investigates the efficacy of external rotation immobilization for first-time shoulder dislocations.

Purpose of the Study:

  • To compare the frequency of recurrent instability after primary anterior shoulder dislocation.
  • To evaluate disease-specific quality-of-life scores between external and internal rotation immobilization.
  • To assess treatment outcomes in young patients (<35 years) with traumatic anterior shoulder dislocations.

Main Methods:

  • A randomized controlled trial included 60 patients younger than 35 with primary anterior shoulder dislocations.

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  • Patients were randomized to either an internal rotation sling (n=29) or an external rotation brace (n=31) for 4 weeks.
  • Outcomes assessed included recurrent instability and quality-of-life scores (WOSI, ASES) over a mean follow-up of 25 months.

    • Main Results:

    • No significant difference in recurrent instability rates was observed between the external rotation (37%) and internal rotation (40%) groups (p=0.41).
    • Western Ontario Shoulder Instability (WOSI) scores were comparable between the two groups (p=0.74).
    • American Shoulder and Elbow Surgeons (ASES) scores showed a trend towards significance (p=0.05) but with small, clinically uncertain differences.

    Conclusions:

    • Immobilization in external rotation did not demonstrate a significant benefit over traditional sling immobilization in preventing recurrent instability after primary anterior shoulder dislocation.
    • Further research with larger sample sizes is needed to explore potential benefits in functional outcomes, compliance, or comfort.
    • Current evidence does not support a change in standard treatment protocols based on this study's findings.