Comparing external vs. internal rotation immobilization following primary anterior shoulder dislocation: a...

Area of Science:

• Orthopedics
• Sports Medicine
• Rehabilitative Medicine

Background:

• Immobilization is standard after anterior shoulder dislocation to aid healing and prevent recurrence.
• Internal rotation (IR) slings are conventional, while external rotation (ER) braces are newer, aiming for better labral coaptation.
• ER bracing raises concerns about patient comfort and compliance, with mixed clinical trial results.

Purpose of the Study:

• To compare functional and stability outcomes between ER and IR immobilization after primary anterior shoulder dislocation.
• To determine if ER bracing provides a clinically meaningful advantage over traditional IR immobilization.
• To synthesize evidence from randomized controlled trials (RCTs) and comparative cohort studies.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, Scopus, Embase, Google Scholar) up to December 2025.
• Included studies were RCTs and comparative cohort studies evaluating ER versus IR immobilization for first-time anterior shoulder dislocations.
• Seventeen studies involving 1170 patients were analyzed for outcomes including WOSI, recurrence rates, Constant-Murley Score, return-to-sport, and apprehension.

Main Results:

• Internal rotation (IR) immobilization showed a statistically significant but clinically insignificant improvement in Western Ontario Shoulder Instability Index (WOSI) scores.
• No significant differences were observed between IR and ER groups regarding dislocation recurrence rates.
• Functional outcomes, including Constant-Murley Score, return-to-sport rates, and shoulder apprehension, were comparable between the two immobilization methods.

Conclusions:

• External rotation (ER) and internal rotation (IR) immobilization yield similar functional and stability outcomes for primary anterior shoulder dislocations.
• Given the comparable recurrence and return-to-sport rates, and lack of clinically meaningful functional improvement, routine use of ER bracing is not supported.
• Current evidence suggests that traditional IR immobilization remains a viable and effective strategy.