Reference:
Hovelius L, Eriksson K, Fredin H, Hagberg G, Hussenius A, Lind B, Thorling J, Weckstrom J. Recurrences after Initial Dislocation of the Shoulder. J Bone Joint Surg. 1983;65-A(3):343-49
Clinical Question:
Does immobilization in internal rotation and adduction produce lower recurrence rates of shoulder dislocation than early mobilization?
Design:
3 x 3 factorial post-test only design.
Setting:
Twenty-seven Swedish hospitals.
Patients or Participants:
Two-hundred and fifty-seven subjects with a primary anterior shoulder dislocation.
Interventions:
Immobilization with the arm in a position of internal rotation and adduction for three to four weeks (group 1: N=112), or early mobilization (group 2: N=104.) A third treatment group (group 3: N=41) consisted of subjects who did not comply with their assigned treatment protocol, and received immobilization for a variety of durations. Within each treatment group, subjects were divided into subgroups by age (<= 22 years, 23-29 years or 30-40 years.)
Main Outcome Measures:
Incidence of recurrent dislocations.
Results:
For subjects less than 22 years old, recurrence rates were 49% (group 1), 46% (group 2), and 44% (group 3.) For subjects between the ages of 23 and 29 years old, recurrence rates were 26%, 28%, and 33% respectively. For subjects between the ages of 30 and 40 years old, recurrence rates were 11%, 15% and 13%.
Conclusions:
After a period of two years, there was no significant difference in the incidence of recurrence between any of the three treatment groups.
Commentary:
Traditional conservative treatment of glenohumeral dislocation has been ineffective in the prevention of redislocation. Recent studies have suggested that the position of immobilization may affect the ability of Bankart lesions to heal, and therefore affect recurrence rates. This commentary discusses the rationale for use of immobilization in external rotation, and gives an overview of the current evidence base for the issue.
Key Words:
Anterior shoulder dislocation, Bankart lesion, immobilization, external rotation.