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How to immobilise after shoulder dislocation?
  1. Lennard Funk, Consultant,
  2. Martin Smith, Consultant
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; s.carley1btinternet.com

    Abstract

    A short cut review was carried out to establish the best way to immobilise dislocated shoulders after reduction. A total of 47 papers were identified using the reported search, of which four represent the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. For patients with a first anterior shoulder dislocation immobilisation in external rotation may be of more benefit than immobilisation in internal rotation.

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    Report by Lennard Funk, ConsultantChecked by Martin Smith, Consultant

    Three part question

    [In patients with primary anterior shoulder disclocation] is [immobilisation in internal or external rotation] better at [reducing redislocation rates]?

    Clinical scenario

    A 25 year old man presents to the emergency department with a first left anterior shoulder dislocation. This is reduced satisfactorily under sedation. You decide to put the patient in a collar and cuff in internal rotation (as you have always done). However, your emergency department physiotherapist suggests that it should be placed in external rotation. You wonder why?

    Search strategy

    Medline 1966 to June 2005 using the OVID interface; Embase 1996 to week 31, 2005: [shoulder dislocation.mp. or exp Shoulder Dislocation/] and [exp Immobilization/or immobilisation.mp. or exp Casts, Surgical/] and [external.af.]. Cochrane 2005, Issue 3: “shoulder dislocation external”.

    Search outcome

    Medline: 15 papers found of which four were relevant (table 1). Embase: nine papers found, no new references found. Cochrane: 23 citations, no new references found.

    Table 1

    Comment(s)

    Standard teaching has been to immobilise patients with anterior shoulder dislocations in internal rotation, typically using a collar and cuff system. These interesting studies question this perceived wisdom and suggest that external rotation may be a better position. There is only one clinical study here that suggests good results, though the follow up for the clinical study was short and the position of external rotation immobilisation may not achieve such good compliance in clinical practice.

    CLINICAL BOTTOM LINE

    For patients with a first anterior shoulder dislocation immobilisation in external rotation may be of more benefit than immobilisation in internal rotation.

    Report by Lennard Funk, ConsultantChecked by Martin Smith, Consultant

    References

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