A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study

doi:10.1016/S1058-2746(03)00171-X

Journal of Shoulder and Elbow Surgery

Volume 12, Issue 5, September–October 2003, Pages 413-415

https://doi.org/10.1016/S1058-2746(03)00171-X Get rights and content

Abstract

This preliminary prospective study was conducted to determine whether immobilization with the arm in external rotation would decrease the rate of recurrence after initial traumatic anterior dislocation of the shoulder. Forty patients with initial shoulder dislocations were assigned to (1) conventional immobilization in internal rotation (IR group, n = 20) or (2) a new method of immobilization in external rotation (ER group, n = 20). The recurrence rate was 30% in the IR group and 0% in the ER group at a mean 15.5 months. The difference in recurrence rate was even greater among those who were aged less than 30 years (45% in the IR group and 0% in the ER group). Immobilization with the arm in external rotation is effective in reducing the rate of recurrence after initial dislocation of the shoulder.

Section snippets

Materials and methods

From January 2000, 42 patients with an initial anterior dislocation of the shoulder were referred to our institutions. Of these, 14 had undergone reduction and were referred to us, whereas the remaining 28 visited us directly with their shoulders dislocated. After routine radiographic examination of the anteroposterior view, the shoulders were reduced manually. Radiographic examination revealed a fracture of the greater tuberosity in 9 cases and a fracture of the glenoid in 1 case. The greater

Results

Five patients in the IR group (twenty-five percent) and four patients in the ER group (twenty percent) took off the immobilizer in less than a week despite our instructions. All others immobilized the shoulder for 3 weeks as instructed. There was no significant difference in compliance (P = .70). The recurrence rate was 6 of 20 in the IR group (30%) and 0 of 20 in the ER group (0%) (P = .008). Among those who were aged younger than 30 years, the recurrence rate was 5 of 11 in the IR group (45%)

Discussion

Immobilization in internal rotation after shoulder dislocation has been performed for over 2000 years, since the era of Hippocrates.⁴ Surprisingly, there has been no evidence that this position is optimum for healing of the Bankart lesion. The shoulder never redislocates in 52% of patients after an initial dislocation, and recurrent dislocations spontaneously cease in 20% of patients with recurrent dislocations.⁵ This information suggests that the Bankart lesion has the ability to heal.

References (8)

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Should acute anterior dislocation of the shoulder be treated in external rotation
Trans Orthop Res Soc
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Hippocrates. On the articulations. The genuine works of Hippocrates. Clin Orthop...

There are more references available in the full text version of this article.

Cited by (207)

Arthroscopic findings of traumatic first-time anterior shoulder instability: a comparison of adolescent versus adult patients
2024, JSES International
Recurrence rates after first-time shoulder dislocation in young patients are high, especially in their early teens. Only a few studies have arthroscopically investigated the inside of the glenohumeral joint in young patients. Such arthroscopic investigation would help in solving the cause of the greater incidence of recurrent instability in the young population, especially in their early teens.
Data from 42 patients with first-time anterior shoulder dislocation were retrospectively reviewed. The participants were divided into two groups: those aged 10 to 15 years at the time of the dislocation (adolescent group) and those aged 20- 29 years (adult group). The arthroscopic findings regarding the glenohumeral joint in the adolescent group were assessed and compared to those in the adult group. The intra-articular pathology was examined in all cases and recorded with specific reference to (1) the anterior capsulolabral lesion, (2) Hill-Sachs lesion, (3) labrum-anteroinferior glenohumeral ligament complex, and (4) other concomitant lesions.
Anterior joint laxity was found more in the adolescent group than in the adult group (P = .046). Thirty-six (83%) shoulders had Hill-Sachs lesions: 6 shoulders (60%) in the adolescent group and 30 shoulders (97%) in the adult group, with a significant difference (P < .001).
Pathological findings observed during arthroscopy are more common in the adult group, whereas recurrent instability is more likely in adolescent group.
Kinematic analysis of damaged capsulolabral structure in patients with anterior shoulder instability using cine-magnetic resonance imaging
2023, JSES International
We assessed damaged anterior capsulolabral motion during axial shoulder rotation in patients with anterior shoulder instability.
Twenty-nine shoulders of 28 patients with anterior shoulder instability who underwent cine-magnetic resonance imaging during axial rotation of the adducted arm were included. The motion was captured after an intra-articular injection of saline solution (10-20 mL). During imaging, the shoulder was rotated passively from maximum internal rotation to maximum external rotation in the first 10 s and then back to maximum internal rotation in the subsequent 10 s. We assessed the rotational angles of the damaged labrum during compressing and pulling the humeral head against the glenoid. Evaluation of the rotational angles was performed on a series of axial images through the humeral head center.
The mean angles that damaged labrum compressed and pulled off against the glenoid were 12.0 ± 19.1° and 2.8 ± 21.2°, respectively. Additionally, seven of the 29 shoulders showed that the damaged labrum compressed on the glenoid rim before the rotational angle exceeded 0° during external rotation. In 13 shoulders, the damaged labrum could remain repositioned on the glenoid rim over the neutral position during internal rotation. In two shoulders, the damaged labrum was not compressed against the glenoid at the maximum external rotation. The injected saline moved from the posterior to the anterior side of the glenohumeral joint during internal rotation in each shoulder.
The damaged labrum could be positioned on the glenoid when the arm was in a traditional internal immobilization.
Management of first shoulder dislocation
2022, Journal de Traumatologie du Sport
Les luxations antéro-internes de l’épaule sont un problème fréquent, notamment lors de certaines activités sportives chez des sujets de moins de 30 ans. Le but de cette mise au point est de faire un rappel anatomique et physiopathologique des lésions observées lors d’une première luxation. Une bonne connaissance des lésions anatomiques est indispensable. Tous les facteurs de récidive doivent être identifiés afin d’adapter le traitement à sa principale nécessité : éviter une récidive. En 2022, la gestion thérapeutique d’une primoluxation de l’épaule demeure très controversée depuis l’immobilisation relative du bras en rotation interne ou en rotation externe au moyen d’une simple écharpe, d’un gilet orthopédique ou d’une orthèse spécifique. La durée de l’immobilisation varie d’une à quelques semaines. L’autre choix thérapeutique est la réparation chirurgicale des lésions qui peut se faire à l’heure actuelle à ciel ouvert ou en arthroscopie.
Antero-internal dislocations of the shoulder are a common problem, especially during certain sports activities in subjects under 30 years. The purpose of this development is to make an anatomical and physiopathological reminder of the lesions observed during a first dislocation. A good knowledge of anatomical lesions is essential. All the factors of recidivism may be identified in order to adapt the treatment to its main necessity: to avoid a recidivism. In 2022, the therapeutic management of a primary dislocation of the shoulder remains highly controversial since the relative immobilization of the arm in internal rotation or in external rotation by means of a simple sling, an orthopedic vest or a specific orthosis. The duration of the asset varies from one to a few weeks. The other therapeutic choice is surgical repair of lesions that can currently be done in the open or in arthroscopy.
Editorial Commentary: A Consensus of Experts Complements the Clinical Evidence on Diagnosis and Treatment of Anterior Glenohumeral Instability
2022, Arthroscopy - Journal of Arthroscopic and Related Surgery
The current diagnostic and treatment strategies for anterior glenohumeral instability have been refined by high-quality clinical and basic science studies, but many controversies remain. These include the bone loss threshold for arthroscopic Bankart repair and the influence of other clinical factors on this decision, the optimal bracing position following anterior glenohumeral dislocation, and the optimal coracoid graft orientation during the Latarjet procedure. Randomized clinical trials often present conflicting results, and many of these are small-sample and fragile studies. Obtaining an expert consensus on the topic, by means of the Delphi method, is an attractive alternative to such clinical trials. Several studies employing variations of the Delphi method have addressed the diagnosis and treatment of anterior glenohumeral instability. These have stressed the importance of a meticulous technique during arthroscopic Bankart repair and of recognition of glenoid and humeral bone loss and treating this appropriately. These studies have also helped identify areas where consensus is modest or lacking to motivate additional clinical research study.
Anterior Shoulder Instability Part I—Diagnosis, Nonoperative Management, and Bankart Repair—An International Consensus Statement
2022, Arthroscopy - Journal of Arthroscopic and Related Surgery
The purpose of this study was to establish consensus statements via a modified Delphi process on the diagnosis, nonoperative management, and Bankart repair for anterior shoulder instability.
A consensus process on the treatment using a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability.
The independent factors identified in the 2 statements that reached unanimous agreement in diagnosis and nonoperative management were age, gender, mechanism of injury, number of instability events, whether reduction was required, occupation, sport/position/level played, collision sport, glenoid or humeral bone-loss, and hyperlaxity. Of the 3 total statements reaching unanimous agreement in Bankart repair, additional factors included overhead sport participation, prior shoulder surgery, patient expectations, and ability to comply with postoperative rehabilitation. Additionally, there was unanimous agreement that complications are rare following Bankart repair and that recurrence rates can be diminished by a well-defined rehabilitation protocol, inferior anchor placement (5-8 mm apart), multiple small-anchor fixation points, treatment of concomitant pathologies, careful capsulolabral debridement/reattachment, and appropriate indications/assessment of risk factors.
Overall, 77% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the aspects of patient history that should be evaluated in those with acute instability, the prognostic factors for nonoperative management, and Bankart repair. Furthermore, there was unanimous consensus on the steps to minimize complications for Bankart repair, and the placement of anchors 5-8 mm apart. Finally, there was no consensus on the optimal position for shoulder immobilization.
Level V, expert opinion.
Mid- to long-term results of postoperative immobilization in internal vs. external rotation after arthroscopic anterior shoulder stabilization
2021, JSES International
There is still a disagreement on the postoperative rehabilitation concerning position of immobilization of the shoulder after arthroscopic anterior shoulder stabilization and its influence on the clinical outcome. The aim of this study was to evaluate the clinical results and the recurrence rate after arthroscopic anteroinferior shoulder stabilization and postoperative immobilization in internal rotation vs. external rotation.
Twenty-five patients (22 male and 3 female, mean age 28.5 years) were included in this prospective nonrandomized cohort study. In group I (11 male, 2 female, mean age 28 years), the postoperative functional immobilization was carried out in internal rotation of 60°, and in group II (11 male, 1 female, mean age 30 years), 15° of external rotation of the arm for 4 weeks in both groups. The clinical follow-up was performed at 2, 4, and 6 weeks as well as at 3, 6, and 12 months postoperatively including assessment of range of motion and functional shoulder scores (Subjective Shoulder Value, Constant score, Rowe score, Walch Duplay score, Melbourne Instability Shoulder Score). Furthermore, shoulder instability was evaluated using the apprehension, relocation, and surprise tests. Mid-term follow-up data were additionally assessed after a minimum of 4 years.
Twenty patients (19 male and 1 female) with an average age of 28 years were followed up for 62 (53-72) months after arthroscopic stabilization. The comparison of both groups showed almost equal results regarding the range of motion without any significant differences (P > .05). The evaluation of the shoulder function scores also showed no significant differences with an average Subjective Shoulder Value of 95% vs. 91%, Constant score of 89 vs. 88 points, Rowe score of 96 vs. 94 points, Walch Duplay score of 86 vs. 89 points, Melbourne Instability Shoulder Score of 96 points, and Western Ontario Shoulder Instability Index of 88% vs. 84% (P > .05). There was no recurrent dislocation in both groups.
The type of immobilization after arthroscopic shoulder stabilization does not influence the clinical results after a mid- to long-term follow-up.

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Original articleA new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study

Abstract

Section snippets

Materials and methods

Results

Discussion

Recurrent or habitual dislocation of the shoulder-joint

BMJ

Skeletal fibrous tissuestendon, joint capsule, and ligament

Should acute anterior dislocation of the shoulder be treated in external rotation

Trans Orthop Res Soc

Original article
A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study