Conservative management following closed reduction of traumatic anterior dislocation of the shoulder

Braun, C.; McRobert, Cliona

doi:10.1002/14651858.cd004962.pub4

Cited by 21 publications

(18 citation statements)

References 75 publications

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“…The concept of immobilization in ER was introduced by Itoi et al 25 in 2001, and since then multiple studies have been performed comparing different kinds of immobilization. In their Cochrane review, Braun and McRobert 6 concluded that the evidence was insufficient regarding whether immobilization in ER confers any benefit compared with immobilization in IR after FSD with regard to recurrent instability. The pooled recurrence rate was 22.4% for immobilization in ER versus 30% for immobilization in IR.…”

Section: Discussionmentioning

confidence: 99%

“…The pooled recurrence rate was 22.4% for immobilization in ER versus 30% for immobilization in IR. 6 None of the studies used an immobilization of 60° of ER plus 30° of ABD, which, according to biomechanical and arthroscopic data, is the best position for reduction of the labrum to allow healing in an anatomic position. 18 , 24 The degree of ER used varied from 0° to 30°, and in only 2 trials was the arm additionally immobilized in ABD.…”

Section: Discussionmentioning

confidence: 99%

“… 18 , 24 The degree of ER used varied from 0° to 30°, and in only 2 trials was the arm additionally immobilized in ABD. 6 , 9 , 13 , 19 , 23 , 32 , 44 , 49 Heidari et al 19 presented the first RCT comparing the risk of recurrent instability after immobilization in IR versus ER+ABD. In their study, the shoulder was stabilized in 10° of ER and 15° of ABD or was immobilized in IR in a conventional sling.…”

Section: Discussionmentioning

confidence: 99%

“…Several clinical studies comparing IR and ER immobilization for nonoperative management of FSD were performed. 13 , 22 , 23 , 32 , 44 , 49 In a recent Cochrane review, Braun et al 6 concluded that there is insufficient evidence as to whether immobilization in ER confers any benefit over immobilization in IR. However, it must be kept in mind that all of these studies used different angles of ER between 0° and 30°.…”

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confidence: 99%

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Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial

et al. 2021

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Background: Treatment of first-time shoulder dislocation (FSD) is a topic of debate. After high rates of recurrent instability after nonoperative management were reported in the literature, primary repair of FSD significantly increased. At the same time, new concepts were proposed that had promising results for immobilization in external rotation (ER) and abduction (ABD). Purpose: The aim of this study was to evaluate the recurrence rates (primary outcome) and clinical outcomes (secondary outcome parameters) of immobilization in ER+ABD versus arthroscopic primary stabilization after FSD. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In a multicenter randomized controlled trial, patients with FSD were randomized to either treatment with immobilization in 60° of ER plus 30° of ABD (group 1) or surgical treatment with arthroscopic Bankart repair (group 2). Clinical evaluation was performed 1, 3, and 6 weeks as well as 6, 12, and 24 months postoperatively or after reduction, including range of motion, instability testing, subjective shoulder value, Constant-Murley score, Rowe score, and Western Ontario Shoulder Instability Index. Recurrent instability events were prospectively recorded. Results: Between 2011 and 2017, a total of 112 patients were included in this study. Of these, 60 patients were allocated to group 1 and 52 to group 2. At the 24-month follow-up, 91 patients (81.3%) were available for clinical examination. The recurrence rate was 19.1% in group 1 and 2.3% in group 2 ( P = .016). No significant differences were found between groups regarding clinical shoulder scores ( P > .05). Due to noncompliance with the immobilization treatment protocol, 4 patients (6.7%) were excluded. Conclusion: Immobilization in ER+ABD versus primary arthroscopic shoulder stabilization for the treatment of FSD showed no differences in clinical shoulder scores. However, recurrent instability was significantly higher after nonoperative treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial

et al. 2021

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“…[ 6 ] Nevertheless, several articles reported a high incidence of poor functional outcome. [ 7 , 8 ] More and more studies have recommended that surgical procedure is an alternative choice for shoulder instability. [ 9 , 10 ] The rehabilitation after operation is a necessary condition for the recovery of shoulder joint activity.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of a phone assistance nursing program for functional outcomes in patients after shoulder instability surgery

Zheng¹,

Wang²,

Wang³

et al. 2020

Medicine

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Objective: We conduct this research protocol for the assessment of the effect of phone-assisted care programs on functional outcomes in patients receiving shoulder instability surgery. Methods: This is a randomized controlled, single center trial which will be implemented from October 2020 to December 2021. This trial is conducted according to the SPIRIT Checklist of randomized researches. It was authorized via the Ethics Committee of the First People's Hospital of Xiangyang city affiliated to Hubei Medical College (XY234-026). Ninety participants who undergo shoulder instability surgery are analyzed. Patients are randomly divided into control group (standard management group, with 45 patients) and study group (the phone program group, with 45 patients). In control group, the exercises at home are not monitored. Whereas in study group, patients are asked about their at-home activities, and the extra coaching sessions are provided to patients on self-care, exercise guidance, and the importance of exercise at home, and then answers to their questions. The primary outcome is the range of motion of the shoulder joint, and the pain arcs are determined through the range of motion. The extra assessments include the shoulder functional outcome, pain, and the quality of life. All the analysis needed in this study is implemented with SPSS (IBM, Chicago, USA) for Windows Version 19.0. Results: The clinical outcome variables between groups are shown in Table. Conclusion: This investigation can offer a reliable basis for the effectiveness of phone assistance nursing program in patients after shoulder instability surgery. Trial registration number: researchregistry6010

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How do different immobilization positions compare for improving longer-term outcomes following closed reduction of traumatic anterior dislocation of the shoulder?

Edwards¹

2020

Cochrane Clinical Answers

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Conservative management following closed reduction of traumatic anterior dislocation of the shoulder

Abstract: Conservative management following closed reduction of traumatic anterior dislocation of the shoulder.

Cited by 21 publications

References 75 publications

Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial

Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial

The efficacy of a phone assistance nursing program for functional outcomes in patients after shoulder instability surgery

How do different immobilization positions compare for improving longer-term outcomes following closed reduction of traumatic anterior dislocation of the shoulder?

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