Immobilization in External Rotation After Shoulder Dislocation Reduces the Risk of Recurrence

Abstract

Immobilization in external rotation after an initial shoulder dislocation reduces the risk of recurrence compared with that associated with the conventional method of immobilization in internal rotation. This treatment method appears to be particularly beneficial for patients who are thirty years of age or younger.

Evaluation of immobilization in external rotation after primary traumatic anterior shoulder dislocation: 5-year results

“…In comparison with traditional immobilization in internal rotation, this new method was assumed to reduce the recurrence rate after a first-time traumatic anterior shoulder dislocation. These findings were later supported by Itoi et al [2,3] in an MRI study (2001) and in a randomized controlled study (2007) in which a significantly lower recurrence rate could be found in patients who were initially treated with an external rotation brace (20 % recurrence rate in the external rotation group vs. 38 % in the internal rotation group). Several other studies have been published since the initial reports by Itoi et al, investigating the immobilization period [4] and the amount of external rotation that is required to effectively reduce the labroligamentous complex (LLC) [5].…”

“…An expanded prospective study was published by Itoi et al in 2007. In this trial, the rate of recurrence was significantly lower within the group of bracing in external rotation compared to the group with internal rotation with an average follow-up of 25.6 months ( Table 2).…”

“…Additional calculations revealed a lowering of the relative risk of recurrence of about 38.2 % in the patients treated with the external rotation brace compared to the patients with internal rotation. Especially in the critical age range of \30 years, a reduction in the relative risk of recurrence was achieved at approximately 46.1 % [3]. For the first time, important questions have been raised in recent years regarding the method of immobilization in external rotation based on two further prospective trials, in which no benefit could been shown in relation to the rate of re-dislocations [6,7].…”

“…However, within the study by Itoi et al [3], an older patient population (internal rotation: 37 years; external rotation: 35 years) was included. It is known that patients\30 years of age are at higher risk of re-dislocations regardless of the form of immobilization [3,7,[19][20][21], which is also proven in the underlying study in relation to the whole study population (25 vs. 15 % see above).…”

The Recognition and Treatment of First-Time Shoulder Dislocation in Active Individuals

“…A subsequent short-term clinical study revealed decreased recurrence rates in patients immobilized in external rotation compared to those immobilized in internal rotation. 12 After 3 weeks of immobilization, the external rotation group had a recurrence rate of 26%, while the recurrence rate for those in the internal rotation group was 42%, with a relative risk reduction of 46% in patients younger than 30 years.…”