Immobilization in external rotation combined with abduction reduces the risk of recurrence after primary anterior shoulder dislocation

Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study

“…The tuberosities were repositioned as anatomically as possible. They were reattached as described by Boileau et al, 4 with horizontal and vertical nonabsorbable sutures to fix the tuberosities to each other, to the prosthesis, and to the shaft. Intraoperatively, a rotator cuff tear was found in 11 cases.…”

“…30 However, many authors have reported that the results of HA are closely related to the accuracy of reduction and healing of the tuberosities. 2,4 Reverse shoulder arthroplasty (RSA) has been proposed as an alternative option for acute complex proximal humeral fractures, 7,20,24 especially in elderly patients with degenerative arthritis or rotator cuff deficiency. The theoretical advantage of the RSA is that functional results appear to depend less on healing of tuberosities and rotator cuff integrity, 7 but this is still under assessment.…”

The Epidemiology and Natural History of Anterior Shoulder Instability

“…Most recently, Whelan et al conducted a meta-analysis of six randomized controlled trials comparing internal rotation versus external rotation bracing and found no overall significant difference in rates of recurrence or in patients' perceptions of their health-related quality of life [57]. Recently, a clinical study found a reduced recurrence rate with ER bracing in not only external rotation (10°) but also abduction (15°), utilizing a customized arm and thoracic shell [58]. Despite the multitude of current studies examining the position of the shoulder with regard to immobilization (Table 2), it remains an individualized decision by the physician and patient.…”

Shoulder instability: A myriad of decisions for optimal emergency department care

“…The RANP considered placing this patient in an external rotation brace as described and advocated by Itoi et al (2003) and Heidari et al (2014); however there is ongoing debate as to the best approach to immobilisation post glenohumeral dislocation. Randomised controlled trials by Liavaag et al (2011) and Whelan et al (2014) have demonstrated no reduction in reoccurrence rates by managing the patient in an external rotation brace vs. the more traditional approach of internal rotation.…”