Low-Cost Alternative External Rotation Shoulder Brace and Review of Treatment in Acute Shoulder Dislocations

Abstract

Traumatic dislocations of the shoulder commonly present to emergency departments (EDs). Immediate closed reduction of both anterior and posterior glenohumeral dislocations is recommended and is frequently performed in the ED. Recurrence of dislocation is common, as anteroinferior labral tears (Bankart lesions) are present in many anterior shoulder dislocations.14,15,18,23 Immobilization of the shoulder following closed reduction is therefore recommended; previous studies support the use of immobilization with the shoulder in a position of external rotation, for both anterior and posterior shoulder dislocations.7–11,19 In this study, we present a technique for assembling a low-cost external rotation shoulder brace using materials found in most hospitals: cotton roll, stockinette, and shoulder immobilizers. This brace is particularly suited for the uninsured patient, who lacks the financial resources to pay for a pre-fabricated brace out of pocket. We also performed a cost analysis for our low-cost external rotation shoulder brace, and a cost comparison with pre-fabricated brand name braces. At our institution, the total materials cost for our brace was $19.15. The cost of a pre-fabricated shoulder brace at our institution is $150 with markup, which is reimbursed on average at $50.40 according to our hospital billing data. The low-cost external rotation shoulder brace is therefore a more affordable option for the uninsured patient presenting with acute shoulder dislocation.

Reply to Comments on “Low-Cost Alternative External Rotation Shoulder Brace and Review of Treatment in Acute Shoulder Dislocations”

“…They further state that, the paper is “likely to be subject to reporting bias.” Jordan et al 2 quote articles that question the value of external rotation bracing over internal rotation bracing for acute anterior dislocations. 3 – 7 Each one of these publications 3 – 7 is also referenced in our review 1 and are the reason we clearly state in our article that “Posterior dislocations are immobilized in external rotation or a ‘gunslinger’ position of neutral rotation, abduction, and slight flexion. 8 The position of immobilization for anterior shoulder dislocations is somewhat controversial,” and we repeat that “larger randomized controlled trials, as well as meta-analyses comparing external and internal rotation immobilization for acute traumatic anterior shoulder dislocation, have not shown a statistically significant difference in regards to recurrence of dislocation.” 3 – 7 …”

“…We would like to thank the editors of the Western Journal of Emergency Medicine for the opportunity to reply to the letter to the editor by Jordan et al regarding our paper “Low-Cost Alternative External Rotation Shoulder Brace and Review of Treatment in Acute Shoulder Dislocations.” 1 …”

Best Position and Duration for Immobilization in Primary Anterior Shoulder Dislocation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…The prevalence of primary anterior shoulder dislocation is high in athletic activities, with the mechanism of apprehension position of shoulder abduction and external rotation [29]. Traditionally, anterior 498 shoulder dislocations are treated with closed reduction, stages of immobilization in external or internal rotation for 2-6 weeks, and a series of physical exercise treatment, perhaps reducing the risk of recurrent dislocation and enhance the soft tissue healing [12,18,20] Despite its protocol to treat the anterior shoulder dislocation, the most advantageous time and position of immobilization yet the best position has to be proven. Therefore, we conducted a systematic review and meta-analysis from the available literature to consider the best duration and position for immobilization after the reduction of anterior shoulder dislocation.…”

Comments on “Low-Cost Alternative External Rotation Shoulder Brace and Review of Treatment in Acute Shoulder Dislocations”

“…We read the paper of Lacy et al (2015) with interest. 1 The authors present a narrative review of the use of external rotation bracing in acute shoulder dislocations. One of the weaknesses of a narrative review is that it is more likely to be subject to reporting bias.…”