Position of Immobilization After First-Time Traumatic Anterior Glenohumeral Dislocation: A Literature Review

Abstract

Anterior glenohumeral dislocation affects about 2% of the general population during the lifetime. The incidence of traumatic glenohumeral dislocation ranges from 8.2 to 26.69 per 100 000 population per year. The most common complication is recurrent dislocation occurring in 17–96% of the patients. The majority of patients are treated conservatively by closed reduction and immobilization in internal rotation for 2–3 weeks. However, no clear conservative treatment protocol exists. Immobilization in external rotation can be considered an alternative. A range of external rotation braces are commercially available.The purpose of this work was to review the current literature on conservative management of glenohumeral dislocation and to compare the results of immobilization in internal and external rotation.A comprehensive literature search and review was performed using the keywords “glenohumeral dislocation”, “shoulder dislocation”, “immobilization”, “external rotation”, and “recurrent dislocation” in PubMed, MEDLINE, Cochrane Library, Scopus, and Google Scholar databases from their inceptions to May 2016.Three cadaveric studies, 6 imaging studies, 10 clinical studies, and 4 meta-analyses were identified. The total number of 734 patients were included in the clinical studies.Literature analysis revealed better coaptation of the labrum on the glenoid rim in external rotation in cadaveric and imaging studies. However, this tendency was not confirmed by lower redislocation rates or better quality of life in clinical studies.On the basis of the available literature, we cannot confirm the superiority of immobilization in external rotation after glenohumeral dislocation when compared to internal rotation. A yet-to-be-determined group of patients with specific labroligamentous injury pattern may benefit from immobilization in external rotation. Further studies are needed to identify these patients.

Management of primary anterior shoulder dislocations: a narrative review

“…Reports of external rotation are not unanimously favorable. A recent literature review of the position of immobilization after first-time traumatic anterior shoulder dislocations found that external rotation posed no superiority to internal rotation [42]. Although external rotation did result in better coaptation of the labrum and glenoid fossa, there were no significant differences in dislocation recurrence rates or patient quality of life.…”

“…Although external rotation did result in better coaptation of the labrum and glenoid fossa, there were no significant differences in dislocation recurrence rates or patient quality of life. It is speculated that external rotation immobilization may be the method of choice for patients with a specific labroligamentous injury with anterior shoulder dislocation, but research-supported conclusions are yet to be determined [42]. It has been suggested external rotation immobilization should only be considered in highly motivated, compliant patients who are informed of the discomfort and possible difficulties with everyday tasks while the brace is being used.…”

“…It has been suggested external rotation immobilization should only be considered in highly motivated, compliant patients who are informed of the discomfort and possible difficulties with everyday tasks while the brace is being used. Finally, high-demand patients, including professional athletes, should receive MRI evaluation before immobilization for any potential soft tissue injuries, such as a subscapularis muscle tear, which would eliminate the possibility for external rotation immobilization [42].…”

Luxação do Ombro: Avaliação e Tratamento

“…No entanto, estudos mais recentes têm falhado em demonstrar a superioridade de um tipo de imobilização sobre a outra em relação à diminuição da taxa de recorrência e melhoria da qualidade de vida dos pacientes. 13 Em relação à duração, a imobilização por um período superior a uma semana não demonstrou superioridade na taxa de recorrência em relação à imobilização por períodos mais curtos. Neste contexto a individualização do tratamento tendo em conta o controlo álgico parece ser a melhor estratégia.…”

Luxação do Ombro em Jogador de Futebol Profissional

“…2 Por outro lado, a intervenção cirúrgica, nomeadamente artroscópica está recomendada nos doentes com menos de 30 anos de idade, nos atletas de elevado nível 19 e na presença de lesão de Hill-Sachs. 13 A instabilidade recorrente, a perda de massa óssea e o final da época têm sido critérios para a realização da cirurgia. 18 A intervenção cirúrgica proporciona menores taxas de recorrência 20 , mas obriga a maior tempo de paragem até ao Return to play (RTP), cerca de 4 a 6 meses 4 , durante os quais existem várias fases: 1 -imobilização durante quatro semanas com contrações isométricas; 2 -mobilização ativa do ombro até 45 graus de rotação externa durante mais 4 semanas; 3 -mobilização ativa do ombro em toda a amplitude articular, com treino de resistência e de pliometria, e também da propriocetividade.…”