Is Protecting the Healing Ligament Beneficial After Immobilization in External Rotation for an Initial Shoulder Dislocation?
Itoi E, Hatakeyama Y, Itoigawa Y, Omi R, Shinozaki N, Yamamoto N, Sano H. Am J Sports Med. 2013 Mar 22. [Epub ahead of print]
Take Home Message: Limiting shoulder abduction for 3 or 6 weeks did not reduce the rate of reinjury among patients with shoulder dislocation who were initially treated with 3 weeks of immobilization.
Shoulder dislocations typically occur from a very traumatic event, which commonly results in injury to the inferior glenohumeral ligament and the anterior-inferior labrum. After a dislocation, patients are often immobilized for 3 weeks to allow capsule and labral healing. However, even after a patient is immobilized they are at risk for another dislocation, which suggests that additional protection may be needed. Therefore, the purpose of this study was to determine the efficacy of a motion restriction band to reduce the recurrence rate of dislocations following immobilization. One hundred and nine first-time dislocators (without additional injury) were recruited for the study. Participants were randomly assigned to one of three groups that wore a motion restriction band for different lengths of time: 0-week, 3-week, and 6-week group. Following shoulder reduction patients were immobilized for 3 weeks in 10° to 15° of external rotation. After the initial 3 weeks patients received a shoulder motion restriction band which wrapped around the patients elbow and trunk and was adjusted to only allow shoulder abduction to 60° without restricting external or internal rotation. The authors instructed the patients to use the restriction band all day except during sleep. They determined patient compliance with the band and immobilization by an interview at the end of the study. Patients avoided sporting activities until 3 months post injury. The authors examined the patients at 6, 12, and 24 months and recorded reinjuries, return to preinjury sport, and if recurrence occurred then when and how it happened. Of the 109 initial patients only 90 completed a 2 year follow-up. Overall, compliance for the immobilizer was 72% and 78.5% for the band. Twenty-eight shoulders sustained a recurrent dislocation at a mean of 9 months. Most shoulders (47%) were reinjured in contact sports, followed by 37% in noncontact sports, and only 8.3% in nonsporting activities. When the authors examined the recurrence rate by groups they found no differences: the 0-week group was 24%, 3-week group was 28%, and 6-week group was 27%.
This study found that using a motion restriction band did not reduce the recurrence rate of shoulder dislocations. A previous monkey study found that it took 8 weeks to have capsule and labral healing following a traumatic dislocation. Due to the results from the animal study the authors hypothesized that additional restricted motion may be required to allow optimal healing of the labrum. Limiting shoulder abduction to 60° decreases tension on the labrum and inferior glenohumeral ligament without limiting external or internal rotation. However, 6 additional weeks of restricted shoulder abduction did not lower the recurrence rate. The only significant contributing factor to recurrent dislocation was participation in sport activities with contact sports producing slightly more recurrent dislocations. Combining these results with others it seems that first time dislocators that want to remain active in sports, especially contact sports, may want to consider surgical treatment while those not returning to sport may do well with just 3 weeks of immobilization. Do you attempt conservative treatment following shoulder dislocation or do you recommend surgery? Have you tried alternative strategies to improve outcomes following conservative treatment?
Written by: Stephen Thomas
Reviewed by: Jeffrey Driban
Itoi E, Hatakeyama Y, Itoigawa Y, Omi R, Shinozaki N, Yamamoto N, & Sano H (2013). Is Protecting the Healing Ligament Beneficial After Immobilization in External Rotation for an Initial Shoulder Dislocation? The American Journal of Sports Medicine PMID: 23524151