Protecting the Healing Ligament Beneficial After Immobilization in External
Rotation for an Initial Shoulder Dislocation?
E, Hatakeyama Y, Itoigawa Y, Omi R, Shinozaki N, Yamamoto N, Sano H. Am J
Sports Med. 2013 Mar 22. [Epub ahead of print]
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.
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%.
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?
by: Stephen Thomas
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