Three Part Question
In [patients less than 30 years old presenting with first anterior shoulder dislocation] is [early mobilisation better than delayed mobilisation] at [reducing the dislocation rate]?
A 25 year old man presents to the emergency department with a left anterior shoulder dislocation. This is reduced satisfactory. You wonder how long his shoulder should be immobilised? There is no previous history of a dislocation.
Medline 1966-06/98 using the OVID interface.
([exp shoulder dislocation OR shoulder dislocation ti.ab.sh] AND [immobilisation ti.ab.sh OR exp bandages OR bandages ti.ab.sh]) AND maximally sensitive RCT filter.
31 papers found of which 27 were irrelevant and 2 were early reports of another.
|Author, date and country
||Study type (level of evidence)
|Kiviluto O, et al.|
|226 patients aged 16 - 86 years with primary anterior shoulder dislocation.
53 patients were less than 30 years old.
Immobilisation for 3 weeks vs immobilisation for 1 week.||Prospective controlled trial over 1 year.||Redislocation rate||6/27 (22%) vs 13/26 (50%). P < 0.05||Randomisation not stated.|
|Hovelius L, et al.|
|257 patients aged 12 - 40 years with primary anterior shoulder dislocation. 84 patients were less than 30 years old.
Immobilisation for 3 - 4 weeks vs immobilisation in a sling until comfortable.||Prospective multi centre controlled trial over 10 years.||Redislocation rate||44/65 (67%) vs 40/68 (59%)||10 patients lost to follow up.
Randomisation not uniform.|
The numbers of young patients studied is small and randomisation is suboptimal. The two studies have different follow up periods (1 vs 10 years). The study with the longer follow up suggests that any early benefit of immobilisation may be lost in the long term.
Clinical Bottom Line
For patients under 30 years old with a first anterior shoulder dislocation immobilisation, maximum early benefit is obtained by maintaining immobilisation for 3 weeks.
- Kiviluoto O, Pasila M, Jaroma H, Sundholm A. Immobilization after primary dislocation of the shoulder. Acta Orthopaedica 1980;51(6):915-919.
- Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the shoulder in young patients. A ten year prospective study. JBJS(A) 1996;78(11):1677-1684.