There are differing opinion regarding position of shoulder immobilisation following reduction of dislocation, I wish to know the opinion of the fellow colleagues in this context.
This should help you to get informed opinions and new methods:
Reprint requests: Eiji Itoi, MD, Professor and Chairman, Department
of Orthopedic Surgery, Akita University School of Medicine,
Hondo 1-1-1, Akita 010-8543, Japan. (E-mail:[email protected]).
Yes I agree that position of shoulder immobilization was change during the time. Actually position of external rotation is more preferable because of low rate of recurrent dislocation.
Anterior dislocation should be immobilized in internal rotation position, while posterior dislocation (rare) - external rotation. This rule ensures a better healing of the torn capsule.
No doubt about that: INTERNAL ROTATION ONLY+++ This article from Japan is very good but of no help for this question, the mechanical conditions of which are quite different regarding fresh dislocations. Dislocation means an antero-inferior capsular tear giving some permanent sliding for the humeral head (Hill-Sachs sign). Let's be reminded here that the degree of external rotation is also a good criteria for instability risk of this joint. There is also no evidence that a prolongated immobilisation might be of any help, as well as arthroscopy - as we've done for a while in these cases a few years ago. The only chance to reduce the risk of re-dislocation, if local anatomy permits it, is so certainly a short immobilisation in internal rotation, no longer than three weeks (and probably less).
All the best to you all!
There is an excellent review of this question in the American Journal of Sports Med - see below.
Am J Sports Med. 2015 Sep;43(9):2328-33. doi: 10.1177/0363546514555661. Epub 2014 Nov 3.
Does external rotation bracing for anterior shoulder dislocation actually result in reduction of the labrum? A systematic review.
Jordan RW1, Saithna A2, Old J2, MacDonald P2.
Although they can make External rotation bracing work in Japan where their subjects are smaller and lighter, it is much more difficult to brace patients in countries with bigger subjects. Also the early success rates dropped on later review.
Angus Wallace
In my opinion the anterior dislocation should be immobilized in internal rotation position , maximun three weeks of immobilitation .The problem is that immobilisation does not ensure the healing of the labrum, and therefore, especially in young individuals and athletes danger of recurrence is high. So in these cases is indicated subsequently checked the joint with MRI and if necessary repair the labrum by arthroscopy
Prof. Itoi is a great orthopedic surgeon and has a lot of nice and relevant conceptions which I use in my daily practice, but for sure there's no evidence based superiority in literature for immobilization in ER after 1st dislocation. There's in no consensus for 1st time dislocation as well. Many factor should be considered to choose the right initialy treatment option like laxity, sports activity, coexisting bony defects, age energy of trauma etc.
Hope helpful
Kind regards
In my opinion shouder dislocation should be immobilized in internal rotation for 3 weeks. If is a usually dislocation 2 weeks are enough.
In most cases the labrum is intact and I do not see any rationale for immobilization in ER. In the most common cases IR immobilization for 3 weeks is sufficient.
There are some nice resources! In our practice usually IR immobilisation is mostly used.
https://link.springer.com/content/pdf/10.1007%2Fs11999-013-3432-6.pdf
http://www.tandfonline.com/doi/abs/10.3109/03093648909078219
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