Immobilization in external rotation after primary shoulder dislocation reduces the risk of recurrence in young patients. A randomized controlled trial - 03/12/18

Doi : 10.1016/j.otsr.2018.10.007

Jean-Christophe Murray ^a, Alexandre Leclerc ^b, Amerigo Balatri ^a, Stéphane Pelet ^a,^c,^⁎
^a Department of orthopaedic surgery, CHU de Québec, hôpital Enfant-Jésus, 1401, 18^e rue, G1J 1Z4 Québec, Canada
^b Department of orthopaedic surgery, CHU de Québec, CHUL, 2705, boulevard Laurier, G1V 4G2 Québec, Canada
^c Centre de recherche FRQS du CHU de Québec, hôpital Enfant-Jésus, 1401, 18^e rue, G1J 1Z4 Québec, Canada

^⁎Corresponding author at: Surgical department, université Laval, centre de recherche FRQS, CHU de Québec, hôpital Enfant-Jésus, 1401, 18^e rue, G1J 1Z4 Québec, Canada.Surgical department, université Laval, centre de recherche FRQS, CHU de Québec, hôpital Enfant-Jésus, 140118^e rueQuébecG1J 1Z4Canada

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Abstract

Introduction

Patients that sustain anterior shoulder dislocation frequently experience recurrence. Immobilisation in external rotation has been proposed as a treatment that could lower this risk.

Hypothesis

There is a difference in recurrence rates between immobilization in internal or external rotation following a first-time anterior shoulder dislocation.

Patients and methods

Single-center randomized controlled trial. Fifty patients with a first episode of traumatic anterior dislocation were randomly assigned to immobilization in internal rotation (IR; 25 patients) or external rotation (ER; 25 patients) for three weeks. Clinical follow-up: 24 months. Additionally, some patients underwent a magnetic resonance imaging with intra-articular contrast (MR arthrography) within seven days after trauma, and then at three months. Primary outcome: recurrence of dislocation. Secondary outcome: healing rate of labral lesions on MR arthrography.

Results

Follow-up rate in the IR and ER group was 92% and 96% respectively. Recurrence rate did not show a statistically significant difference overall (IR 47.8% vs. ER 29.2%; p=0.188), but showed a significant difference favouring ER in the 20–40 years subgroup (IR 50% vs. ER 6.4%; p=0.044). Labral lesions’ healing rate was 46.2% vs. 60% (IR vs ER; p=0.680). The recurrence rate among those with healed vs. non-healed labrum (regardless of immobilization) was 11.1% vs. 77.7% (p=0.001).

Discussion

This study suggests that immobilization in ER compared to IR reduces the risk of recurrence after a first-time anterior shoulder dislocation in patients aged between 20 and 40 years.

Level of evidence

II, low-powered prospective randomized trial.

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Keywords : (MeSH) Shoulder dislocation, Conservative treatment, Randomized controlled trial, (Non MeSH) Internal rotation, External rotation, Recurrence