Do Bankart lesions heal better in shoulders immobilized in external rotation?
OBJECTIVE
Immobilization in external rotation (ER) for shoulder dislocation has been reported to improve the coaptation of Bankart lesions to the glenoid. We compared the position of the labrum in patients treated with immobilization in ER or internal rotation (IR). A secondary aim was to evaluate the rate of Bankart lesions.


METHODS
55 patients with primary anterior shoulder dislocation, aged between 16 and 40 years, were randomized to immobilization in ER or IR. Computer tomography (CT) and magnetic resonance imaging (MRI) were performed shortly after the injury. After the immobilization, MRI arthrography was performed. We evaluated the rate of Bankart lesions and measured the separation and displacement of the labrum as well as the length of the detached part of the capsule on the glenoid neck.


RESULTS
Immobilization in ER reduced the number of Bankart lesions (OR = 3.8, 95% CI: 1.1 -13; p = 0.04). Separation decreased to a larger extent in the ER group than in the IR group (mean difference 0.6 mm, 95% CI: 0.1 - 1.1, p = 0.03). Displacement of the labrum and the detached part of the capsule showed no significant differences between the groups.


CONCLUSIONS
Immobilization in ER results in improved coaptation of the labrum after primary traumatic shoulder dislocation.
Liavaag
Sigurd
S
Department of Orthopedic Surgery, Sørlandet Hospital, Arendal, Norway. sigurd.liavaag@sshf.no
Stiris
Morten Georg
MG
Lindland
Elisabeth Stokke
ES
Enger
Martine
M
Svenningsen
Svein
S
Brox
Jens Ivar
JI
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007103:Immobilization; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D012399:Rotation; D012783:Shoulder Dislocation / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D012784:Shoulder Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult