title: Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence: a randomized controlled trial.
abstract: BACKGROUND
  The treatment of primary traumatic anterior shoulder dislocation varies widely from no immobilization, to two or three weeks of immobilization in internal rotation with the arm in a sling, to treatment with a brace in external rotation. The aim of the present clinical trial was to compare immobilization in internal and external rotation after anterior shoulder dislocation.
  
  
  METHODS
  One hundred and eighty-eight patients with a primary anterior traumatic dislocation of the shoulder were randomly assigned to treatment with immobilization in either internal rotation (ninety-five patients) or external rotation (ninety-three patients) for three weeks. The primary outcome measure was a recurrent dislocation within twenty-four months of follow-up.
  
  
  RESULTS
  The follow-up rate after a minimum period of two years was 97.9% (ninety-three of ninety-five) in the internal rotation group and 97.8% (ninety-one of ninety-three) in the external rotation group. The compliance rate with the immobilization was 47.4% (forty-five of ninety-five) in the internal rotation group and 67.7% (sixty-three of ninety-three) in the external rotation group. The intention-to-treat analyses showed that the recurrence rate was 24.7% (twenty-three of ninety-three) in the internal rotation group and 30.8% (twenty-eight of ninety-one) in the external rotation group (p = 0.36).
  
  
  CONCLUSIONS
  Immobilization in external rotation does not reduce the rate of recurrence for patients with first-time traumatic anterior shoulder dislocation.
authors.affiliation: Department of Orthopedic Surgery, Sørlandet Hospital, Service Box 605, 4809 Arendal, Norway. sigurd.liavaag@sshf.no
authors.forename: Sigurd
authors.initials: S
authors.lastname: Liavaag
authors.forename: Jens Ivar
authors.initials: JI
authors.lastname: Brox
authors.forename: Are Hugo
authors.initials: AH
authors.lastname: Pripp
authors.forename: Martine
authors.initials: M
authors.lastname: Enger
authors.forename: Lars Atle
authors.initials: LA
authors.lastname: Soldal
authors.forename: Svein
authors.initials: S
authors.lastname: Svenningsen
mesh_terms: D000293:Adolescent; D000328:Adult; D001915:Braces; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization / Q000379:methods*; D008297:Male; D010349:Patient Compliance; D011187:Posture; D011446:Prospective Studies; D055502:Secondary Prevention; D012783:Shoulder Dislocation / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult