title: Is protecting the healing ligament beneficial after immobilization in external rotation for an initial shoulder dislocation?
abstract: BACKGROUND
  Immobilization in external rotation is one of the treatment options for an initial dislocation of the shoulder. However, it remains unclear how long it takes for a Bankart lesion to heal.
  
  
  OBJECTIVE
  Protection of a healing Bankart lesion from stretching would promote the healing process and decrease the recurrence rate after an initial dislocation of the shoulder.
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 2.
  
  
  METHODS
  This was a multicenter, prospective randomized study. Between January 2005 and August 2009, 109 patients (71 male and 38 female; mean age, 30 years) with an initial traumatic dislocation of the shoulder were enrolled. After 3 weeks of immobilization in external rotation, a shoulder motion restriction band designed to avoid stretching the anteroinferior shoulder capsule was used for 0 weeks (36 patients), 3 weeks (37 patients), or 6 weeks (36 patients). After using the band, patients were allowed to use their shoulders freely, but they were advised to avoid vigorous sport activities for at least 3 months after the injury. Any recurrent dislocation and return to sports were assessed at 2-year follow-up.
  
  
  RESULTS
  Of 109 patients, 90 were followed up for 2 years. The compliance rates were 60% to 72% among the groups (P = .54). The recurrence rate of dislocation was 28% in the 0-week group, 33% in the 3-week group, and 32% in the 6-week group (P = .88) according to the intention-to-treat analysis, and they were a respective 24%, 28%, and 27% according to the per-protocol analysis (P = .95). Based on the sport activity level, the recurrence rates for patients involved in contact sports (7/15, 47%) and those involved in noncontact sports (19/51, 37%) were significantly higher than for those not involved in sport activities (2/24, 8.3%) (P = .0076). Among the 3 groups, there were no significant differences in the recurrence rates. There was no significant difference in the rate of return to sports (P = .39).
  
  
  CONCLUSIONS
  No difference in the recurrence rate was seen with the use of a shoulder motion restriction band after 3 weeks of immobilization in external rotation after an initial dislocation of the shoulder.
authors.affiliation: Department of Orthopaedic Surgery, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. itoi-eiji@med.tohoku.ac.jp
authors.forename: Eiji
authors.initials: E
authors.lastname: Itoi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hatakeyama
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Itoigawa
authors.forename: Rei
authors.initials: R
authors.lastname: Omi
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Shinozaki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Sano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001265:Athletic Injuries / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D008023:Ligaments, Articular / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012149:Restraint, Physical; D012399:Rotation; D055502:Secondary Prevention; D012783:Shoulder Dislocation / Q000517:prevention & control / Q000628:therapy*; D013177:Sports; D013997:Time Factors; D055815:Young Adult
keywords: Bankart lesion; external rotation; healing; immobilization; inferior glenohumeral ligament; shoulder dislocation