title: Immobilization in external rotation combined with abduction reduces the risk of recurrence after primary anterior shoulder dislocation.
abstract: BACKGROUND
  We aimed to compare the effectiveness of immobilization in abduction and external rotation vs immobilization in adduction and internal rotation after primary anterior dislocation of the shoulder.
  
  
  METHODS
  The study randomized 102 patients (age range, 15-55 years) with the diagnosis of primary anterior dislocation of the shoulder to receive immobilization in adduction and internal rotation (AdIR, n = 51) using sling and swathe bandage or immobilization in abduction and external rotation (AbER, n = 51) with a stabilizer brace. Patients received a rehabilitation program 3 weeks after the intervention.
  
  
  RESULTS
  After a 24-month follow-up, 33.3% in the AdIR group and 3.9% in the AbER group had recurrence (P < .001). The difference in the recurrence rate was greater in the subgroup aged between 31 and 40 years (44.8% in the AdIR group and 3.8% in the AbER group, P < .001). Ten patients in the AbER group (19.6%) and 3 in the AdIR group (5.8%) discontinued shoulder immobilization before 3 weeks (P = .03). In patients without recurrence, the anterior apprehension test was positive in 6 of 34 in the AdIR group (17.6%) and in 4 of 49 in the AbER group (8.1%, P = .19).
  
  
  CONCLUSIONS
  Immobilization with the shoulder joint in abduction and external rotation is an effective method to reduce the risk of recurrence after primary anterior shoulder dislocations and should be preferred to the traditional method of immobilization in adduction and internal rotation in clinical practice.
authors.affiliation: Department of Emergency Medicine, Shohadaye-Haftom Tir Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Kamran
authors.initials: K
authors.lastname: Heidari
authors.affiliation: School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: asadollahi.shadi@yahoo.com.
authors.forename: Shadi
authors.initials: S
authors.lastname: Asadollahi
authors.affiliation: Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Vafaee
authors.affiliation: Department of Orthotics & Prosthetics, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Barfehei
authors.affiliation: Department of Emergency Medicine, Shohadaye-Haftom Tir Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Kamalifar
authors.affiliation: Department of Emergency Medicine, Shohadaye-Haftom Tir Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Zein Alabedin
authors.initials: ZA
authors.lastname: Chaboksavar
authors.affiliation: Department of Emergency Medicine, Shohadaye-Haftom Tir Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Sabbaghi
mesh_terms: D000293:Adolescent; D000328:Adult; D001915:Braces; D005260:Female; D006801:Humans; D007103:Immobilization / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012399:Rotation; D055502:Secondary Prevention; D012783:Shoulder Dislocation / Q000628:therapy*; D055815:Young Adult
keywords: Shoulder dislocation; braces; clinical trial; immobilization; management; rehabilitation