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Conservative management following closed reduction of traumatic anterior dislocation of the shoulder

  1. Nigel CA Hanchard1,*,
  2. Lorna M Goodchild2,
  3. Lucksy Kottam3

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 30 APR 2014

Assessed as up-to-date: 1 MAR 2014

DOI: 10.1002/14651858.CD004962.pub3


How to Cite

Hanchard NCA, Goodchild LM, Kottam L. Conservative management following closed reduction of traumatic anterior dislocation of the shoulder. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD004962. DOI: 10.1002/14651858.CD004962.pub3.

Author Information

  1. 1

    Teesside University, Health and Social Care Institute, Middlesbrough, Tees Valley, UK

  2. 2

    The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Department of Physiotherapy, Middlesbrough, Tees Valley, UK

  3. 3

    The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Department of Orthopaedics, Middlesbrough, UK

*Nigel CA Hanchard, Health and Social Care Institute, Teesside University, Middlesbrough, Tees Valley, TS1 3BA, UK. n.hanchard@tees.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 30 APR 2014

SEARCH

References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Finestone 2009 {published data only}
  • Finestone A, Milgrom C, Radeva-Petrova DR, Rath E, Barchilon V, Beyth S, et al. Bracing in external rotation for traumatic anterior dislocation of the shoulder. Journal of Bone & Joint Surgery - British Volume 2009;91(7):918-21.
  • Milgrom C. Personal communication 5 October 2009.
Itoi 2007 {published data only}
  • Itoi E. Personal communication 8 April 2011.
  • Itoi E. Personal communication July 2005.
  • Itoi E, Hatakeyama Y, Sato T, Kido T, Minagawa H, Yamamoto N, et al. Immobilization in external rotation after dislocation of the shoulder reduces the risk of recurrence [platform presentation]. American Academy of Orthopaedic Surgeons Annual Meeting; 2007 Feb 14-18; San Diego (CA). 2007.
  • Itoi E, Hatakeyama Y, Sato T, Kido T, Minagawa H, Yamamoto N, et al. Immobilization in external rotation after shoulder dislocation reduces the risk of recurrence: a randomized controlled trial. Journal of Bone & Joint Surgery - American Volume 2007;89(10):2124-31.
Liavaag 2011 {published data only}
  • Liavaag S. Personal communication 21 April 2013.
  • Liavaag S, Brox JI, Pripp AH, Enger M, Soldal LA, Svenningsen S. Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence: a randomized controlled trial. Journal of Bone & Joint Surgery - American Volume 2011;93(10):897-904.
  • Liavaag S, Stiris MG, Lindland ES, Enger M, Svenningsen S, Brox JI. Do Bankart lesions heal better in shoulders immobilized in external rotation? A randomized single-blind study of 55 patients examined with MRI. Acta Orthopaedica 2009;80(5):579-84.
  • Svenningsen S. Does immobilization of the shoulder in external rotation reduce the recurrence rate of shoulder dislocation?. http://clinicaltrials.gov/show/NCT00202735 (accessed 12 November 2012).
Taskoparan 2010 {published data only}
  • Taskoparan H, Kilincoglu V, Tunay S, Bilgic S, Yurttas Y, Komurcu M. Immobilization of the shoulder in external rotation for prevention of recurrence in acute anterior dislocation. Acta Orthopaedica et Traumatologica Turcica 2010;44(4):278-84.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Chutkan 2012 {published data only}
  • Chutkan NB. Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence: a randomized controlled trial. Orthopedics 2012;35(7):610-1.
Harper 2000 {unpublished data only}
  • Harper W. Anterior shoulder dislocations in the over 45 years of age. A prospective randomised study. In: National Resarch Register, Issue 1, 2005. Oxford: Update Software. http://www.nrr.nhs.uk/ViewDocument.asp?ID=N0122017162 (accessed 12 May 2005).
Hovelius 1983 {published data only}
  • Arciero RA, Taylor DC. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study [letter]. Journal of Bone and Joint Surgery - American Volume 1998;80(2):299-300.
  • Hovelius L. Anterior dislocation of the shoulder in teenagers and young adults. Five year prognosis. Journal of Bone and Joint Surgery - American Volume 1987;69(3):393-9.
  • Hovelius L. The natural history of primary anterior dislocation of the shoulder in the young. Journal of Orthopaedic Science 1999;4(4):307-17.
  • Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. Journal of Bone and Joint Surgery - American Volume 1996;78(11):1677-84.
  • Hovelius L, Eriksson K, Fredin H, Hagberg G, Hussenius A, Lind B, et al. Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment. Journal of Bone and Joint Surgery - American Volume 1983;65(3):343-9.
  • Hovelius L, Lind B, Thorling J. Primary dislocation of the shoulder. Factors affecting the two-year prognosis. Clinical Orthopaedics and Related Research 1982;(176):181-5.
  • Kirkley S. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study [letter]. Journal of Bone and Joint Surgery - American Volume 1998;80(2):300-1.
Itoi 2003 {published data only}
  • Itoi E. Personal communication 10 July 2005.
  • Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, et al. A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study. Journal of Shoulder and Elbow Surgery 2003;12(5):413-5.
  • Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, et al. A new method of immobilization in dislocation of the shoulder: a prospective randomized study [abstract]. Annual Meeting of the American Academy of Orthopaedic Surgeons; 2003 February 5-9; New Orleans [LA]. http://www.aaos.org/wordhtml/anmt2003/sciprog/200.htm (accessed 01 October 2003).
  • Itoi E, Hatakeyama Y, Sato T, Kido T, Minagawa H, Wakabayashi I, et al. Immobilization in external rotation after shoulder dislocation: an interim report of an ongoing trial [abstract]. Annual Meeting of the American Academy of Orthopaedic Surgeons; 2004 March 10-14; San Francisco (CA). http://www.aaos.org/wordhtml/anmt2004/sciprog/071.htm (accessed 07 April 2004).
Kiviluoto 1980 {published data only}
Staply 2002 {unpublished data only}
  • Luya M. Personal communication 6 June 2005.
  • Staply S. Anterior shoulder trial dislocation external rotation trial. In: National Resarch Register, Issue 1, 2005. Oxford: Update Software. http://www.nrr.nhs.uk/ViewDocument.asp?ID=N0284109750 (accessed 12 May 2005).
Wakefield 2001 {unpublished data only}
  • Wakefield A. Personal communication 24 June 2005.
  • Wakefield A. The role of physiotherapy in the prevention of recurrence of anterior shoulder dislocation. In: National Research Register, Issue 1, 2005. Oxford: Update Software. http://www.nrr.nhs.uk/ViewDocument.asp?ID=N0519070803 (accessed 12 May 2005).
Whelan 2010 {published data only}
  • Whelan D. Immobilization in an external or internal rotation brace did not differ in preventing recurrent shoulder dislocation. Journal of Bone and Joint Surgery - American Volume 2010;92(5):1262.
Xu 2003 {published data only}
  • Xu Q, Gong Y, Lan Z, Xue C. Effects of systematic rehabilitation treatment on the stability of shoulder in young patients with shoulder dislocation. Zhongguo Linchuang Kangfu [Chinese Journal of Clinical Rehabilitation] 2003;14(7):2050-1.

References to studies awaiting assessment

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
ISRCTN41070054 {unpublished data only}
  • Nicolaou N. Splintage in external rotation for anterior glenohumeral dislocation: a prospective randomised and controlled study. WHO International Clinical Trials Registry Platform: http://apps.who.int/trialsearch/Trial.aspx?TrialID=ISRCTN41070054 (accessed 12 November 2012).
ISRCTN48254181 {unpublished data only}
  • Pimpalnerker A. A comparison study of internal versus external rotation immobilisation for primary anterior shoulder dislocation. WHO International Clinical Trials Registry Platform: http://apps.who.int/trialsearch/Trial.aspx?TrialID=ISRCTN48254181 (accessed 12 November 2012).
Itoi 2013 {published data only}
  • Itoi E, Hatakeyama Y, Itoigawa Y, Omi R, Shinozaki N, Yamamoto N, et al. Is protecting the healing ligament beneficial after immobilization in external rotation for an initial shoulder dislocation?. American Journal of Sports Medicine 2013;41(5):1126-32.
Kelly 2011 {unpublished data only}
  • Kelly CP, Smith HJ, Kuiper JH. External rotation bracing compared to conventional sling in first time anterior shoulder dislocation (abstract). British Elbow and Shoulder Society 22nd Annual Scientific Meeting; 2011 June 22-24; Newcastle (UK) http://www.bess.org.uk/pages/meetings/meetings-archive/abstracts-archive.php?aid=393&abstract=763 (accessed 14 June 2013) 2011.
  • Kuiper JH, Smith HJ, Wales J, Kelly CP. External rotation bracing compared to conventional sling in first time anterior shoulder dislocation – The Shoulder Orthosis Study (SOS). Institute of Orthopaedics - Annual Report 2010/2011 http://www.orthopaedic-institute.org/images/user/Institute%20Report%202011_Web.pdf (accessed 14 June 2013).
Miller 2007 {published data only}
  • Miller BS, Cole EM, Sonnabend D, Kaar SG. Sling vs external rotation brace for shoulder dislocations: preliminary results of a randomized trial [poster presentation]. American Academy of Orthopaedic Surgeons Annual Meeting; 2007 Feb 14-18; San Diego (CA) 2007.
NCT00707018 {unpublished data only}
  • McCarty E. Immobilization in external rotation after first time anterior shoulder dislocation: a prospective randomized study. WHO International Clinical Trials Registry Platform: http://apps.who.int/trialsearch/Trial.aspx?TrialID=NCT00707018 (accessed 12 November 2012).
Whelan 2008 {published data only}
  • Litchfield RB. A randomized evaluation of immobilization in external rotation in the management of acute anterior dislocations of the shoulder. http://clinicaltrials.gov/show/NCT00196560 (accessed 12 November 2012).
  • Whelan D, Litchfield RB, Boorman RS, Dainty K, Wambolt E, Chan DS, et al. A randomized evaluation of immobilization in external rotation after primary shoulder dislocation [abstract]. American Academy of Orthopaedic Surgeons 75th Annual Meeting; 2008 Mar 5-9; San Francisco (CA) 2008.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
ACTRN12611001183976 {unpublished data only}
  • Walker T. Personal communication 13 November 2012.
  • Walker T. A randomised controlled trial on the effect of physiotherapy and an external rotation brace on redislocation rate and shoulder function in patients aged 15-40 years with a first time anterior shoulder dislocation. WHO International Clinical Trials Registry Platform: http://apps.who.int/trialsearch/Trial.aspx?TrialID=ACTRN12611001183976 (accessed 12 November 2012).
NCT01111500 {unpublished data only}
  • Pelet S. Personal communication 21 January 2013.
  • Pelet S, Cote H. First time anterior glenohumeral joint dislocation with a Bankart lesion in young patients: which type of immobilization should be chosen? A prospective randomized study. WHO International Clinical Trials Registry Platform: http://apps.who.int/trialsearch/Trial.aspx?TrialID=NCT01111500 (accessed 12 November 2012).
NCT01648335 {published data only}
  • NCT01648335. A prospective study of the effect of treatment of first time traumatic shoulder anterior dislocation by immobilization in external rotation on the incidence of recurrent dislocation. WHO Clinical Trials Registry Platform. http://apps.who.int/trialsearch/Trial.aspx?TrialID=NCT01648335 (accessed 1 November 2012). [: NCT01648335]

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Bankart 1938
  • Bankart AS. The pathology and treatment of recurrent dislocation of the shoulder joint. British Journal of Surgery 1938;26(101):23-9.
Dawson 1999
  • Dawson J, Fitzpatrick R, Carr A. The assessment of shoulder instability. The development and validation of a questionnaire. Journal of Bone and Joint Surgery - British Volume 1999;81(3):420–6.
de Boer 2005
  • de Boer P. Personal communication 21 October 2005.
Dymond 2011
  • Dymond C, Stone R, Furyk J, Seymour J. Conservative management for traumatic shoulder dislocations: is external rotation clinically effective?. EMA - Emergency Medicine Australasia. Conference: 27th Annual Scientific Meeting of the Australasian College for Emergency Medicine Canberra, ACT Australia 2011;23:28.
Gibson 2004
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Goss 1988
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Handoll 2003
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Handoll 2004
  • Handoll HHG, Almaiyah MA. Surgical versus non-surgical treatment for acute anterior shoulder dislocation. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD004325.pub2]
Higgins 2003
Higgins 2011
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Hill 1940
  • Hill HA, Sachs MD. The grooved defect of the humeral head: a frequently unrecognised complication of dislocations of the shoulder joint. Radiology 1940;35:690-700.
Hovelius 1982
  • Hovelius L. Incidence of shoulder dislocation in Sweden. Clinical Orthopaedics and Related Research 1982;(166):127-31.
Hovelius 1996
  • Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. Journal of Bone and Joint Surgery - American Volume 1996;78(11):1677-84.
Hovelius 2008
  • Hovelius L, Olofsson A, Sandstrom B, Augustini BG, Krantz L, Fredin H, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. A prospective twenty-five-year follow-up. Journal of Bone and Joint Surgery - American Volume 2008;90:945-52.
Itoi 2001
  • Itoi E, Sashi R, Minagawa H, Shinizu T, Wakabayashi I, Sato K. Position of immobilization after dislocation of the glenohumeral joint. A study with use of magnetic resonance imaging. Journal of Bone and Joint Surgery - American Volume 2001;83(5):661-7.
Itoi 2004
  • Itoi E, Hatakeyama Y, Sato T, Kido T, Minagawa H, Wakabayashi I, et al. Immobilization in external rotation after shoulder dislocation: an interim report of an ongoing trial [abstract]. Annual Meeting of the American Academy of Orthopaedic Surgeons; 2004 March 10-14; San Francisco (CA). http://www.aaos.org/wordhtml/anmt2004/sciprog/071.htm (accessed 07 April 2004).
Karatsolis 2006
  • Karatsolis K, Athanasopoulos S. The role of exercise in the conservative treatment of the anterior shoulder dislocation. Journal of Bodywork and Movement Therapies 2006;10(3):211-9.
Kirkley 1998
  • Kirkley A, Griffin S, McLintock H, Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). American Journal of Sports Medicine 1998;6:764–72.
Kitamura 2005
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Lefebvre 2011
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Liavaag 2009
  • Liavaag S, Stiris MG, Lindland ES, Enger M, Svenningsen S, Brox JI. Do Bankart lesions heal better in shoulders immobilized in external rotation? A randomized single-blind study of 55 patients examined with MRI. Acta Orthopaedica 2009;80(5):579-84.
Limpisvasti 2008
  • Limpisvasti O, Yang BY, Hosseinzadeh P, Leba T, Tibone JE, Lee TQ. The effect of glenohumeral position on the shoulder after traumatic anterior dislocation. American Journal of Sports Medicine 2008;36(4):775-80.
Miller 2004
  • Miller BS, Sonnabend DH, Hatrick C, O'Leary S, Goldberg J, Harper W, et al. Should acute anterior dislocations of the shoulder be immobilized in external rotation? A cadaveric study. Journal of Shoulder and Elbow Surgery 2004;13:589-92.
Moxon 2010
  • Moxon AP, Walker T, Rando A. External rotation brace combined with a physiotherapy program for first time anterior shoulder dislocators: a 2 year follow-up. Australasian Medical Journal. 2010;1(4):253-8.
Murray 2013
O'Brien 1987
Paterson 2010
  • Paterson WH, Throckmorton TW, Koester M, Azar FM, Kuhn JE. Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. Journal of Bone & Joint Surgery - American Volume 2010;92(18):2924-33.
Pennekamp 2006
  • Pennekamp W, Gekle C, Nicolas V, Seybold D. Initial results of shoulder MRI in external rotation after primary shoulder dislocation and after immobilization in external rotation [Initiale ergebnisse der schulter-MRT in ausenrotation bei primarer schulterluxation und nach ruhigstellung in ausenrotation]. RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren 2006;178(4):410-5.
Rhee 2009
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Robinson 2006
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Robinson 2012
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  • Seybold D, Schliemann B, Heyer CM, Muhr G, Gekle C. Which labral lesion can be best reduced with external rotation of the shoulder after a first-time traumatic anterior shoulder dislocation?. Archives of Orthopaedic and Trauma Surgery 2009;129(3):299-304.
Siegler 2010
  • Siegler J, Proust J, Marcheix PSM, Charissoux JL, Mabit C, Arnaud JP. Is external rotation the correct immobilisation for acute shoulder dislocation? An MRI study. Orthopaedics and Traumatology: Surgery and Research 2010;96(4):329-33.
Simonet 1984
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References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. References to ongoing studies
  5. Additional references
  6. References to other published versions of this review
Handoll 2006