Is anyone routinely immobilising 1st (new) shoulder dislocations in external rotation and have the results been audited?
These two papers show the evidence for immobilising new anterior shoulder dislocations in external rotation in the younger age group < 40 yrs.
There are new splints on the market... though they cost about £50 in the UK
Will be interesting to see if patient compliance in Morecambe is the same as Japan!
Ray McGlone
Lancaster
Authors Itoi E. Hatakeyama Y. Kido T. Sato T. Minagawa H. Wakabayashi I. Kobayashi M.
Institution Department of Orthopedic Surgery, Akita University School of Medicine, Hondo, Akita, Japan. [log in to unmask]
Title A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study.
Source Journal of Shoulder & Elbow Surgery. 12(5):413-5, 2003 Sep-Oct.
Abstract This preliminary prospective study was conducted to determine whether immobilization with the arm in external rotation would decrease the rate of recurrence after initial traumatic anterior dislocation of the shoulder. Forty patients with initial shoulder dislocations were assigned to (1) conventional immobilization in internal rotation (IR group, n = 20) or (2) a new method of immobilization in external rotation (ER group, n = 20). The recurrence rate was 30% in the IR group and 0% in the ER group at a mean 15.5 months. The difference in recurrence rate was even greater among those who were aged less than 30 years (45% in the IR group and 0% in the ER group). Immobilization with the arm in external rotation is effective in reducing the rate of recurrence after initial dislocation of the shoulder.
Authors Itoi E. Sashi R. Minagawa H. Shimizu T. Wakabayashi I. Sato K.
Institution Department of Orthopedic Surgery, Akita University School of Medicine, Japan. [log in to unmask]
Title Position of immobilization after dislocation of the glenohumeral joint. A study with use of magnetic resonance imaging.[see comment].
Comments Comment in: J Bone Joint Surg Am. 2002 May;84-A(5):873-4; author reply 874; PMID: 12004038
Source Journal of Bone & Joint Surgery - American Volume. 83-A(5):661-7, 2001 May.
Local Messages Held at BMA Library
Abstract BACKGROUND: Glenohumeral dislocations often recur, probably because a Bankart lesion does not heal sufficiently during the period of immobilization. Using magnetic resonance imaging, we assessed the position of the Bankart lesion, with the arm in internal and external rotation, in shoulders that had had a dislocation. METHODS: Coaptation of a Bankart lesion was examined with use of magnetic resonance imaging, with the arm held at the side of the trunk and positioned first in internal rotation (mean, 29 degrees) and then in external rotation (mean, 35 degrees), in nineteen shoulders. Six shoulders (six patients) had had an initial anterior dislocation, and thirteen shoulders (twelve patients) had had recurrent anterior dislocation. Fast-spin-echo T2-weighted axial images were made when the dislocation had occurred less than two weeks earlier, and spin-echo T1-weighted axial images after intra-articular injection of gadolinium-diethylenetriamine pentaacetic acid were made when the dislocation had occurred more than two weeks earlier. Separation and displacement of the anteroinferior portion of the labrum from the glenoid rim were measured on the axial images, and coaptation of the anterior part of the capsule to the glenoid neck was assessed by measurement of the detached area, opening angle, and detached length. RESULTS: Separation and displacement of the labrum were both significantly less (p = 0.0047 and p = 0.0017, respectively) when the arm was in external rotation than when it was in internal rotation. The detached area and the opening angle of the anteroinferior portion of the capsule were both significantly smaller (p = 0.0003 and p < 0.0001, respectively), and the detached length was significantly shorter (p < 0.0001) with the arm in external rotation. CONCLUSION: Immobilization of the arm in external rotation better approximates the Bankart lesion to the glenoid neck than does the conventional position of internal rotation.
