Immobilization in internal or external rotation does not change recurrence rates after traumatic anterior shoulder dislocation

J Shoulder Elbow Surg. 2014 Jan;23(1):13-9. doi: 10.1016/j.jse.2013.07.037. Epub 2013 Sep 30.


Background: The objective of this study was to systematically review and quantitatively synthesize the data on recurrence rates after shoulder immobilization in internal versus external rotation in first-time, traumatic shoulder dislocations.

Materials and methods: We performed a systematic search of the keywords "(((external rotation) OR internal rotation) AND immobilization) AND shoulder" in the online databases PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library. Random-effects models were used to calculate the cumulatively pooled risk ratios (RRs) of recurrent shoulder dislocations. All analyses were also stratified by age.

Results: We included 5 studies with a total of 471 patients (230 internal rotation and 241 external rotation) published between 2001 and 2011 in English. The pooled random-effects RR for recurrence of shoulder dislocations at all ages was 0.74 (95% confidence interval [CI], 0.44-1.27; P = .278). The RR was 0.70 (95% CI, 0.38 to 1.29; P = .250) for patients aged 30 years or younger and 0.78 (95% CI, 0.32 to 1.88; P = .579) for those aged older than 30 years.

Conclusion: The current best evidence does not support a relative effectiveness of immobilization in external rotation compared with internal rotation to avoid recurrent shoulder dislocations in patients with traumatic anterior shoulder dislocations.

Keywords: Immobilization; Level II; Meta-analysis; meta-analysis; recurrence rate; shoulder dislocation.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Adult
  • Algorithms
  • Braces*
  • Female
  • Humans
  • Immobilization / methods*
  • Male
  • Middle Aged
  • Range of Motion, Articular
  • Recurrence
  • Rotation
  • Shoulder Dislocation / physiopathology
  • Shoulder Dislocation / therapy*
  • Shoulder Joint / injuries
  • Shoulder Joint / physiopathology