The study involved 22 subjects split evenly between a group that was immobilized for 3 weeks and another that was immobilized for 5 weeks. Both groups were immobilized in a position of 30 degrees of external rotation in a DonJoy Ultrasling. Displacement and separation of the capsulolabral complex was measured using MRI.
The authors report that immobilization yielded improved results regardless of the length of immobilization. There was no significant difference in results when comparing the group immobilized for 3 weeks with the group immobilized for 5 weeks. The results of this study are interesting and certainly support the use of an immobilization brace in external rotation, though it doesn’t seem that lengthy immobilization of more than 3 weeks will achieve superior results.
Standardized or Individualized?
I personally think that there should be a little variation in the immobilization protocol based on the specific patient. I would say that I routinely immobilize patients anywhere from 2 to 6 weeks based on their history of dislocations, amount of concomitant trauma, their tissue type, and the status of their dynamic stabilizers. For example, patients with congenital laxity that suffer frequent dislocations probably need to be immobilized longer than a person with an acute, first-time, dislocation.
This study also examined the effect of rotation on the approximation of the labrum and again noted that the more external rotation the better. A word of caution, there are some braces on the market that I do not believe achieve enough external rotation. My brace of choice has always been the DonJoy Ultrasling in slight abduction and 30 degrees of external rotation, I highly recommend it. Your patients will also like it as it seems to be one of the more comfortable braces available.
What has your experience been with acute anterior dislocations? How long do you usually immobilize? Do you have a brace you prefer? Do you see large variations in protocols from different physicians in your area?
Scheibel, M., Kuke, A., Nikulka, C., Magosch, P., Ziesler, O., & Schroeder, R. (2009). How Long Should Acute Anterior Dislocations of the Shoulder Be Immobilized in External Rotation? The American Journal of Sports Medicine DOI:10.1177/0363546509331943
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