A Cochrane review [Abstract] 1 included 7 RCTs and 1 quasi-randomised trial with a total of 704 subjects with primary traumatic anterior dislocation of the shoulder reduced by various closed methods.
The mean age across the trials was 29 years (range 12 to 90 years), and 82% of the participants were male. All trials compared immobilisation in external rotation (with or without an additional abduction component) versus internal rotation (the traditional method) following closed reduction. No trial evaluated any other interventions or comparisons, such as rehabilitation. All trials provided data for a follow-up of one year or longer; the commonest length was two years or longer.
It is uncertain whether immobilisation in external rotation makes a difference to the risk of re-dislocation after 12 months' or longer follow-up compared with immobilisation in internal rotation (55/245 versus 73/243; RR 0.67, 95% CI 0.38 to 1.19; 488 participants; 6 studies. In a moderate-risk population with an illustrative risk of 312 per 1000 people experiencing a dislocation in the internal rotation group, this equates to 103 fewer (95% CI 194 fewer to 60 more) re-dislocations after immobilisation in external rotation. Thus this result covers the possibility of a benefit for each intervention.Individually, the four studies (380 participants) reporting on validated patient-reported outcome measures for shoulder instability at a minimum of 12 months' follow-up found no evidence of a clinically important difference between the two interventions.
Comment: The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment and blinding), by inconsistency (variability in results), and by imprecise results (few patients and outcome events).
Primary/Secondary Keywords