Primary Anterior Shoulder Dislocation
Conditions
Brief summary
Shoulder dislocations are quite common, the prevalence over a lifetime being estimated at 2% in the general population. In young patients, recurrence after a primary dislocation is also common (\ 60%) and multiple recurrent episodes can cause significant disability over time. Following initial reduction of the joint, the traditional treatment for primary shoulder dislocations has been immobilization in a sling, with the arm in a position of adduction and internal rotation. The length of the immobilization period is controversial, however most authors would recommend between three to six weeks in a sling followed by several months of rehabilitation to include range of motion and strengthening exercises. The clinical course of patients after this approach has been extensively investigated. Of particular interest is the relatively high rate of recurrent instability in young patients, reported to be between 17 and 96%. A prospective randomized trial is needed to determine whether in young patients (16-30 yrs of age) following reduction of a first-time traumatic anterior shoulder dislocation, does EMERGENT (\<4 hours post reduction) immobilization of the affected shoulder in external rotation reduce the rate of recurrent instability experienced within 12 months versus emergent immobilization in a traditional internal rotation sling? Eligible patients will be randomly allocated to the sling or ER brace. The results of this study will provide the best evidence for choosing emergent immobilization for shoulder dislocations.
Interventions
DEVICESling
DEVICEExternal Rotation Brace
Sponsors
Unity Health Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Skeletally mature patients between 18 - 35 years of age inclusive * Patient is seen within 24 hours from time of injury. * Sustained an acute, first-time, traumatic anterior dislocation of the shoulder as defined by; * Mechanism of abduction, external rotation * Sudden pain in the shoulder * Manipulative reduction required or * Radiograph documenting a dislocated joint * Willing to participate in follow-up for at least 24 months.
Exclusion criteria
* Incompetent or unwilling to consent * Inability or unwillingness to comply with rehabilitative protocol or required follow-up assessments. * Previous instability of the affected shoulder * Significant associated fracture (Exception Hill Sachs or bankart lesions) * Concomitant ipsilateral upper extremity injuries which may affect the patient's ability to participate in, or benefit from, a rehabilitative program. * Neurovascular compromise of the affected limb * A medical condition making the patient unable to wear a brace or sling * Patient is seen within 24 hours from time of injury
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Re-dislocation of shoulder | within 12 months |
Countries
Canada
Outcome results
None listed