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Immobilization in External Rotation After Primary Shoulder Dislocation Did Not Reduce the Risk of RecurrenceA Randomized Controlled Trial
Sigurd Liavaag, MD1; Jens Ivar Brox, MD, PhD2; Are Hugo Pripp, PhD3; Martine Enger, MD4; Lars Atle Soldal, MD5; Svein Svenningsen, MD, PhD1
1 Department of Orthopedic Surgery, Sørlandet Hospital, Service Box 605, 4809 Arendal, Norway. E-mail address for S. Liavaag: sigurd.liavaag@sshf.no, sliavaa@online.no
2 Department of Orthopedic Surgery, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway
3 Research Services Department, Rikshospitalet, Forskningsveien 2, Rikshospitalet, 0027 Oslo, Norway
4 Orthopedic Center, Skadelegevakten, Oslo University Hospital and Medical School, Ullevaal, University of Oslo, Storgaten 40, 0182 Oslo, Norway
5 Department of Emergency, Bergen kommunale legevakt, Vestre Strømkaien 19, 5008 Bergen, Norway
View Disclosures and Other Information

Investigation performed at Sørlandet Hospital HF Arendal, Arendal; Oslo University Hospital Ullevaal, Oslo; Bergen public medical ward, Bergen; Sørlandet Hospital HF Kristiansand, Kristiansand; Sykehuset i Telemark HF (STHF), Skien; Stavanger University Hospital HF (SUS), Stavanger; St. Olavs Hospital, Trondheim; Akershus University Hospital (AHUS), Lillestrøm; Sørlandet Hospital HF Flekkefjord, Flekkefjord; Bærum Hospital (SABHF), Bærum; Drammen Hospital, Drammen; Kongsberg Hospital (earlier Blefjell Hospital Kongsberg), Kongsberg; and Sykehuset i Vestfold (SIV), Tønsberg, Norway

A commentary by Bruce S. Miller, MD, MS, is linked to the online version of this article at jbjs.org.

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 18;93(10):897-904. doi: 10.2106/JBJS.J.00416
A commentary by Bruce S. Miller, MD, MS, is available here
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The treatment of primary traumatic anterior shoulder dislocation varies widely from no immobilization, to two or three weeks of immobilization in internal rotation with the arm in a sling, to treatment with a brace in external rotation. The aim of the present clinical trial was to compare immobilization in internal and external rotation after anterior shoulder dislocation.


One hundred and eighty-eight patients with a primary anterior traumatic dislocation of the shoulder were randomly assigned to treatment with immobilization in either internal rotation (ninety-five patients) or external rotation (ninety-three patients) for three weeks. The primary outcome measure was a recurrent dislocation within twenty-four months of follow-up.


The follow-up rate after a minimum period of two years was 97.9% (ninety-three of ninety-five) in the internal rotation group and 97.8% (ninety-one of ninety-three) in the external rotation group. The compliance rate with the immobilization was 47.4% (forty-five of ninety-five) in the internal rotation group and 67.7% (sixty-three of ninety-three) in the external rotation group. The intention-to-treat analyses showed that the recurrence rate was 24.7% (twenty-three of ninety-three) in the internal rotation group and 30.8% (twenty-eight of ninety-one) in the external rotation group (p = 0.36).


Immobilization in external rotation does not reduce the rate of recurrence for patients with first-time traumatic anterior shoulder dislocation.

Level of Evidence: 

Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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