First Time Anterior Shoulder Dislocators

BackgroundThere are a multitude of international studies that have considered the rates of redislocation and instability of shoulders managed non-operatively vs. operatively after first time anterior dislocation. Initial management has included no treatment, internal rotation sling immobiliser, external rotation brace and early or late stabilisation. The majority of those managed in internal rotation or with no support initially have had poor long term results. There are several small trials of the use of the External Rotation Brace that have shown promising results comparable to acute surgical stabilisation. The use of the External Rotation brace for first time anterior dislocators in the 15-40 years age group was initiated to attempt to reduce the rates of redislocation and instability without requiring surgical intervention.Method Consecutive patients that fit the selection criteria were selected and followed over time. A physiotherapy program was initiated early in the management and regular clinic reviews undertaken. 2 years post first time anterior dislocation, patients were reviewed subjectively and a Quick DASH score performed. They were asked to give an estimate of their recovery and report any redislocations, instability or subluxation.ResultsThere was 1 redislocation (3%) during this period in the 32 patients. The majority were functioning at predislocation levels at review and no surgical intervention for instability was required. Quick-Dash results were excellent, with a vast majority scoring less than 2/100 level of disability. Estimated recovery scores supported these findings with the majority of patients reporting 90-95% recovery compared with the unaffected side.ConclusionThe external rotation brace has proven to be an excellent alternative to early shoulder stabilisation for first time anterior dislocators in the 15-40 years age group