Importance Cadaveric and MRI findings have demonstrated significantly less labral separation and displacement when the shoulder is placed in external rotation as compared with internal rotation.
Objective The purpose of the current study is to meta-analyse the randomised controlled trials in the literature to compare immobilisation in external versus internal rotation after first-time anterior shoulder dislocation.
Evidence review A literature search of MEDLINE, EMBASE and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomised controlled trials comparing immobilisation in external rotation versus internal rotation for first-time anterior shoulder dislocation were included.
Findings Nine randomised controlled trials with 795 patients were included. The mean age of included patients was 29 years, 82.4% were male and the mean follow-up was 25.5 months. As compared with immobilisation in internal rotation, compliance was significantly higher (74.5% vs 67.4%, p=0.01), and the rate of recurrent dislocations was significantly lower (22.2% vs 33.4%, p=0.02) with immobilisation in external rotation. Additionally, in patients 20–40 years old the rate of recurrent dislocations was significantly lower in those treated with immobilisation in external rotation than internal rotation (12.1% vs 31.4%, p=0.006). Immobilisation in external rotation also resulted in a higher rate of return to preinjury level of play (60.1% vs 42.6%, p=0.0001).
Conclusions and relevance Immobilisation of the shoulder in external rotation after a traumatic first-time anterior shoulder dislocation results in a higher compliance rate, a lower recurrent dislocation rate and a higher rate of return to play as compared with immobilisation in internal rotation.
Level of evidence Level I.
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Contributors ETH and JWF authored the manuscript. ETH and BAM came up with the conceptualised project. MJA, EJS and LMJ edited the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests EJS: AAOS: board or committee member; American Orthopaedic Association: board or committee member; Arthrex: paid consultant; paid presenter or speaker; Arthroscopy Association of North America: board or committee member; Better PT: stock or stock options; Cartiheal: research support; Cartilage, Bulletin of the Hospital for Joint Diseases: editorial or governing board; Fidia: paid consultant; research support; Flexion Therapeutics: paid consultant; Jaypee Publishing: publishing royalties, financial or material support; Joint Restoration Foundation: paid consultant; Organogenesis: paid consultant; paid presenter or speaker; research support; Smith & Nephew: paid consultant; paid presenter or speaker; Springer: publishing royalties, financial or material support; Subchondral Solutions: paid consultant; Vericel: paid consultant; paid presenter or speaker. LMJ: Arthrex: research support; Bulletin for the Hospital for Joint Diseases: editorial or governing board; JBJS Reviews: editorial or governing board; Mitek: research support; Smith & Nephew: research support; Wolters Kluwer Health-Lippincott Williams & Wilkins: publishing royalties, financial or material support. MJA: AAOS: board or committee member; Arthrex: paid consultant; research support; Arthroscopy Association of North America: board or committee member; Concours Pharmaceuticals: research support.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
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