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1. Position and Duration of
Immobilization After Primary
Anterior Shoulder Dislocation
Habtamu T. OSR4

2. • Three studies (including one Level-I and two Level-II
studies) compared recurrence rates with
immobilization in external and internal rotation.

3. • Review of the Level-I and Level-II literature
identified six studies involving patients who
were managed primarily with immobilization
in internal rotation following first-time
shoulder dislocations for varying lengths of
time.
• Over a twenty-five-year period, those studies
all demonstrated no difference in recurrent
dislocation rates between patients managed
with immobilization in internal rotation for one
week and those managed with immobilization
for three weeks or more.

4. • Hovelius et al. compared the rate of recurrent
shoulder instability in 112 patients who used
simple sling immobilization for 3–4 weeks with
104 patients who began to use the shoulder
as early and as freely as possible.
• At the two-year follow-up, both groups
showed an equal rate of recurrent shoulder
instability.

5.  Study have shown no clinical advantage for immobilization for
longer than one week

6. • A recent meta-analysis comparing the position
and duration of immobilization after primary
anterior shoulder dislocation showed no
difference in recurrence rates.
• Other authors have found no significant
difference in recurrence rates after
immobilization in external and internal
rotation in patients with a primary shoulder
dislocation.

7. • The current Level-I and Level-II evidence
suggests that there is no benefit to
immobilization in internal rotation for
more than one week.
• There is no significant difference between
those immobilized in internal rotation and
external rotation.