Immobilization after primary dislocation of the shoulder

Opinions have differed on the most appropriate treatment of primary anterior dislocation of the shoulder in patients who are less than forty years old. Our retrospective study sought to analyze whether the incidence of recurrences varied with the type and duration of immobilization of the shoulder following primary dislocation. One hundred and twelve patients with a primary anterior dislocation treated during the years 1988-1990 in two orthopaedic departments were studied. Based of the type conservative treatment, patients were divided in two groups, each consisting of 56 cases. In group A (47 men and 9 women, aged 16 to 47 years) (with a mean of 27 years) the affected shoulder was immobilized in a Desault dressing for 18 to 25 days (mean 21 days). The patients in group B (45 men and 11 women, aged 16 to-90 years, with a mean of 28 years) were treated with a shoulder spica holding the arm in 60° of abduction. The mean time between treatment and follow- up was 4.2 years, with a range of 3.1 to 6.5 years. In assessing the results, the age, activity and disability of the patients, the severity of trauma and the complications caused by it were analyzed. The age of the patients when the primary dislocation occtured was the most influential factor for prognosis. Seventy four per cent of the patients in the group A underwent one to four redislocations during the follow-up period, whereas one or more recunences occurred in only 21 of those in group B. The recurrence rate in the patients of group A aged less than 2 years was 90%, while the corrisponding figure for the patients in group B was only 33%. From our figures, the incidence of recurrence seemed to be affected by the type and lenght of immobilization of the shoulder following the shoulder anterior dislocation.