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Abstract

Objective

To investigate whether immobilisation duration and rehabilitation initiation influence functional recovery, recurrence, and treatment failure in first-time anterior shoulder dislocation managed conservatively.

Design

Retrospective multicentre cohort study.

Setting

Orthopaedic departments of multiple hospitals, data were collected between 2015 and 2021.

Participants

A total of two hundred and one patients with first-time anterior shoulder dislocation were managed non-surgically. Patients were divided into three groups: Group 1 (early mobilisation; n = 61) – one to two weeks of immobilisation with rehabilitation starting in week two; Group 2 (standard protocol; n = 76) – three to four weeks of immobilisation with rehabilitation starting in week four; and Group 3 (delayed rehabilitation; n = 64) – more than four weeks of immobilisation with rehabilitation starting in week six.

Intervention

Non-surgical treatment with varying immobilisation durations followed by rehabilitation.

Main Measures

Functional outcomes were the Rowe, Disabilities of the Arm, Shoulder and Hand, American Shoulder and Elbow Surgeons, and Western Ontario Shoulder Instability Scores. Clinical outcomes included shoulder range of motion, recurrence, return-to-activity time, and treatment failure.

Results

Functional scores and range of motion did not differ significantly between groups. Recurrence occurred in 18.0% (Group 1), 23.7% (Group 2), and 23.4% (Group 3), with no statistically significant difference (p = .135). However, treatment failure – defined as persistent instability or the need for surgical stabilisation – was significantly higher in Group 3 (23.4%) compared with Group 1 (16.4%) and Group 2 (18.4%) (p = .022). Mean follow-up was 42.1 ± 10.2 months.

Conclusions

Immobilisation duration and rehabilitation timing were not associated with statistically significant differences in functional recovery or recurrence. Prolonged immobilisation appeared to increase the risk of treatment failure. Early or standard protocols may therefore represent reasonable options, and prospective randomised studies are needed to define optimal management.

Level of Evidence: Level Three.

Keywords

Anterior shoulder dislocation shoulder instability recurrence immobilisation rehabilitation non-operative treatment

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References

Zacchilli

Owens

. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am 2010; 92: 542–549.

Minkus

Königshausen

Maier

, et al. Immobilization in external rotation and abduction versus arthroscopic stabilization after first-time anterior shoulder dislocation: a multicenter randomized controlled trial. Am J Sports Med 2021; 49: 57.

Kao

Chang

, et al. Incidence of recurrence after shoulder dislocation: a nationwide database study. J Shoulder Elbow Surg 2018; 27: 1519–1525.

Samadov

Rafi

Sulek

, et al. Bilateral anterior glenohumeral dislocation following grand mal epileptic seizure, case report. Sisli Etfal Hastan Tip Bul 2022; 56: 568–571.

Buss

Lynch

Meyer

, et al. Nonoperative management for in-season athletes with anterior shoulder instability. Am J Sports Med 2004; 32: 1430–1433.

Smith

. Immobilisation following traumatic anterior glenohumeral joint dislocation: a literature review. Injury 2006; 37: 228–237.

Maeda

Yoneda

Horibe

, et al. Longer immobilization extends the “symptom-free” period following primary shoulder dislocation in young rugby players. J Orthop Sci 2002; 7: 43–47.

Kralinger

Golser

Wischatta

, et al. Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med 2002; 30: 116–120.

Düzgün

Baltaci

Ahmet Atay

. Comparison of slow and accelerated rehabilitation protocol after arthroscopic rotator cuff repair: pain and functional activity. Acta Orthop Traumatol Turc 2011; 45: 23–33.

10.

Ching-Wei

Tsai

SLH

Chen

, et al. Early versus delayed mobilization for arthroscopic rotator cuff repair (small to large sized tear): a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2023; 24: 38.

11.

Cuff

Pupello

. Prospective randomized study of arthroscopic rotator cuff repair using an early versus delayed postoperative physical therapy protocol. J Shoulder Elbow Surg 2012; 21: 1450–1455.

12.

Chan

MacDermid

Hoppe

, et al. Delayed versus early motion after arthroscopic rotator cuff repair: a meta-analysis. J Shoulder Elbow Surg 2014; 23: 1631–1639.

13.

Deyle

Nagel

. Prolonged immobilization in abduction and neutral rotation for a first-episode anterior shoulder dislocation. J Orthop Sports Phys Ther 2007; 37: 192–198.

14.

Kirkley

Werstine

Ratjek

, et al. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation. Arthroscopy – J Arthroscopic Related Surg 2005; 21: 55–63.

15.

Kearney

Ellard

Parsons

, et al. Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised controlled trial. Br Med J 2024: 384. https://doi.org/10.1136/BMJ-2023-076925

16.

Rees

Shah

Edwards

, et al. Treatment of first-time traumatic anterior shoulder dislocation: the UK TASH-D cohort study. Health Technol Assess 2019; 23: 1.

17.

Kim

Chung

Kim

, et al.

Is early passive motion exercise necessary after arthroscopic rotator cuff repair?

Am J Sports Med 2012; 40: 815–821.

18.

Park

Lee

Hyun

, et al. Minimal clinically important differences in Rowe and Western Ontario Shoulder Instability Index scores after arthroscopic repair of anterior shoulder instability. J Shoulder Elbow Surg 2018; 27: 579–584.

19.

Jones

Togashi

Heckmann

, et al. Minimal clinically important difference (MCID) for patient-reported shoulder outcomes. J Shoulder Elbow Surg 2020; 29: 1484–1492.

20.

Dabija

Jain

. Minimal clinically important difference of shoulder outcome measures and diagnoses: a systematic review. Am J Phys Med Rehabil 2019; 98: 671–676.

21.

Pasqualini

Rossi

Pan

, et al. High variability in standardized outcome thresholds of clinically important changes in shoulder instability surgery: a systematic review. Arthroscopy 2025; 41: 2061–2071.e2.

22.

Paterson

Throckmorton

Koester

, et al. Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. J Bone Joint Surg 2010; 92: 2924–2933.

23.

Scheibel

Kuke

Nikulka

, et al.

How long should acute anterior dislocations of the shoulder be immobilized in external rotation?

Am J Sports Med 2009; 37: 1309–1316.

24.

Gibson

Growse

Korda

, et al. The effectiveness of rehabilitation for nonoperative management of shoulder instability: a systematic review. J Hand Ther 2004; 17: 229–242.

25.

Chalidis

Sachinis

Dimitriou

, et al.

Has the management of shoulder dislocation changed over time?

Int Orthop 2006; 31: 85.

26.

Herman

Reddy

Fails

, et al. Rehabilitation and return to sport following operative and nonoperative treatment of anterior shoulder instability. Clin Sports Med 2024; 43: 705–722.

27.

Hanai

Hirose

Nakai

, et al. Early muscular training and immobilization in external rotation could reduce the recurrence rate in first-time shoulder dislocators among young rugby athletes. J Shoulder Elbow Surg 2025; 34: e446–e454.

28.

Chin

Kraeutler

Batiste

, et al. Management of the in-season athlete with an anterior shoulder dislocation. J Shoulder Elbow Surg 2024; 33: 2780–2790.

Long-term outcomes of non-surgical treatment in first-time anterior shoulder dislocation: Does immobilisation duration and rehabilitation timing affect functional results and recurrence rates?

Abstract

Objective

Design

Setting

Participants

Intervention

Main Measures

Results

Conclusions

Keywords

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References