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

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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