Position of Immobilization After First-Time Traumatic Anterior Glenohumeral Dislocation: A Literature Review

Positioning efficacy and comfort profile of shoulder support braces: A randomized repeated-measures study using three-dimensional kinematic analysis

BACKGROUND

Shoulder bracing is very common in musculoskeletal rehabilitation.

OBJECTIVE

In this study, the positioning efficacy of shoulder support braces was investigated by analyzing their three-dimensional kinematic properties, as well as their perceived comfort was investigated with user ratings.

STUDY DESIGN

A randomized repeated-measures study.

METHODS

Seventeen asymptomatic participants were included. Scapular, humeral, and thoracic kinematics for all participants were measured using an electromagnetic tracking device in 6 experiments in randomized order: no brace, neutral brace, abduction brace, internal rotation brace, 15-degree external rotation brace (ER15-B), and 30-degree external rotation brace (ER30-B). Also, comfort ratings were obtained during each session.

RESULTS

Internal rotation brace achieved a mean of 29.34° of humerothoracic internal rotation while providing increased scapular internal rotation and upward rotation ( p < 0.05). Abduction brace achieved a mean of 45.39° of humerothoracic and 39.58° of glenohumeral elevation coupled with increased scapular upward rotation, posterior tilt, and humeral internal rotation ( p < 0.05). 30-Degree external rotation brace achieved a mean of 33.25° of glenohumeral external rotation and resulted in increased scapular external rotation, upward rotation, posterior tilt, and humeral external rotation ( p < 0.05). Abduction brace, internal rotation brace, ER15-B, and ER30-B moved the thoracic spine into a more axial rotation in the contralateral direction. Internal rotation brace, ER15-B, and ER30-B were rated more uncomfortable when compared with the no brace condition, with no significant differences observed among the braces.

CONCLUSIONS

The positioning efficacy was enhanced when an abduction pillow and external rotation wedge were applied. Selection of commercially available shoulder support braces should involve consideration of whether it can achieve the desired position and orientation as well as its comfort profile.

Biomechanical analysis of anterior stability after 15% glenoid bone loss: comparison of Bankart repair, dynamic anterior stabilization, dynamic anterior stabilization with Bankart repair, and Latarjet

BACKGROUND

Dynamic anterior shoulder stabilization (DAS) with Bankart repair is a recently described stabilization technique thought to be more robust than an isolated Bankart repair while avoiding many coracoid transfer-related complications and technical demands. DAS involves transfer of the long head biceps through a subscapularis split to the anterior glenoid to create a sling effect. We hypothesize that DAS with Bankart repair will restore anterior stability in a human-cadaveric model with subcritical (15%) glenoid bone loss.

METHODS

Eight cadaveric shoulders were tested using an established shoulder simulator to record glenohumeral translations with an accuracy of ±0.2 mm. Shoulders were tested in 5 states-intact soft tissues, Bankart defect with 15% bone loss, isolated Bankart repair, DAS with Bankart repair, isolated DAS, and Latarjet. A 45 N anterior force was applied through the pectoralis major tendon, and translation of the humeral head was recorded and compared with repeated measures analysis of variance.

RESULTS

The anterior translation in the intact (native) glenoid was 4.7 mm at neutral position and 4.6 mm at 45° external rotation. Anterior translation significantly increased after introducing a Bankart defect with 15% glenoid bone loss to 9.1 mm (neutral, P = .002) and 9.5 mm (45° external rotation, P < .001). All repair conditions showed a significant decrease in anterior translation relative to Bankart defect. DAS with Bankart repair decreased anterior translation compared with the Bankart defect: 2.7 mm (neutral, P < .001) and 2.1 mm (45° external rotation, P < .001). DAS with Bankart repair significantly decreased anterior translation compared with the isolated Bankart repair (2.7 mm vs. 4.7 mm, P = .023) and the isolated DAS (2.7 mm vs. 4.3 mm, P = .041) in neutral position. The Latarjet procedure resulted in the greatest reduction in anterior translation compared with the Bankart defect: 1.2 mm (neutral, P < .001) and 1.9 mm (45° external rotation, P < .001).

CONCLUSIONS

DAS with Bankart repair is a viable alternative to restore anterior glenohumeral stability with a 15% glenoid defect at a greater degree than either DAS or Bankart repair alone. The Latarjet procedure was the most effective in reducing anterior translation but restrained the anterior translation significantly more than the native glenoid.

Management of primary anterior shoulder dislocations: a narrative review

Abstract

The recurrence rate following acute anterior shoulder dislocations is high, particularly in young, active individuals. The purpose of this paper is to provide a narrative overview of the best available evidence and results with regards to diagnostic considerations, comorbidities, position of immobilization, surgical versus conservative management, and time to return to play for the management of primary anterior shoulder dislocations. Three independent reviewers performed literature searches using PubMed, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials and systematic reviews meeting inclusion criteria from 1930 to April 2019 were appraised and discussed with the intent to consolidate the best available evidence with regards to lowering recurrence rates. A majority of studies support early surgical intervention for individuals between 21 and 30 years of age following primary shoulder dislocations, as this group is particularly susceptible to recurrence. Conservative treatment plans favor 1–3 weeks of immobilization in internal rotation, followed by rehabilitation. Surgical methods are associated with longer time to return to play, but lower recurrence rates. Return to play time is best determined on an individualized basis, when subjective and objective function of both shoulders is determined to be symmetric. This paper broadly summarizes the best available evidence for the management of primary anterior shoulder dislocations. There remains a need for randomized studies to determine ideal long-term treatment following conservative or surgical management, as general timelines for returning to play following injury remain vague.

Level of evidence

IV, Narrative Review