Prolonged immobilization in abduction and neutral rotation for a first-episode anterior shoulder dislocation

STUDY DESIGN: Case report. BACKGROUND: Patients who sustain first-episode anterior glenohumeral dislocations are at risk to develop chronic glenohumeral instability. Current treatment options after an initial anterior glenohumeral dislocation include immediate surgery, delayed surgery, or conservative interventions such as immobilization and strengthening exercises. Duration of immobilization is variable among formal studies. Recent research suggests that typical immobilization positions may not allow adequate healing and in fact may promote glenohumeral joint instability. CASE DESCRIPTION: The patient was a 19-year-old male who sustained a first-episode anterior glenohumeral dislocation during athletic activity. Physical therapy management included a longer-than-typical period of immobilization and protected activity to allow for more complete healing. The shoulder abduction and neutral rotation immobilization position used with this patient may increase healing of structures that influence stability of the shoulder. OUTCOMES: At 13 weeks after the dislocation, the patient had full active and passive range of motion, near normal strength, and no complaints of pain or instability. At a 20-month follow-up the patient had resumed full activities of daily living including recreational sports without symptoms of instability. DISCUSSION: Conservative intervention options for first-episode anterior shoulder dislocations need further study. Immobilization and protected activity periods should be adequate to allow for complete healing. The optimal positions for immobilization should be determined and implemented.