SHOULDER & ELBOW
Is protecting the healing ligament beneficial after immobilization in external rotation for an initial shoulder dislocation?
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):214 Am J Sports Med. 2013 May;41(5):1126-32. doi: 10.1177/0363546513480620. Epub 2013 Mar 22109 patients with traumatic shoulder dislocation were randomized to determine the effect of a shoulder motion restriction band on recurrence rates. Following reduction and immobilization in external rotation for 3 weeks, participants received either 6- or 3-week use of the restriction band, or no band use. Assessments were conducted for a minimum of 2 years following reduction, and no difference between groups was observed for overall recurrence of shoulder dislocation, even when patients were stratified by age.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
3/4
Randomization
3/4
Outcome Measurements
3/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Traumatic shoulder dislocations, which boast one of the highest recurrence rates, are almost invariably associated with a Bankart lesion. Immobilization in 10 degrees external rotation for 3 weeks following the injury has been suggested as an appropriate protocol for healing of the lesion, however the true length of time required for healing is still unknown. Furthermore, it is imperative that the inferior glenohumeral ligament-labrum (IGHL) complex, in which healing is still ongoing following 3 weeks of immobilization, not be stretched. Maximum tension on the IGHL occurs with the arm at 90 degrees abduction and maximum external rotation, which may be protected by the use of a motion restriction band.
Qual era a principal questão de investigação?
Following 3-week immobilization at 10-15 degrees external rotation after traumatic shoulder dislocation, what was the effect of 6- or 3-week use of a shoulder motion restriction band compared to no band use on recurrent shoulder dislocation within 2 years?
Quais foram os resultados importantes?
- Recurrent dislocation occurred in 8/29 0-week patients (28%), 10/30 3-week patients (33%), and 10/31 6-week patients (32%) (P=0.88). 20 of the shoulders with recurrent dislocation (71%) were due to sports injuries.
- In the subgroup analysis of patients 30 years of age or younger, recurrence rates were 7/15 in the 0-week group (47%), 9/21 in the 3-week group (43%), and 8/24 in the 6-week group (33%) (P=0.67).
- In the subgroup analysis of patients over the age of 30, recurrence rates were 1/14 in the 0-week group (7%), 1/9 in the 3-week group (11%), and 2/7 in the 6-week group (29%) (P=0.43).
- Rates of return to sports was 18/21 0-week patients (86%), 16/22 3-week patients (73%), and 21/24 6-week patients (88%) (P=0.39). Return to preinjury level was 13/21 in the 0-week group (62%), 12/22 in the 3-week group (55%), 14/24 in the 6-week group (58%) (P=0.89).
- Return to contact sports was 1/2 in the 0-week group (50%), 4/7 in the 3-week group (57%), and 2/2 in the 6-week group (100%) (P=0.35). Return to noncontact sports was 9/16 in the 0-week group (56%), 6/13 in the 3-week group (46%), and 12/22 in the 6-week group (55%) (P=0.85).
- There was no significant difference between groups in rates of compliance to immobilizer use (P=0.11), restriction band use (P=0.28), or both (P=0.54).
De que é que me devo lembrar mais?
There was no difference in recurrence rates of shoulder dislocation observed with the use of a shoulder motion restriction band (for 3 and 6 weeks) compared to no use after 3 weeks of immobilization in external rotation following primary traumatic shoulder dislocation.
Como é que isto afectará o tratamento dos meus doentes?
These results do not suggest there is an advantageous effect of shoulder motion restriction bands with respect to recurrence of dislocation. Further investigation may consider the effect of restriction band use on clinical outcome and shoulder range of motion.
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