The majority (98%) of traumatic shoulder dislocations are in the anterior direction. Recurrence rates following primary anterior dislocations are significantly high (up to 100%). There is a debate as to whether immobilization in IR (traditional view) or in ER in a functional brace (current view) is more effective in reducing the recurrence rates.This concept was first proposed by Ito et al (2001) base on cadaveric and MRI findings demonstrating significantly less labral separation and displacement when the shoulder is placed in ER as compared with IE.
Hurley et al., (2021) published a meta-analysis of 9 RCTs with 795 patients. This Level 1 systematic review concluded that immobilization of the shoulder in ER in a functional brace results:
- more functional position for ADL
- higher compliance rate / comfort
- lower recurrent dislocation rate, including younger patients, who are at higher risk for recurrence.
- higher rate of return to playas compared with immobilization in IR in traditional shoulder immobilizer.
Hurley ET et al., J ISAKOS. 2021 Jan; 6(1):22-27
Itoi E et al., J Shoulder Elbow Surg. 2021 Oct 14; S1058-2746(21)00727-8
Hatta T et al., Ups J Med Sci. 2013 May; 118(2):105-10
So, what should a shoulder rehabilitation protocol include? Firstly, it requires to be phased. Phases determined by the structures involved and patient compliance. There are two acronyms currently in use that guide acute soft tissue injury management and rehabilitation. POLICE (Protect-Optimal-Loading-Ice-Compression-Elevation) (Bleakley, 2012) is aimed at immediate interventions and PEACE and LOVE (Protect-Elevation-Avoid Anti-inflammatory-Compression-Education and Loading-Optimism-Vascularization-Exercise) at interventions throughout the rehab process and putting the patient at the center of the decision-making process (Dubois and Esculier, 2020).Both these acronyms include Protection and Optimal Loading. Protection, as we have discussed, can be provided by bracing. Optimal Loading using closed kinetic chain exercises should be commenced early in Phase I.
View full video: Shoulder Post-op Pain Free Return to ADL at home with Functional Bracing and Cryocompression
PEACE & LOVE also suggests avoiding anti-inflatmmation medications which may negatively affect long-term tissue healing, and to use external mechanical pressure (C for Compression) to help limit intra-articular oedema and tissue haemorrhage. Due to the opioid epidemic globally, opioid addiction was cited as the "FDA's biggest crisis". Cryocompression with Cryocuff Shoulder could help patient to return to ADL at home and encourage pain free rehab exercises.
Management of Traumatic Dislocation of Shoulder - From POLICE to PEACE & LOVE
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Dr. Chan Kin Yuen and Mr. Cliff Eaton shared their expertise and openly discuss about Shoulder dislocation with high recurrent rate, especially with young patients.
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