Closed Treatment of Shoulder Dislocations

Closed treatment of shoulder dislocation is indicated in those with an initial dislocation without any obvious fractures of the humerus or the glenoid and in those who select conservative treatment. Those who strongly desire to undergo surgical stabilization should be excluded. There are three options of conservative treatment: (1) immobilization in internal rotation; (2) immobilization in external rotation; and (3) skillful neglect. There is evidence that skillful neglect provides the same outcome as immobilization in internal rotation in terms of recurrence rate. Immobilization in external rotation is a new method of conservative treatment. The efficacy is controversial. Recently, immobilization in abduction and external rotation has been reported to be better than in adduction and external rotation in a magnetic resonance imaging study. Based on this study, a prospective randomized clinical trial will be undertaken.