Description
Objectives: Rugby is a popular sport where collisions of two players is common, this results in frequent shoulder joint injuries. Among these, anterior shoulder joint dislocation is a challenge to treat especially in limited season and athletic careers, as it leads to shoulder instability requiring prolonged postoperative rest when surgery is required. Conservative therapy with immobilization of the shoulder joint external rotation (ER) or early muscle training without immobilization has been reported as an effective option in managing initial shoulder dislocation and could shorten the return to sport interval. The purpose of the present study is to compare the outcomes of conservative treatment of primary anterior shoulder dislocation in rugby players using different methods of immobilization.
Methods: Thirty-four rugby players (31 males and 3 females; mean age at injury was 17.3 +/- 2.0 years old) who chose conservative treatment for traumatic primary shoulder dislocation without glenoid bone loss were enrolled in this study. The recurrence rate and recurrence-free period were retrospectively investigated for each immobilization method. The immobilization methods were classified into three groups: the non-immobilization (NI) group, in which no clear immobilization was achieved; the iER group, in which strength training was started after 3-4 weeks of immobilization in the external rotation position; and the iER+T group, in which intrinsic muscle training was combined immediately after the start of external rotation immobilization. After immobilization, rotator cuff periscapular muscle training was continued, and the player was allowed to return to sport (RTS), 8 weeks post injury based on a comprehensive assessment of the player's condition. The endpoint was defined as dislocation or subluxation, and the point when the player could no longer continue to play due to recurrence pain or instability in a season.
Results: The NI, iER, and iER+T groups had 8, 8, and 18 shoulders, respectively. The recurrence rate during the first season after RTS was 100%, 87.5%, and 55.5%, respectively, with statistically significant difference between the groups (p=.037). When comparing the survival curve for the treatment success rate, the curve of the iER+T group seemed to survive long completely and there was a significant difference in the transition of each curve (p=.045 for log-rank test). The patients who were able to continue to play for more than half of the remaining season without any recurrences were 0%, 11.7%, and 50.0%, respectively.
Conclusions: The treatment by immobilized in external rotation position combined with early muscle strength training may be a treatment option for limited duration in a season for the young athletes.
