A Cochrane review included 3 RCTs and 1 quasi-randomised trial with a total of 470 subjects with primary traumatic anterior dislocation of the shoulder reduced by various closed methods. Three studies evaluated mixed populations and in one study, all participants were male and 80% were soldiers. All studies evaluated the same comparison - immobilisation in external rotation versus internal rotation. There was no difference between the two groups in re-dislocation (RR 1.06 favouring internal rotation, 95% CI 0.73 to 1.54; 3 studies, n=252) or return to pre-injury levels of activity (RR 1.25 favouring external rotation, 95% CI 0.71 to 2.2; 2 studies, n=278) at two-year or longer follow-up. Adverse event data were collected only in an ad hoc way, and it is unclear whether identification and reporting of such events was comprehensive (3 events, 2 studies). No report addressed participant satisfaction or health-related quality of life outcome measures.
Comment: The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment and blinding), by inconsistency (variability in results), and by imprecise results (few patients and outcome events).