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Study Seeks to Position Patients for Better Dislocation Recovery

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Posted: 8/1/2005

COLUMBUS, Ohio – Ohio State University Medical Center physicians are participating in a national study to determine if the position in which an arm is immobilized after a shoulder dislocation injury can make a significant difference in the way the injury heals.

In the trial, patients with shoulder dislocations will be randomized to receive the current standard of care – immobilization of the arm across the body followed by physical therapy – or to have their arm immobilized in the experimental position, with the extremity held perpendicular to the body, followed by physical therapy.

Building on results from a small study in Japan, the researchers hope to find that the changed arm position will allow cartilage in the shoulder to heal more closely to its original position, reducing the likelihood that the injury will reoccur.

“We hope to see a declining rate of recurrence and we hope to reduce the need for surgery in the future,” said Dr. Grant Jones, an orthopedic surgeon at OSU Medical Center and principal investigator of Ohio State’s participation in the study. “This would help in terms of keeping health care costs down and reducing risks to patients.”

Improved healing with the new arm position would be particularly helpful for patients under age 25, who are at significantly higher risk for recurrent shoulder dislocations after the first injury and therefore at a higher risk of needing shoulder surgery.

The most common type of shoulder dislocation, which occurs in about 90 percent of these injuries, is anterior dislocation, when the ball – or top of the humerus bone – slips out of the front of the joint. The less common type is a posterior dislocation, when the ball comes out of the back of the joint.

The injury occurs most often in active younger people who get their arm caught out to the side in an athletic activity. Other causes tend to be falls on ice or other recreational activities in which the arm can be pulled out to the side.

“Traditional treatment tends to be conservative for a first injury,” said Jones, who sees patients at The OSU Sports Medicine Center. The arm is often immobilized in a sling for two to six weeks, followed by physical therapy.

But because younger patients remain at higher lifetime risk for a repeat injury, surgery is more commonly performed on young patients as a more aggressive way to repair the tear and prevent additional dislocations, Jones said.

When a shoulder is dislocated, the labrum, a capsule surrounding the joint in which ligaments develop tension, separates from the bone. Surgery puts the labrum back in place. Immobilizing the arm externally brings the torn labrum closer to its pre-injury location. Leaders of the study hope to determine if this position allows the labrum to heal better than in the traditional position.

In the study, patients whose arms are immobilized at a 90-degree angle will have the help of a specially designed sling that has a built-in pillow to keep the arm in place. Researchers will take magnetic resonance imaging scans of the shoulders to monitor the healing and track recurrence rates among patients in the study.

The multisite study is led by the University of Colorado and funded by a grant from the Orthopaedic Research and Education Foundation.

For more information about this study at the OSU Medical Center, call research coordinator Angela Pedroza at 614-293-7952.

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Emily Caldwell
Medical Center Communications

Clinical/Translational Research; Orthopaedics; Sports Medicine