Long-term outcomes of non-surgical treatment in first-time anterior shoulder dislocation: Does immobilisation duration and rehabilitation timing affect functional results and recurrence rates?
Bibliographic record
Abstract
Objective To investigate whether immobilisation duration and rehabilitation initiation influence functional recovery, recurrence, and treatment failure in first-time anterior shoulder dislocation managed conservatively. Design Retrospective multicentre cohort study. Setting Orthopaedic departments of multiple hospitals, data were collected between 2015 and 2021. Participants A total of two hundred and one patients with first-time anterior shoulder dislocation were managed non-surgically. Patients were divided into three groups: Group 1 (early mobilisation; n = 61) – one to two weeks of immobilisation with rehabilitation starting in week two; Group 2 (standard protocol; n = 76) – three to four weeks of immobilisation with rehabilitation starting in week four; and Group 3 (delayed rehabilitation; n = 64) – more than four weeks of immobilisation with rehabilitation starting in week six. Intervention Non-surgical treatment with varying immobilisation durations followed by rehabilitation. Main Measures Functional outcomes were the Rowe, Disabilities of the Arm, Shoulder and Hand, American Shoulder and Elbow Surgeons, and Western Ontario Shoulder Instability Scores. Clinical outcomes included shoulder range of motion, recurrence, return-to-activity time, and treatment failure. Results Functional scores and range of motion did not differ significantly between groups. Recurrence occurred in 18.0% (Group 1), 23.7% (Group 2), and 23.4% (Group 3), with no statistically significant difference ( p = .135). However, treatment failure – defined as persistent instability or the need for surgical stabilisation – was significantly higher in Group 3 (23.4%) compared with Group 1 (16.4%) and Group 2 (18.4%) ( p = .022). Mean follow-up was 42.1 ± 10.2 months. Conclusions Immobilisation duration and rehabilitation timing were not associated with statistically significant differences in functional recovery or recurrence. Prolonged immobilisation appeared to increase the risk of treatment failure. Early or standard protocols may therefore represent reasonable options, and prospective randomised studies are needed to define optimal management. Level of Evidence: Level Three.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".