Acute rehabilitation after traumatic shoulder dislocation

Most anterior shoulder dislocations occur for the first time related to sports (59%1 to 74%2), or from falls.1 Following closed reduction, primary care for these injuries involves a supportive sling and individually tailored advice for optimising recovery such as rehabilitative exercises to improve range of motion, sensorimotor control, strength, and function. To inform decision making, a linked BMJ paper by Kearney and colleagues (doi:10.1136/bmj-2023-076925) compared the effectiveness of two different approaches to acute rehabilitation following anterior shoulder dislocations (ARTISAN) across 40 hospital sites in the UK’s National Health Service. The approaches were advice, supporting materials, and the option to self-refer to physiotherapy, or the same advice and supporting materials alongside a tailored programme of physiotherapy.3

This randomised clinical trial was well planned, executed, and reported, and the authors should be commended for conducting a trial involving 482 patients (at baseline) and 96 clinicians during the covid-19 pandemic.

The primary outcome measure, the Oxford shoulder instability score, includes questions about re-dislocations, physical impairments, and psychosocial consequences of the injury. Higher scores (maximum 48) indicate …