Decreasing the incidence of recurrence of first time anterior shoulder dislocations with rehabilitation.

Studies of adolescent and young adult males sustaining primary anterior shoulder dislocations reveal the likelihood of recurrence to be virtually always above 50% and as high as 79% to 94%. Common among these investigations is the lack of a specific, rigidly adhered to rehabilitation program. During a 3 1/2 year period, 20 midshipmen at the United States Naval Academy sustained primary anterior shoulder dislocations. All participated in an identical treatment regimen which included a restrengthening program emphasizing the muscles of internal rotation and adduction, plus rigid restrictions of activities until the goals of their rehabilitation program were satisfied. Exercises progressed from isometrics through isotonics and isokinetics. Goals included return to full active, unrestricted duty and athletic participation which included participation in the sport that resulted in the original dislocation. Patients were followed for an average of 35.8 months (with a range of 17 to 45 months). During the period of study there were five recurrences (25%). A success rate of 75% would suggest that adherence to a specific, aggressive postdislocation rehabilitation program, plus rigid restrictions of activities until the goals of the program are satisfied, can substantially improve the likelihood of a full return to activity without recurrent shoulder dislocation.