This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
For people with a shoulder dislocation, researchers compared self-management advice from a physiotherapist (such as education and home exercises) with the same advice plus extra physiotherapy.
They found that both groups had:
- similar shoulder function (ability to carry out everyday tasks) after 6 months
- a similar number of complications after 12 months.
The findings show that not everyone with a shoulder dislocation needs an extra physiotherapy programme, as long as there is a way for people to self-refer if they are not recovering as expected.
Information on shoulder dislocation is available on the NHS website.
Does extra physiotherapy help with shoulder dislocation?
A dislocated shoulder means that the upper arm bone comes out of place from the shoulder socket. These dislocations are common, especially in young men due to sports injuries and older women due to falls. They can be painful and make everyday activities impossible, especially when the shoulder dislocates repeatedly.
Most people have their shoulder put back in place by clinicians and then rest it in a sling; some need surgery. Afterwards, people are normally given advice on recovery (including home exercises). But some people receive additional physiotherapy, typically over 6 months. It is not clear if this extra physiotherapy aids recovery.
This randomised controlled trial compared self-management advice only with advice plus extra physiotherapy for people with a dislocated shoulder who hadn’t had surgery.
What’s new?
The study was carried out at 40 UK hospitals and included 482 people who had a single dislocated shoulder for the first time. 240 people received a self-management advice session that included education and progressive exercises (up to 1 hour), a self-management booklet (also available online), and the option to self-refer for physiotherapy. 242 received the same self-management programme, plus extra physiotherapy for up to 4 months. Most participants (66%) were male, and their average age was 45 years.
The main outcome of the study was how well the shoulder worked (shoulder function) after 6 months. This was measured using the Oxford shoulder instability score. 180 people from the self-management group, and 174 from the physiotherapy group, contributed data to the main outcome.
The researchers found that both groups had:
- similar shoulder function after 6 months (self-management score 36, physiotherapy group score 38)
- a similar number of complications after 12 months, including re-dislocation (3% for self-management, 1% for physiotherapy) and fractures (3% for self-management, 2% for physiotherapy).
At 6 weeks, 3 months and 12 months, shoulder function was similar in both groups. This was a secondary outcome.
Why is this important?
In this study, extra physiotherapy offered no functional benefit over self-management advice for shoulder dislocation. The findings imply that encouraging self-management of recovery after dislocation could save NHS time. This approach may also be more convenient for people and give them more control over their own recovery.
Some people in the self-management group (18%) referred themselves for extra physiotherapy when they thought their recovery was not going as expected. Some (27%) people did not complete the study, which may reduce the strength of its findings.
What’s next?
The findings of the study will be considered in the next addition of the British Elbow and Shoulder Society guidelines on shoulder instability.
The researchers are developing the patient materials further to help people self-manage their own recovery. They plan to share these materials with hospitals in their local area.
You may be interested to read
This is a summary of: Kearney RS, and others. Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised controlled trial. British Medical Journal 2024; 384: e076925.
The NIHR Journals Library report of the study: Kearney RS, and others. Advice only versus advice and a physiotherapy programme for acute traumatic anterior shoulder dislocation: the ARTISAN RCT. Health Technology Assessment 2024; 28(22).
The self-management booklet from the trial.
Exercises to aid recovery for shoulder dislocation.
The British Elbow and Shoulder Society guidelines on shoulder instability.
Funding: This study was funded by the NIHR Health Technology Assessment programme.
Conflicts of Interest: Several of the study authors have received funding from pharmaceutical companies. See paper for full details.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
