Rehabilitation after primary shoulder dislocation in young patients (16-35 years): optimal immobilization timing and early strengthening protocols

Relevance. Primary traumatic dislocation of the shoulder joint is the most frequent dislocation in humans and is accompanied by a high risk of recurrence, reaching 70-90% in young patients. The choice of the optimal protocol for conservative treatment – the duration and position of immobilization as well as the timing of the start of active rehabilitation – remains the subject of scientific discussion. Objective. To systematize data from randomized controlled trials (RCTs), meta-analyses, and cohort studies (2010-2025) regarding optimal immobilization timing and effective protocols for early shoulder girdle muscle strengthening after primary shoulder dislocation in patients aged 16-65. Methods. The search was done in PubMed, Cochrane Library, Scopus and Web of Science databases. 15 sources of I-II evidence level were selected from the 150+ identified papers. Priority was given to systematic reviews, meta-analyses of RCTs, and large prospective cohort studies with a follow-up of at least 12 months. Key conclusions. Immobilization for more than 1 week in the internal rotation position does not reduce the risk of recurrence in young patients compared to early mobilization. The data on immobilization in external rotation are contradictory: a number of RCTs show a 38% reduction in the risk of recurrence, while others did not reveal significant differences. The beginning of isometric exercises from the 1st-2nd weeks and proprioceptive protocols from 4th 6th weeks is considered safe. The leading predictors of recurrence remain the age under 25, male sex, contact sports and the presence of bone defects (Hill-Sachs, Bankart).