BACKGROUND: We aimed to compare the effectiveness of immobilization in abduction and external rotation versus immobilization in adduction and internal rotation after primary anterior dislocation of the shoulder. METHODS: The study randomized 102 patients (age range 15 to 55 years) with the diagnosis of primary anterior dislocation of the shoulder to receive immobilization in adduction and internal rotation (AdIR n = 51) using sling and swathe bandage or immobilization in abduction and external rotation (AbER n = 51) with a stabilizer brace. Patients received a rehabilitation program 3 weeks after the intervention. RESULTS: After a 24-month follow-up, 33.3% in the AdIR group and 3.9% in the AbER group had recurrence (p < 0.001). The difference in the recurrence rate was greater in the subgroup aged between 31 and 40 years (44.8% in the AdIR group and 3.8% in the AbER group p < 0.001). Ten patients in the AbER group (19.6%) and 3 in the AdIR group (5.8%) discontinued shoulder immobilization before 3 weeks (p = 0.03). In patients without recurrence, the anterior apprehension test was positive in 6 of 34 in the AdIR group (17.6%) and in 4 of 49 in the AbER group (8.1%, p = 0.19). CONCLUSIONS: Immobilization with the shoulder joint in abduction and external rotation is an effective method to reduce the risk of recurrence after primary anterior shoulder dislocations and should be preferred to the traditional method of immobilization in adduction and internal rotation in clinical practice.

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