Management of Shoulder Instability in the Overhead Athletes

Editorial Commentary: The Shoulder Instability-Return to Sports After Injury Scale Is More Than Just a Psychological Readiness Tool-It Is a Potential Predictive Model for Outcomes and Recurrence

The Shoulder Instability-Return to Sports After Injury (SIRSI) scale is a useful psychological readiness tool to determine whether athletes are prepared to return to sport. Although questions remain on the optimal timing of survey administration based on the type of procedure (i.e., arthroscopic Bankart repair vs Latarjet procedure) and external factors contributing to psychological readiness, its current use begs the question of what other applications may be appropriate. The SIRSI scale has recently been able to effectively predict patient-reported and clinical outcomes, such as postoperative instability recurrence. However, it also may have added value as a serial screening tool for determining a safe return to preinjury activity rather than just serving as a harbinger of further negative outcomes after shoulder stabilization. Increasingly, we must recognize the fundamental limitations in our current rehabilitation pathways and sometimes myopic, 1-dimensional return-to-play criteria (e.g., range of motion or isokinetic testing) in facilitating a safe return to competition. We must transition to a more regimented, criteria-based return-to-play battery that incorporates optimized psychological readiness. As such, the SIRSI scale, like its anterior cruciate ligament counterpart, could become the standard of care in determining confidence in returning to sport and ultimately serve as a benchmark of surgical success.