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Watson L, Hoy G, Barwood S, Pizzari T, Balster S, Mulholland J, French J, Lawrence S, Verdon D, Warby S. The Posterior Shoulder Instability Questionnaire: internal consistency, content and criterion validity, responsiveness, and reliability of a new tool for the assessment of posterior shoulder instability. J Shoulder Elbow Surg 2024:S1058-2746(24)00383-5. [PMID: 38821172 DOI: 10.1016/j.jse.2024.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/05/2024] [Accepted: 03/29/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Posterior shoulder instability (PSI) is an increasingly recognized cause of shoulder dysfunction particularly in young active patients and certain athlete populations. When evaluating the efficacy of treatment for PSI, specific outcome measures for this population are essential. The aim of the current research was to describe the development and evaluation of a patient reported outcome measure specific for PSI. METHODS A retrospective cohort study design of patients with PSI was used to develop and evaluate the "Posterior Shoulder Instability Questionnaire (PSI-Q)". Items for PSI-Q were generated through an expert focus group and existing questionnaires. Preliminary data analysis identified redundancy of items and resulted in the PSI-Q being refined. The final PSI-Q was evaluated on 128 patients with PSI with a structural lesion requiring surgical intervention. Participants were excluded in the absence of a posterior glenohumeral joint lesion. Internal consistency (Cronbach α and corrected item-total correlation), content validity, criterion validity, responsiveness, and test-retest reliability (intraclass correlation coefficient) were examined. Content validity, criterion validity and responsiveness were compared with the Melbourne Instability Shoulder Scale (MISS) and the Western Ontario Shoulder Instability Index (WOSI). The minimum detectable change score (MDC) was calculated. RESULTS The Cronbach α for the total scale preintervention and postintervention was high (α = 0.97). All five domains (pain, instability/weakness/stiffness, function, occupation and sport, and quality of life and satisfaction) demonstrated acceptable internal consistency for each subsection and the overall score of the scale (α > 0.70). The corrected-item total correlation for each domain was within an acceptable range. The responsiveness of the PSI-Q questionnaire was excellent (effect size, 2.06; standard response mean, 1.34) and was higher than the MISS and WOSI. There were no relevant floor effects and 1 ceiling effect. Reliability was excellent (intraclass correlation coefficient(1,1) = 0.93) and the calculated MDC was 10.9 points. DISCUSSION This study designed and validated a questionnaire specific for measuring symptoms and function in people with structural PSI requiring surgery. The PSI-Q demonstrates good measurement properties and provides an MDC that is useful for researchers and clinicians. In structural PSI, the PSI-Q has a higher responsiveness and more accurately reflects a patient's overall perceived shoulder status compared to current patient reported outcomes for shoulder instability. The psychometric properties of the PSI-Q are still to be determined in a nonsurgical population.
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Affiliation(s)
- Lyn Watson
- Melbourne Shoulder Group, Prahran, Victoria, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia; Monash Medical Centre, Department of Surgery, Monash University, Clayton, Victoria, Australia; Glenferrie Private Hospital, Hawthorn, Victoria, Australia
| | - Shane Barwood
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Tania Pizzari
- Melbourne Shoulder Group, Prahran, Victoria, Australia; Mill Park Physiotherapy, South Morang, Victoria, Australia
| | - Simon Balster
- Melbourne Shoulder Group, Prahran, Victoria, Australia
| | | | | | - Sam Lawrence
- Melbourne Shoulder Group, Prahran, Victoria, Australia
| | - Daniel Verdon
- Melbourne Shoulder Group, Prahran, Victoria, Australia
| | - Sarah Warby
- Melbourne Shoulder Group, Prahran, Victoria, Australia; Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Bundoora, Victoria, Australia.
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Watson L, Hoy G, Wood T, Pizzari T, Balster S, Barwood S, Warby SA. Posterior Shoulder Instability in Tennis Players: Aetiology, Classification, Assessment and Management. Int J Sports Phys Ther 2023; V18:769-788. [PMID: 37425109 PMCID: PMC10324327 DOI: 10.26603/001c.75371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/14/2023] [Indexed: 07/11/2023] Open
Abstract
Background Micro-traumatic posterior shoulder instability (PSI) is an often missed and misdiagnosed pathology presenting in tennis players. The aetiology of micro-traumatic PSI in tennis players is multifactorial, including congenital factors, loss of strength and motor control, and sport-specific repetitive microtrauma. Repetitive forces placed on the dominant shoulder, particularly combinations of flexion, horizontal adduction, and internal rotation contribute to the microtrauma. These positions are characteristic for kick serves, backhand volleys, and the follow-through phase of forehands and serves. The aim of this clinical commentary is to present an overview of the aetiology, classification, clinical presentation, and treatment of micro-traumatic PSI, with a particular focus on tennis players. Level of Evidence 5.
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Affiliation(s)
- Lyn Watson
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
| | - Gregory Hoy
- Melbourne Orthopaedic Group, 33 The Avenue Windsor, Victoria, Australia, 3181
- Monash University, Department of Surgery, Monash Medical Centre Level 5, Block E 246 Clayton Road Clayton, Victoria, Australia, 3168
- Glenferrie Private Hospital, 25 Linda Crescent, Hawthorn, Victoria, Australia, 3122
| | - Timothy Wood
- Glenferrie Private Hospital, 25 Linda Crescent, Hawthorn, Victoria, Australia, 3122
| | - Tania Pizzari
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
- Mill Park Physiotherapy, 22/1 Danaher Dr, South Morang, Victoria, Australia, 37522
- La Trobe University, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, Corner of Kingsbury Drive and Plenty Road Bundoora, Victoria, Australia, 3080
| | - Simon Balster
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
| | - Shane Barwood
- Melbourne Orthopaedic Group, 33 The Avenue Windsor, Victoria, Australia, 3181
| | - Sarah Ann Warby
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
- La Trobe University, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, Corner of Kingsbury Drive and Plenty Road Bundoora, Victoria, Australia, 3080
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Tennent DJ, Slaven SE, Slabaugh MA, Cameron KL, Posner MA, Owens BD, LeClere LE, Rue JPH, Tokish JM, Dickens JF. Recurrent Instability and Surgery Are Common After Nonoperative Treatment of Posterior Glenohumeral Instability in NCAA Division I FBS Football Players. Clin Orthop Relat Res 2021; 479:694-700. [PMID: 33724975 PMCID: PMC8083809 DOI: 10.1097/corr.0000000000001471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/05/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND In-season return to play after anterior glenohumeral instability is associated with high rates of recurrent instability and the need for surgical stabilization. We are not aware of previous studies that have investigated in-season return to play after posterior glenohumeral instability; furthermore, as posterior shoulder instability in collision athletes occurs frequently, understanding the expected outcome of in-season athletes may improve the ability of physicians to provide athletes with a better understanding of the expected outcome of their injury and their ability to return to sport. QUESTIONS/PURPOSES (1) What proportion of athletes returned to play during the season after posterior instability in collegiate football players? (2) How much time did athletes lose to injury, what proportion of athletes opted to undergo surgery, and what proportion of athletes experienced recurrent instability after a posterior instability episode during a collegiate football season? METHODS A multicenter, prospective, observational study of National Collegiate Athletic Association (NCAA) Division 1 Football Bowl Subdivision athletes was performed at three US Military Service Academies. Ten athletes who sustained a posterior instability event during the regular football season and who pursued a course of nonoperative treatment were identified and prospectively observed through the subsequent season. All athletes in the observed cohort attempted an initial course of nonoperative treatment during the season. All athletes sustained subluxation events initially identified through history and physical examination at the time of injury. None of the athletes sustained a dislocation event requiring a manual reduction. Intraarticular pathology consisting of posterior labral pathology was further subsequently identified in all subjects via MRI arthrogram. Return to play was the primary outcome of interest. Time lost to injury, surgical intervention, and subsequent instability were secondary outcomes. RESULTS Of the 10 athletes who opted for a trial of initial nonoperative management, seven athletes were able to return to play during the same season. Although these seven athletes returned within 1 week of their injury (median of 1 day), 5 of 7 athletes sustained recurrent subluxation events with a median (range) of four subluxation events per athlete (0 to 8) during the remainder of the season. Seven athletes were treated surgically after the completion of their season, four of whom returned to football. CONCLUSION This study suggests that although collegiate football players are able to return to in-season sport after a posterior glenohumeral instability event, they will likely sustain multiple recurrent instability events and undergo surgery after the season is completed. The results of this study can help guide in-season management of posterior shoulder instability by allowing more appropriate postinjury counseling and decision making through the identification of those athletes who may require additional attention from medical staff during the season and possible modifications to training regimens to minimize long-term disability. Further prospective studies involving a larger cohort over several seasons should be performed through collaborative studies across the NCAA that better assess function and injury risk factors before beginning collegiate athletics. This would better characterize the natural history and associated functional limitations that athletes may encounter during their collegiate careers. LEVEL OF EVIDENCE Level IV, prognostic study.
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Affiliation(s)
- David J Tennent
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Sean E Slaven
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Mark A Slabaugh
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Kenneth L Cameron
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Matthew A Posner
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Brett D Owens
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Lance E LeClere
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - John-Paul H Rue
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - John M Tokish
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
| | - Jonathan F Dickens
- D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA
- D. J. Tennent, Department of Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
- S. E. Slaven, J. F. Dickens, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- S. E. Slaven, K. L. Cameron, J. F. Dickens, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- M. A. Slabaugh, United States Air Force Academy, Colorado Springs, CO, USA
- B. D. Owens, Department of Orthopedic Surgery, Brown University, East Providence, RI, USA
- L. E. LeClere, J.-P. H. Rue, United States Naval Academy, Annapolis, MD, USA
- J. M. Tokish, Mayo Clinic, Phoenix, AZ, USA
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