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Stambaugh JR, Bryan TP, Edmonds EW, Pennock AT. Arthroscopic Shoulder Stabilization in High School Football Players. Orthop J Sports Med 2024; 12:23259671241239334. [PMID: 38584991 PMCID: PMC10998486 DOI: 10.1177/23259671241239334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 04/09/2024] Open
Abstract
Background Destabilizing shoulder injuries are common in high school American football players; however, the rate of recurrent glenohumeral instability and return to play after arthroscopic labral stabilization surgery remains unknown. Purpose/Hypothesis The purpose of this study was to determine the rate of recurrent instability on return to competitive high school football after arthroscopic shoulder labral stabilization and capsulorrhaphy procedures. It was hypothesized that the instability rate would be greater in players with more years of eligibility remaining (YER) to play at the high school level. Study Design Case series; Level of evidence, 4. Methods Consecutive male high school football players with at least 1 YER who sustained at least 1 anterior traumatic inseason shoulder instability episode and underwent arthroscopic stabilization between 2012 and 2017 were identified. Patients and/or families were contacted by phone to discuss (1) recurrent instability episodes and (2) return to competitive sport and/or recreational athletic activity. Statistical analysis was conducted using chi-square tests to compare recurrent shoulder instability with return to play and YER. Results A total of 45 football players aged 14 to 17 years were included, with a mean follow-up of 4.1 years. Most patients (60%) chose not to return to competitive football, due mainly to fear of recurrent injury. Overall, the recurrent instability rate was 15.6% (7/45). The instability rate in players who returned to football was 16.7%, with 66.7% requiring revision surgery. The instability rate in patients who did not return to football was 14.8%, with no revision procedures required. In players who returned to football, the instability rate in YER group 4 was significantly higher than that in YER groups 1 to 3 (42% vs 10.5%, respectively, P = .03), with each year of play conferring an additional 10% risk of reinjury. There was a significant difference in the type of recurrent instability in players who returned to any sport versus those who did not (P = .029). Conclusion High school football players who returned to competitive play after arthroscopic shoulder stabilization surgery experienced a higher rate of recurrent instability that was dependent on their YER. Over half of the players chose not to return to football, with fear of reinjury being the most common reason.
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Affiliation(s)
- Jessica R. Stambaugh
- Department of Orthopedic Surgery, Naval Medical Center, San Diego, California, USA
| | - Tracey P. Bryan
- Department of Orthopedic Surgery, Rady Children’s Hospital, San Diego, California, USA
| | - Eric W. Edmonds
- Department of Orthopedic Surgery, Rady Children’s Hospital, San Diego, California, USA
| | - Andrew T. Pennock
- Department of Orthopedic Surgery, Rady Children’s Hospital, San Diego, California, USA
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2
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Chiddarwar V, de Zoete RMJ, Dickson C, Lathlean T. Effectiveness of combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis. Br J Sports Med 2023; 57:1498-1508. [PMID: 37451706 DOI: 10.1136/bjsports-2022-106422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To investigate the effectiveness, risk of recurrence and return to activity (RTA) of surgery combined with exercise-based interventions (EBI) versus EBI alone after traumatic anterior shoulder dislocation (ASD). DESIGN Systematic review and meta-analysis. DATA SOURCES Systematic literature search (MEDLINE, Web of Science, Scopus, Google Scholar). ELIGIBILITY Studies focused on EBI or EBI as a part of postoperative care for adults with an ASD, written in English, and published after 1990. We excluded diagnostic, assessment-based studies on individuals experiencing recurrent shoulder dislocations, concomitant shoulder injury, animal or cadaveric studies. Primary outcomes were dislocation RTA. Secondary outcomes were self-reported outcome measures, strength and range of motion. Random-effects meta-analysis was used to estimate the effect of EBI (SMD; Hedges' g, RR). The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence. RESULTS Sixty studies were included (n=3598); seven were meta-analysed (n=345). The mean age of participants in the included studies was 26.71±9.19 and 56% of those included were male. Of the 60 studies included in the systematic review, 29 were fair quality (48.3%), 15 studies were good quality (25%) and 16 studies were poor quality (26.7%), (k=0.66). Individuals who underwent EBI alone were 2.03 times more likely to experience recurrent instability than individuals who underwent EBI in conjunction with surgery (RR 2.03, 95% CI 1.03 to 3.97). Individuals who underwent EBI with surgery appeared 1.81 times more likely to RTA than those who underwent EBI alone, although results were not statistically significant (RR 1.81, 95% CI 0.96 to 3.43). CONCLUSIONS Surgery combined with EBI is more effective in reducing the risk of recurrence and possibly increasing RTA than EBI alone after traumatic ASD.
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Affiliation(s)
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Timothy Lathlean
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
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3
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Anderson MJ, Confino JE, Mack CD, Herzog MM, Levine WN. Determining the True Incidence of Glenohumeral Instability Among Players in the National Football League: An Epidemiological Study of Non-Missed Time Shoulder Instability Injuries. Orthop J Sports Med 2023; 11:23259671231198025. [PMID: 37840903 PMCID: PMC10568991 DOI: 10.1177/23259671231198025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/24/2023] [Indexed: 10/17/2023] Open
Abstract
Background Shoulder instability encompasses a spectrum of glenohumeral pathology ranging from subluxation to dislocation. While dislocation frequently leads to removal from play, athletes are often able to play through subluxation. Previous research on glenohumeral instability among athletes has largely focused on missed-time injuries, which has likely disproportionately excluded subluxation injuries and underestimated the overall incidence of shoulder instability. Purpose To describe the epidemiology of shoulder instability injuries resulting in no missed time beyond the date of injury (non-missed time injuries) among athletes in the National Football League (NFL). Study Design Descriptive epidemiology study. Methods The NFL's electronic medical record was retrospectively reviewed to identify non-missed time shoulder instability injuries during the 2015 through 2019 seasons. For each injury, player age, player position, shoulder laterality, instability type, instability direction, injury timing, injury setting, and injury mechanism were recorded. For injuries that occurred during games, incidence rates were calculated based on time during the season as well as player position. The influence of player position on instability direction was also investigated. Results Of the 546 shoulder instability injuries documented during the study period, 162 were non-missed time injuries. The majority of non-missed time injuries were subluxations (97.4%), occurred during games (70.7%), and resulted from a contact mechanism (91.2%). The overall incidence rate of game-related instability was 1.6 injuries per 100,000 player-plays and was highest during the postseason (3.5 per 100,000 player-plays). The greatest proportion of non-missed time injuries occurred in defensive secondary players (28.4%) and offensive linemen (19.8%), while kickers/punters and defensive secondary players had the highest game incidence rates (5.5 and 2.1 per 100,000 player-plays, respectively). In terms of direction, 54.3% of instability events were posterior, 31.9% anterior, 8.5% multidirectional, and 5.3% inferior. Instability events were most often anterior among linebackers and wide receivers (50% and 100%, respectively), while posterior instability was most common in defensive linemen (66.7%), defensive secondary players (58.6%), quarterbacks (100.0%), running backs (55.6%), and tight ends (75.0%). Conclusion The majority of non-missed time shoulder instability injuries (97.4%) were subluxations, which were likely excluded from or underreported in previous shoulder instability studies due to the inherent difficulty of detecting and diagnosing shoulder subluxation.
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Affiliation(s)
- Matthew J.J. Anderson
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Jamie E. Confino
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - William N. Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
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4
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Apostolakos JM, Brusalis CM, Uppstrom T, R Thacher R, Kew M, Taylor SA. Management of Common Football-Related Injuries About the Shoulder. HSS J 2023; 19:339-350. [PMID: 37435133 PMCID: PMC10331269 DOI: 10.1177/15563316231172107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 07/13/2023]
Affiliation(s)
- John M Apostolakos
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | | | - Tyler Uppstrom
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Ryan R Thacher
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Michelle Kew
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A Taylor
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
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5
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Amorim E, Maganinho P, Rodrigues-Gomes D, Rodrigues-Gomes S, Sevivas N. Type IX Superior Labrum Anterior and Posterior Lesion in a Professional Football Player: A Rare Pattern of Shoulder Instability in a Non-throwing Athlete. Cureus 2023; 15:e34753. [PMID: 36909022 PMCID: PMC9999051 DOI: 10.7759/cureus.34753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Anterior shoulder instability is the most frequent type of glenohumeral instability, especially among young athletes. Superior labral anterior-posterior (SLAP) injuries involve the superior glenoid labrum where the long head of the biceps tendon (LHBT) inserts. There is still some debate regarding the pathogenesis, clinical presentation, and treatment of these lesions. We report a clinical case of an 18-year-old male professional football player with a rare type IX SLAP lesion. Given the recurrence of instability after prior nonoperative management, surgical treatment was seen as the best option, and a pan-labral arthroscopic repair suture anchor fixation was performed. Three months after undergoing a personalized postoperative rehabilitation program, he was able to return to full sport with the same competitive level, and no recurrent instability or other symptoms were reported throughout the 18-month follow-up period.
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Affiliation(s)
- Edgar Amorim
- Physical Medicine and Rehabilitation, Hospital de Braga, Braga, PRT
| | - Pedro Maganinho
- Radiology, Centro Hospitalar Universitário do Porto, Porto, PRT
| | | | | | - Nuno Sevivas
- Orthopedics and Traumatology, Centro Hospitalar do Médio Ave, Braga, PRT
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6
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Stokes DJ, McCarthy TP, Frank RM. Physical Therapy for the Treatment of Shoulder Instability. Phys Med Rehabil Clin N Am 2023; 34:393-408. [PMID: 37003660 DOI: 10.1016/j.pmr.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Shoulder instability is the separation of the humeral head from the glenoid. Injury to the static and dynamic stabilizers can result in instability. Anterior shoulder instability is the predominant form of instability. It is usually a result of trauma. Posterior shoulder instability often presents with an insidious onset of pain. Multidirectional instability of the shoulder is symptomatic laxity in more than one plane of motion. The primary goal of rehabilitation is to restore pain-free mobility, strength, and functioning. Rehabilitation implements range of motion and strengthening exercises to restore proprioceptive control and scapular kinematics.
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7
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Belk JW, Wharton BR, Houck DA, Bravman JT, Kraeutler MJ, Mayer B, Noonan TJ, Seidl AJ, Frank RM, McCarty EC. Shoulder Stabilization Versus Immobilization for First-Time Anterior Shoulder Dislocation: A Systematic Review and Meta-analysis of Level 1 Randomized Controlled Trials. Am J Sports Med 2022; 51:1634-1643. [PMID: 35148222 DOI: 10.1177/03635465211065403] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multiple studies have compared redislocation rates after stabilization and immobilization for patients experiencing a traumatic, first-time anterior shoulder dislocation (ASD). PURPOSE To systematically review the literature to compare rates of recurrent instability and subsequent instability surgery in patients undergoing treatment for a first-time ASD with surgical stabilization versus shoulder immobilization. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 1. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify level 1 randomized studies that compared outcomes of surgical stabilization versus immobilization for treatment of primary ASD. The following search phrase was used: (glenohumeral OR anterior shoulder) AND (conservative OR nonoperative OR nonsurgical OR physiotherapy) AND (Bankart OR repair OR stabilization OR surgical OR surgery OR arthroscopic OR arthroscopy) AND (instability OR dislocation). Patients with soft tissue disruption alone as well as those with additional minor bony lesions (Hill-Sachs, Bankart) were included. Recurrent instability and subsequent instability surgery rates, the Western Ontario Shoulder Instability Index (WOSI), and range of motion were evaluated. RESULTS A total of 5 studies met inclusion criteria, including 126 patients undergoing surgical stabilization (mean age, 23.6 years; range, 15.0-39.0 years) and 133 patients undergoing treatment with sling immobilization only (mean age, 23.1 years; range, 15.0-31.0 years). Mean follow-up was 59.7 months. Overall, 6.3% of operative patients experienced recurrent instability at latest follow-up compared with 46.6% of nonoperative patients (P < .00001). Similarly, 4.0% of operative patients underwent a subsequent instability surgery compared with 30.8% of nonoperative patients (P < .00001). These same trends were demonstrated when data were isolated to nonoperative patients immobilized in internal rotation. When comparing the operative and nonoperative groups at latest follow-up, 1 study found significantly improved WOSI scores among operative patients (P = .035) and 1 study found significantly improved abducted external rotation in nonoperative patients (P = .02). CONCLUSION Patients, particularly active men in their 20s and 30s, undergoing treatment for a first-time ASD with a surgical stabilization procedure can be expected to experience significantly lower rates of recurrent instability and a significantly decreased need for a future stabilization procedure when compared with patients treated nonoperatively.
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Affiliation(s)
- John W Belk
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Benjamin R Wharton
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Darby A Houck
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Jonathan T Bravman
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Matthew J Kraeutler
- St Joseph's University Medical Center, Department of Orthopaedic Surgery, Paterson, New Jersey, USA
| | - Braden Mayer
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Thomas J Noonan
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Adam J Seidl
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Rachel M Frank
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
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8
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Eberlin CT, Varady NH, Kucharik MP, Naessig SA, Best MJ, Martin SD. Comparison of Perioperative Complications Following Surgical Treatment of Shoulder Instability. JSES Int 2022; 6:355-361. [PMID: 35572454 PMCID: PMC9091785 DOI: 10.1016/j.jseint.2022.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Surgical repair for shoulder instability includes arthroscopic Bankart, open Bankart, and Latarjet-Bristow. Methods This is a cohort study of patients who underwent arthroscopic Bankart, open Bankart, or Latarjet-Bristow procedures that were identified within the National Surgical Quality Improvement Program database (2007-2019). Unadjusted and adjusted analyses were performed (α = 0.05). Outcomes included 30-day adverse events, readmission, and operative time. Results This study included 10,955 patients (9128 arthroscopic Bankart, 1148 open Bankart, and 679 Latarjet-Bristow). Compared with arthroscopic Bankart, Latarjet-Bristow had longer operative times (129.96 [95% CI: 126.49-133.43] vs. 86.35 [85.51-87.19] minutes), along with a higher percentage of serious adverse events (2.5% vs. 0.4%), reoperation (1.9% vs. 0.1%), readmission (1.8% vs. 0.3%), thromboembolic complications (0.4% vs. 0.1%), and sepsis (0.4% vs. 0.0%) (P < .05 for all). Open Bankart had longer operative times (98.17 [95.52-100.82] vs. 86.35 [85.51-87.19] minutes) and a higher percentage of sepsis (0.2% vs. 0.0%) (P < .05 both). Latarjet-Bristow had increased odds of a serious adverse event (odds ratio [OR]: 7.68 [4.19-14.07]), reoperation (OR: 17.32 [7.58-39.56]), readmission (OR: 5.73 [2.84-11.54]), and deep wound complications (OR: 14.98 [3.92-57.23]) (P < .05 for all). In comparing the relative utilization of arthroscopic versus open Bankart, arthroscopic Bankart increased (83.4% to 91.2%) while open Bankart decreased (16.6% to 8.8%) from the 2011-2013 time period to 2017-2019 (Ptrend < .001). Conclusion In addition to a low complication rate, the relative utilization of arthroscopic Bankart increased compared with open Bankart over the past decade. Furthermore, Latarjet-Bristow was associated with a higher incidence of serious adverse events than arthroscopic Bankart.
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Affiliation(s)
- Christopher T. Eberlin
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
- Corresponding author: Christopher T. Eberlin, BS, Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA 02114, USA.
| | - Nathan H. Varady
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Michael P. Kucharik
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Sara A. Naessig
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Matthew J. Best
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Scott D. Martin
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
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9
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Baker HP, Krishnan P, Meghani O, Athiviraham A, Ho S, Owens BD. Protective Sport Bracing for Athletes With Mid-Season Shoulder Instability. Sports Health 2022; 15:105-110. [PMID: 35081842 PMCID: PMC9808839 DOI: 10.1177/19417381211069069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
CONTEXT In-season glenohumeral instability is a common clinical dilemma faced by physicians who care for athletes. Both nonoperative and operative management of athletes with in-season glenohumeral instability have been well described. Functional bracing remains less understood as a treatment modality. This review aims to provide an update on the most recent literature regarding the use of functional bracing for shoulder instability. EVIDENCE ACQUISITION MEDLINE (PubMed and Ovid platforms), Web of Science, Embase, and Cochrane Database of Systemic Reviews were searched for articles available in English through June 1, 2021. The search terms shoulder brace, shoulder instability, athlete, in-season, glenohumeral instability, anterior shoulder instability, posterior shoulder instability, and bracing were used. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS Research on the clinical outcomes of functional bracing remains mixed for patients with shoulder instability. Two studies have demonstrated improved return to play with functional bracing, while 1 study demonstrated no difference in return to play between braced athletes and nonbraced athletes with anterior instability. One previous study demonstrated that prophylactic use of bilateral shoulder stabilizing braces significantly decreased time lost due to injury in athletes with posterior instability. Previous biomechanical studies have demonstrated improved proprioception with brace wear as well as successful limitation of active shoulder range of motion. CONCLUSION Bracing in athletes with shoulder instability remains an important nonoperative treatment modality. While clinical benefits are yet to be validated through high-quality studies, preliminary results suggest a potential benefit to recovery, with minimal downsides. Nevertheless, the use of bracing remains an individual choice but is especially recommended in settings of high-risk sports for shoulder instability, such as football.
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Affiliation(s)
- Hayden P. Baker
- Department of Orthopaedic Surgery, The
University of Chicago, Chicago, Illinois,Hayden Baker, MD,
Department of Orthopaedic Surgery, The University of Chicago, 5758 South
Maryland Avenue, Department 4B, Chicago, IL 60637 (
)
| | - Pranav Krishnan
- Department of Orthopaedic Surgery, The
University of Chicago, Chicago, Illinois
| | - Ozair Meghani
- Brown University Alpert Medical School,
Providence, Rhode Island
| | - Aravind Athiviraham
- Department of Orthopaedic Surgery, The
University of Chicago, Chicago, Illinois
| | - Sherwin Ho
- Department of Orthopaedic Surgery, The
University of Chicago, Chicago, Illinois
| | - Brett D. Owens
- Brown University Alpert Medical School,
Providence, Rhode Island
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10
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Wolf BR, Tranovich MA, Marcussen B, Powell KJ, Fleming JA, Shaffer MA. Team Approach: Treatment of Shoulder Instability in Athletes. JBJS Rev 2021; 9:01874474-202111000-00002. [PMID: 34757979 DOI: 10.2106/jbjs.rvw.21.00087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Shoulder instability is a complex problem with a high rate of recurrence in athletes. Treatment of a first-time subluxation or dislocation event is controversial and depends on patient-specific factors as well as the identified pathology. » Athletic trainers and physical therapists are an integral part of the treatment team of an in-season athlete who has experienced a shoulder instability event. Through comprehensive physiological assessments, these providers can effectively suggest modifications to the patient's training regimen as well as an appropriate rehabilitation program. » Surgical intervention for shoulder stabilization should use an individualized approach for technique and timing. » A team-based approach is necessary to optimize the care of this high-demand, high-risk population.
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Affiliation(s)
- Brian R Wolf
- University of Iowa Sports Medicine, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
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11
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Fink Barnes LA, Jobin CM, Popkin CA, Ahmad CS. Athletes With Anterior Shoulder Instability: A Prospective Study on Player Perceptions of Injury and Treatment. Orthop J Sports Med 2021; 9:23259671211032239. [PMID: 34541015 PMCID: PMC8447104 DOI: 10.1177/23259671211032239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Many in-season athletes choose to delay or avoid surgery in order to continue
playing and avoid downtime such as missed games or seasons. Purpose: To learn about the attitudes toward the injury and treatment of in-season
shoulder instability in competitive athletes who have suffered a shoulder
dislocation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A study-specific questionnaire about athletes’ perceptions of injury and
treatment was administered to injured players. Secondary outcomes included
the American Shoulder and Elbow Surgeons (ASES) score and the Western
Ontario Shoulder Instability Index (WOSI). Mean scores and standard
deviations were calculated, and between-group analyses with
t tests were performed to compare the ASES and WOSI
scores. The Mann-Whitney U test was used for analyses
performed on the following groups: early operative versus nonoperative
management; age <18 versus ≥18 years; first-time dislocators versus
recurrent dislocators; self-reducing subluxations versus dislocations
requiring assistance; and dominant arm affected versus nondominant arm. Results: There were 45 patients included in this study (33 male, 12 female) with a
mean age of 18 ± 2.8 years. Several sports were represented, with the most
common being football, baseball, soccer, and rugby. In this study of
in-season athletes with shoulder instability, 13 (28.9%) chose early
surgery, 4 (8.9%) chose surgery at season’s end, while 28 (62.2%) chose
physical therapy followed by a wait-and-see approach, with 13 (46.4%) of
these patients ultimately requiring surgery. Athletes who chose nonoperative
treatment were statistically more likely to believe that their shoulder
would heal on its own (P < .001) or with physical
therapy (P < .025); they were also more likely to agree
that they would rather stop sports than undergo surgery (P
< .04). Athletes with worse ASES and WOSI scores at injury were more
likely to choose surgery (P < .03 and P
< .05, respectively). Athletes with >1 dislocation were less likely to
believe that the shoulder would heal without surgery (P
< .025). Most athletes agreed that seasonal timing and recruitment
prospects were an important factor in their decision in favor of surgery
(P < .038), and most agreed that their doctor
influenced their ultimate treatment decision (P < .006).
Most athletes also agreed that a repeat dislocation would cause further
injury to the shoulder. Conclusion: Treatment decisions were most strongly related to the athletes’ perceptions
of injury severity and the influence of the treating surgeon.
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Affiliation(s)
- Leslie A Fink Barnes
- Department of Orthopedic Surgery and Sports Medicine, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Charles M Jobin
- Columbia University Center for Shoulder, Elbow and Sports Medicine, New York, New York, USA
| | - Charles A Popkin
- Columbia University Center for Shoulder, Elbow and Sports Medicine, New York, New York, USA
| | - Christopher S Ahmad
- Columbia University Center for Shoulder, Elbow and Sports Medicine, New York, New York, USA
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12
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Abstract
Anterior shoulder instability commonly occurs in young and active individuals, particularly those participating in contact or collision sports. At the intercollegiate level, rates of anterior instability have been reported to be 0.12 events per 1000 athlete exposures. The treatment of in-season athletes with anterior instability presents a challenge for the team physician. The desire to return to play within the same season with nonoperative management must be weighed against the increased risk of recurrence as well as athlete and team specific demands. The purpose of this chapter is to discuss the key considerations for the management of the athlete with anterior shoulder instability that occurs within the competitive season.
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13
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Bixby EC, Ahmad CS. Anterior Shoulder Instability in the Throwing Athlete. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Kraeutler MJ, Belk JW, Carver TJ, McCarty EC, Khodaee M. Traumatic Primary Anterior Glenohumeral Joint Dislocation in Sports: A Systematic Review of Operative versus Nonoperative Management. Curr Sports Med Rep 2020; 19:468-478. [PMID: 33156033 DOI: 10.1249/jsr.0000000000000772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Anterior shoulder (glenohumeral joint [GHJ]) dislocations are relatively common injuries in sports. Previous studies have evaluated clinical outcomes of operative and nonoperative management for primary traumatic anterior GHJ dislocations. The purpose of this study was to systematically review the literature in an effort to provide a thorough analysis of patients after undergoing closed reduction of a traumatic anterior GHJ dislocation, particularly among the athletic population. Two independent reviewers performed a comprehensive search of PubMed and the Cochrane Library through February 23, 2020. Unfortunately, the quantity and quality of published articles on this subject is very limited. In many studies, younger age (between 21 and 30 years) was associated with greater risk for recurrence of GHJ dislocations. Twelve studies (total N = 753) directly compared outcomes of operative versus nonoperative management. It seems that operative management significantly reduces recurrence rates with patients treated operatively among the young and active population. Operative management should be considered as a treatment option for young and athletic patients presenting with a first-time anterior GHJ dislocation.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ
| | | | | | | | - Morteza Khodaee
- Department of Family Medicine and Orthopedics, University of Colorado School of Medicine, Denver, CO
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Lemme NJ, Kuczmarski AS, Goodman AD, Ready LV, Dickens JF, Owens BD. Management and Outcomes of In-Season Anterior Shoulder Instability in Athletes. JBJS Rev 2019; 7:e2. [DOI: 10.2106/jbjs.rvw.19.00010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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16
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Heneghan NR, Webb K, Mahoney T, Rushton A. Thoracic spine mobility, an essential link in upper limb kinetic chains in athletes: A systematic review. TRANSLATIONAL SPORTS MEDICINE 2019. [DOI: 10.1002/tsm2.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Nicola R. Heneghan
- Centre of Precision Rehabilitation for Spinal Pain School of Sport, Exercise & Rehabilitation Sciences University of Birmingham Birmingham UK
| | - Katie Webb
- Physiotherapy Department Northwick Park Hospital Harrow UK
| | - Tom Mahoney
- Physiotherapy Department Sandwell General Hospital West Bromwich UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain School of Sport, Exercise & Rehabilitation Sciences University of Birmingham Birmingham UK
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Early surgical treatment of first-time anterior glenohumeral dislocation in a young, active population is superior to conservative management at long-term follow-up. INTERNATIONAL ORTHOPAEDICS 2019; 43:2799-2805. [DOI: 10.1007/s00264-019-04382-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
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Hasebroock AW, Brinkman J, Foster L, Bowens JP. Management of primary anterior shoulder dislocations: a narrative review. SPORTS MEDICINE - OPEN 2019; 5:31. [PMID: 31297678 PMCID: PMC6624218 DOI: 10.1186/s40798-019-0203-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/24/2019] [Indexed: 01/20/2023]
Abstract
Abstract The recurrence rate following acute anterior shoulder dislocations is high, particularly in young, active individuals. The purpose of this paper is to provide a narrative overview of the best available evidence and results with regards to diagnostic considerations, comorbidities, position of immobilization, surgical versus conservative management, and time to return to play for the management of primary anterior shoulder dislocations. Three independent reviewers performed literature searches using PubMed, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials and systematic reviews meeting inclusion criteria from 1930 to April 2019 were appraised and discussed with the intent to consolidate the best available evidence with regards to lowering recurrence rates. A majority of studies support early surgical intervention for individuals between 21 and 30 years of age following primary shoulder dislocations, as this group is particularly susceptible to recurrence. Conservative treatment plans favor 1–3 weeks of immobilization in internal rotation, followed by rehabilitation. Surgical methods are associated with longer time to return to play, but lower recurrence rates. Return to play time is best determined on an individualized basis, when subjective and objective function of both shoulders is determined to be symmetric. This paper broadly summarizes the best available evidence for the management of primary anterior shoulder dislocations. There remains a need for randomized studies to determine ideal long-term treatment following conservative or surgical management, as general timelines for returning to play following injury remain vague. Level of evidence IV, Narrative Review
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Affiliation(s)
- Andrew W Hasebroock
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68105, USA
| | - Joseph Brinkman
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68105, USA
| | - Lukas Foster
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68105, USA.
| | - Joseph P Bowens
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68105, USA
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Abstract
BACKGROUND Twenty percent of shoulder dislocations occur in people younger than 20 years old. Management of anterior shoulder instability in young patients remains an evolving and controversial topic. Herein we review the natural history of anterior shoulder dislocation in young patients. METHODS The English-language literature was searched for studies examining the natural history of pediatric and adolescent shoulder dislocation. Recurrent dislocation was the primary outcome of interest in most studies. RESULTS Most studies found that recurrent instability was likely in young patients. Several systematic reviews reported the recurrence rate for young patients to be >70%. Recurrent instability was likely to cause greater damage to the joint and may result in more extensive and costly surgery. CONCLUSIONS Most studies agree that recurrent anterior shoulder instability is likely in young patients. Some authors advocate for consideration of early surgery in this high-risk population.
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Patzkowski JC, Dickens JF, Cameron KL, Bokshan SL, Garcia EJ, Owens BD. Pathoanatomy of Shoulder Instability in Collegiate Female Athletes. Am J Sports Med 2019; 47:1909-1914. [PMID: 31150277 DOI: 10.1177/0363546519850810] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder instability has been well described in young men; however, few studies have specifically evaluated the pathoanatomy and unique spectrum of injuries in women with shoulder instability. PURPOSE To describe the pathoanatomy of operative shoulder instability in a collegiate female cohort. STUDY DESIGN Case series; Level of evidence, 4. METHODS The authors performed a retrospective analysis of a consecutive series of female students at a National Collegiate Athletic Association Division I military service academy treated operatively for shoulder instability by a single surgeon between September 2008 and September 2014. Preoperative data collected included patient age, sport, mechanism of injury, number and frequency of dislocations, direction of instability, and co-occurring surgical abnormalities at the time of arthroscopy. Outcome variables included recurrent instability after surgery and need for revision. RESULTS Thirty-six female student athletes with an average age of 20 years (range, 18-22 years) were included. The majority of instability events were traumatic in nature (69%), and 61% of the total events were subluxations. Rugby was the most common sport for experiencing instability (7 patients), followed by obstacle course training (6 patients). Thirty-two patients (89%) reported multiple instability events, averaging 4 per shoulder. The primary direction of instability was anterior in 26, combined anterior and posterior in 7, and 3 met criteria for multidirectional instability. At the time of surgery, 26 patients (72%) had a Bankart tear, 9 (25%) had a posterior labral tear, and 5 (14%) had superior labrum anterior to posterior tears. Nine patients (25%) were found to have humeral avulsion of the glenohumeral ligament (HAGL) lesions, 7 (19%) had partial-thickness articular-sided rotator cuff tears, and only 1 patient (3%) had evidence of true attritional glenoid bone loss. Hill-Sachs lesions were found in 16 patients (44%). Recurrent instability occurred in 9 patients (25%) following arthroscopic stabilization, and revision surgery was performed in 6 (17%). CONCLUSION Shoulder instability in female athletes presents commonly as multiple subluxation events. While soft tissue Bankart lesions were found in numbers equal to those in previous studies include both sexes, bony Bankart lesions were less common in women. Finally, the presence of combined anterior and posterior labral tears and HAGLs in women was more common than previously reported.
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Affiliation(s)
- Jeanne C Patzkowski
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, Iowa, USA
| | | | - Kenneth L Cameron
- Keller Army Hospital, US Military Academy, West Point, New York, USA
| | - Steven L Bokshan
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Brett D Owens
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Trojan JD, DeFroda SF, Mulcahey MK. Patient understanding, expectations, outcomes, and satisfaction regarding surgical management of shoulder instability. PHYSICIAN SPORTSMED 2018; 47:6-9. [PMID: 30424710 DOI: 10.1080/00913847.2019.1546535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Shoulder instability is a common condition encountered by sports medicine and shoulder surgeons. Management can be challenging, both with regards to the underlying pathology and the high expectations associated with the very active patient population that this condition typically affects. High-performance athletes who are used to performing at activity levels which typically challenge the normal physiologic limits of the glenohumeral joint may be particularly difficult to treat. As physicians increasingly evaluate patient reported outcomes (PROs), a growing body of literature has emerged related to patient expectations for a variety of orthopaedic conditions, including shoulder instability. Physicians may face difficulty when using the literature to counsel patients due to the difference between a successful PRO and true patient satisfaction. Having a better understanding of patient expectations may improve preoperative evaluation, patient counseling, postoperative PROs, and patient satisfaction with shoulder instability surgery. The purpose of this paper was to review the literature regarding patient understanding of shoulder instability injuries, expectations following surgical repair of shoulder instability pathology, and satisfaction with operative intervention. Additionally, we sought to determine the effect of patient expectations on outcomes.
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Affiliation(s)
| | - Steven F DeFroda
- b Orthopaedic Surgery , The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Mary K Mulcahey
- c Orthopaedic Surgery , Tulane University School of Medicine , New Orleans , LA , USA
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22
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DeFroda SF, Goyal D, Patel N, Gupta N, Mulcahey MK. Shoulder Instability in the Overhead Athlete. Curr Sports Med Rep 2018; 17:308-314. [DOI: 10.1249/jsr.0000000000000517] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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23
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Akeda M, Mihata T, Jeong WK, McGarry MH, Yamazaki T, Lee TQ. Lower shoulder abduction during throwing motion may cause forceful internal impingement and decreased anterior stability. J Shoulder Elbow Surg 2018; 27:1125-1132. [PMID: 29426741 DOI: 10.1016/j.jse.2017.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/19/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Internal impingement and decreased anterior stability, which result from shoulder capsular loosening, are common shoulder pathologies in throwing athletes. The purpose of this study was to assess the effect of shoulder abduction angle on shoulder internal impingement and anterior shoulder stability during the simulated throwing motion. METHODS Eight cadaveric shoulders were tested by simulating the late-cocking and acceleration phases of the throwing motion for intact and thrower's shoulder conditions. The maximal glenohumeral external rotation, anterior translation, location of the rotator cuff insertion with respect to the glenoid, length and site of internal impingement, and glenohumeral contact pressure were measured. All data were compared between shoulder abduction angles of 80°, 90°, and 100°. RESULTS Decreasing shoulder abduction in the simulated late-cocking phase shifted the humeral head posteriorly (P < .03) and superiorly (P < .001), decreasing the total internal impingement area between the greater tuberosity and glenoid (P = .04) and increasing the glenohumeral contact pressure during internal impingement (P = .02). In the simulated acceleration phase, anterior glenohumeral translation significantly increased as the shoulder abduction angle decreased (P < .001). CONCLUSION Decreasing shoulder abduction significantly increased the contact pressure during internal impingement in the simulated late-cocking phase of the throwing motion. During the simulated acceleration phase of the throwing motion, anterior glenohumeral translation significantly increased as shoulder abduction decreased.
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Affiliation(s)
- Masaki Akeda
- Department of Sports Orthopaedic Center, Yokohama Minami Kyosai Hospital, Yokohama, Japan; Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Woong Kyo Jeong
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopaedic Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Tetsuya Yamazaki
- Department of Sports Orthopaedic Center, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Thay Q Lee
- Department of Sports Orthopaedic Center, Yokohama Minami Kyosai Hospital, Yokohama, Japan; Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopaedic Surgery, University of California, Irvine, CA, USA.
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24
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Abstract
Shoulder dislocation and subsequent instability is a common problem in young athletes. Though it is not uncommon to attempt nonoperative rehabilitation in the early going, reinjury rates are high, particularly with contact sport athletes. As a result, many athletes will undergo a primary repair of one, or multiple, glenohumeral ligaments that make up the anterior shoulder capsule. This paper presents phases of rehabilitation from the preoperative stage up to returning to play. Criteria for phase progression are included, along with examples of common exercises and themes for each phase that allow the physical therapist to consider when working with patients who have had this type of shoulder surgery, allowing them to return to full function with low risk of reinjury.
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Abstract
Glenohumeral instability secondary to glenohumeral bone loss presents a complex problem to the treating surgeon because of the complex biomechanics of the glenohumeral joint and its reliance on numerous dynamic and static stabilizers. The role of glenoid bone loss, specifically inferior-anterior glenoid bone loss, has been well characterized in the setting of recurrent unidirectional instability with greatly improved clinical results when following an algorithmic reconstructive approach to the location and percentage of overall bone loss. Furthermore, as the role of bipolar bone loss in the setting of glenohumeral engagement becomes more apparent, surgeons can more effectively address those lesions contributing to the recurrent instability. As such, surgeons should carefully and critically asses patients with recurrent anterior instability to optimize patient clinical outcomes.
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26
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Abstract
Anterior shoulder dislocations, subluxations, and recurrent instability of the shoulder joint are common problems usually affecting a young active population. However, it can be a problem for patients up to the late decades in life and can lead to major shoulder arthropathy if left untreated or improperly treated. This article discusses the natural history, pathologic morphologic changes of the shoulder joint associated with anterior instability along with normal anatomic variants. We will also discuss current treatment recommendations and possible causes of the patient with recurrent instability despite prior stabilization procedures.
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27
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Pogorzelski J, Fritz EM, Godin JA, Imhoff AB, Millett PJ. Nonoperative treatment of five common shoulder injuries: A critical analysis. ACTA ACUST UNITED AC 2018; 13:89-97. [PMID: 29887915 PMCID: PMC5976697 DOI: 10.1007/s11678-018-0449-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/29/2018] [Indexed: 12/31/2022]
Abstract
Economic pressure highlights the critical need for appropriate diagnosis and treatment of various shoulder pathologies since under-diagnosis and under-treatment can result in increased costs to society in the form of disability and lost production. On the other hand, aggressive over-treatment can further inflate already burgeoning health-care costs and potentially harm the patient. Therefore, it is crucial to distinguish the indications between operative and nonoperative management, especially in common shoulder pathologies such as rotator cuff tears, anterior shoulder instability, biceps tendinitis, lesions to the acromioclavicular joint, and proximal humeral fractures. As a result, a detailed analysis of individual risk factors for potential failures should be performed and treatment should be based on individualized care with consideration given to each patient’s particular injury pattern, functional demands, and long-term goals.
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Affiliation(s)
- Jonas Pogorzelski
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA.,Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Erik M Fritz
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA
| | - Jonathan A Godin
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA.,3The Steadman Clinic, 181 West Meadow Drive suite 400, 81657 Vail, CO USA
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Peter J Millett
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA.,3The Steadman Clinic, 181 West Meadow Drive suite 400, 81657 Vail, CO USA
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28
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Wolfe JA, Christensen DL, Mauntel TC, Owens BD, LeClere LE, Dickens JF. A History of Shoulder Instability in the Military: Where We Have Been and What We Have Learned. Mil Med 2018; 183:e158-e165. [DOI: 10.1093/milmed/usx086] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jared A Wolfe
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Daniel L Christensen
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Timothy C Mauntel
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Brett D Owens
- Department of Orthopaedics, Brown University, Alpert Medical School, 100 Butler Drive, Providence, RI 02906
| | - Lance E LeClere
- United States Naval Academy, Naval Health Clinic Annapolis, 626 MacCubbin Ln, Gambrills, Annapolis, MD 21054
| | - Jonathan F Dickens
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and clinical management of pediatric and adolescent patients following a first-time shoulder dislocation. RECENT FINDINGS Shoulder instability is becoming increasingly common as pediatric and adolescent patients engage in earlier organized sports competition. Recommended treatment following a first-time glenohumeral dislocation event in adolescents depends on several factors, but surgical stabilization is becoming more frequently performed. Surgical indications include bony Bankart lesion, ALPSA lesion, bipolar injury (e.g. Hill-Sachs humeral head depression fracture) or off-season injury in an overhead or throwing athlete. Complications following surgical treatment are rare but most commonly are associated with recurrent instability. Young children (eg. open proximal humerus growth plate), individuals averse to surgery, or in-season athletes who accept the risk of redislocation may complete an accelerated rehabilitation program for expedited return to play in the absence of the structural abnormalities listed above. SUMMARY Following a first-time dislocation event in pediatric and adolescent patients, a detailed discussion of the risks and benefits of nonoperative versus operative management is critical to match the recommended treatment with the patient's injury pattern, risk factors, and activity goals.
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30
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DeFroda S, Bokshan S, Stern E, Sullivan K, Owens BD. Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes. Curr Rev Musculoskelet Med 2017; 10:442-451. [PMID: 28971317 PMCID: PMC5685957 DOI: 10.1007/s12178-017-9435-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Arthroscopic Bankart repair is commonly utilized for shoulder stabilization in patients with anterior shoulder instability with minimum glenoid bone loss. The purpose of this review is to provide the indications, surgical technique, complications, and recent outcomes in arthroscopic Bankart repair for shoulder instability. RECENT FINDINGS Improvements in arthroscopic techniques have led to better patient outcomes, as well as an improved understanding of the pathoanatomy of instability. More recent studies have shown that one of the potential failures of primary arthroscopic repair may be due to unaddressed bone loss. This underscores the importance of evaluating glenoid bone loss and proper patient selection for this procedure to ensure successful outcome. When indicated, arthroscopic stabilization is the treatment of choice for many surgeons due to its lower morbidity and low overall complication rate. Future work must focus on longer-term outcomes in patients undergoing arthroscopic Bankart repair, as well as the clinical outcomes of new fixation techniques, augmentation techniques, and the effect of glenoid bone loss in outcome.
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Affiliation(s)
- Steven DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Steven Bokshan
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, 02903, USA
| | - Evan Stern
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, 02903, USA
| | | | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, 02903, USA
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31
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Conti M, Garofalo R, Castagna A, Massazza G, Ceccarelli E. Dynamic brace is a good option to treat first anterior shoulder dislocation in season. Musculoskelet Surg 2017; 101:169-173. [PMID: 28770511 DOI: 10.1007/s12306-017-0497-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE We evaluate the ability of in-season competitive athletes to return to competition after an anterior shoulder instability treated conservatively with a new dynamic brace combined with a specific rehabilitation program. METHODS Twenty soccer players affected by traumatic anterior shoulder dislocation have been enrolled in the "Footballer In Season Fast Rehab" project during 2 consecutive football seasons. We excluded patients affected by rotator cuff tears and the bony defect over 25%. All the players have been treated the day after the first dislocation with a new dynamic brace used until the end of the second month after the first glenohumeral dislocation combined with a specific rehab protocol. Athletes were evaluated for the time necessary to completely resume sport activities, to complete the season, and for the recurrence of dislocation. RESULTS All the athletes enrolled in this study were able to come back on the ground in approximately 40 days after the dislocation except 2 of them. Only two athletes claimed a slight discomfort at the return to play. One athlete had a traumatic relapse of the instability, 50 days after the dislocation. Another athlete claimed to have had a subluxation during a training session 45 days after the dislocation. 90% of the athletes were able to end the season without any shoulder discomfort. CONCLUSIONS The dynamic brace combined to the rehabilitation protocol represents the solution that allows a quick start of resumption of training while maintaining a stable pain-free shoulder. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- M Conti
- MedSport Human Performance Lab, Como, Italy
| | - R Garofalo
- Ospedale Generale Regionale "F. Miulli" Acquaviva delle Fonti, Bari, Italy
| | - A Castagna
- Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - G Massazza
- Physical Medicine and Rehabilitation, University of Turin, Turin, Italy
| | - E Ceccarelli
- Ospedale Casilino, Via Casilina, 1040, Rome, Italy.
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Elsenbeck MJ, Dickens JF. Return to Sports After Shoulder Stabilization Surgery for Anterior Shoulder Instability. Curr Rev Musculoskelet Med 2017; 10:491-498. [PMID: 29076041 PMCID: PMC5685962 DOI: 10.1007/s12178-017-9440-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Young athletes continue to experience traumatic shoulder instability and are often plagued by recurrent instability, limiting their return to sport. The purpose of this paper was to review return to sport in athletes after shoulder stabilization surgery for anterior shoulder instability. RECENT FINDINGS Athletes managed nonoperatively demonstrate unacceptably high rates of recurrent instability and are less likely to successfully return to sport. Operative management includes capsuloligamentous repair (arthroscopic versus open) and bone augmentation techniques. While modern arthroscopic techniques have provided favorable outcomes, open techniques have demonstrated lower recurrence rates among young collision athletes. A subset of athletes continue to experience recurrent instability, leading to further investigation of concomitant pathologies, which may put patients at risk of failure following Bankart repair. Bony augmentation procedures remain favorable for patients with glenoid bone loss; however, what constitutes critical bone loss in the decision between anterior labral repair versus bone augmentation has recently been questioned. Operative management of anterior shoulder instability provides superior results, including lower recurrent instability and return to sport. Future research on patient-specific risk factors may aid surgical decision-making and optimization of outcomes.
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Affiliation(s)
- Michael J Elsenbeck
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bldg. 19, Fl 2, Bethesda, MD, 20889, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bldg. 19, Fl 2, Bethesda, MD, 20889, USA.
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33
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Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the natural history and best clinical practices for nonoperative management of anterior shoulder instability. RECENT FINDINGS Recent studies continue to demonstrate a role for nonoperative treatment in the successful long-term management of anterior glenohumeral instability. The success of different positions of shoulder immobilization is reviewed as well. There are specific patients who may be best treated with nonoperative means after anterior glenohumeral instability. There are also patients who are not good nonoperative candidates based on a number of factors that are outlined in this review. There continues to be no definitive literature regarding the return to play of in-season athletes. Successful management requires a thorough understanding of the epidemiology, pathoanatomy, history, physical examination, diagnostic imaging modalities, and natural history of operative and nonoperative treatment.
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Dickens JF, Rue JP, Cameron KL, Tokish JM, Peck KY, Allred CD, Svoboda SJ, Sullivan R, Kilcoyne KG, Owens BD. Successful Return to Sport After Arthroscopic Shoulder Stabilization Versus Nonoperative Management in Contact Athletes With Anterior Shoulder Instability: A Prospective Multicenter Study. Am J Sports Med 2017; 45:2540-2546. [PMID: 28657778 DOI: 10.1177/0363546517712505] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The debate continues regarding the optimal treatment of intercollegiate contact athletes with in-season anterior shoulder instability. PURPOSE To examine return to sport and recurrent instability in the season after the index in-season anterior instability event. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Forty-five contact intercollegiate athletes treated nonoperatively or with arthroscopic stabilization were prospectively followed in a multicenter observational study to evaluate return to play (RTP) and recurrent instability in the season after an initial in-season anterior glenohumeral instability event. Baseline data collection included sport played, previous instability events, direction of instability, type of instability (subluxation or dislocation), and treatment method (nonoperative management or arthroscopic stabilization). All nonoperatively treated athletes underwent a standardized accelerated rehabilitation program without shoulder immobilization. Surgical stabilization was performed arthroscopically in all cases, and successful RTP was evaluated during the next competitive season after complete rehabilitation. RESULTS Thirty-nine of 45 intercollegiate contact athletes had remaining National Collegiate Athletic Association eligibility and were followed through the subsequent competitive season after the index instability event. Of the 10 athletes electing nonoperative treatment, 4 (40%) successfully returned to play without recurrence during the subsequent season. Of the 29 athletes treated surgically, 26 (90%) were able to successfully return to play without recurrence the following season (recurrence: n = 1; inadequate function: n = 2). Athletes who underwent surgical reconstruction before the next season were 5.8 times (95% CI, 1.77-18.97; P = .004) more likely to complete the subsequent season without recurrent instability. Of the 29 athletes electing surgical stabilization, there was no difference (risk ratio, 0.95; 95% CI, 0.10-9.24; P > .99) in RTP between the 9 stabilized after a single instability event (90% RTP rate) and the 20 stabilized after multiple in-season recurrent instability events (89% RTP rate). CONCLUSION Collegiate contact and collision athletes with in-season anterior shoulder instability are significantly more likely to successfully return to sport without subsequent instability events the next season if they undergo surgical repair in the off-season.
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Affiliation(s)
- Jonathan F Dickens
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - John-Paul Rue
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Naval Health Clinic Annapolis, United States Naval Academy, Annapolis, Maryland, USA
| | - Kenneth L Cameron
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | - John M Tokish
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA
| | - Karen Y Peck
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | | | - Steven J Svoboda
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | - Robert Sullivan
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,University of Arizona, Tucson, Arizona, USA
| | - Kelly G Kilcoyne
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Brett D Owens
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Knapik DM, Gillespie RJ, Salata MJ, Voos JE. Prevalence and Impact of Glenoid Augmentation in American Football Athletes Participating in the National Football League Scouting Combine. Orthop J Sports Med 2017; 5:2325967117722945. [PMID: 28840148 PMCID: PMC5555500 DOI: 10.1177/2325967117722945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Bony augmentation of the anterior glenoid is used in athletes with recurrent shoulder instability and bone loss; however, the prevalence and impact of repair in elite American football athletes are unknown. Purpose: To evaluate the prevalence and impact of glenoid augmentation in athletes invited to the National Football League (NFL) Scouting Combine from 2012 to 2015. Study Design: Case series; Level of evidence, 4. Methods: A total of 1311 athletes invited to the NFL Combine from 2012 to 2015 were evaluated for history of either Bristow or Latarjet surgery for recurrent anterior shoulder instability. Athlete demographics, surgical history, imaging, and physical examination results were recorded using the NFL Combine database. Prospective participation data with regard to draft status, games played, games started, and status after the athletes’ first season in the NFL were gathered using publicly available databases. Results: Surgical repair was performed on 10 shoulders in 10 athletes (0.76%), with the highest prevalence in defensive backs (30%; n = 3). Deficits in shoulder motion were exhibited in 70% (n = 7) of athletes, while 40% (n = 4) had evidence of mild glenohumeral arthritis and 80% demonstrated imaging findings consistent with a prior instability episode (8 labral tears, 2 Hill-Sachs lesions). Prospectively, 40% (n = 4) of athletes were drafted into the NFL. In the first season after the combine, athletes with a history of glenoid augmentation were not found to be at significant risk for diminished participation with regard to games played or started when compared with athletes with no history of glenoid augmentation or athletes undergoing isolated shoulder soft tissue repair. After the conclusion of the first NFL season, 60% (n = 6 athletes) were on an active NFL roster. Conclusion: Despite being drafted at a lower rate than their peers, there were no significant limitations in NFL participation for athletes with a history of glenoid augmentation when compared with athletes without a history of shoulder surgery or those with isolated soft tissue shoulder repair. Glenohumeral arthritis and advanced imaging findings of labral tearing and Hill-Sachs lesions in elite American football players with a history of glenoid augmentation did not significantly affect NFL participation 1 year after the combine.
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Affiliation(s)
- Derrick M Knapik
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA
| | | | - Michael J Salata
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA
| | - James E Voos
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA
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Dickens JF, Owens BD, Cameron KL, DeBerardino TM, Masini BD, Peck KY, Svoboda SJ. The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football. Am J Sports Med 2017; 45:1769-1775. [PMID: 28474965 DOI: 10.1177/0363546517704184] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is no consensus on the optimal method of stabilization (arthroscopic or open) in collision athletes with anterior shoulder instability. PURPOSE To examine the effect of "subcritical" bone loss and football-specific exposure on the rate of recurrent shoulder instability after arthroscopic stabilization in an intercollegiate American football population. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Fifty intercollegiate football players underwent primary arthroscopic stabilization for anterior shoulder instability and returned to football for at least a single season. Preoperatively, 32 patients experienced recurrent subluxations, and 18 patients experienced a single or recurrent dislocation. Shoulders with glenoid bone loss >20%, an engaging Hill-Sachs lesion, an off-track lesion, and concomitant rotator cuff repair were excluded from the study. The primary outcome of interest was the ability to return to football without subsequent instability. Patients were followed for time to a subsequent instability event after return to play using days of exposure to football and total follow-up time after arthroscopic stabilization. RESULTS Fifty consecutive patients returned to American football for a mean 1.5 seasons (range, 1-3) after arthroscopic stabilization. Three of 50 (6%; 95% CI, 1.3%-16.5%) patients experienced recurrent instability. There were no subsequent instability events after a mean 3.2 years of military service. All shoulders with glenoid bone loss >13.5% (n = 3) that underwent arthroscopic stabilization experienced recurrent instability upon returning to sport, while none of the shoulders with <13.5% glenoid bone loss (n = 47) sustained a recurrent instability event during football ( X2 = 15.80, P < .001). Shoulders with >13.5% glenoid bone loss had an incidence rate of 5.31 cases of recurrent instability per 1000 athlete-exposures of football. In 72,000 athlete-exposures to football with <13.5% glenoid bone loss, there was no recurrent instability. Significantly more anchors were used during the primary arthroscopic stabilization procedure in patients who experienced multiple preoperative instability events ( P = .005), and lesions spanned significantly more extensive portions along the circumference of the glenoid ( P = .001) compared with shoulders having a single preoperative instability event before surgical stabilization. CONCLUSION Arthroscopic stabilization of anterior shoulder instability in American football players with <13.5% glenoid bone loss provides reliable outcomes and low recurrence rates.
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Affiliation(s)
- Jonathan F Dickens
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Brett D Owens
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Kenneth L Cameron
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | | | - Brendan D Masini
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Evans Army Community Hospital, Fort Carson, Colorado, USA
| | - Karen Y Peck
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | - Steven J Svoboda
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
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Streufert B, Reed SD, Orlando LA, Taylor DC, Huber JC, Mather RC. Understanding Preferences for Treatment After Hypothetical First-Time Anterior Shoulder Dislocation: Surveying an Online Panel Utilizing a Novel Shared Decision-Making Tool. Orthop J Sports Med 2017; 5:2325967117695788. [PMID: 28377932 PMCID: PMC5363455 DOI: 10.1177/2325967117695788] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Although surgical management of a first-time anterior shoulder dislocation (FTASD) can reduce the risk of recurrent dislocation, other treatment characteristics, costs, and outcomes are important to patients considering treatment options. While patient preferences, such as those elicited by conjoint analysis, have been shown to be important in medical decision-making, the magnitudes or effects of patient preferences in treating an FTASD are unknown. Purpose: To test a novel shared decision-making tool after sustained FTASD. Specifically measured were the following: (1) importance of aspects of operative versus nonoperative treatment, (2) respondents’ agreement with results generated by the tool, (3) willingness to share these results with physicians, and (4) association of results with choice of treatment after FTASD. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A tool was designed and tested using members of Amazon Mechanical Turk, an online panel. The tool included an adaptive conjoint analysis exercise, a method to understand individuals’ perceived importance of the following attributes of treatment: (1) chance of recurrent dislocation, (2) cost, (3) short-term limits on shoulder motion, (4) limits on participation in high-risk activities, and (5) duration of physical therapy. Respondents then chose between operative and nonoperative treatment for hypothetical shoulder dislocation. Results: Overall, 374 of 501 (75%) respondents met the inclusion criteria, of which most were young, active males; one-third reported prior dislocation. From the conjoint analysis, the importance of recurrent dislocation and cost of treatment were the most important attributes. A substantial majority agreed with the tool’s ability to generate representative preferences and indicated that they would share these preferences with their physician. Importance of recurrence proved significantly predictive of respondents’ treatment choices, independent of sex or age; however, activity level was important to previous dislocators. A total of 125 (55%) males and 33 (23%) females chose surgery after FTASD, as did 37% of previous dislocators compared with 45% of nondislocators. Conclusion: When given thorough information about the risks and benefits, respondents had strong preferences for operative treatment after an FTASD. Respondents agreed with the survey results and wanted to share the information with providers. Recurrence was the most important attribute and played a role in decisions about treatment.
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Affiliation(s)
- Ben Streufert
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Lori A Orlando
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, North Carolina, USA.; Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Dean C Taylor
- Duke Sports Science Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Joel C Huber
- The Fuqua School of Business, Duke University, Durham, North Carolina, USA
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Baker HP, Tjong VK, Dunne KF, Lindley TR, Terry MA. Evaluation of Shoulder-Stabilizing Braces: Can We Prevent Shoulder Labrum Injury in Collegiate Offensive Linemen? Orthop J Sports Med 2016; 4:2325967116673356. [PMID: 27975072 PMCID: PMC5140042 DOI: 10.1177/2325967116673356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Shoulder injuries remain one of the most common injuries among collegiate football athletes. Offensive linemen in particular are prone to posterior labral pathology. Purpose: To evaluate the efficacy of shoulder bracing in collegiate offensive linemen with respect to injury prevention, severity, and lost playing time. Study Design: Cohort study; Level of evidence, 3. Methods: Offensive linemen at a single collegiate institution wore bilateral shoulder-stabilizing braces for every contact practice and game beginning in the spring of 2013. Between spring of 2007 and fall of 2012, offensive linemen did not wear any shoulder braces. Player injury data were collected for all contact practices and games throughout these time periods to highlight differences with brace use. Results: Forty-five offensive linemen (90 shoulders) participated in spring and fall college football seasons between 2007 and 2015. There were 145 complete offensive linemen seasons over the course of the study. Offensive linemen not wearing shoulder braces completed 87 seasons; offensive linemen wearing shoulder braces completed 58 seasons. Posterior labral tear injury rates were calculated for players who wore the shoulder braces (0.71 per 1000 athlete-exposures) compared with shoulders of players who did not wear the braces (1.90 per 1000 athlete-exposures). The risk ratio was 0.46 (95% CI, 0.16-1.30; P = .14). Mean time (contact practices and games) missed due to injury was significant, favoring less time missed by players who used braces (8.7 vs 36.60 contact practices and games missed due to injury; P = .0019). No significant difference in shoulder labral tears requiring surgery was found for brace use compared with no brace use. Conclusion: Shoulder-stabilizing braces were shown not to prevent posterior labral tears among collegiate offensive lineman, although they were associated with less time lost to injury. The results of this study have clinical significance, indicating that wearing a shoulder brace provides a protective factor for offensive linemen.
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Affiliation(s)
- Hayden P Baker
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin F Dunne
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tory R Lindley
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael A Terry
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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39
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Donohue MA, Brelin AM, LeClere LE. Management of First-Time Shoulder Dislocation in the Contact Athlete. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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40
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Poland SG, Gitelis ME, Thorsness RJ, Cole BJ. Decision-Making, Bracing, and Other Adjuncts for Management of In-Season Contact Athletes With Shoulder Instability. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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41
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Donohue MA, Owens BD, Dickens JF. Return to Play Following Anterior Shoulder Dislocation and Stabilization Surgery. Clin Sports Med 2016; 35:545-61. [DOI: 10.1016/j.csm.2016.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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42
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Watson S, Allen B, Grant JA. A Clinical Review of Return-to-Play Considerations After Anterior Shoulder Dislocation. Sports Health 2016; 8:336-41. [PMID: 27255423 PMCID: PMC4922522 DOI: 10.1177/1941738116651956] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Context: Shoulder dislocations are common in contact sports, yet guidelines regarding the best treatment strategy and time to return to play have not been clearly defined. Evidence Acquisition: Electronic databases, including PubMed, MEDLINE, and Embase, were reviewed for the years 1980 through 2015. Study Design: Clinical review. Level of Evidence: Level 4. Results: Much has been published about return to play after anterior shoulder dislocation, but almost all is derived from expert opinion and clinical experience rather than from well-designed studies. Recommendations vary and differ depending on age, sex, type of sport, position of the athlete, time in the sport’s season, and associated pathology. Despite a lack of consensus and specific recommendations, there is agreement that before being allowed to return to sport, athletes should be pain free and demonstrate symmetric shoulder and bilateral scapular strength, with functional range of motion that allows sport-specific participation. Return to play usually occurs 2 to 3 weeks from the time of injury. Athletes with in-season shoulder instability returning to sport have demonstrated recurrence rates ranging from 37% to 90%. Increased bone loss, recurrent instability, and injury occurring near the end of season are all indications that may push surgeons and athletes toward earlier surgical intervention. Conclusion: Most athletes are able to return to play within 2 to 3 weeks but there is a high risk of recurrent instability.
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Affiliation(s)
- Scott Watson
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Benjamin Allen
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - John A Grant
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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Mihata T, McGarry MH, Neo M, Ohue M, Lee TQ. Effect of Anterior Capsular Laxity on Horizontal Abduction and Forceful Internal Impingement in a Cadaveric Model of the Throwing Shoulder. Am J Sports Med 2015; 43:1758-63. [PMID: 25939611 DOI: 10.1177/0363546515582025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Excessive anterior capsular laxity (elongation of the anterior capsular ligaments) causes shoulder subluxation during acceleration of the throwing motion, leading to a disabled throwing shoulder. Few biomechanical studies have investigated the relationship between anterior capsular laxity and internal impingement, another cause of the disabled throwing shoulder. PURPOSE/HYPOTHESIS The purpose of this study was to assess the effect of anterior capsular laxity on forceful internal impingement during the late cocking phase. The hypothesis was that excessive anterior shoulder laxity caused by elongation of the anterior capsular ligaments will increase the horizontal abduction angle to increase glenohumeral contact pressure. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen cadaveric shoulders were tested with the shoulder abducted to 90° and at maximal external rotation to simulate the late cocking phase of the throwing motion. The angle of external rotation, anterior translation, angle of horizontal abduction, locations of the articular insertion of the rotator cuff tendons (supraspinatus and infraspinatus) on the greater tuberosity relative to the glenoid, and the glenohumeral contact pressure and area during internal impingement were measured. All data were compared between intact and elongated anterior capsule, which was created by repeatedly applying external rotational stretching. RESULTS Elongation of the anterior capsular ligaments was confirmed by the increase in glenohumeral external rotation and anterior translation after our stretching technique. Location data showed that the posterior half of supraspinatus tendon, the entire infraspinatus tendon, and the posterosuperior labrum were impinged between the greater tuberosity and glenoid. Maximal glenohumeral horizontal abduction (2.2% increase; P = .003) and glenohumeral contact pressure (27.3% increase; P = .04) were significantly increased in the shoulder joint with increased anterior capsular laxity as compared with the intact condition. CONCLUSION Increased anterior capsular laxity created by applying repetitive excessive external rotational torque significantly increased horizontal abduction and contact pressure in the glenohumeral joint. Concurrently, the supraspinatus and infraspinatus tendons and posterosuperior labrum were impinged between the greater tuberosity and glenoid. CLINICAL RELEVANCE Increased anterior capsular laxity may exacerbate forceful internal impingement during the late cocking phase of the throwing motion.
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Affiliation(s)
- Teruhisa Mihata
- Orthopaedic Biomechanics Laboratory, Long Beach VA Healthcare System and University of California-Irvine, Irvine, California, USA Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan Katsuragi Hospital, Kishiwada, Japan Daiichi Towakai Hospital, Takatsuki, Japan
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Long Beach VA Healthcare System and University of California-Irvine, Irvine, California, USA
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Long Beach VA Healthcare System and University of California-Irvine, Irvine, California, USA
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Fabricant PD, Taylor SA, McCarthy MM, Gausden EB, Moran CJ, Kang RW, Cordasco FA. Open and Arthroscopic Anterior Shoulder Stabilization. JBJS Rev 2015; 3:01874474-201502000-00004. [PMID: 27490744 DOI: 10.2106/jbjs.rvw.n.00060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Peter D Fabricant
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Samuel A Taylor
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Moira M McCarthy
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | | | - Cathal J Moran
- Sports Surgery Clinic, Suite 17, Santry, Dublin 9, Ireland
| | - Richard W Kang
- The University of Chicago, 5841 S. Maryland Avenue, MC 3079, Chicago, IL 60637
| | - Frank A Cordasco
- Hospital for Special Surgery, Belaire Building, 525 East 71st Street, New York, NY 10021
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45
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Joshi MA, Young AA, Balestro JC, Walch G. The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes. Orthop Clin North Am 2015; 46:105-11. [PMID: 25435039 DOI: 10.1016/j.ocl.2014.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recurrent anterior shoulder instability is common in contact athletes and the high-energy injuries seen in this group make them more prone to bone loss. Athletes with recurrent instability and associated bone loss have high failure rates when treated with a soft tissue reconstruction procedure. Therefore it is preferred to manage recurrent instability in contact athletes with the Latarjet-Patte procedure. In this article, the authors describe their technique. They have found this procedure to be safe and effective, with very low recurrence and early return to sport. A meticulous surgical technique is important to avoid intraoperative and postoperative complications.
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Affiliation(s)
- Mithun A Joshi
- Sydney Shoulder Specialists, Suite 201, 156 Pacific Highway, St Leonards, Sydney, New South Wales 2065, Australia
| | - Allan A Young
- Sydney Shoulder Specialists, Suite 201, 156 Pacific Highway, St Leonards, Sydney, New South Wales 2065, Australia.
| | - Jean-Christian Balestro
- Sydney Shoulder Specialists, Suite 201, 156 Pacific Highway, St Leonards, Sydney, New South Wales 2065, Australia
| | - Gilles Walch
- Centre Orthopédique Santy, 24 Avenue Paul Santy, Lyon 69008, France
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Dickens JF, Owens BD, Cameron KL, Kilcoyne K, Allred CD, Svoboda SJ, Sullivan R, Tokish JM, Peck KY, Rue JP. Return to play and recurrent instability after in-season anterior shoulder instability: a prospective multicenter study. Am J Sports Med 2014; 42:2842-50. [PMID: 25378207 DOI: 10.1177/0363546514553181] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is no consensus on the optimal treatment of in-season athletes with anterior shoulder instability, and limited data are available to guide return to play. PURPOSE To examine the likelihood of return to sport and the recurrence of instability after an in-season anterior shoulder instability event based on the type of instability (subluxation vs dislocation). Additionally, injury factors and patient-reported outcome scores administered at the time of injury were evaluated to assess the predictability of eventual successful return to sport and time to return to sport during the competitive season. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS Over 2 academic years, 45 contact intercollegiate athletes were prospectively enrolled in a multicenter observational study to assess return to play after in-season anterior glenohumeral instability. Baseline data collection included shoulder injury characteristics and shoulder-specific patient-reported outcome scores at the time of injury. All athletes underwent an accelerated rehabilitation program without shoulder immobilization and were followed during their competitive season to assess the success of return to play and recurrent instability. RESULTS Thirty-three of 45 (73%) athletes returned to sport for either all or part of the season after a median 5 days lost from competition (interquartile range, 13). Twelve athletes (27%) successfully completed the season without recurrence. Twenty-one athletes (64%) returned to in-season play and had subsequent recurrent instability including 11 recurrent dislocations and 10 recurrent subluxations. Of the 33 athletes returning to in-season sport after an instability event, 67% (22/33) completed the season. Athletes with a subluxation were 5.3 times more likely (odds ratio [OR], 5.32; 95% CI, 1.00-28.07; P = .049) to return to sport during the same season when compared with those with dislocations. Logistic regression analysis suggests that the Western Ontario Shoulder Instability Index (OR, 1.05; 95% CI, 1.00-1.09; P = .037) and Simple Shoulder Test (OR, 1.03; 95% CI, 1.00-1.05; P = .044) administered after the initial instability event are predictive of the ability to return to play. Time loss from sport after a shoulder instability event was most strongly and inversely correlated with the Simple Shoulder Test (P = .007) at the time of initial injury. CONCLUSION In the largest prospective study evaluating shoulder instability in in-season contact athletes, 27% of athletes returned to play and completed the season without subsequent instability. While the majority of athletes who return to sport complete the season, recurrent instability events are common regardless of whether the initial injury was a subluxation or dislocation.
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Affiliation(s)
- Jonathan F Dickens
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Brett D Owens
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Kenneth L Cameron
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Kelly Kilcoyne
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - C Dain Allred
- United States Air Force Academy, Colorado Springs, Colorado, USA
| | - Steven J Svoboda
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Robert Sullivan
- United States Air Force Academy, Colorado Springs, Colorado, USA
| | - John M Tokish
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Karen Y Peck
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - John-Paul Rue
- Naval Heath Clinic Annapolis, United States Naval Academy, Annapolis, Maryland, USA
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[Shoulder dislocation in athletes]. Chirurg 2014; 85:864-71. [PMID: 25113089 DOI: 10.1007/s00104-014-2769-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Shoulder dislocation is a common injury in athletes. Surgical and non-surgical therapy options are still the subject of controversial debate. STUDY AIM This article presents important considerations for decision-making and current concepts for the therapy of shoulder dislocation in athletes. METHODS A selective literature search was carried out in PubMed. RESULTS Surgical and non-surgical therapy options are described in the literature without yet defining a gold standard. CONCLUSION Early surgical stabilization is currently recommended in young athletes. For decision-making numerous sport and patient-related factors need to be considered. Most athletes are able to return to the pre-injury level after surgical stabilization.
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Joshi MA, Young AA, Balestro JC, Walch G. The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes. Clin Sports Med 2014; 32:731-9. [PMID: 24079431 DOI: 10.1016/j.csm.2013.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The Latarjet-Patte procedure satisfies all of the requirements for treating recurrent anterior instability in contact athletes and is therefore their preferred management in this patient group.
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Affiliation(s)
- Mithun A Joshi
- Sydney Shoulder Specialists, Suite 201, 156 Pacific Highway, St Leonards, Sydney, New South Wales 2065, Australia
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Abstract
The glenohumeral joint is the most frequently dislocated major joint, and most cases involve an anterior dislocation. Young male athletes competing in contact sports are at especially high risk of recurrent instability. Surgical timing and selection of surgical technique continue to be debated. Full characterization of the injury requires an accurate history and physical examination. Diagnostic imaging assists in identifying the underlying anatomic lesions, which range from no discernible lesion to significant bone loss of the glenoid or humeral head and/or capsulolabral stretching or avulsion from the glenoid or humerus. Historically, open Bankart repair has been considered to be the standard method of managing capsulolabral injuries, but comparable results have been achieved with arthroscopic techniques. In the setting of anterior glenoid bone loss >20% of the articular surface, iliac crest bone grafting or coracoid transfer via the Bristow or Latarjet procedures has demonstrated satisfactory outcomes. Favorable results have been reported with bone grafting or remplissage for engaging Hill-Sachs lesions and those that affect >30% of the humeral circumference.
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Vavken P, Sadoghi P, Quidde J, Lucas R, Delaney R, Mueller AM, Rosso C, Valderrabano V. Immobilization in internal or external rotation does not change recurrence rates after traumatic anterior shoulder dislocation. J Shoulder Elbow Surg 2014; 23:13-9. [PMID: 24090981 DOI: 10.1016/j.jse.2013.07.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 07/05/2013] [Accepted: 07/16/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of this study was to systematically review and quantitatively synthesize the data on recurrence rates after shoulder immobilization in internal versus external rotation in first-time, traumatic shoulder dislocations. MATERIALS AND METHODS We performed a systematic search of the keywords "(((external rotation) OR internal rotation) AND immobilization) AND shoulder" in the online databases PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library. Random-effects models were used to calculate the cumulatively pooled risk ratios (RRs) of recurrent shoulder dislocations. All analyses were also stratified by age. RESULTS We included 5 studies with a total of 471 patients (230 internal rotation and 241 external rotation) published between 2001 and 2011 in English. The pooled random-effects RR for recurrence of shoulder dislocations at all ages was 0.74 (95% confidence interval [CI], 0.44-1.27; P = .278). The RR was 0.70 (95% CI, 0.38 to 1.29; P = .250) for patients aged 30 years or younger and 0.78 (95% CI, 0.32 to 1.88; P = .579) for those aged older than 30 years. CONCLUSION The current best evidence does not support a relative effectiveness of immobilization in external rotation compared with internal rotation to avoid recurrent shoulder dislocations in patients with traumatic anterior shoulder dislocations.
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Affiliation(s)
- Patrick Vavken
- Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland; Division of Sports Medicine & Department of Orthopedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA; Center for Population and Development Studies, Harvard School of Public Health, Boston, MA, USA
| | - Patrick Sadoghi
- Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria.
| | - Julia Quidde
- Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Robert Lucas
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Ruth Delaney
- Harvard Combined Residency Program, Massachusetts General Hospital, Boston, MA, USA
| | - Andreas M Mueller
- Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland; Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Claudio Rosso
- Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland; Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Victor Valderrabano
- Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland
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