Sage Journals: Discover world-class research

Abstract

Background

Consensus favours conservative treatment for atraumatic shoulder instability, but literature is scarce on the topic. We therefore prospectively assessed the results of structured physiotherapy for these patients.

Methods

Patient reported outcomes were recorded prior to physiotherapy and on discharge. Notes review identified patients re-referred for the same condition.

Results

N = 85. Review range was 12–72 months post-treatment. Median Oxford Shoulder Instability Score (OSIS) improved from 21 (range: 2–47) to 39 (11–47). Median Western Ontario Shoulder Instability Index (WOSI) improved from 1117 (range: 306–2028) to 485 (0–1569). Patients with posterior instability demonstrated better results compared with other groups (OSIS change, p = 0.025; WOSI change, p = 0.060). Quicker referral to physiotherapy gave improved outcomes (OSIS change, p = 0.004, r_s = −0.4; WOSI change, p = 0.047, r_s = 0.24). Twenty-one patients (24.7%) were re-referred, seven of them for repeat physiotherapy and 14 of them for surgery. Previous surgery significantly affected the possibility of a further referral (p < 0.001), and initial diagnosis was significantly correlated with further surgery (p = 0.032).

Discussion

Early referral to physiotherapy may produce better results. Patients with posterior instability responded better to physiotherapy. Previous surgery increased the risk of re-referral. Re-referred patients with posterior instability tended to be managed with further physiotherapy.

Keywords

shoulder instability atraumatic instability physiotherapy rehabilitation anterior posterior multidirectional Oxford Shoulder Instability Score Western Ontario Shoulder Instability Index

Get full access to this article

View all access options for this article.

References

Kibler

. The role of the scapula in athletic shoulder function. Am J Sports Med 1998; 26: 325–337.

Wilk

Arrigo

Andrews

. Current concepts: the stabilizing structures of the glenohumeral joint. J Orthop Sports Phys Ther 1997; 25: 364–379.

Gaskill

Taylor

Millett

. Management of multidirectional instability of the shoulder. J Am Acad Orthop Surg 2011; 19: 758–767.

Gibson

Growse

Korda

, et al. The effectiveness of rehabilitation for nonoperative management of shoulder instability: a systematic review. J Hand Ther 2004; 17: 229–242.

Matsen

3rd Zuckerman

. Anterior glenohumeral instability. Clin Sports Med 1983; 2: 319–338.

Rowe

. Acute and recurrent anterior dislocations of the shoulder. Orthop Clin North Am 1980; 11: 253–270.

O'Driscoll SW. Atraumatic instability: pathology and pathogenesis. In: Matsen FAFF and Hawkins RJ (eds). The shoulder: a balance of mobility and stability. Rosemont, IL: AAOS, 1993, pp.305–316.

Werner

Lichtenberg

Schmitz

, et al. Arthroscopic findings in atraumatic shoulder instability. Arthroscopy 2004; 20: 268–272.

Gartsman

Brinker

Khan

, et al. Self-assessment of general health status in patients with five common shoulder conditions. J Shoulder Elbow Surg 1998; 7: 228–237.

10.

Jaggi

Alexander

Herbert

, et al. Does surgery followed by physiotherapy improve short and long term outcome for patients with atraumatic shoulder instability compared with physiotherapy alone? – protocol for a randomized controlled clinical trial. BMC Musculoskelet Disord 2014; 15: 439–439.

11.

Kiss

Damrel

Mackie

, et al. Non-operative treatment of multidirectional shoulder instability. Int Orthop 2001; 24: 354–357.

12.

Wilk

Macrina

Reinold

. Non-operative rehabilitation for traumatic and atraumatic glenohumeral instability. N Am J Sports Phys Ther 2006; 1: 16–31.

13.

Burkhead

Jr Rockwood

Jr . Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am 1992; 74: 890–896.

14.

Baker

3rd Mascarenhas

Kline

, et al. Arthroscopic treatment of multidirectional shoulder instability in athletes: a retrospective analysis of 2- to 5-year clinical outcomes. Am J Sports Med 2009; 37: 1712–1720.

15.

Engelsma

Willems

. Arthroscopic stabilization of posterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 2010; 18: 1762–1766.

16.

Takwale

Calvert

Rattue

. Involuntary positional instability of the shoulder in adolescents and young adults. Is there any benefit from treatment? J Bone Joint Surg Br 2000; 82: 719–723.

17.

Bateman

Smith

Osborne

, et al. Physiotherapy treatment for atraumatic recurrent shoulder instability: early results of a specific exercise protocol using pathology-specific outcome measures. Shoulder Elbow 2015; 7: 282–288.

18.

Kirkley

Griffin

McLintock

, et al. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med 1998; 26: 764–772.

19.

Dawson

Fitzpatrick

Carr

. The assessment of shoulder instability. The development and validation of a questionnaire. J Bone Joint Surg Br 1999; 81: 420–426.

20.

Neer

2nd Foster

. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg Am 1980; 62: 897–908.

21.

Dawson J, Fitzpatrick R and Carr A. The assessment of shoulder instability. The development and validation of a questionnaire. J Bone Joint Surg Br 1999; 81: 420–426.

22.

Kirkley

Griffin

McLintock

23.

Gabbett

. The training – injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med 2016; 50: 273–280.

24.

Faul

Erdfelder

Buchner

, et al. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009; 41: 1149–1160.

25.

Davis

. A conservative treatment for habitual dislocations of the shoulder. J Am Med Assn 1936, pp. 1012–1015.

26.

Kuroda

Sumiyoshi

Moriishi

, et al. The natural course of atraumatic shoulder instability. J Shoulder Elbow Surg 2001; 10: 100–104.

27.

Watson

Balster

Lenssen

, et al. The effects of a conservative rehabilitation program for multidirectional instability of the shoulder. J Shoulder Elbow Surg 2017; 27: 104–111.

28.

Warby

Ford

Hahne

, et al. Comparison of 2 Exercise Rehabilitation Programs for multidirectional instability of the glenohumeral joint: a randomized controlled trial. Am J Sports Med 2018; 46: 87–97.

29.

Dvir

Berme

. The shoulder complex in elevation of the arm: a mechanism approach. J Biomech 1978; 11: 219–225.

30.

Rowe

Pierce

Clark

. Voluntary dislocation of the shoulder. A preliminary report on a clinical, electromyographic, and psychiatric study of twenty-six patients. J Bone Joint Surg Am 1973; 55: 445–460.

31.

Huber

Gerber

. Voluntary subluxation of the shoulder in children. A long-term follow-up study of 36 shoulders. J Bone Joint Surg Br 1994; 76: 118–122.

The role of structured physiotherapy in treating patients with atraumatic shoulder instability: Medium term results from a case series