Background: Advances in arthroscopic surgery have resulted in biomechanically stronger repairs that might allow for accelerated rehabilitation protocols and hence faster return to play. Evidence for such regimes in the shoulder, particularly in elite athletes, is lacking. Methods: This prospective single surgeon (PB) series included 34 professional footballers undergoing an accelerated rehabilitation programme following arthroscopic soft tissue stabilization subsequent to traumatic anterior shoulder dislocation. Data were collected on time to regain elevation range, external rotation range, return to play and rate of recurrence. Results: Mean follow-up time was 4.8 years (range 2 years to 10 years). Full range of forward elevation was regained at a mean of 5 weeks (range 3 weeks to 7 weeks) and external rotation range (in neutral) at a mean of 6 weeks (range 4 weeks to 8 weeks). Mean return to play time was 11 weeks (range 9 weeks to 14 weeks). Three players (9%) reported a recurrent episode of dislocation at a mean of 19 months. Conclusions: An accelerated rehabilitation programme resulted in a return to play time of 11 weeks compared to previously reported times of between 5 months and 9 months in the contact sports population. A recurrence rate of 9% compares favourably to other published studies following similar surgery (5.1% to 28.6%) but which employed more conservative postoperative rehabilitation regimes.

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The pathophysiology of Stanmore Classification Polar type II/III shoulder instability is not well understood. Functional Magnetic Resonance Imaging was used to measure brain activity in response to forward flexion and abduction in 16 patients with Polar Type II/III shoulder instability and 16 age-matched controls. When a cluster level correction was applied patients showed significantly greater brain activity than controls in primary motor cortex (BA4), supramarginal gyrus (BA40), inferior frontal gyrus (BA44), precentral gyrus (BA6) and middle frontal gyrus (BA6): the latter region is considered premotor cortex. Using voxel level correction within these five regions a unique activation was found in the primary motor cortex (BA4) at MNI coordinates -38 -26 56. Activation was greater in controls compared to patients in the parahippocampal gyrus (BA27) and perirhinal cortex (BA36). These findings show, for the first time, neural differences in patients with complex shoulder instability, and suggest that patients are in some sense working harder or differently to maintain shoulder stability, with brain activity similar to early stage motor sequence learning. It will help to understand the condition, design better therapies and improve treatment of this group; avoiding the common clinical misconception that their recurrent shoulder dislocations are a form of attention-seeking.

Background: Disorders associated with the rotator cuff are regarded as the most common shoulder pain presentation. The range of diagnostic terms used to explain this problem reflect uncertainty in relation to causative mechanisms, diagnosis, prognosis, and the most effective treatments. The aim of this consensus exercise was to facilitate a shared understanding as a means of reducing mixed messages, informing clinical practice and providing a foundation for future research. Methods: Ten physiotherapists with clinical and academic expertise in shoulder pain participated in an online and face-to-face consensus exercise. Results: This consensus exercise suggests specific factors in the history and physical examination that might raise the index of suspicion of Rotator Cuff Related Shoulder Pain. The suggestions for non-surgical management include a minimal number of exercises prescribed to challenge the functional deficit of the patient over a minimum 12-week period. Apart from aiding exclusion of red flag pathology, imaging is not regarded as useful unless the patient does not respond as expected. Steroid injections wouldn't be considered a first-line intervention unless pain was severe and preventing engagement with exercise. Conclusion: This consensus exercise provides a benchmark for clinical reflection while highlighting areas of uncertainty that still exist and require further research.