Traumatic anterior shoulder instability in the athlete

Abstract

Anterior glenohumeral dislocation is common among athletes and may progress to recurrent instability. The pathoanatomy of instability and specific needs of each individual should be considered to prevent unnecessary absence from sport. Traditionally, primary dislocations have been managed with immobilization followed by rehabilitation exercises and a return to sporting activity. However, arthroscopic stabilization and external rotation bracing are increasingly used to prevent recurrent instability. In addition to the typical capsulolabral disruptions seen following a primary dislocation, patients with recurrent instability often have coexistent osseous injury to the humeral head and glenoid. In patients without significant bone loss, open soft‐tissue stabilizations have long been considered the ‘gold standard treatment’ for recurrent instability, but with advances in technology, arthroscopic procedures have gained popularity. However, enthusiasm for arthroscopic repair has not been supported with evidence, and there is currently no consensus for treatment. In patients with greater bone loss, soft‐tissue stabilization alone is insufficient to treat recurrent instability and open repair or bone augmentation should be considered. We explore the recent advances in epidemiology, classification, pathoanatomy and clinical assessment of young athletes with anterior shoulder instability, and compare the relative merits and outcomes of the different forms of treatment.

The experience of patients with ABI and their families during the hospital stay: A systematic review of qualitative literature

“…For instance, a mixed-methods systematic literature review on support needs of family members of patients with ABI showed that families reported multiple support needs, including informational, emotional, and practical support [56]. Examples of their needs included wanting: 1) quality information about the patient’s symptoms [12,57]; brain injury care [58,59] and prognosis [60]; 2) their emotions to be taken into account by healthcare providers [61]; and 3) to participate in the patient’s care [62] and decision making [63]. …”

Epidemiology, identification, treatment and return to play of musculoskeletal-based ice hockey injuries

“…For players without a history of dislocation, it is possible for return to play once their overall shoulder strength and motion return to normal. Joint rehabilitation may be achieved through the strengthening of the shoulder and periscapular muscles, but surgery is often required in recurrent dislocators to repair the torn labrum, ligaments and joint capsule 12 17 18. Traumatic anterior instability may be successfully rehabilitated after surgical intervention with a return to sport averaging 4–6 months 17.…”

“…Joint rehabilitation may be achieved through the strengthening of the shoulder and periscapular muscles, but surgery is often required in recurrent dislocators to repair the torn labrum, ligaments and joint capsule 12 17 18. Traumatic anterior instability may be successfully rehabilitated after surgical intervention with a return to sport averaging 4–6 months 17. Bracing, such as the SAWA brace and Duke-Wyre brace, may help prevent a repeated dislocation for first time dislocators during the season and if discomfort and instability continues, athletes should consider surgery postseason 12 13 19 20…”

Traumatic Anterior Shoulder Instability: Part I. General Concepts and Proper Management

“…Overall, these studies report a sevenfold reduction in the risk of recurrent instability after arthroscopic stabilization, when compared with nonoperative treatment for the fi rst-time dislocator [ 59 ]. A Cochrane review concluded that early surgical intervention is warranted in young adults aged less than 30 years engaged in highly demanding physical activities [ 68 ].…”

“…After reducing the dislocation, plain radiographs are obtained to verify the adequacy of the reduction. Results concerning conservative treatment are still debatable [ 59 ]. A stable shoulder is obtained at 10 years in only half of the patients with conservative treatment [ 60 ].…”