Instability Severity Index Score Does Not Predict the Risk of Shoulder Dislocation after a First Episode Treated Conservatively (original) (raw)
Related papers
BMC Musculoskeletal Disorders
Background: Patients with non-operated traumatic primary anterior shoulder dislocation (PASD) are assumed to have less shoulder impairment than patients with recurrent anterior shoulder dislocations (RASD). This may impact treatment decision strategy. The aim was to study whether patients with non-operated traumatic PASD have less shoulder impairment than those with RASD. Methods: In a cross-sectional study baseline data from patients with PASD and RASD in a randomised controlled trial of non-operative shoulder exercise treatment were used. Shoulder function was self-reported (Western Ontario Shoulder Instability (WOSI), Tampa Scale of Kinesiophobia (TSK), General Health (EQ-5D-VAS), Numeric Pain Rating Scale (NPRS)), and measured (Constant-Murley shoulder Score (CMS total), CMS-Range of Motion (CMS-ROM, CMS strength, proprioception, clinical tests). Results: In total, 56 patients (34 (28 men) with PASD and 22 (21 men) with RASD) (mean age 26 years) participated. WOSI total was 1064 and 1048, and TSK above 37 (indicating high re-injury fear) was present in 33 (97%) and 21 (96%) of the groups with PASD and RASD, with no group difference. CMS total (66.4 and 70.4), CMS-ROM (28.7 and 31.5), CMS-strength (injured shoulder: 7.6 kg and 9.1 kg), proprioception and clinical tests were the same. Furthermore, 26 (76%) with PASD and 13 (59%) with RASD reported not to have received non-operative shoulder treatment. Conclusions: Non-operated patients with PASD and self-reported shoulder trouble three-six weeks after initial injury do not have less shoulder impairment (self-reportedly or objectively measured) than non-operated patients RASD and self-reported shoulder trouble three-six weeks after their latest shoulder dislocation event.
2015
Traumatic anterior shoulder dislocation has high rate of recurrence when treated non operatively especially in young active patients. An evidence-based approach is therefore necessary to determine the best treatment regime for a patient presenting initially with traumatic anterior shoulder dislocation. The purpose of this study was to determine the frequency of recurrent shoulder dislocation after primary traumatic anterior dislocation treated non operatively. The study design was prospective observational cohort and was conducted in level I Orthopaedic and Traumatology Unit “A” Medical Teaching Institution (MTI) Lady Reading Hospital (LRH) Peshawar, Khyber Pakhtunkhwa, Pakistan from May 2011 to May 2015.A total of eighteen patients(14 male and 4 females) mean age 32 years with first episode traumatic anterior shoulder dislocation fulfilling the inclusion criteria were treated with close reduction under general anaesthesia and sling immobilization followed by supervised physical the...
Conservative treatment of traumatic shoulder instability: a case series study
MUSCULOSKELETAL SURGERY, 2015
The aim of this case series study was to evaluate the efficacy of a rehabilitative approach to restoring stability, range of motion, and function of shoulder joint in non-operated adults presenting a first episode of traumatic anterior shoulder dislocation. Methods In this case series study, we evaluated patients aged from 20 to 44 years, with diagnosis of first episode of traumatic anterior shoulder dislocation. All participants underwent a conservative treatment protocol, lasting 3 months. The primary outcome measure was the Rowe score for instability. Follow-up evaluations were done at 3, 6, 12, and 24 months. Results We evaluated 32 participants mean aged 27.94 ± 2.23 years. At the baseline (T 0), the participants had a mean Rowe score of instability of 44.53 ± 7.00 SD, where 81.25 % had a poor score and 18.75 % had a fair score. At 24 months (T 4), the Rowe score for instability was 79.84 ± 6.66 SD. 21.88 % of patients had a fair score, 71.87 % had a good score, and 6.25 % had an excellent score. Conclusions We showed that our rehabilitative approach seems to be effective in the conservative management of shoulder instability in adults with first episode of traumatic anterior shoulder dislocation, not involved in sport activity, and not overhead workers.
Annals of Joint
Traumatic anterior shoulder dislocations are a common problem. There is a high rate of recurrent instability, especially in patients <30 years of age that are involved in high level sports. The purpose of this review is to discuss the natural history after a first-time shoulder dislocation and provide a brief overview of management options. Initial nonoperative management consists of immobilization in internal rotation for 1-3 weeks. The current evidence does not support immobilization in external rotation or for longer periods of time. For those patients who are at a high risk of recurrent instability, the evidence suggests that early surgical repair to address the pathology can be undertaken. This has shown to be clinically and fiscally effective while improving patient outcomes.
Dicle Tıp Dergisi, 2021
Objective: The aim of this study is to compare demographic and clinical characteristics of cases with primary and recurrent shoulder dislocations. Methods: Cases who presented to a tertiary center Emergency Medicine Clinic with shoulder dislocation between January 2013 and December 2016 were evaluated.The cases were divided into two groups as primary (Group 1) and recurrent (Group 2) dislocations.Characteristics such as age, gender, seasonal period, dislocation side, causes of trauma, accompanying additional injuries and treatment modalities were compared between the groups. Results: 119 cases were included in the study. 64.7% (n=77) of the cases were classified as Group 1, and 35.3% (n=42) as Group 2. There was no difference between Group 1 and Group 2 in terms of age, gender and dislocation side (P values: 0.484, 0.570, 0.251, respectively). Inferior dislocations were more common in Group 1 (n=7/77) compared to Group 2 (n=1/42), and a statistically significant difference was found (p=0.009). Group 2 cases (n=19/42) were found to be more common in the spring than group 1 (n=17/77) (p=0.012). Additional injuries were detected in 8.4% of the cases (n=10/119), 8 of them were in group 1 and 2 of them were in group 2, and there was no statistically significant difference between the groups in terms of additional injury (p=0.491). 11.8% (n=14) of the cases were hospitalized by orthopedics for surgery (open reduction) or closed reduction under general anesthesia. Surgical treatment (open reduction) was applied in 23.8% (n=10/42) in Group 2, and 5.2% (n=4/77) in Group 1, and a statistically significant difference was found between the groups (p= 0.005). Conclusion: It was found that surgical treatment was preferred more frequently on recurrent dislocations compared to primary dislocations. Therefore, we recommend that cases with a history of primary dislocation should take precautions for trauma during active periods of social life.
Arthroscopically Determined Degree of Injury After Shoulder Dislocation Relates to Recurrence Rate
Clinical Orthopaedics and Related Research®, 2012
Background The glenohumeral joint is the most mobile articulation in the body and the most commonly dislocated diarthrodial joint with peaks in the incidence of dislocation occurring during the second and sixth decades. Age at the time of the initial dislocation is inversely related to the recurrence rate. Traumatic anterior instability is often associated with intraarticular injuries. The frequency of injuries may increase with dislocation or subluxation episodes. Questions/purposes We compared the frequency of lesions associated with traumatic anterior instability in patients with primary and recurrent instability. Methods We retrospectively reviewed 96 selected patients with traumatic anterior instability treated arthroscopically between 2005 and 2008. Forty-five had arthroscopy after a first episode of dislocation (Group I) and 51 had two or more episodes of instability (Group II). We compared the frequencies and percentage of intraarticular lesions in both groups. Results We observed a Bankart lesion in all patients of both groups. The posterior Bankart lesion was observed more frequently in Group II than in Group I: 47% versus 28%. SLAP lesions were observed in 12% in Group I and 24% in Group II. In 10 patients in Group II, there was an associated rotator cuff tear. Conclusions Patients with recurrent shoulder dislocation had a higher arthroscopic degree of injury. These patients presented more posterior labral lesions, SLAP tears, and rotator cuff pathology than patients with a first episode of shoulder dislocation.
Journal of Shoulder and Elbow Surgery, 2014
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 ¼ .278). The RR was 0.70 (95% CI, 0.38 to 1.29; P ¼ .250) for patients aged 30 years or younger and 0.78 (95% CI, 0.32 to 1.88; P ¼ .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.
Age-Dependent Prognosis Following Conservative Treatment of Traumatic Anterior Shoulder Dislocation
European Journal of Trauma and Emergency Surgery, 2001
First traumatic anterior shoulder dislocation still remains a topic of controvery regarding the factors which have an impact on the functional result and the development of chronic instability. In the presented study, criteria influencing the recurrence rate and the final outcome after conservative treatment are assessed. Material and Methods: Between January 1989 and March 1997, 175 patients were treated conservatively. In 91 patients, a clinical and radiologic follow-up was obtained using a retrospective study design. In all patients, adequate trauma was found. Two groups were formed according to the patients' age (PY30: patients aged 30 years and younger, n = 45; PO30: patients older than 30 years, n = 46). For clinical assessment, the Rowe score was used. Bilateral shoulder ultrasaound and X-rays of the involved shoulder were obtained for radiologic evaluation. Results: The recurrence rate was 89% in the PY30 group and 26% in the PO30 group (p < 0.05). A relationship between the immobilization period and the recurrence rate could not be found (p = 0.8). According to the Rowe score, excellent or good results were achieved in 19 patients of PY30 (42%) and in 29 patients of PO30 group (63%). However, main criteria significantly influencing the recurrence rate are the patients' age and activity level. Additionally, the presence of a Hill-Sachs lesion, glenohumeral subluxation or rotator cuff tears is important to the development of chronic instability. Conclusion: The results of the presented study indicate the high risk of chronic instability in young and active patients following primary conservative treatment.