BackgroundRecurrent instability following a first-time anterior traumatic shoulder dislocation may exceed 26%. We systematically reviewed risk factors which predispose this population to events of recurrence.MethodsA systematic review of studies published before 1 July 2014. Risk factors which predispose recurrence following a first-time traumatic anterior shoulder dislocation were documented and rates of recurrence were compared. Pooled ORs were analysed using random-effects meta-analysis.ResultsTen studies comprising 1324 participants met the criteria for inclusion. Recurrent instability following a first-time traumatic anterior shoulder dislocation was 39%. Increased risk of recurrent instability was reported in people aged 40 years and under (OR=13.46), in men (OR=3.18) and in people with hyperlaxity (OR=2.68). Decreased risk of recurrent instability was reported in people with a greater tuberosity fracture (OR=0.13). The rate of recurrent instability decreased as time from the initial dislocation increased. Other factors such as a bony Bankart lesion, nerve palsy and occupation influenced rates of recurrent instability.ConclusionsSex, age at initial dislocation, time from initial dislocation, hyperlaxity and greater tuberosity fractures were key risk factors in at least two good quality cohort studies resulting in strong evidence as concluded in the GRADE criteria. Although bony Bankart lesions, Hill Sachs lesions, occupation, physiotherapy treatment and nerve palsy were risk factors for recurrent instability, the evidence was weak using the GRADE criteria—these findings relied on poorer quality studies or were inconsistent among studies.

ObjectiveTo develop a multivariate tool that would predict recurrent instability after a first-time traumatic anterior shoulder dislocation.MethodsParticipants (aged 16–40 years) were recruited across New Zealand into a prospective cohort study. Baseline data were collected during a telephone interview and through examination of radiology records. Variables associated with recurrent instability were selected for the multivariate logistic regression model using backwards selection (p<0.10). Coefficients for those variables retained in the model were used to develop the predictive tool.ResultsAmong the 128 participants, 36% had redislocated at least once in the first 12 months. Univariate analysis showed an increased likelihood of recurrent dislocation with bony Bankart lesions (OR=3.65, 95% CI 1.05 to 12.70, p=0.04) and participants who had: not been immobilised in a sling (OR = 0.38, 95% CI 0.15 to 0.98, p=0.05), higher levels of shoulder activity (OR=1.13, 95% CI 1.01 to 1.27, p=0.03), higher levels of pain and disability (OR=1.03, 95% CI 1.01 to 1.06, p=0.02), higher levels of fear of reinjury (OR=1.12, 95% CI 1.01 to 1.26, p=0.04) and decreased quality of life (OR=1.01, 95% CI 1.00 to 1.02, p=0.05). There was no significant difference in those with non-dominant compared with dominant shoulder dislocations (p=0.10) or in those aged 16–25 years compared with 26–40 years (p=0.07).ConclusionSix of seven physical and psychosocial factors can be used to predict recurrent shoulder instability following a first-time traumatic anterior shoulder dislocation.

Background Skeletal maturity and age-related changes in the composition of the glenoid labrum and joint capsule may influence rates of recurrent instability in children. We systematically review risk factors which predispose children to recurrent shoulder instability. Methods The systematic review-concerned studies published before May 2015. Statistical analysis was undertaken to compare rates of recurrence for each extracted risk factor. Pooled ORs were analysed using random effects meta-analysis. Results 6 retrospective cohort studies met the inclusion criteria. 8 risk factors were identified across the studies including age, sex, shoulder dominance and injury side, mechanism of injury, state of physis closure, and HillSachs and Bankart lesions. The rate of recurrent instability was 73%. Children aged 14-18 years were 24 times more likely to experience recurrent instability than children aged 13 years and less (93% vs 40%; OR=24.14, 95% CI (3.71 to 156.99), Z=3.33, p=0.001, I 2 =6.83%). There was a non-significant trend indicating males were 3.4 times more likely to experience recurrent instability (OR=3.44, 95% CI (0.98 to 12.06), Z=1.93, p=0.053, I 2

ABSTRACT:We compared the effects of a non-weight bearing protocol (NWB) and a weight bearing (WB) protocol on energy stored, stiffness, and shock absorption in the plantar flexor muscle-tendon unit of patients managed non-operatively following an Achilles tendon rupture. Thirty-eight subjects were randomized to a WB cast fitted with a Bohler iron or a traditional non-weight-bearing cast. At a 6-month follow-up, a biomechanical assessment utilizing an isokinetic dynamometer allowed measurement of peak passive torque, energy stored, shock absorption, and stiffness. The WB group had greater peak passive torque ($20%). Irrespective of group, peak passive torque in unaffected legs was greater ($26%) than affected legs. Across the groups, energy stored in the NWB group was 74% of the WB group. The energy stored in affected legs was 80% of that in unaffected legs. Shock absorption was not significantly different across legs or groups. Irrespective of group, affected legs had significantly less stiffness (20-40%). While the augmentation of plaster with a Bohler iron to allow increased weight bearing had positive effects, deficits in affected compared to unaffected legs irrespective of group were notable, and should be addressed prior to participation in vigorous physical activities. ß

Background: Rates of return to play after shoulder dislocation vary between 48% and 96%, and there has been scant attention given to the psychosocial factors that influence return to play after a shoulder injury. Purpose: To establish the factor structure of the Shoulder Return to Sport after Injury (SI-RSI) scale and examine how the SI-RSI is associated with the Western Ontario Shoulder Instability Index (WOSI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: The SI-RSI is designed to measure psychological readiness to return to play after shoulder dislocation and was administered to participants who had at least 1 episode of shoulder dislocation and were planning or had returned to sports. The WOSI was also completed by the participants, and descriptive data were gathered. Reliability (Cronbach α) and factor analysis of the SI-RSI were undertaken. Correlations between the SI-RSI and WOSI were made, and differences between various patient subgroups (first-time dislocations vs multiple episodes of instability, surgery vs no surgery, return to sports vs no return) were analyzed. Results: The SI-RSI had high internal consistency (Cronbach α = 0.84) and was shown to have 4 distinct factors that represented the following constructs: performance confidence, reinjury fear and risk, emotions, and rehabilitation and surgery. Moderate correlations were seen between SI-RSI and WOSI scores. Participants who had undergone surgery scored significantly lower on the reinjury fear and risk subscale of the SI-RSI ( P = .04). Those who had sustained multiple dislocations were significantly more concerned about having to undergo rehabilitation and surgery again ( P = .007). Participants who had returned to sports had significantly greater fear and thought they were more at risk of reinjury ( P = .02). Conclusion: Athletes return to sports after a shoulder dislocation despite reporting high levels of fear and concern for their shoulder. High levels of fear and concern may underpin why rates of recurrent shoulder instability are so high. Four distinct elements of psychological readiness appeared to be present in this patient group.

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Background Limited evidence exists which details changes in quality of life, shoulder activity level, kinesiophobia, shoulder pain and disability following a first-time traumatic anterior shoulder dislocation (FTASD) in people treated non-operatively. This study had three objectives: (1) to examine quality of life, pain, disability and kinesiophobia after an FTASD within 12 weeks, (2) to examine whether these variables were different in people with and without recurrent shoulder instability and (3) to assess how these variables changed over 12 months. Methods A prospective cohort study was undertaken in people with an FTASD aged between 16 and 40 years. Measures of quality of life, kinesiophobia, shoulder activity, shoulder pain and disability were recorded within 12 weeks of an FTASD and at 3, 6, 9 and 12 months. Results An FTASD negatively impacted quality of life, shoulder pain and function and these variables improved over time. People with recurrent shoulder instability had poorer quality of life 12 months after an FTASD. Across the entire cohort, kinesiophobia did not significantly change across time in people following an FTASD. Conclusions Quality of life was significantly affected by an FTASD in people with recurrent shoulder instability. Across the entire cohort of people with an FTASD, kinesiophobia remained elevated in people following an FTASD. Level of evidence Level 1 prognostic study.

Rehabilitation following surgical rotator cuff repair may enable return to pre-injury function. Optimal recovery is facilitated by the use of post-operative protocols that enhance communication between the surgeon and physiotherapist. The purpose of this study was to describe the rotator cuff repair rehabilitation protocols currently used in New Zealand. Orthopaedic surgeons practising in New Zealand were contacted to determine their current rehabilitation protocols. Length of immobilisation and exercise progression following surgical repair were analysed across weekly timeframes from the day of surgery until nine months post-operatively. The response rate was 55% with protocols received from 31 surgeons. Post-surgical rotator cuff protocols currently in use in New Zealand are predominantly determined by weekly time periods which vary from surgeon to surgeon. Immobilisation was most commonly recommended for four to six weeks, pendular exercises were started the week of surgery, active exercises commenced at six weeks, followed by resisted exercises at twelve weeks. Few protocols based the rehabilitation upon tissue quality and size of rotator cuff tear. Level of detail regarding sets and repetitions of exercises also differed between protocols. Variability across protocols was evident regarding the recommended activity level and time period from surgery. Consideration of tissue quality, size of the tear and strength of the repair is recommended to facilitate optimal results.