Predictors for Surgery in Shoulder Instability

Abstract

Background:Shoulder instability is a common cause of pain and dysfunction in young, active patients. While studies have analyzed risk factors for recurrent instability and failure after instability surgery, few have examined which variables are associated with initial surgery in this patient population.Purpose:To identify variables that may be associated with surgical intervention in patients with shoulder instability in the context of the FEDS (frequency, etiology, direction, severity) classification, a system that may be useful in the surgical treatment of shoulder instability patients.Study Design:Cohort study (prognosis); Level of evidence, 2.Methods:A database of patients treated for shoulder instability from 3 separate institutions from 2005 to 2010 was generated using International Classification of Diseases–9th Revision data. Data were collected via retrospective review. Injury data were categorized according to the FEDS system. Data were analyzed for significance, with the primary outcome of surgical intervention. Summary statistics were used to assess which variables were associated with eventual surgery. To test the unadjusted bivariate associations between shoulder surgery and each data point, Pearson chi-square tests were used for categorical variables and Wilcoxon tests were used for continuous variables.Results:Over the study time period, 377 patients were treated for shoulder instability. Patients who had surgery were more likely younger, had recurrent instability, and had their initial injury while playing a sport. Most patients had anterior instability; however, there was a greater proportion of posterior instability patients in the operative group. Severity of dislocation, measured by whether the patient required help to relocate the shoulder, was not significantly associated with eventual surgery. While imaging was not available for all patients, surgical patients were more likely to have magnetic resonance imaging findings of anterior labral injury and less likely to have a supraspinatus or subscapularis tear.Conclusion:Patients who underwent surgery for shoulder instability were younger, more likely to have experienced recurrent instability, and more likely to have sustained their original injury while playing sports. The FEDS classification, particularly the frequency and etiology of the patient’s shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment.

Translation and validation of a Hebrew version of the Western Ontario Shoulder Instability index

“…In patients with SI, the ability to participate in sports-related activities is often inhibited, resulting in decreased quality of life [4]. Due to high recurrence rates and unsatisfactory outcomes after non-operative rehabilitation [6, 7], more than 60% of patients choose surgical treatment [8].…”

The Relationship Between Fear Avoidance Beliefs, Muscle Strength, and Short-Term Disability After Surgical Repair of Shoulder Instability

“…Anterior shoulder instability (SI), which often develops following primary shoulder dislocation, is a common cause for reduced performance that impairs quality of life of young, active individuals. 1 Incidence rate of shoulder dislocation have been reported to be as high as 2.8% in a 9-month follow-up of 4141 healthy military cadets, 2 with 80.3% diagnosed for anterior shoulder dislocation. Recurrent shoulder dislocation, or SI, may develop in more than 55% of patients who sustained anterior shoulder dislocation.…”

“…3,5,6 Retrospective data of patients with SI from 3 separate institutions in the United States indicated that over 60% underwent surgical treatment. 1 Surgical treatment is more common in younger patients who have experienced several dislocations, or those who were injured during sports activity. 1 Several surgical options are available for SI.…”

“…1 Surgical treatment is more common in younger patients who have experienced several dislocations, or those who were injured during sports activity. 1 Several surgical options are available for SI. A commonly utilized procedure is arthroscopic anterior capsulolabral repair, in which the detached labrum is sutured back to the glenoid, a procedure known as Bankart repair.…”

Structural white matter and functional connectivity alterations in patients with shoulder apprehension

“…Anterior glenohumeral instability has been recognized as a common ailment for individuals of all demographics 1 . Its prevalence is approximately 1.7% of the population 2 .…”