The role of structured physiotherapy in treating patients with atraumatic shoulder instability: Medium term results from a case series

Abstract

Background Consensus favours conservative treatment for atraumatic shoulder instability, but literature is scarce on the topic. We therefore prospectively assessed the results of structured physiotherapy for these patients. Methods Patient reported outcomes were recorded prior to physiotherapy and on discharge. Notes review identified patients re-referred for the same condition. Results N = 85. Review range was 12–72 months post-treatment. Median Oxford Shoulder Instability Score (OSIS) improved from 21 (range: 2–47) to 39 (11–47). Median Western Ontario Shoulder Instability Index (WOSI) improved from 1117 (range: 306–2028) to 485 (0–1569). Patients with posterior instability demonstrated better results compared with other groups (OSIS change, p = 0.025; WOSI change, p = 0.060). Quicker referral to physiotherapy gave improved outcomes (OSIS change, p = 0.004, rs = −0.4; WOSI change, p = 0.047, rs = 0.24). Twenty-one patients (24.7%) were re-referred, seven of them for repeat physiotherapy and 14 of them for surgery. Previous surgery significantly affected the possibility of a further referral ( p < 0.001), and initial diagnosis was significantly correlated with further surgery ( p = 0.032). Discussion Early referral to physiotherapy may produce better results. Patients with posterior instability responded better to physiotherapy. Previous surgery increased the risk of re-referral. Re-referred patients with posterior instability tended to be managed with further physiotherapy.

A systematic review to compare physiotherapy treatment programmes for atraumatic shoulder instability

“…The number of participants receiving physiotherapy was approximately 491 ranging from 15 [27] to 85 [16]; one study reported the number of shoulders rather than participants [28]. The mean age of participants was similar between studies, ranging from 16 [29] to 25 years [28].…”

“…One provided an age and gender-adjusted Constant score [28]. The other adjusted for several confounding factors [16].…”

“…Several systematic reviews have evaluated the outcomes of physiotherapy management for ASI [7,13,14]. However, none have compared treatments in detail, and four additional studies have been released since the most recent review [15,16,17,18]. Given the relative infancy in this research area, an up-to-date review of the content of current treatment programmes will help to inform future clinical practice and research.…”

Management of atraumatic shoulder instability in physiotherapy (MASIP): a survey of physiotherapy practice

“…In the wider research available on shoulder pain, there is emerging evidence in support of tailoring education to the patient, with activity and general exercise promotion, for example, recommended in patients who have a sedentary lifestyle [54]. Education is advocated in managing ASI following a recent case series involving 85 patients [55] and also features in the BESS guidelines [17]. Given the high utilisation of education, there is justification for further research to investigate this aspect of management and inform future practice.…”

Evaluating the clinical decision making of physiotherapists in the assessment and management of paediatric shoulder instability

“…Poor prognoses for patients may plausibly be due to delayed and/or inaccurate diagnoses, and inappropriate treatment selection (15). There are many models available for the diagnosis (3,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) and management (15,16,(29)(30)(31)(32)(33) of shoulder instability, but clinical practice is not routinely drawing on these models. Existing models and guidelines recognise that the underpinning evidence base used to inform clinical decision making is limited and heavily informed by expert opinion (24,32,34).…”