Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation

Abstract

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.

Management of primary anterior shoulder dislocations: a narrative review

“…Another study of 154 anterior shoulder dislocations found a similar trend, with a 68% recurrence rate in patients under 20 years old, 54% in patients under 30, and only 12% in patients over 30 [66]. A more recent study focused only on those who re-dislocated within 1 year of the initial event and found a recurrence rate of 46% in 128 participants [67].…”

“…A primary study evaluating recurrent dislocations in cases of glenoid bone loss found recurrence rates similar to the rest of the literature, with a 27% rate in patients over 30 and a 72% rate in patients under 23 years old [13]. In addition, more recent studies, including a systematic review and meta-analysis, found that younger patient age, male sex, glenohumeral joint hyperlaxity, higher activity levels, increased pain, and higher levels of reinjury fear also increase the risk of dislocation recurrence [13, 67]. A separate investigation observed recurrent dislocations in view of anatomical factors and found that increases in the humeral containing angle and glenoid height-to-width ratio were significant risk factors [71].…”

“…The commonality of recurrent anterior shoulder dislocations can be attributed to the shoulder anatomy deformities present following initial dislocation. Such injury-caused deformities include abnormal laxity of the joint capsule and surrounding muscles, deformities of the head of the humerus, and contracture of the muscles surrounding the glenohumeral joint [13, 67, 68]. Of note, greater tuberosity fractures have been shown to decreased the risk of recurrent instability in patients who obtained the injury in first-time traumatic anterior shoulder dislocations [68].…”

Outcome Measures After Shoulder Stabilization in the Athletic Population: A Systematic Review of Clinical and Patient-Reported Metrics

“…98 Ardern et al 9 showed that preoperative psychological responses were associated with the likelihood of successful return to preinjury level at 12 months after ACLR. Olds et al 78 demonstrated that psychosocial factors and fear of reinjury are associated with risk of recurrent shoulder instability after a first-time traumatic shoulder dislocation. However, no study included in our review specifically evaluated an athlete's psychological responses to the initial injury, to surgery, and to the recovery journey.…”

“…69,87 Psychosocial factors also appear important in the RTS decision-making process. 8,36,71,78 The biopsychosocial model for RTS decision making advocates a multidisciplinary approach, with regular assessments of functional tests, health, well-being, and motivation and frequent review of goals in the athletic population. 7 However, RTS criteria after shoulder stabilization remain elusive.…”