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


Ann Cools, New in / Friday, January 10th, 2020

The incidence of a traumatic shoulder dislocation is 23/100 000 persons/year with a recurrence rate from 26% up to 92%. Incidence of a first time traumatic anterior shoulder dislocation (FTASD) is higher in contact sports, and recurrence rate depends upon risk factors that may be modifiable (such as activity level) or non-modifiable (such as age or gender).

Margie Olds (PT, PhD) from Auckland, New Zealand (@margie_olds) followed 128 patients after a FTASD for 12 months. Recurrence rate on average was 36%, with the highest number of re-dislocations in the younger patients (see figure 1). The authors found physical as well as psychological risk factors for recurrent dislocation. The combination of a bony Bankart lesion + young age + dominant side + NOT being immobilized + kinesiophobia and self-reported pain and disability seems to increase significantly the recurrence rate after a FTASD. Although some previously described risk factors were confirmed in this study, some new findings are of interest.

Figure 1: recurrence rate after FTASD (Olds et al. 2019)

Apparently, immobilization decreases the rate of re-injury. In the study, immobilization periods varied between 1 and 70 days, but the number of days was not associated with recurrent shoulder instability.

One of the most striking findings is the association between patient reported questionnaires for physical, psychosocial, emotional and cognitive factors and the recurrence rate. This illustrates the multifactorial nature of recurrent shoulder instability and the influence of patient beliefs, level of activity, kinesiophobia and self-reported pain and function as predictors of recurrent instability.

Some caution is needed, since the study was performed in New Zealand, where rugby and rugby league are popular sports. 75% of the injuries occurred during sport, of which half of them were collision sports. In this group, nearly 3 out of 4 players reported a dislocation during contact. It might be difficult to translate these data directly to other populations.

In summary, this paper offers us the opportunity to use physical and psychological screening tools in the shared decision making with the patients regarding their risk for recurrent dislocations.

Reference:

Olds MK, et al. BMJ Open Sport Exerc Med 2019;5:e000447. doi:10.1136/bmjsem-2018-000447 7https://bmjopensem.bmj.com/content/5/1/e000447.info

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