Today’s article “Multiple Instability Events at Initial Presentation Are the Major Predictor of Failure of Nonoperative Treatment for Anterior Shoulder Instability” is from Duethman et al. out of Mayo clinic.
Anterior shoulder instability and the ideal treatment algorithm continue to be studied. Success of treatment can vary from minimal to no pain, return to all athletic activities, patient reported outcomes, and lack of recurrence of instability. Studies have looked at how age, sporting type, bone loss, number of instability events, and sex of the patient affect future recurrence risk.
The authors in this study were able to look at patients 14-39 years old that presented between 1994 and 2016 with traumatic anterior shoulder instability. They looked at outcomes for patients that had at least 6 months of conservative treatment. Ultimately, 131 of 379 patients had recurrent instability after 6 months of conservative treatment with 79 converting to a stabilization procedure. They found that in the cohort of patients that over 50% experienced at least 2 instability events. The authors found that 2 or greater instability events prior to initial presentation to the clinic was predictive of conversion to surgery. At final follow up, in the group that did not convert to surgery, 63.8% had no pain and 29.8% had mild pain. This is compared to the group that converted to surgery showing 84.7% with no pain and 13.9% with mild pain.
This was an interesting and well-done study. It adds to the growing knowledge regarding risk factors and outcomes regarding treatment for traumatic anterior shoulder instability.