Effectiveness of Shoulder Taping in Treating Hemiplegic Shoulder Subluxation: A Randomized Controlled Study of 35 Patients.

BACKGROUND Shoulder subluxation in patients with stroke impairs recovery and quality of life. Kinesiology tape is elastic and water-resistant, is commonly used to prevent musculoskeletal injury, and is increasing in use for rehabilitation of patients requiring neurological or physical rehabilitation. This study included 35 patients with shoulder subluxation following stroke and aimed to compare outcomes from standard physical therapy with and without shoulder kinesiology taping. MATERIAL AND METHODS This randomized controlled study involved 35 participants. The patients were randomized into a shoulder kinesiology taping group (n=18) or sham taping group (n=17). All patients underwent a conventional rehabilitation exercise program 5 days a week for 6 weeks. Half of the patients underwent shoulder kinesiology taping, and the other half underwent sham taping. Pre- and post-assessment scores were recorded for all participants for shoulder subluxation distance (SSD), active range of motion (AROM), visual analog scale (VAS), shoulder pain and disability index (SPADI), and modified Barthel index (MBI). RESULTS After the intervention, SSD, AROM, VAS, SPADI, and MBI improved significantly in the shoulder kinesiology taping and sham taping groups (P<0.05). Also, the shoulder kinesiology taping group showed more effective changes in SSD, AROM, VAS, SPADI, and MBI than the sham taping group (P<0.05). CONCLUSIONS These results suggest that the shoulder kinesiology taping is effective in improving SSD, AROM, VAS, SPADI, and MBI in patients with hemiplegic shoulder subluxation.

Advice only versus advice and a physiotherapy programme for acute traumatic anterior shoulder dislocation: the ARTISAN RCT.

Background: The extra benefit of a programme of physiotherapy in addition to advice alone, following first-time traumatic shoulder dislocation, is uncertain. We compared the clinical and cost-effectiveness of a single session of advice with a single session of advice and a programme of physiotherapy. Objective: The primary objective was to quantify and draw inferences about observed differences in the Oxford Shoulder Instability Score between the trial treatment groups 6 months post randomisation, in adults with a first-time traumatic shoulder dislocation. Design: A pragmatic, multicentre, superiority, randomised controlled trial with embedded qualitative study. Setting: Forty-one hospitals in the UK NHS. Participants: Adults with a radiologically confirmed first-time traumatic anterior shoulder dislocation, being managed non-operatively. People with neurovascular complications or bilateral dislocations, and those unable to adhere to trial procedures or unable to attend physiotherapy within 6 weeks of injury, or who had previously been randomised, were excluded. Interventions: All participants received the same initial shoulder examination followed by advice to aid self-management, lasting up to 1 hour and administered by a physiotherapist (control). Participants randomised to receive an additional programme of physiotherapy were offered sessions lasting for up to 30 minutes, over a maximum duration of 4 months from the date of randomisation (intervention). Main outcome measures: The primary outcome measure was the Oxford Shoulder Instability Score. This is a self-completed outcome measure containing 12 questions (0-4 points each), with possible scores from 0 (worst function) to 48 (best function). Measurements were collected at 6 weeks, 3 months, 6 months and 12 months by postal questionnaire; 6 months was the primary outcome time point. The primary health outcome for economic evaluation was the quality-adjusted life-year, in accordance with National Institute of Health and Care Excellence guidelines. Results: Between 14 November 2018 and 14 March 2022, 482 participants were randomised to advice (n = 240) or advice and a programme of physiotherapy (n = 242). Participants were 34% female, with a mean age of 45 years, and treatment arms were balanced at baseline. There was not a statistically significant difference in the primary outcome between advice only and advice plus a programme of physiotherapy at 6 months for the primary intention-to-treat adjusted analysis (favours physiotherapy: 1.5, 95% confidence interval -0.3 to 3.5) or at earlier 3-month and 6-week time points on the Oxford Shoulder Instability Score (0-48; higher scores indicate better function). The probability of physiotherapy being cost-effective at a willingness-to-pay threshold of £30,000 was 0.95. Conclusions: We found little difference in the primary outcome or other secondary outcomes. Advice with additional physiotherapy sessions was found likely to be cost-effective. However, small imprecise incremental costs and quality-adjusted life-years raise questions on whether it is the best use of scarce physiotherapy resources given current service demands. Limitations: Loss to follow-up was 27%; however, the observed standard deviation was much smaller than anticipated. These changes in parameters reduced the number of participants required to observe the planned target difference of four points. Our post hoc sensitivity analysis, accounting for missing data, gives similar results. Future work: Further research should be directed towards optimising self-management strategies. Study registration: This study is registered as ISRCTN63184243. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/167/56) and is published in full in Health Technology Assessment; Vol. 28, No. 22. See the NIHR Funding and Awards website for further award information.

The shoulder dislocates (comes out of its socket joint) when the upper end of the arm bone is forced out during an injury. This common problem occurs mostly in men in their 20s and women aged over 80. After the bone is put back in its socket, most people are managed with physiotherapy. In the United Kingdom, once the bone is back in its socket, there is a range of physiotherapy provision: some hospitals offer advice, and some offer advice and a course of additional physiotherapy sessions. We compared advice alone to advice and physiotherapy for people who had a shoulder that had come out of its joint for the first time. Physiotherapy advice and additional sessions included education about the injury and exercises to move and strengthen the shoulder. When we started this project, this was the first time these two treatments had been compared. Our aim was to compare what activities the two groups could do 6 months after injury via a questionnaire. We also compared quality of life and the cost of rehabilitation at 6 weeks, 3 months, 6 months and 12 months after injury. Adults with a shoulder out of its joint and who were not having surgery were asked to take part. All adults who were eligible and consented to take part were assigned, by chance, to either a single session of advice or the same session followed by physiotherapy. Between 14 November 2018 and 14 March 2022 we collected data on 482 people, from 41 NHS sites across the UK. We found at 6 months there was little evidence that additional physiotherapy was better, when compared to advice alone. Cost-effectiveness analysis (comparing changes in costs and quality of life) suggests additional physiotherapy might provide value for money. However, the changes involved are small and uncertain.

Shoulder MRI parameters in anticipating anterior shoulder dislocation: Are they a reliable and reproducible tool in clinical practice?

BACKGROUND: Anterior shoulder dislocation (ASD) is a frequently observed musculoskeletal injury that is often encountered in the context of sports activities or as a result of trauma. Several magnetic resonance imaging (MRI) parameters have been previously investigated for the purpose of characterizing the anatomical features, which could potentially be responsible for the episodes of instability. These measurements have the potential to identify patients who are susceptible to dislocation. Consequently, ensuring the reliability and consistency of these measurements is crucial in the diagnosis and the management of athletic or traumatic shoulder injuries. METHODS: A group of four students, who had no previous experience in reading MRI series, were selected to perform radiographic measurements on specific parameters of MRI scans. These parameters were glenoid version, glenoid depth, glenoid width, humeral head diameter, humeral containing angle, and the ratio of humeral head diameter to glenoid diameter. The four participants conducted two distinct readings on a total of 28 sets of shoulder MRI scans. Simultaneously, the aforementioned measures were assessed by a consultant shoulder surgeon. RESULTS: A total of 1512 measurements were categorized into nine sets: eight from students' measurements (two per student) and one from the consultant. Intra-rater reliability assessed by the intra-class correlation (ICC) test indicated excellent or good reliability for all parameters (p < 0.05), with glenoid depth showing the highest (0.925) and humeral-containing angles the lowest (0.675) ICC value. Inter-rater correlation, also evaluated using ICC, demonstrated strong correlation (p < 0.05), with glenoid diameter having the highest ICC score (0.935) and glenoid depth the lowest (0.849). Agreement analysis, expressed by Cohen's Kappa test, revealed substantial agreement (p < 0.05) for all parameters, with humeral head diameter having the highest agreement (0.90) and humeral-containing angle the lowest (0.73). CONCLUSION: In this study, intra- and inter-rater MRI parameters are substantially concordant. Credibility comes from these reliability and agreement analyses' statistical significance. Glenoid diameter and depth are the most reliable intrarater and interrater, respectively. Best agreement was with the humeral-containing angle. These data demonstrate repeatability and clinical relevance. LEVEL OF EVIDENCE: Level IV.

[Bilateral Dorsal Fracture-Dislocation of the Proximal Humerus]. / Bilaterálna dorzálna luxacná zlomenina proximálneho humeru.

Fractures of the proximal humerus constitute approximately 5% of all fractures. Shoulder joint injuries without any external mechanical impact during seizures with the occurrence of spasms occur only sporadically. The occurrence rate is reported in approximately 0.4% of patients. Very rarely they occur in the form of epileptic seizure-induced dorsal fracturedislocation impacting both sides. The case report describes a case of a 48-year-old woman with no treatment for epileptic seizures in her medical history. During the first seizure she sustained a bilateral dorsal fracture-dislocation caused by a muscle spasm, without any other mechanical impact. The fractures were classified as a 3-fragment fracture on the right side and a 4-fragment fracture on the left side. After the patient's admission to the inpatient emergency department, reduction under anaesthesia was attempted. Subsequently, after preparation, open reduction and osteosynthesis using an angularly stable plate were performed as a two-stage surgery. No complications were observed postoperatively Currently, at 3 years after surgeries, the female patient has full mobility of her shoulder joints with no subjective difficulties. Key words: epilepsy, seizure, dorsal fracture-dislocation of the proximal humerus.

Quadruple Disruption of Superior Shoulder Suspensory Complex With Proximal Humerus Open Fracture-Dislocation: A Case Report.

CASE: A 34-year-old man was a restrained passenger involved in a high-speed rollover motor vehicle crash. The patient sustained a type 5 AC joint separation, severely comminuted intra-articular glenoid fracture with extension to the coracoid process base, displaced open scapular body fracture, a posterior shoulder dislocation of the glenohumeral joint, and a 2-part proximal humerus fracture. CONCLUSION: To our knowledge, this is the first report describing this injury pattern involving the superior shoulder suspensory complex with an associated open proximal humerus fracture-dislocation.

Bony Bankart Lesion: Diagnosis, Management, and Outcomes.

¼ Bony Bankart lesions are fractures of the anteroinferior glenoid rim, commonly associated with a traumatic anterior shoulder dislocation, and are diagnosed through radiological imaging and physical examination. Young male athletes playing contact sports are at highest risk of these injuries. Early diagnosis and treatment are crucial because, if left untreated, recurrent anterior shoulder instability and glenoid bone loss can occur. Both nonsurgical and surgical treatment options are available depending on the size of the lesion, with arthroscopic repair being the most common treatment method. After repair, patients typically have favorable outcomes with low rates of recurrent instability. This review aims to discuss the etiology, diagnosis, and treatment of bony Bankart lesions.¼ Bony Bankart lesions are fractures of the anteroinferior glenoid rim and occur in up to 22% of first-time anterior shoulder dislocations.¼ Young men involved in contact sports or combat training are at the highest risk of sustaining bony Bankart lesions.¼ Diagnosis and treatment of bony Bankart lesions are essential to prevent long-term shoulder instability.¼ Bony Bankart lesions can be treated either nonoperatively or operatively (arthroscopic vs open repair), with the size of the glenoid defect being the primary determinant of treatment.

Efficacy of supervised self-reduction vs. physician-assisted techniques for anterior shoulder dislocations: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: Reduction manipulation using self-reduction procedures such as Stimson, Milch, and Boss-Holtzach should be easy and effective and also require less force, pain medication, and outside assistance. This technique should not cause damage to arteries, nerves, or shoulder joint components. Self-reduction is straightforward and can be done in clinics, making it ideal for people who suffer from shoulder joint dislocation frequently. The goal of this study is to compare the effectiveness of supervised self-reduction procedures vs. physician-assisted treatments in the treatment of anterior shoulder dislocations. METHOD: We conducted a comprehensive search on PubMed, Scopus, Web of Science, and Cochrane up to March 22, 2023, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Relevant articles were reviewed, with a focus on studies comparing supervised self-reduction techniques to physician-assisted techniques in cases of anterior shoulder dislocation. RESULTS: Four papers in all were included in the meta-analysis. One prospective trial, one case-control study, one randomized clinical trial, and one retrospective trial made up these studies. The studies involved 283 patients in the physician-assisted group and 180 patients in the supervised self-reduction group. They were carried out in four European countries: Italy, Germany, Portugal, and Spain. The success rate of supervised self-reduction techniques was significantly higher, with an odds ratio of 2.71 (95% CI 1.25-5.58, p-value = 0.01). Based on the Visual Analog Scale (VAS) score, the physician-assisted group reported significantly higher maximum pain, with a mean difference of 1.98 (95% CI 1.24-2.72, p-value < 0.01). The self-reduction approaches exhibit shorter reduction time in comparison to physician-assisted groups. In addition, the self-reduction groups do not document any complications. Based on the GRADE system, the level of assurance in the evidence was high. CONCLUSION: Supervised self-reduction techniques outperform in terms of success rate and reduction-related maximum pain. These techniques could be used as an effective first-line treatment for anterior shoulder dislocation, potentially reducing the need for analgesics and emergency room visits.

Comparison of Return to Sports and Competition After the Arthroscopic Bristow-Latarjet Procedure Versus Arthroscopic Bankart Repair in Adolescents With Recurrent Anterior Shoulder Instability.

BACKGROUND: The use of isolated soft tissue repair versus bone block stabilization for the treatment of recurrent anterior shoulder instability in adolescents has no scientific evidence. PURPOSE: To compare the clinical outcomes of adolescent patients who underwent isolated arthroscopic Bankart (iB) repair with those who underwent the arthroscopic Bristow-Latarjet procedure in addition to Bankart (BLB) repair. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 60 shoulders in adolescents (aged 13-18 years) were reviewed with a minimum 2 years' follow-up: iB repair (n = 36) and arthroscopic Bankart repair with an additional Bristow-Latarjet procedure (BLB; n = 24). The characteristics of the patients in each group in terms of age at the first instability episode, age at surgery, hyperlaxity, participation in at-risk sports, and Instability Severity Index Score were comparable. The mean follow-up was longer in the iB group (7.7 vs 4.1 years, respectively), whereas the rates of patients engaged in competition and those with glenoid lesions were higher in the BLB group. The primary outcome measures were failure, defined as the recurrence of instability (clinical dislocation or subluxation), and return to sports. The mean follow-up was 6.2 years (range, 2-16 years). RESULTS: At the last follow-up, the rate of recurrence was significantly higher in the iB group, with 22% (8/36) failures, than in the BLB group, with 8% (2/24) instability recurrences (P < .05). The rate of return to sports at the same level was significantly higher after the BLB repair than after iB repair (79% vs 47%, respectively; P < .001). No statistical difference was found in patient-reported outcome scores between treatment groups (P > .05). Although failures occurred early after the BLB repair, 88% of failures after iB repair occurred after 2 years. On multivariate analysis, adolescents in the iB group with >3 episodes of preoperative dislocation and shoulder hyperlaxity (external rotation >90°) had a 60% recurrence rate (P < .005). CONCLUSION: Adolescent patients undergoing the BLB repair had a lower rate of recurrent instability and higher rates of return to sports and competition than those undergoing iB repair. Patients with shoulder hyperlaxity (external rotation >90°) and >3 dislocations had an unacceptable failure rate of 60% after iB repair.

Rate of Successful Shoulder Reduction on First Confirmatory Imaging in the Emergency Department.

BACKGROUND: Management of acute shoulder dislocation in the emergency department (ED) is common. OBJECTIVE: This study describes the rate, risk factors, and length of stay (LOS) associated with shoulder dislocation reduction failure in the ED. METHODS: The study was a retrospective case-control study of patients 18 years and older presenting to the ED with acute shoulder dislocation who underwent attempted reduction. Patients with successful reduction on post-reduction first confirmatory imaging are compared with those requiring multiple attempts. RESULTS: Of 398 ED encounters when a shoulder reduction was attempted in the ED, 18.8% (75/398 [95% CI 15.2-22.9%]) required multiple reduction attempts. Patients with successful reduction on first confirmatory imaging were more commonly male (80.2% [95% CI 75.6-84.3%] vs. 68.0% [95% CI 56.8-77.8%]; p = 0.0220), discharged home from the ED (95.4% [95% CI 92.6-97.3%] vs. 84.0% [95% CI 74.4-91.0%]; p = 0.0004), reduced using a traction/countertraction technique (42.1% [95% CI 36.8-47.6%] vs. 29.3% [95% CI 19.9-40.4%]; p = 0.0415), and less likely to have a pre-reduction fracture (26.0% [95% CI 21.4-31.0%] vs. 45.3% [95% CI 34.4-56.7%]; p = 0.0010). Mean length of stay (LOS) for those with successful reduction on first confirmatory imaging was 2 hours and 8 minutes shorter than for those with more than one attempt (p < 0.001). CONCLUSIONS: The rate of failed first-pass reduction is higher than previously reported. Furthermore, the ED LOS was significantly longer in patients requiring multiple attempts. Knowledge of the failure rate and risk factors may raise physician awareness and guide future studies evaluating approaches for verification of reduction success.

Glenohumeral morphological predictors of recurrent shoulder instability following arthroscopic Bankart repair.

PURPOSE: The purpose of this study was to evaluate glenohumeral morphological features on a magnetic resonance arthrogram (MRA) to determine risk factors for recurrence of anterior shoulder instability following arthroscopic Bankart repair (ABR). METHODS: A retrospective review of patients who underwent ABR between 2012 and 2017 was performed to identify patients who had recurrence of instability following stabilisation (Group 1). These were pair-matched in a 2:1 ratio for age, gender and sport with a control (Group 2) who underwent ABR without recurrence. Preoperative MRAs were evaluated for risk factors for recurrence, with glenoid bone loss and Hill-Sachs lesions also measured. Multilinear and multilogistic regression models were used to evaluate factors affecting recurrence. RESULTS: Overall, 72 patients were included in this study, including 48 patients without recurrence and 24 patients with recurrent instability. There was a significant difference between the two groups in mean glenoid bone loss (Group 1: 7.3% vs. Group 2: 5.7%, p < 0.0001) and the rate of off-track Hill-Sachs lesions (Group 1: 20.8% vs. Group 2: 0%, p = 0.0003). Of the variables analysed in logistic regression, increased glenoid anteversion (p = 0.02), acromioclavicular (AC) degeneration (p = 0.03) and increased Hill-Sachs width were associated with increased risk of failure. Increased chondral version (p = 0.01) and humeral head diameter in the anteriorposterior view were found to be protective and associated with a greater likelihood of success. CONCLUSION: Glenoid anteversion was a risk factor for recurrent instability, whereas increased chondral version and humeral head diameter were associated with higher rates of success following ABR. Glenoid bone loss, presence of an off-track Hill-Sachs lesion, increased Hill-Sachs width and AC degeneration were also associated with failure. These findings should be used by surgeons to stratify risk for recurrence following ABR. LEVEL OF EVIDENCE: Level III.

Shoulder dislocations in professional male football (soccer): A retrospective epidemiological analysis of the German Bundesliga from season 2012/2013 until 2022/2023.

PURPOSE: Injuries exert a detrimental impact on the team performance in professional football. Shoulder dislocations are known for their severity and often cause substantial lay-off times. However, there is a notable gap in the general understanding regarding the frequency and convalescence of these events in professional football. Thus, the aims of this study were (1) to determine the incidence, (2) to evaluate return to competition (RTC) and redislocation events (RDEs) and (3) to identify relevant player-, match- and injury-related parameters. METHODS: All shoulder dislocations within the highest three German football leagues (1.-3. Bundesliga) during the seasons 2012/2013 until 2022/2023 were identified. Player-, injury- and match-related data were obtained by performing a media analysis. Data were analysed using descriptive statistics. p Value was set at 0.05. RESULTS: A total of 90 first-time shoulder dislocations in 89 players with a median age of 25 years (interquartile range [IQR]: 23-28) were available for analysis. The incidence was 9.1 per 1000 Bundesliga matches played and increased over time. Forty-four (49%) shoulder dislocations were treated conservatively and 46 (51%) operatively. Median RTC was 24 days (IQR: 12-43) following conservative and 103 days (IQR: 85-135) following surgical treatment (p < 0.001). Twenty-two (24%) players suffered a redislocation, of whom 13 (59%) underwent initial conservative and nine (41%) initial surgical treatment (not significant [n.s.]). RDE following conservative treatment was after a median of 4 months (IQR: 2-22) and 7 months (IQR: 3-23) following surgical treatment (n.s.). CONCLUSION: The incidence of shoulder dislocation within professional football is increasing and currently amounts to 9.1 per 1000 matches played. A conservative treatment leads to a quicker RTC, while frequency and time to RDE were similar regardless of treatment. The increasing incidence of shoulder dislocations in professional football necessitates an analysis of relevant injury mechanisms and the implementation of specific preventive measures. LEVEL OF EVIDENCE: Level III.

[Anterior shoulder dislocation: revised Dutch Clinical Guideline in practice]. / Primaire anterieure schouderluxatie.

Shoulder dislocations remain the most frequent of joint dislocations, with anterior displacement of the humeral head being the direction of dislocation seen most often (97%). Recently, the Dutch clinical guideline on shoulder dislocations has been revised on the basis of predetermined bottlenecks in clinical practice. In this paper, the guideline is translated to clinical practice by means of two fictional cases, in which the novel recommendations are incorporated. The following topics were systematically assessed based on the best available scientific evidence: primary diagnostics, reduction techniques, painmedication/ sedation surrounding reduction and the need for physiotherapy, stabilization surgery and immobilization. Also, a best practice care pathway is advocated. Since scientific evidence is often inconclusive to provide undebatable therapeutic rules, the committee graded the available evidence and additionally used expert opinion to carefully draft recommendations. The paper concludes with an overview of all the recommendations stated in the updated multidisciplinary guideline.

Demographics and Outcomes of Glenohumeral Dislocations in Individuals With Elevated Body Mass Index.

INTRODUCTION: No specific study has investigated the characteristics and outcomes of anterior shoulder dislocations in morbidly obese individuals. The purpose of this study was to describe shoulder dislocations in patients with body mass index (BMI) greater than 40. METHODS: A retrospective review was conducted to identify patients aged 18 years and older with a BMI ≥40 who presented with a shoulder dislocation in a single institution from 2000 to 2020. Dislocation patterns, associated injuries, treatment modalities, and associated complications were recorded. RESULTS: A significant increase was noted in the number of patients with BMI greater than 40 presenting per year (r2 = -0.831, P < 0.01) over the past 20 years. A significant increase was noted in the average BMI per year in this population (r2 = 0.504, P = 0.028). Fifteen patients (19.5%) experienced at least one recurrent dislocation episode. Ten patients had a Bankart lesion that was associated with an elevated BMI (P = 0.04). Nine patients (11.7%) sustained an associated neurologic injury (no association with BMI). CONCLUSIONS: Over time, there has been an increase in shoulder dislocations in morbidly obese individuals in the United States, alongside an overall increase in the average BMI of patients who present with shoulder dislocations.

Exploring temporal trends and burden of traumatic shoulder dislocation: a global perspective.

Objective: To explore the geographical and temporal trends of traumatic shoulder dislocation, describe the association between the social and demographic factors and the health burden due to traumatic shoulder dislocation, and further investigate its causes. Methods: Data on traumatic shoulder dislocation was collected from the Global Burden of Disease 2019, spanning the years 1990 to 2019. The epidemiology and disease burden were examined at global, regional, and national levels. Additionally, the age and gender patterns were analyzed, followed by an investigation into the primary causes. Lastly, the study studied the correlation between age-standardized rates and the socio-demographic index (SDI). Results: Over a span of 30 years, both the crude and age-standardized rates of incidence and years lived with disability (YLDs) rates for all genders displayed a slight fluctuating downward trend. The incidence and YLDs rates in males were consistently higher than those in females. The study analyzed both incidence and YLDs rates of the global, regional, and national of traumatic shoulder dislocations from 1990 to 2019, as well as the temporal trends. Among males, the highest incidence rate was observed in young adulthood, while females exhibited the highest incidence rate in old age. This pattern was mirrored in the YLDs rate. Falls were identified as the main cause contributing to the disease burden related to traumatic shoulder dislocations. Moreover, a positive correlation was found between the age-standardized rates and SDI. Conclusion: The disease burden of traumatic shoulder dislocation has not significantly decreased from 1990 to 2019. The incidence and YLD rates are associated with age, gender, and SDI. A thorough examination of the disease burden contributes to the efficient allocation and utilization of resources, as well as the development of targeted and effective intervention strategies.

Developing a Rehabilitation Guideline (REGUIDE) for Patients Undergoing an Arthroscopic Bankart Repair After Traumatic Anterior Shoulder Dislocation, Focusing on Managing Apprehension: An International Delphi-Based Consensus Study.

OBJECTIVE: We aimed to develop a consensus-based rehabilitation guideline specifically designed to reduce apprehension following arthroscopic Bankart repair after traumatic anterior shoulder dislocation. DESIGN: Delphi-based consensus. METHOD: A comprehensive list of interventions for potential inclusion in a postoperative rehabilitation guideline was developed. American and European physiotherapists and orthopedic surgeons were invited to participate in a Delphi panel, engaging in 3 survey rounds. The health professionals were surveyed about their level of agreement on both initially listed and newly suggested interventions. Consensus was established when a "critical-to-include" rating was given in ≥70% of all responses. Ten former patients were consulted to identify the intervention during standard care rehabilitation that had the most impact on reducing postoperative apprehension following ABR. Any interventions not initially listed in the first round were added to the second survey round of the Delphi process. RESULTS: Forty-four health professionals reached consensus on a set of 27 interventions for managing apprehension after arthroscopic Bankart repair. New interventions included gradual exposure to shoulder positions eliciting apprehension, training in anterior stability-provoking positions, and education addressing the impact of psychosocial factors. Former patients identified specific interventions that were effective in reducing postoperative apprehension following ABR. These interventions encompassed medicine ball throws, active-assisted wall slides, and kinetic chain exercises in anterior stability-provoking positions. CONCLUSION: Our Delphi process informed expert recommendations for various interventions aimed at addressing apprehension associated with ABR. The recommendations were the foundation for developing a rehabilitation guideline (REGUIDE). The REGUIDE integrates principles from cognitive-behavioral therapy to improve rehabilitation and mitigate apprehension. J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 20 March 2024. doi:10.2519/jospt.2024.12106.

Efficacy and safety of the Latarjet procedure for the treatment of athletes with glenoid bone defects ≥ 20%: a single-arm meta-analysis.

BACKGROUND: The shoulder joint is the most commonly dislocated joint in the human body, and the recurrence rate exceeds 50% after nonsurgical treatment. Although surgical treatment reduces the recurrence rate, there is controversy regarding the optimal surgical approach. Previous studies suggest that the Latarjet procedure yields favourable outcomes for specific populations at risk of recurrence, such as competitive athletes with significant glenoid defects. However, most of the existing related research consists of nonrandomized controlled trials with small sample sizes, and there is a lack of strong evidence regarding the efficacy and safety of the Latarjet procedure. METHODS: The PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched. Athletes with ≥ 20% glenoid defects were selected for inclusion. The following data were extracted: general patient information, instability rates, return to sports (RTS) rates, imaging features (graft positioning rate and graft healing rate), functional assessments [Rowe score, Athletic Shoulder Outcome Scoring System(ASOSS), visual analogue scale (VAS), forward flexion function, and external rotation function], and complications. RESULTS: After excluding suspected duplicate cases, a total of 5 studies were included in this meta-analysis. The studies involved a total of 255 patients, including 237 males (93%) and 18 females (7%). The average age at the time of surgery was 25.4 ± 8.5 years. All the studies had a minimum follow-up period of 2 years, with an average follow-up time of 48.7 ± 18.9 months. The pooled rate of return to sport (RTS) was 94.3% (95% CI: 87.3%, 98.8%), and 86.1% (95% CI: 78.2%, 92.5%) of patients returned to their preoperative level of activity. The pooled redislocation rate was 1.1% (95% CI: 0%, 3.8%). Regarding the imaging results, the combined graft retention rate was 92.1% (95% CI: 88.1%, 95.5%), and the graft healing rate was 92.1% (95% CI: 88%, 95.4%). Postoperative functional evaluation revealed that the combined Rowe score, ASOSS score, and VAS score were 93.7 ± 6.5 points, 88.5 ± 4.4 points, and 1.1 ± 10 points, respectively. The forward flexion and external rotation angles were 170.9 ± 6.9 degrees and 65.6 ± 4.5 degrees, respectively. After excluding one study with unclear complications, the combined complication rate was 9.4% (95% CI: 1.0%, 23.6%). CONCLUSION: For athletes with shoulder instability and a total of ≥ 20% glenoid bone defects, the Latarjet procedure can achieve excellent functional outcomes, with the majority of patients returning to preoperative levels of sports activity. This procedure also leads to a low recurrence rate. Therefore, the Latarjet procedure has been proven to be a safe and effective treatment.

The Global Track Concept for Assessment of Engaging Hill-Sachs Defects in Anterior Shoulder Instability.

BACKGROUND: The glenoid track concept is used to determine preoperatively whether a Hill-Sachs defect is engaging or not. Currently, the glenoid track concept relies on measurements of bony structures as well as on the confines and elasticity of the rotator cuff as a reference point, which varies extensively among individuals and therefore limits the reliability and accuracy of this concept. PURPOSE: To evaluate the reliability of the global track concept, which determines the angular distance of the Hill-Sachs defect from the center of the articular surface of the humeral head as a new reference point with the help of an automated image analysis software and 3-dimensional analysis of the humeral head. STUDY DESIGN: Controlled laboratory study. METHODS: Computed tomography scans of 100 patients treated for anterior shoulder instability with different sizes of Hill-Sachs defects were evaluated manually by 2 orthopaedic surgeons independently using the software OsiriX as well as automatically by using a dedicated prototype software (ImFusion). Obtained manual and automated measurements included the Hill-Sachs length, Hill-Sachs width, and Hill-Sachs depth of the defect; the Hill-Sachs interval (HSI); and the glenoid width for the glenoid track concept, as well as the angular distance of the Hill-Sachs defect from the center of the articular surface of the humeral head (global track concept). The reliability of the different measurement techniques was compared by calculating intraclass correlation coefficients (ICCs). RESULTS: There was a significant difference for all obtained parameters comparing manual and automatic measurements. For manually obtained parameters, measurements referring to bony boundaries (glenoid width, Hill-Sachs length, and Hill-Sachs width) showed good to excellent agreement (ICC, 0.86, 0.82, and 0.62, respectively), while measurements referring to soft tissue boundaries (HSI and glenoid track; ICC, 0.56 and 0.53, respectively) or not directly identifiable reference points (center of articular surface and global track) only showed fair reliability (ICC middle excursion, 0.42). When the same parameters were measured with the help of an automated software, good reliability for the glenoid track concept and excellent reliability for the global track concept in the middle excursion were achieved. CONCLUSION: The present study showed that the more complex global track measurements of humeral defects are more reliable than the current standard HSI and glenoid track measurements. However, this is only true when automated software is used to perform the measurements. CLINICAL RELEVANCE: Future studies using the new proposed method in combination with an automated software need to be conducted to determine critical threshold values for defects prone to engagement.

Shoulder Arthroplasty After Previous Nonarthroplasty Surgery: A Systematic Review and Meta-Analysis of Clinical Outcomes and Complications.

BACKGROUND: Many patients who undergo shoulder arthroplasty (SA) have had at least 1 nonarthroplasty shoulder surgery before the surgery. There is conflicting evidence regarding the effects of previous shoulder surgery on the outcome of SA. A systematic review was conducted to compare functional outcomes and complications between SA patients with and without prior non-SA surgery on the ipsilateral shoulder. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched MEDLINE/PubMed, Embase, Scopus, and Web of Science comprehensively from inception to January 2023. Based on 9,279 records reviewed, 26 comparative studies were included in the meta-analysis consisting of 5,431 shoulders with prior nonarthroplasty procedures (cases) and 55,144 shoulders without previous surgery (controls). Variables such as functional scores, complications, and range of motion were compared between cases and controls using Review Manager Software. In addition, subgroup analysis was conducted based on prior surgery type (rotator cuff repair [RCR], open reduction and internal fixation [ORIF], soft tissue repairs, and not specified) and type of SA (hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty [RTSA]). The results were presented as odds ratios (ORs) or standardized mean differences (SMDs). RESULTS: Except for a higher rate of periprosthetic joint infection (PJI) in patients who had undergone previous arthroscopic surgery (OR, 2.58; 95% confidence interval [CI], 1.66-4.01; p < 0.01), a higher rate of complications was only observed in patients with previous ORIF. These complications included aseptic loosening (OR, 3.43; 95% CI, 2.14-5.50; p < 0.01), shoulder dislocation (OR, 2.25; 95% CI, 1.05-4.84; p = 0.04), overall complication (OR, 3.95; 95% CI, 2.38-6.55; p < 0.01), and revision (OR, 2.52; 95% CI, 1.28-4.97; p = 0.01). Patients with a history of previous surgery demonstrated inferior functional outcomes in comparison with the control group, including American Shoulder and Elbow Surgeons (SMD, -0.39; 95% CI, -0.51 to -0.27; p < 0.01; I2 = 36%), Constant-Murley score (SMD, -0.34; 95% CI, -0.44 to -0.24; p < 0.01; I2 = 0%), abduction (SMD, -0.26; 95% CI, -0.45 to -0.08; p = 0.01; I2 = 54%), and flexion (SMD, -0.33; 95% CI, -0.46 to -0.21; p < 0.01; I2 = 40%). Subgroup analysis by previous type of surgery was not possible regarding functional outcomes. CONCLUSION: Patients who have had prior fracture surgery are at a higher risk of complications, reoperations, and revisions after SA than controls. The normal shoulder anatomy may be disrupted by prior surgery, which makes arthroplasty technically challenging, particularly when it comes to soft tissue balance. On the other hand, RCR before SA did not negatively affect clinical outcomes after RTSA and did not have a higher rate of overall complications (except PJI). LEVEL OF EVIDENCE: Level III (Treatment Studies). See Instructions for Authors for a complete description of levels of evidence.