Contact athletes can return to in-season sport after conservative treatment of anterior shoulder instability
SEATTLE — Most young in-season intercollegiate contact athletes with anterior glenohumeral instability can be expected to return to sport 1 week after nonoperative treatment, according to data presented here.
“However, recurrent instability is common, and only one in three athletes successfully complete the season without recurrence. Long-term consequences, however, associated with recurrent instability remain unclear,” said Jonathan F. Dickens, MD, at the American Orthopaedic Society for Sports Medicine Annual Meeting.
In a prospective, observational study, Dickens and colleagues examined the return to sport of 53 contact intercollegiate athletes at the U.S. Military Academy, U.S. Air Force Academy and U.S Naval Academy after an in-season anterior glenohumeral instability event based on whether the initial injury was a subluxation or dislocation. Eight patients were excluded due to primary posterior events, leaving 45 anterior shoulder instability events for the study. The researchers evaluated the injury factors and patient-reported outcome scores administered at the time of injury to assess the predictability of return to sport and time to return to sport during the competitive season after the injury. Average patient age was 20.7 years, and football accounted for two-thirds of the injuries and instability events.
Researchers found that 73% of the athletes returned to sport for either all or part of the season. Of the 27% of athletes who failed to return to any portion of the season, 59% were due to insufficient shoulder function and 33% were due to injuries at the end of the season.
Dickens said dislocation represented 58% of instability events, and the median return to sport for athletes after dislocation was 7 days compared to 3 days for athletes with subluxation. For athletes with dislocation, 19% completed the season without subsequent instability event compared to 47% of athletes in the subluxation group. Dickens said athletes with a subluxation were 5.3 times more likely to return to sport after the initial in-season shoulder instability event compared to athletes with dislocations. Of the 33 athletes who returned to in-season sport after an instability event, 63% had recurrent instability, with a mean of 2.5 instability events per athlete per season. Researchers found no difference in recurrence rates between athletes who had subluxation and dislocations.
The Western Ontario Shoulder Instability Index (WOSI) and Simple Shoulder Test (SST) scores found after the initial instability event were predictive of an athlete’s ability to return to play, he said. For every one point higher on the WOSI scale at the time of injury, the athlete was 5% more likely to return to play in-season. Dickens said SST scores had the strongest correlation with time away from sport, as an athlete returned to sport 1.2 days sooner for every 10 points higher on the SST scale score at the time of injury. – by Kristine Houck
Dickens JF. Paper #1. Presented at: the American Orthopaedic Society for Sports Medicine Annual Meeting; July 10-13, 2014; Seattle.
Disclosure: Dickens has no relevant financial disclosures.