Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study

Birgit Juul-Kristensen,Lars Henrik Frich,Sten Rasmussen,Steen Lund Jensen,Karen Søgaard,Henrik Eshoj

doi:10.1186/s12891-019-2444-0

Abstract

BackgroundPatients with non-operated traumatic primary anterior shoulder dislocation (PASD) are assumed to have less shoulder impairment than patients with recurrent anterior shoulder dislocations (RASD). This may impact treatment decision strategy. The aim was to study whether patients with non-operated traumatic PASD have less shoulder impairment than those with RASD.MethodsIn a cross-sectional study baseline data from patients with PASD and RASD in a randomised controlled trial of non-operative shoulder exercise treatment were used. Shoulder function was self-reported (Western Ontario Shoulder Instability (WOSI), Tampa Scale of Kinesiophobia (TSK), General Health (EQ-5D-VAS), Numeric Pain Rating Scale (NPRS)), and measured (Constant-Murley shoulder Score (CMS total), CMS - Range of Motion (CMS-ROM, CMS – strength, proprioception, clinical tests).ResultsIn total, 56 patients (34 (28 men) with PASD and 22 (21 men) with RASD) (mean age 26 years) participated. WOSI total was 1064 and 1048, and TSK above 37 (indicating high re-injury fear) was present in 33 (97%) and 21 (96%) of the groups with PASD and RASD, with no group difference. CMS total (66.4 and 70.4), CMS-ROM (28.7 and 31.5), CMS-strength (injured shoulder: 7.6 kg and 9.1 kg), proprioception and clinical tests were the same. Furthermore, 26 (76%) with PASD and 13 (59%) with RASD reported not to have received non-operative shoulder treatment.ConclusionsNon-operated patients with PASD and self-reported shoulder trouble three-six weeks after initial injury do not have less shoulder impairment (self-reportedly or objectively measured) than non-operated patients RASD and self-reported shoulder trouble three-six weeks after their latest shoulder dislocation event.

Highlights

Patients with non-operated traumatic primary anterior shoulder dislocation (PASD) are assumed to have less shoulder impairment than patients with recurrent anterior shoulder dislocations (RASD)
Risk factors associated with RASD are age, male gender, generalized joint hypermobility (GJH), and shoulder laxity, besides a history of fractures to the greater tuberosity of the humerus [4, 5]
Described test protocols were used and, before data collection, the two clinical outcome assessors trained together to align their testing and interpretation procedures. This cross-sectional study draws on baseline data from patients with traumatic PASD and RASD included in a randomised controlled multi-centre trial (The SINEX study) [18] investigating the effect of a non-operative neuromuscular shoulder exercise program

Summary

Introduction

Patients with non-operated traumatic primary anterior shoulder dislocation (PASD) are assumed to have less shoulder impairment than patients with recurrent anterior shoulder dislocations (RASD). Patients with RASD may, to a higher degree than patients with PASD, develop worse shoulder impairments, leading to the anticipation that those with PASD have less indication for shoulder treatment This is how current practice [12, 13] is described today with most surgeons taking on a “wait and see” treatment approach in relation to immediate operation in patients with traumatic PASD [14]. Though, taking the high risk of RASD following a PASD into account, a Dutch survey on the management of patients with PASD revealed that only 60% of the orthopaedic surgeons at public hospitals in the Netherlands routinely refer non-operatively treated PASD patients to physical therapy [15].

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