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Management of Shoulder Instability in the Collision Athlete

A Technique-Based Review, Focusing on the Indications, Evaluation, Techniques, Outcomes, and Evidence on this Topic in the Area of Shoulder Instability Surgery

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Book cover Surgery of Shoulder Instability

Abstract

Glenohumeral instability is a common problem in the athletic population. Instability can range from microinstability to dislocation and the mechanism of injury often varies between sports. Collision athletes are often subjected to isolated traumatic events resulting in the humeral head being displaced either anteriorly or posteriorly with resultant instability. In contrast, throwing athletes can develop instability resulting from repetitive ‘microtrauma’ to the labrum and capsule. Management decisions for the athlete with shoulder instability must take into consideration their age, hand dominance, sport, position, level of activity, timing of season, expectations, and recovery timetable [1]. The sizable loads transferred to shoulders in collision athletes result in an incidence of traumatic shoulder instability double that of the general population, and make this a significant problem in sports medicine [2]. Also, the risk of recurrence after anterior shoulder dislocation is higher in young, active patients, and approaches 90–95 % in patients younger than 20 years [3]. For these reasons, special consideration must be given to treating the collision athlete with shoulder instability. This chapter will discuss the management of shoulder instability in collision athletes with a focus on evaluation, indications, techniques, outcomes, and current evidence on this topic. Evaluation of all types of shoulder instability will be covered in this chapter, however management will focus on traumatic anterior glenohumeral instability as this is most common among collision athletes. Management of posterior instability will be covered in different chapter.

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References

  1. Wang RY, Arciero RA (2008) Treating the athlete with anterior shoulder instability. Clin Sports Med 27:631–648

    Article  PubMed  CAS  Google Scholar 

  2. Owens BD, Duffey ML, Nelson BJ et al (2007) The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med 35(7):1168–1173

    Article  PubMed  Google Scholar 

  3. Cole BJ, Warner JP (2000) Arthroscopic versus open Bankart repair for traumatic anterior shoulder instability. Clin Sports Med 19:19–48

    Article  PubMed  CAS  Google Scholar 

  4. Hulstyn MJ, Fadale PD (1997) Shoulder injuries in the athlete. Clin Sports Med 16:663–679

    Article  PubMed  CAS  Google Scholar 

  5. Lazarus MD, Harryman DT (2000) Complications of open anterior stabilization of the shoulder. J Am Acad Orthop Surg 8:122–132

    PubMed  CAS  Google Scholar 

  6. Visser CP, Coene LN, Brand R et al (1999) The incidence of nerve injury in anterior dislocation of the shoulder and its influence on functional recovery. A prospective clinical and EMG study. J Bone Joint Surg [Br] 81-B:679–685

    Google Scholar 

  7. Piasecki DP, Verma NN, Romeo AA et al (2009) Glenoid bone deficiency in recurrent anterior shoulder instability: diagnosis and management. J Am Acad Orthop Surg 17:482–493

    PubMed  Google Scholar 

  8. Gaskill TR, Taylor DC, Millett PJ (2011) Management of multidirectional instability of the shoulder. J Am Acad Orthop Surg 19:758–767

    PubMed  Google Scholar 

  9. Kvitne RL, Jobe FW, Jobe CM (1995) Shoulder instability in the overhand or throwing athlete. Clin Sports Med 14(4):917–935

    PubMed  CAS  Google Scholar 

  10. Skendzel JG, Sekiya JK (2012) Diagnosis and management of humeral head bone loss in shoulder instability. Am J Sports Med 40:2633–2644

    Article  PubMed  Google Scholar 

  11. Mologne TS, Provencher MT, Menzel KA et al (2007) Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid. Am J Sports Med 35:1276–1283

    Article  PubMed  Google Scholar 

  12. Jobe FW, Kvitne RS, Giangarra CE (1989) Shoulder pain in the overhand or throwing athlete: the relationship of anterior instability and rotator cuff impingement. Ortho Rev 18(9):963–975

    CAS  Google Scholar 

  13. Lo IK, Nonweiler B, Woolfrey M et al (2004) An evaluation of the apprehension, relocation, and surprise tests for anterior shoulder instability. Am J Sports Med 32(2):301–307

    Article  PubMed  Google Scholar 

  14. Millett PJ, Clavert P, Hatch GF et al (2006) Recurrent posterior shoulder instability. J Am Acad Orthop Surg 14:464–476

    PubMed  Google Scholar 

  15. Blasier R, Soslowsky L, Malicky D et al (1997) Posterior glenohumeral subluxation: active and passive stabilization in a biomechanical model. J Bone Joint Surg Am 79(3):433–440

    Article  PubMed  CAS  Google Scholar 

  16. Provencher MT, LeClere LE, King S et al (2011) Posterior instability of the shoulder: diagnosis and management. Am J Sports Med 39:874–886

    Article  PubMed  Google Scholar 

  17. Kim SH, Park JS, Jeong WK et al (2005) The Kim test: a novel test for posteroinferior labral lesion of the shoulder—a comparison to the jerk test. Am J Sports Med 33(8):1188–1192

    Article  PubMed  Google Scholar 

  18. Tzannes A, Murrell GA (2002) Clinical examination of the unstable shoulder. Sports Med 32(7):447–457

    Article  PubMed  Google Scholar 

  19. Edwards TB, Boulahia A, Walch G (2003) Radiographic analysis of bone defects in chronic anterior shoulder instability. Arthoscopy 19:732–739

    Article  Google Scholar 

  20. Garth WP, Slappey CE, Ochs CW (1984) Roentgenographic demonstration of instability of the shoulder: the apical oblique projection—a technical note. J Bone Joint Surg Am 66:1450–1453

    PubMed  Google Scholar 

  21. Pavlov H, Warren RF, Weiss CB et al (1985) The roentgenographic evaluation of anterior shoulder instability. Clin Orthop Relat Res 194:153–158

    PubMed  Google Scholar 

  22. Itoi E, Lee SB, Amrami KK et al (2003) Quantitative assessment of classic anteroinferior bony Bankart lesions by radiography and computed tomography. Am J Sports Med 31:112–118

    PubMed  Google Scholar 

  23. Sugaya H, Moriishi J, Dohi M et al (2003) Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 85:878–884

    PubMed  Google Scholar 

  24. Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 16:677–694

    Article  PubMed  CAS  Google Scholar 

  25. Kirkley A, Werstine R, Ratjek A et al (2005) Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation. Arthroscopy 21(1):55–63

    Article  PubMed  Google Scholar 

  26. Buss DD, Lynch GP, Meyer CP et al (2004) Nonoperative management for in-season athletes with anterior shoulder instability. Am J Sports Med 32(6):1430–1433

    Article  PubMed  Google Scholar 

  27. Robinson CM, Howes J, Murdoch H et al (2006) Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am 88(11):2326–2336

    Article  PubMed  Google Scholar 

  28. Burns TC, Owens BD (2010) Management of shoulder instability in in-season athletes. Phys Sports Med 38(3):55–60

    Article  Google Scholar 

  29. Itoi E, Sashi R, Minagawa H et al (2001) Position of immobilization after dislocation of the glenohumeral joint: a study with use of magnetic resonance imaging. J Bone Joint Surg Am 83(5):661–667

    PubMed  Google Scholar 

  30. Itoi E, Hatakeyama Y, Sato T et al (2007) Immobilization in external rotation after shoulder dislocation reduces risk of recurrence: a randomized controlled trial. J Bone Joint Surg Am 89(10):2124–2131

    Article  PubMed  Google Scholar 

  31. Liavaag S, Brox JI, Pripp AH et al (2011) Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence: a randomized controlled trial. J Bone Joint Surg Am 93(10):897–904

    Article  PubMed  Google Scholar 

  32. Hovelius L, Eriksson K, Fredin H et al (1983) Recurrences after initial dislocation of the shoulder: results of a prospective study of treatment. J Bone Joint Surg Am 65(3):343–349

    PubMed  CAS  Google Scholar 

  33. Aronen JG, Regan K (1984) Decreasing the incidence of recurrence of first time anterior shoulder dislocations with rehabilitation. Am J Sports Med 12(4):283–291

    Article  PubMed  CAS  Google Scholar 

  34. O’Brien SJ, Neves MC, Arnoczky SP et al (1990) The anatomy and histology of the inferior glenohumeral ligament of the shoulder. Am J Sports Med 18:449–456

    Article  PubMed  Google Scholar 

  35. Thomas SC, Matsen FA (1989) An approach to repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability. J Bone Joint Surg Am 71:506–513

    PubMed  CAS  Google Scholar 

  36. Arciero RA, Wheeler JH, Ryan JB et al (1994) Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 22(5):589–594

    Article  PubMed  CAS  Google Scholar 

  37. Bottoni CR, Wilckens JH, DeBerardino TM et al (2002) A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first time shoulder dislocations. Am J Sports Med 30(4):576–580

    PubMed  Google Scholar 

  38. Yiannakopoulos CK, Mataragas E, Antonogiannakis E (2007) A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 23(9):985–990

    Article  PubMed  Google Scholar 

  39. Urayama M, Itoi E, Sashi R et al (2003) Capsular elongation in shoulders with recurrent anterior dislocation: Quantitative assessment with magnetic resonance arthrography. Am J Sports Med 31(1):64–67

    PubMed  Google Scholar 

  40. Taylor DC, Arciero RA (1997) Pathologic changes associated with shoulder dislocations: arthroscopic and physical examination findings in first-time, traumatic anterior shoulder dislocations. Am J Sports Med 25(3):306–311

    Article  PubMed  CAS  Google Scholar 

  41. Larrain MV, Montenegro HJ, Mauas DM et al (2006) Arthroscopic management of traumatic anterior shoulder instability in collision athletes: analysis of 204 cases with a 4- to 9- year follow-up and results with suture anchor technique. Arthroscopy 22(12):1283–1289

    Article  PubMed  Google Scholar 

  42. Cole BJ, L’Insalata J, Irrgang J et al (2000) Comparison of arthroscopic and open anterior shoulder stabilization. A two to six-year follow-up study. J Bone Joint Surg Am 82:1108–1114

    Article  PubMed  Google Scholar 

  43. O’Neill DB (1999) Arthroscopic Bankart repair of anterior detachments of the glenoid labrum—a prospective study. J Bone Joint Surg Am 81:1357–1366

    PubMed  Google Scholar 

  44. Pagnani MJ, Warren RF, Altchek DW et al (1996) Arthroscopic shoulder stabilization using transglenoid sutures. A four-year minimum followup. Am J Sports Med 24:459–467

    Article  PubMed  CAS  Google Scholar 

  45. Pagnani MJ, Dome DC (2002) Surgical treatment of traumatic anterior shoulder instability in American football players. J Bone Joint Surg 84-A:711–715

    Google Scholar 

  46. Ide J, Maeda S, Takagi K (2004) Arthroscopic Bankart repair using suture anchors in athletes: patient selection and postoperative sports activity. Am J Sports Med 32:1899–1905

    Article  PubMed  Google Scholar 

  47. Mazzocca AD, Brown FM, Carreira DS et al (2005) Arthroscopic anterior shoulder stabilization of collision and contact athletes. Am J Sports Med 33:52–60

    Article  PubMed  Google Scholar 

  48. Gill TJ, Micheli LJ, Gebhard F et al (1997) Bankart repair for anterior instability of the shoulder: long-term outcome. J Bone Joint Surg Am 79(6):850–857

    PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Director of Sports Medicine Research, Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute Sports Medicine, 925 Chestnut St. 5th Floor, Philadelphia, PA, 19107-4216, USA

    Matthew A. Cavagnaro & Steven B. Cohen

Authors
  1. Matthew A. Cavagnaro
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  2. Steven B. Cohen
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Corresponding author

Correspondence to Steven B. Cohen .

Editor information

Editors and Affiliations

  1. School of Medicine, Department of Orthopedic Surgery, University of Virginia, Ray C. Hunt Drive 400, Charlottesville, 22908, Virginia, USA

    Stephen F. Brockmeier

  2. University of Virginia, Ray C. Hunt Drive 400, Charlottesville, 22903, Virginia, USA

    Mark D. Miller

  3. de Diagnóstico y Tratamiento, Department of Orthopaedic Surgery, Instituto Argentino, Marcelo T. de Alvear 2400, Buenos Aires, 1122, Argentina

    Guillermo Arce

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Cavagnaro, M.A., Cohen, S.B. (2013). Management of Shoulder Instability in the Collision Athlete. In: Brockmeier, S., Miller, M., Arce, G. (eds) Surgery of Shoulder Instability. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38100-3_2

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  • DOI: https://doi.org/10.1007/978-3-642-38100-3_2

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-38099-0

  • Online ISBN: 978-3-642-38100-3

  • eBook Packages: MedicineMedicine (R0)

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