• Shoulder & Elbow Conditions Clinical Trials
• Sports Medicine

• Shoulder & Elbow Conditions
• Orthopaedics Clinical Trials
• Orthopaedics
• Sports Medicine

Young collegiate athletes often experience glenohumeral instability. A review of the National Collegiate Athletic Association Injury Surveillance System demonstrated a shoulder instability injury rate of .12 per 1000 exposures, with the highest rates in contact sports [Owens BD et al. Am J Sport Med 2009]. However, there is still no consensus as to the optimal treatment of the in-season athlete with shoulder instability.

According to Jonathan Dickens, MD, John A. Feagin Jr. Sports Medicine Fellowship and Keller Army Hospital, West Point, New York, USA, in-season intercollegiate athletes often do not want to accept the time lost from sport as they seek immediate and safe return to play (RTP) within the competitive season. There is a paucity of data regarding the safety of in-season return to sports after a shoulder instability episode; therefore, Dr. Dickens and his colleagues at 3 US military academies designed a prospective multicenter observational study to determine the likelihood of return to sport and recurrence following an in-season anterior shoulder instability event. Athletes were categorized according to the type of instability (subluxation vs dislocation); the researchers then evaluated the injury factors and baseline patient-reported outcomes that predicted successful RTP.

The study enrolled 53 intercollegiate athletes with a total of 45 anterior shoulder instability events. Two-thirds of the athletes had sustained their injuries playing football. All patients underwent a standardized accelerated rehabilitation program without immobilization. A brace was used at the discretion of the treating physician and the athlete's ability to perform sport-specific tasks with the brace. Shoulder-specific patient-reported outcomes were completed at the time of injury and included 4 shoulder assessment tools.

Dr. Dickens then reviewed the results of the trial. The median time to RTP was 5 days; 73% of athletes attempted a return to sport for all or part of the season. Among the 27% of athletes not able to return to sport by the end of the season, 59% had insufficient return of function, and 33% incurred the injuries at the end of the season. Athletes with subluxations were 5 times more likely to return to sport during the season than are those with dislocations.

Significant predictors of RTP included higher baseline scores at the time of the injury on the Western Ontario Shoulder Instability Index (WOSI; p<.037) and the Simple Shoulder Test (SST; p<.044). For every 1-point increase in the WOSI score at baseline, an athlete was 5% more likely to return to sport in the same season (p = .037). The study also found that scores on the WOSI, SST, and American Shoulder Surgeons Standardized Shoulder Assessment Form at the time of injury were all predictive of faster RTP. For every 10-point increase on the SST, an athlete returned to play 1.2 days sooner.

The authors defined successful RTP as returning to midseason competition without further recurrent instability events; only 36% of the athletes in this study were successful. There was no significant difference in recurrent instability between subluxation and dislocation cohorts, and recurrent instability following return to sport was not associated with failure to complete the season.

Dr. Dickens concluded that according to the present study, athletes can expect to return to sport within 1 week of nonoperative treatment of glenohumeral instability, with the return being sooner if patient had a subluxation rather than a dislocation.

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