Burkhead and Rockwood assessed how well a defined shoulder‑strengthening program controlled recurrent subluxation, and whether the response differed between traumatic and atraumatic instability.
140 shoulders in 115 patients with recurrent anterior, posterior or multidirectional subluxation, followed 2 to 6 years.
Methods
Patients
140 shoulders in 115 patients
Traumatic subluxation: 74 shoulders in 68 patients
Atraumatic subluxation: 66 shoulders
Type I: traumatic subluxation without prior dislocation
Type II: traumatic subluxation after a prior dislocation
Type IIIA: atraumatic voluntary subluxation with psychological problems
Type IIIB: atraumatic voluntary subluxation without psychological problems
Type IV: atraumatic involuntary subluxation
Treatment
Progressive resistance exercise program, starting with Therabands and moving on to pulley weights
Surgery recommended after 3 to 4 months without improvement, but never for voluntary subluxation with psychological problems
Follow-up
2 to 6 years
Outcomes
Good or excellent result by the Rowe‑Zarins grading system
Key Findings
Exercise gave a good or excellent result in 83% of atraumatic shoulders (Types III and IV) vs 12 of 74 traumatic shoulders (16%).
In each instability type, posterior subluxation responded to exercise better than anterior subluxation.
Radiographs showed glenoid or humeral head changes in 55% of Type I and 79% of Type II shoulders, but in none of the 21 Type III shoulders.
Successful Type IV shoulders became stable at an average of 5 weeks (range 2 to 12) and reached maximum stability at an average of 14 weeks (range 6 to 36).
In the senior author's referral practice, reconstructions designed for traumatic instability but done on atraumatic shoulders were the most common cause of failed shoulder reconstruction.
Some patients had symptoms return when they stopped exercising and clear again when they resumed, so the authors advised exercising 2 to 3 times a week after stability returned.
Board pearl
For atraumatic or multidirectional subluxation, the authors recommended a trial of resistance strengthening before any reconstruction, citing an 83% rate of good or excellent results with exercise.
Authors' conclusion
For this reason, each patient who has instability of the shoulder should be thoroughly evaluated if a successful result from conservative treatment is to be expected. Every effort must be made to identify the etiology of the instability through careful history-taking, physical examination, and radiographic evaluation.
Burkhead and Rockwood assessed how well a defined shoulder‑strengthening program controlled recurrent subluxation, and whether the response differed between traumatic and atraumatic instability.
140 shoulders in 115 patients with recurrent anterior, posterior or multidirectional subluxation, followed 2 to 6 years.
Methods
Patients
140 shoulders in 115 patients
Traumatic subluxation: 74 shoulders in 68 patients
Atraumatic subluxation: 66 shoulders
Type I: traumatic subluxation without prior dislocation
Type II: traumatic subluxation after a prior dislocation
Type IIIA: atraumatic voluntary subluxation with psychological problems
Type IIIB: atraumatic voluntary subluxation without psychological problems
Type IV: atraumatic involuntary subluxation
Treatment
Progressive resistance exercise program, starting with Therabands and moving on to pulley weights
Surgery recommended after 3 to 4 months without improvement, but never for voluntary subluxation with psychological problems
Follow-up
2 to 6 years
Outcomes
Good or excellent result by the Rowe‑Zarins grading system
Key Findings
Exercise gave a good or excellent result in 83% of atraumatic shoulders (Types III and IV) vs 12 of 74 traumatic shoulders (16%).
In each instability type, posterior subluxation responded to exercise better than anterior subluxation.
Radiographs showed glenoid or humeral head changes in 55% of Type I and 79% of Type II shoulders, but in none of the 21 Type III shoulders.
Successful Type IV shoulders became stable at an average of 5 weeks (range 2 to 12) and reached maximum stability at an average of 14 weeks (range 6 to 36).
In the senior author's referral practice, reconstructions designed for traumatic instability but done on atraumatic shoulders were the most common cause of failed shoulder reconstruction.
Some patients had symptoms return when they stopped exercising and clear again when they resumed, so the authors advised exercising 2 to 3 times a week after stability returned.
Board pearl
For atraumatic or multidirectional subluxation, the authors recommended a trial of resistance strengthening before any reconstruction, citing an 83% rate of good or excellent results with exercise.
Authors' conclusion
For this reason, each patient who has instability of the shoulder should be thoroughly evaluated if a successful result from conservative treatment is to be expected. Every effort must be made to identify the etiology of the instability through careful history-taking, physical examination, and radiographic evaluation.