Return to Sport as Outcome Measure for Shoulder Instability: Surprising Findings in Non-Operative Management in a High School Athlete Population

Background: Young age and contact sports have been postulated as risk factors for anterior shoulder instability. Management after shoulder instability is controversial, with studies suggesting that nonoperative management increases the risk of recurrence. Several studies examined return to play after an in-season instability episode, and few followed these patients to determine if they were able to successfully compete in a subsequent season. No study has evaluated this question in a high school athlete population. Purpose: To compare the likelihood of return to scholastic sport and complete the next full season without an additional time-loss injury among athletes with anterior shoulder instability in terms of treatment, instability type, and sport classification. Study Design: Cohort study; Level of evidence, 2 Methods: Athletes were included in this study as identified by a scholastic athletic trainer as experiencing a traumatic time-loss anterior shoulder instability injury related to school-sponsored participation. The cohort was predominantly male (n = 108, 84%) and consisted mostly of contact athletes (n = 101, 78%). All athletes had dislocation or subluxation diagnosed by a board-certified physician who determined the athlete’s course of care (nonoperative vs operative). Successful treatment was defined as completion of care and return to the athlete’s index sport, with full participation for the following season. Chi-square and relative risk analyses were completed to compare success of treatment (nonoperative vs operative care) and instability type. Separate logistic regressions were used to compare the effect of sex and sport classification on the athletes’ ability to return to sport. Statistical significance was set a priori as α = .05. Results: Scholastic athletes (N = 129) received nonoperative (n = 97) or operative (n = 32) care. Nonoperatively treated (85%) and operatively treated (72%) athletes successfully returned to the same sport without injury for at least 1 full season ( P = .11). Players sustaining a dislocation were significantly more likely to fail to return when compared with those sustaining a subluxation (26% vs 89%, P = .013). Sex ( P = .85) and sport classification ( P = .74) did not influence the athlete’s ability to return to sport, regardless of treatment type. Conclusion: A high percentage of athletes with shoulder instability achieved successful return to sport without missing any additional time for shoulder injury. Those with subluxations were at almost 3 times the odds of a successful return compared with those sustaining a dislocation.

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Sex Differences in Concussion Symptoms of High School Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-46.1.76 ◽

2011 ◽

Vol 46 (1) ◽

pp. 76-84 ◽

Cited By ~ 180

Author(s):

Leah J. Frommer ◽

Kelly K. Gurka ◽

Kevin M. Cross ◽

Christopher D. Ingersoll ◽

R. Dawn Comstock ◽

...

Keyword(s):

High School ◽

Outcome Measure ◽

Return To Sport ◽

The United States ◽

Return To Play ◽

High School Athletes ◽

Resolution Time ◽

Interscholastic Sports ◽

Symptom Resolution ◽

Males And Females

Abstract Context: More than 1.6 million sport-related concussions occur every year in the United States, affecting greater than 5% of all high school athletes who participate in contact sports. As more females participate in sports, understanding possible differences in concussion symptoms between sexes becomes more important. Objective: To compare symptoms, symptom resolution time, and time to return to sport between males and females with sport-related concussions. Design: Descriptive epidemiology study. Setting: Data were collected from 100 high schools via High School RIO (Reporting Information Online). Patients or Other Participants: Athletes from participating schools who sustained concussions while involved in interscholastic sports practice or competition in 9 sports (boys' football, soccer, basketball, wrestling, and baseball and girls' soccer, volleyball, basketball, and softball) during the 2005–2006 and 2006–2007 school years. A total of 812 sport concussions were reported (610 males, 202 females). Main Outcome Measure(s): Reported symptoms, symptom resolution time, and return-to-play time. Results: No difference was found between the number of symptoms reported (P = .30). However, a difference was seen in the types of symptoms reported. In year 1, males reported amnesia (exact P = .03) and confusion/disorientation (exact P = .04) more frequently than did females. In year 2, males reported more amnesia (exact P = .002) and confusion/disorientation (exact P = .002) than did females, whereas females reported more drowsiness (exact P = .02) and sensitivity to noise (exact P = .002) than did males. No differences were observed for symptom resolution time (P = .40) or return-to-play time (P = .43) between sexes. Conclusions: The types of symptoms reported differed between sexes after sport-related concussion, but symptom resolution time and return-to-play timelines were similar.

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