scholarly journals The Non-Operative Instability Severity Score: A Validated Scoring System to Predict Who Needs Operative Management in the Scholastic Athlete

2018 ◽  
Vol 6 (3_suppl) ◽  
pp. 2325967118S0000
Author(s):  
John M. Tokish ◽  
Charles A. Thigpen ◽  
Michael J. Kissenberth ◽  
Stefan John Tolan ◽  
Keith T. Lonergan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Shoulder Instability ◽  
Scoring System ◽  
Nonoperative Management ◽  
Return To Sport ◽  
Severity Index ◽  
Anterior Shoulder Instability ◽  
Adolescent Athlete ◽  
Risk Of Failure

Objectives: The management of the adolescent athlete who presents for initial treatment after shoulder instability remains controversial. Risk factors such as age, gender, athletic status, and patient goals have all been demonstrated to result in a higher risk of recurrence with nonoperative management, but little work has been done to determine a treatment algorithm that would combine these factors into a decision making algorithm. The purpose of this study, therefore, was to evaluate patients managed nonoperatively for shoulder instability, and to identify factors that led to failure, defined as an inability to return to sport with no subsequent missed time due to shoulder issues. We sought to integrate these factors into a scoring system that would predict the success or failure of nonoperative management in the treatment of shoulder instability in the adolescent athlete. Methods: A retrospective study was conducted of 57 patients who were first time presenters for anterior shoulder instability to a single orthopaedic practice. Inclusion criteria were that patients were managed nonoperatively, that they were involved in high school sports with at least one season of eligibility remaining, and that complete information was available on their ultimate return to their previous sport. Success was defined as those patients who returned to their sport at the same level, and who played at least one subsequent season without any time being missed due to the shoulder that had been unstable. Patient specific risk factors were individually evaluated, and those that were predictive of a higher risk of failure were incorporated into a 10-point Nonoperative Injury Severity Index (NISIS). This score was then retrospectively applied with regression analysis as well as a chi-square analysis to determine the overall score that predicted failure of nonoperative management. Results: Six factors were identified as risk factors and included in the NISIS. Age greater than 15, the presence of bone loss, type of instability (subluxation or dislocation), type of sport (collision vs. non-collision), female gender, and arm dominance, were assigned points based on individual risk. Overall, 79% of patients treated nonoperatively were able to achieve full return to sport without subsequent surgical intervention or missing any time as a result of their shoulder. Patients who had a preoperative NISIS score of >7 returned at over 90% to sport, compared to a success rate of 50% for those who scored <8, revealing an odds ratio of 9.3 times higher risk of failure for those in the high risk group (p=0.001). Conclusion: The non-operative instability severity index is simple and effective preoperative method to determine who is likely to be successful at returning to scholastic sports after presenting for anterior shoulder instability. Further study with a larger prospective cohort should be accomplished to independently validate this score, but this information may be useful for the treating physician to help guide decision making when presented with the unstable shoulder. [Figure: see text]

scholarly journals The Nonoperative Instability Severity Index Score (NISIS): A Simple Tool to Guide Operative Versus Nonoperative Treatment of the Unstable Shoulder

2020 ◽  
Vol 12 (6) ◽  
pp. 598-602
Author(s):  
John M. Tokish ◽  
Charles A. Thigpen ◽  
Michael J. Kissenberth ◽  
Stefan J. Tolan ◽  
Keith T. Lonergan ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Return To Sport ◽  
Severity Index ◽  
Anterior Shoulder Instability ◽  
High Risk Patients ◽  
Severity Index Score ◽  
Risk Patients

Background: The management of the adolescent athlete after initial shoulder instability remains controversial. Hypothesis: Individual risk factors in athletes with shoulder instability who are managed nonoperatively can be integrated into a scoring system that can predict successful return to sport. Study Design: Retrospective cohort study. Level of Evidence: Level 4. Methods: A total of 57 scholastic athletes with primary anterior shoulder instability who were managed nonoperatively were reviewed. Success was defined as a return to index sport at the same level and playing at least 1 subsequent season without missed time as a result of the shoulder. Patient-specific risk factors were individually evaluated, and odds ratios were calculated. A 10-point Nonoperative Injury Severity Index Score (NISIS) incorporated the risk factors for failure. This score was then retrospectively applied with regression analysis and a chi-square analysis to determine the overall optimal score that predicted failure of nonoperative management. Results: In total, 6 risk factors for failure were included in the NISIS: age (>15 years), bone loss, type of instability, type of sport (contact vs noncontact), male sex, and arm dominance. Overall, 79% of patients treated nonoperatively were able to successfully return to sport. Nearly all (97%) low-risk patients (NISIS <7) successfully returned to sport, while only 59% of high-risk patients returned to sport, a relative risk of 12.2 ( P = 0.001). High-risk patients with unipolar bone loss successfully returned (100%), but 67% of high-risk patients with bipolar bone loss failed. Conclusion: The NISIS is a simple and effective clinical tool to determine successful nonoperative management following anterior shoulder instability and may be helpful in guiding decision making when presented with the unstable shoulder in the scholastic athlete.

Return to Sport as an Outcome Measure for Shoulder Instability: Surprising Findings in Nonoperative Management in a High School Athlete Population

2019 ◽  
Vol 47 (5) ◽  
pp. 1062-1067 ◽  
Author(s):  
Ellen Shanley ◽  
Charles Thigpen ◽  
John Brooks ◽  
Richard J. Hawkins ◽  
Amit Momaya ◽  
...  
Keyword(s):  
High School ◽  
Shoulder Instability ◽  
Nonoperative Management ◽  
Return To Sport ◽  
Return To Play ◽  
Anterior Shoulder Instability ◽  
Time Loss ◽  
Additional Time ◽  
High School Athlete ◽  
Treatment Type

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.

Successful Return to Sport After Arthroscopic Shoulder Stabilization Versus Nonoperative Management in Contact Athletes With Anterior Shoulder Instability: A Prospective Multicenter Study

2017 ◽  
Vol 45 (11) ◽  
pp. 2540-2546 ◽  
Author(s):  
Jonathan F. Dickens ◽  
John-Paul Rue ◽  
Kenneth L. Cameron ◽  
John M. Tokish ◽  
Karen Y. Peck ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Nonoperative Management ◽  
Return To Sport ◽  
Return To Play ◽  
Surgical Reconstruction ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Stabilization ◽  
Glenohumeral Instability ◽  
Recurrent Instability ◽  
Competitive Season

Background: The debate continues regarding the optimal treatment of intercollegiate contact athletes with in-season anterior shoulder instability. Purpose: To examine return to sport and recurrent instability in the season after the index in-season anterior instability event. Study Design: Cohort study; Level of evidence, 2. Methods: Forty-five contact intercollegiate athletes treated nonoperatively or with arthroscopic stabilization were prospectively followed in a multicenter observational study to evaluate return to play (RTP) and recurrent instability in the season after an initial in-season anterior glenohumeral instability event. Baseline data collection included sport played, previous instability events, direction of instability, type of instability (subluxation or dislocation), and treatment method (nonoperative management or arthroscopic stabilization). All nonoperatively treated athletes underwent a standardized accelerated rehabilitation program without shoulder immobilization. Surgical stabilization was performed arthroscopically in all cases, and successful RTP was evaluated during the next competitive season after complete rehabilitation. Results: Thirty-nine of 45 intercollegiate contact athletes had remaining National Collegiate Athletic Association eligibility and were followed through the subsequent competitive season after the index instability event. Of the 10 athletes electing nonoperative treatment, 4 (40%) successfully returned to play without recurrence during the subsequent season. Of the 29 athletes treated surgically, 26 (90%) were able to successfully return to play without recurrence the following season (recurrence: n = 1; inadequate function: n = 2). Athletes who underwent surgical reconstruction before the next season were 5.8 times (95% CI, 1.77-18.97; P = .004) more likely to complete the subsequent season without recurrent instability. Of the 29 athletes electing surgical stabilization, there was no difference (risk ratio, 0.95; 95% CI, 0.10-9.24; P > .99) in RTP between the 9 stabilized after a single instability event (90% RTP rate) and the 20 stabilized after multiple in-season recurrent instability events (89% RTP rate). Conclusion: Collegiate contact and collision athletes with in-season anterior shoulder instability are significantly more likely to successfully return to sport without subsequent instability events the next season if they undergo surgical repair in the off-season.

scholarly journals Outcomes and Return to Sport and Work After Open Bankart Repair for Recurrent Shoulder Instability: A Systematic Review

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110269
Author(s):  
Khalid AlSomali ◽  
Erica Kholinne ◽  
Thanh Van Nguyen ◽  
Chang-Ho Cho ◽  
Jae-Man Kwak ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Return To Sport ◽  
Bankart Repair ◽  
Cochrane Library ◽  
Anterior Shoulder Instability ◽  
Functional Score ◽  
High Demand ◽  
Recurrent Instability ◽  
Instability Rate

Background: Open Bankart repair provides surgeons and patients with an alternative solution for managing recurrent instability in young athletes with or without minimal bone loss. Despite many studies that have reported low recurrence rates and good functional outcomes after open Bankart repair, we have limited knowledge about the return to sport and work for high-demand populations. Purpose: To assess the return to sport and work for high-demand populations after open Bankart repair for recurrent anterior shoulder instability, outcomes of open Bankart repair with regard to recurrence, and development of osteoarthritic (OA) changes. Study Design: Systematic review; Level of evidence, 4. Methods: We searched PubMed, EMBASE, Cochrane Library, Scopus, and Google Scholar databases using keywords as well as Medical Subject Headings terms and Emtree using “(Open Bankart OR Bankart surgery) (NOT arthroscopy NOT revision)” for English-language studies. We conducted a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: In total, 11 articles (10 with level 4 and 1 with level 3 evidence) including 563 patients (566 shoulders) were identified. The majority of patients were male (82%), the average age at the time of surgery was 27.4 years, and the mean follow-up was 11.5 years (range, 2.5-29 years). The most common functional score used was the Rowe score (95%) for the reported outcome measures, which showed good to excellent results (mean, 88.5 points). The overall recurrent instability rate, including dislocation and subluxation as a postoperative complication, was 8.5%. A total of 87% of patients were able to return to sport and work postoperatively. Overall, OA changes were reported in 33% of the patients, and the overall revision rate was 1%. Conclusion: Open Bankart repair exhibited favorable results, with a low postoperative instability rate. It is a reliable surgical procedure that allows high-demand patients to return to sport and work.

scholarly journals Treatment of anterior shoulder instability: a bibliometric analysis

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Mingtao Zhang ◽  
Zhitao Yang ◽  
Borong Zhang ◽  
Tao Liu ◽  
Xiangdong Yun
Keyword(s):  
United States ◽  
Risk Factors ◽  
Shoulder Instability ◽  
Sports Medicine ◽  
The United States ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Bankart Repair ◽  
Number Of Citations ◽  
Research Frontiers

Abstract Purpose The treatment of anterior shoulder instability is a focus in the field of sports medicine. While much research has been conducted, few bibliometric studies have been performed in this field. This study analyzed the main characteristics and identified emerging research trends and hotspots related to the treatment of anterior shoulder instability over the past four decades. Methods We searched for (anterior shoulder instability OR anterior shoulder dislocation) AND (treatment OR reconstruction) in ARTICLE (Mesh) in the Web of Science database from 1980 to 2020. We analyzed the keywords, author, institution, country, number of citations, average number of citations, publication year, and partnership of the identified articles. Information about annual publications was analyzed using Microsoft Excel 2019; the remaining data were analyzed using VOSviewer version 1.6.11 (Leiden University, Leiden, Netherlands) and CiteSpace version 5.7.R2 (Drexel University, Philadelphia, PA, USA). Results A total of 1964 articles were published between 1980 and 2020. The American Journal of Sports Medicine, the United States, the United States Department of Defense, and Arcieio were journals, countries, institutions, and authors with the highest numbers of publications. The topic hotspots were instability, shoulder, and dislocation, while the research frontiers were arthroscopic, Bankart repair, Latarjet procedure, risk factors, recurrence, and complications. Conclusion The treatment of anterior shoulder instability has shown an increasing number of publications each year and achieved great progress. The United States made the most outstanding contributions to this important field. Arthroscopic, Bankart repair, and Latarjet procedures were research hotspots and risk factors, recurrence, and complications were likely to research frontiers.

Radiographic Predictors of Delayed Carpal Tunnel Syndrome After Distal Radius Fracture in the Elderly

Hand ◽  
2020 ◽  
pp. 155894472096387
Author(s):  
Kevin H. Kim ◽  
Bryan Duell ◽  
Swapna Munnangi ◽  
Mitchell Long ◽  
Elizabeth Morrison
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Carpal Tunnel Syndrome ◽  
Distal Radius Fracture ◽  
Carpal Tunnel ◽  
Nonoperative Management ◽  
Significant Risk ◽  
The Elderly ◽  
Control Group ◽  
Tunnel Syndrome

Background Delayed-onset carpal tunnel syndrome (DCTS) can develop weeks and months after distal radius fracture (DRFx). A better understanding of the risk factors of DCTS can guide surgeon’s decision making regarding the management of DRFx and also provides another discussion point to be had with elderly patients when discussing outcomes of nonoperative management. Methods We reviewed 216 nonoperatively managed DRFx between June 2015 and January 2019 at a single level 1 trauma center and senior author’s office. We identified 26 patients who developed DCTS at a minimum of 6 weeks after DRFx, which constituted our case group. The remaining 190 patients served as the control group (non–carpal tunnel syndrome [CTS]). Differences between case and control group were evaluated through univariate and multivariate analyses. Results The prevalence of DCTS among nonoperatively managed DRFx was 12%. In univariate analysis, volar tilt (VT) and teardrop angle (TDA) were significant independent predictors of development of DCTS. Multivariate logistic regression analysis determined that the odds of developing CTS increased by 12% and 24% for each degree of decrease in VT and TDA, respectively. No other significant risk factors were identified. Conclusions Decreasing VT and TDA are the most significant risk factors associated with DCTS in nonoperatively managed DRFx. These are simple and reliable radiographic measurements that provide significant prognostic value. These parameters can be used to guide surgeon decision making regarding management of DRFx in the elderly while aiding patient expectations and outcomes following nonoperative management of DRFx.

Decision-Making in Anterior Shoulder Instability

2018 ◽  
pp. 221-240
Author(s):  
Michel P. J. van den Bekerom ◽  
Derek F. P. van Deurzen ◽  
Karin M. C. Hekman ◽  
Olivier Verborgt ◽  
Klaus Bak ◽  
...  
Keyword(s):  
Decision Making ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability
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