Fink Barnes Leslie A, Jobin Charles M, Popkin Charles A, Ahmad Christopher S
Department of Orthopedic Surgery and Sports Medicine, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA.
Columbia University Center for Shoulder, Elbow and Sports Medicine, New York, New York, USA.
Orthop J Sports Med. 2021 Sep 15;9(9):23259671211032239. doi: 10.1177/23259671211032239. eCollection 2021 Sep.
Many in-season athletes choose to delay or avoid surgery in order to continue playing and avoid downtime such as missed games or seasons.
To learn about the attitudes toward the injury and treatment of in-season shoulder instability in competitive athletes who have suffered a shoulder dislocation.
Cross-sectional study; Level of evidence, 3.
A study-specific questionnaire about athletes' perceptions of injury and treatment was administered to injured players. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Shoulder Instability Index (WOSI). Mean scores and standard deviations were calculated, and between-group analyses with tests were performed to compare the ASES and WOSI scores. The Mann-Whitney test was used for analyses performed on the following groups: early operative versus nonoperative management; age <18 versus ≥18 years; first-time dislocators versus recurrent dislocators; self-reducing subluxations versus dislocations requiring assistance; and dominant arm affected versus nondominant arm.
There were 45 patients included in this study (33 male, 12 female) with a mean age of 18 ± 2.8 years. Several sports were represented, with the most common being football, baseball, soccer, and rugby. In this study of in-season athletes with shoulder instability, 13 (28.9%) chose early surgery, 4 (8.9%) chose surgery at season's end, while 28 (62.2%) chose physical therapy followed by a wait-and-see approach, with 13 (46.4%) of these patients ultimately requiring surgery. Athletes who chose nonoperative treatment were statistically more likely to believe that their shoulder would heal on its own ( < .001) or with physical therapy ( < .025); they were also more likely to agree that they would rather stop sports than undergo surgery ( < .04). Athletes with worse ASES and WOSI scores at injury were more likely to choose surgery ( < .03 and < .05, respectively). Athletes with >1 dislocation were less likely to believe that the shoulder would heal without surgery ( < .025). Most athletes agreed that seasonal timing and recruitment prospects were an important factor in their decision in favor of surgery ( < .038), and most agreed that their doctor influenced their ultimate treatment decision ( < .006). Most athletes also agreed that a repeat dislocation would cause further injury to the shoulder.
Treatment decisions were most strongly related to the athletes' perceptions of injury severity and the influence of the treating surgeon.
许多赛季中的运动员选择推迟或避免手术，以便继续参赛并避免诸如错过比赛或赛季等停赛期。
了解遭受肩关节脱位的竞技运动员对赛季中肩部不稳定损伤及治疗的态度。
横断面研究；证据等级，3级。
向受伤运动员发放一份关于运动员对损伤及治疗认知的特定研究问卷。次要结果包括美国肩肘外科医师（ASES）评分和西安大略肩部不稳定指数（WOSI）。计算平均得分和标准差，并进行组间t检验以比较ASES和WOSI评分。采用曼-惠特尼U检验对以下几组进行分析：早期手术与非手术治疗；年龄<18岁与≥18岁；首次脱位者与复发性脱位者；自行复位的半脱位与需要协助复位的脱位；优势臂受累与非优势臂受累。
本研究纳入45例患者（男33例，女12例），平均年龄18±2.8岁。涉及多项运动，最常见的是橄榄球、棒球、足球和英式橄榄球。在这项针对赛季中肩部不稳定的运动员的研究中，13例（28.9%）选择早期手术，4例（8.9%）选择赛季末手术，而28例（62.2%）选择物理治疗并采取观望态度，其中13例（46.4%）患者最终需要手术。选择非手术治疗的运动员在统计学上更有可能认为其肩部会自行愈合（P<.001）或通过物理治疗愈合（P<.025）；他们也更有可能同意宁愿停止运动也不愿接受手术（P<.04）。受伤时ASES和WOSI评分较差的运动员更有可能选择手术（分别为P<.03和P<.05）。脱位超过1次的运动员不太可能相信肩部无需手术就能愈合（P<.025）。大多数运动员同意赛季时间和招募前景是他们决定支持手术的重要因素（P<.038），并且大多数人同意他们的医生影响了他们最终的治疗决定（P<.006）。大多数运动员也同意再次脱位会对肩部造成进一步损伤。
治疗决策与运动员对损伤严重程度的认知以及主治外科医生的影响最为密切相关。
