Athletes With Anterior Shoulder Instability: A Prospective Study on Player Perceptions of Injury and Treatment.

BACKGROUND

Many in-season athletes choose to delay or avoid surgery in order to continue playing and avoid downtime such as missed games or seasons.

PURPOSE

To learn about the attitudes toward the injury and treatment of in-season shoulder instability in competitive athletes who have suffered a shoulder dislocation.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

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.

RESULTS

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.

CONCLUSION

Treatment decisions were most strongly related to the athletes' perceptions of injury severity and the influence of the treating surgeon.