Management of atraumatic shoulder instability

Purpose

There is limited published evidence to guide physiotherapists when treating patients with atraumatic shoulder instability. The aim of this study was to update the results of a previous small service evaluation investigating the outcomes for patients following a specific structured physiotherapy programme.

Approach

A service evaluation was conducted at our unit from August 2013, when the programme was introduced, up until December 2017. Patient reported outcome data was compared from final follow up to baseline using the Western Ontario Shoulder Index (WOSI) and the Oxford Instability Shoulder Score (OISS) analysed using the Wilcoxon Signed Rank Test.

Outcomes

51 patients were treated during this period. There were 16 males and 35 females with mean age 21.6 years. Mean symptom duration was 29 months prior to treatment. One patient had a congenital hand deformity so could not perform the exercises and another likewise due to multiple joint pathologies. Both were excluded from the analysis. 9 failed to complete treatment but their OISS data could be included in analysis as this was data was recorded at every clinic visit. The 40 patients who completed treatment attended on average 6 times (3-16) over 26 weeks (6-80). Mean WOSI score improved from 42.04% to 82.91% (p< 0.001). Mean OISS improved from 39.27 to 23.47 (p< 0.001). For the 9 patients that failed to complete treatment mean OISS improved from 41.89 to 33.86 (p< 0.05) with 6/9 showing improvement. 2/9 failed to attend after the first session. Only one patient who attended 3 times over 11 weeks failed to improve on the OISS.

Implications

For patients with atraumatic shoulder instability this structured physiotherapy programme results in improved levels of pain, stability and function but does require adherence from patients. Long term outcomes for this treatment regime still need to be investigated.

The Derby Shoulder Instability Rehabilitation Programme is simple to teach and results suggest favourable short term outcomes for patients with atraumatic shoulder instability.

Fund acknowledgements

This work was unfunded.

Additional notes

Presented at Physiotherapy UK 2018.