Nearly half of patients failed nonoperative management for posterior shoulder instability
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Key takeaways:
- About 47% of patients failed nonoperative management for posterior shoulder instability.
- Failing treatment was associated with a significantly greater increase in several related risk factors.
NEW ORLEANS — Data presented at the Arthroscopy Association of North America Annual Meeting showed that nearly half of the patients who underwent 6 months of nonoperative management for isolated posterior shoulder instability failed.
In a retrospective review, Patrick K. Mescher, MD, and colleagues evaluated the failure and success rates and anatomical risk factors associated with nonoperative management of isolated posterior shoulder instability.
Nonoperative management included physical activity modification, physical therapy and gradual return to action.
Researchers defined treatment failure as the need for reoperation and/or medical separation from the military because of the injured shoulder.
“Using index MRIs for all these patients, we evaluated a variety of glenohumeral morphologic aspects,” Mescher said during his presentation here.
Among these aspects, Mescher and colleagues evaluated glenoid bone loss, posterior acromial height, posterior acromial coverage and posterior humeral head subluxation.
Researchers found that 42 of the 90 (46.7%) patients who underwent nonoperative treatment failed and underwent a repeat operation and/or separated from military action.
“In those two groups, we didn't see any difference in age, sex, duration of symptoms or mechanisms,” Mescher said. “We did, however, find that increased posterior humeral head subluxation, posterior glenoid bone loss, posterior acromial height and less posterior acromial coverage were all significant risk factors for failing this nonoperative treatment.”
In addition, in the 17 patients who failed nonoperative management and had a repeat MRI to compare with the initial MRI, Mescher and colleagues found that they tended to have significantly greater increases in posterior glenoid bone loss (6.54 ± 1.59 vs. 2.68 ±1.71; P = 0.00274).
“The primary findings of our study were that nonoperative management failed about 47% of the time and that was associated with greater posterior acromial height, less posterior acromial coverage, greater posterior humeral head subluxation and bone loss as well as greater tendencies for retroversion,” Mescher said. “And of those, we do believe that failing nonoperative management also is associated with greater posterior glenoid bone loss.”
Reference:
- Bedrin M, et al. Orthop J Sports Med. 2022;doi:10.1177/2325967121S00570.
- Mescher P, et al. The natural history of nonoperative treatment of posterior instability in a high-demand population. Presented at: Arthroscopy Association of North America Annual Meeting; May 4-6, 2023; New Orleans.
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Mescher P, et al. The natural history of nonoperative treatment of posterior instability in a high-demand population. Presented at: Arthroscopy Association of North America Annual Meeting; May 4-6, 2023; New Orleans.
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