Rehabilitation and return to sports after anterior shoulder stabilization

Anterior shoulder stabilization has become the treatment of choice for athletes after anterior glenohumeral dislocation. Rehabilitation after surgical stabilization plays a vital role in returning the athlete to their desired sports participation level. Historically, rehabilitation, progression, and return to sport clearance after anterior stabilization surgery has been based on tissue healing and elapsed time from surgery. In general, good to excellent functional results have been achieved with this approach and a large proportion of athletes are able to return to sports, with low recurrence rates. However, substantially fewer are able to return to preinjury levels of sports participation; inadequate assessment and thus management of risk factors may be a potential cause. Rehabilitation guidelines and evidence provide only scant information for the clinician when assessing an athlete’s preparedness to return to sports. Additionally, the unique demands of each sport and non-modifiable factors create an additional layer of complexity in return to sport decision making. In this review article, rehabilitation guidelines after anterior shoulder stabilization, examination of factors utilized to determine return to sports preparedness, and clinical tests and measures that may be used during decision making are discussed. The importance of matching rehabilitation interventions based on the goals of each stage and criterion based progressions are emphasized. Establishment of the fundamental motion, strength, and stabilization is paramount before entering into return to sport preparation and testing. Once the athlete is nearing return to sport, appropriate tests and measures must should be performed to replicate the demands commonly placed on the shoulder during sports. Based on the available evidence and the unique functional requirements of each sport, it is recommended that a battery of tests and measures are utilized to assess multiple aspects of sports participation.

[1]  G. Waddington,et al.  Hand-held dynamometry strength measures for internal and external rotation demonstrate superior reliability, lower minimal detectable change and higher correlation to isokinetic dynamometry than externally-fixed dynamometry of the shoulder. , 2016, Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine.

[2]  Peter D. Fabricant,et al.  Return to sports after arthroscopic anterior stabilization in patients aged younger than 25 years. , 2013, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[3]  K. Guskiewicz,et al.  One-arm hop test: reliability and effects of arm dominance. , 2002, The Journal of orthopaedic and sports physical therapy.

[4]  T. Ellenbecker,et al.  The application of isokinetics in testing and rehabilitation of the shoulder complex. , 2000, Journal of athletic training.

[5]  A. Mocci,et al.  Arthroscopic treatment of anterior shoulder instability using knotless suture anchors. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[6]  S. Jaric,et al.  Normalization considerations for using the unilateral seated shot put test in rehabilitation. , 2014, Journal of Orthopaedic and Sports Physical Therapy.

[7]  S. Mattiello,et al.  Shoulder rotator strength and torque steadiness in athletes with anterior shoulder instability or SLAP lesion. , 2014, Journal of science and medicine in sport.

[8]  A. Pavlik,et al.  Sports ability after Bankart procedure in professional athletes , 2005, Knee Surgery, Sports Traumatology, Arthroscopy.

[9]  G. Davies,et al.  Test-Retest Reliability of the Closed Kinetic Chain Upper Extremity Stability Test: A Clinical Field Test , 2000 .

[10]  J. Roush,et al.  Reference Values for the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) for Collegiate Baseball Players. , 2007, North American journal of sports physical therapy : NAJSPT.

[11]  A. Rangan,et al.  Surgical versus non-surgical treatment for acute anterior shoulder dislocation ( Review ) , 2018 .

[12]  Ann M Cools,et al.  Measuring shoulder external and internal rotation strength and range of motion: comprehensive intra-rater and inter-rater reliability study of several testing protocols. , 2014, Journal of shoulder and elbow surgery.

[13]  P. Hardy,et al.  Anterior shoulder stabilization by Bristow–Latarjet procedure in athletes: return-to-sport and functional outcomes at minimum 2-year follow-up , 2016, European Journal of Orthopaedic Surgery & Traumatology.

[14]  Sunghwan Kim,et al.  The Effect of Glenohumeral Internal Rotation Deficit on the Isokinetic Strength, Pain, and Quality of Life in Male High School Baseball Players , 2015, Annals of rehabilitation medicine.

[15]  Emmy K L Wong,et al.  Strength profiles of shoulder rotators in healthy sport climbers and nonclimbers. , 2009, Journal of athletic training.

[16]  Ian Shrier,et al.  Return-to-Play in Sport: A Decision-based Model , 2010, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[17]  H. T. Tucci,et al.  Closed Kinetic Chain Upper Extremity Stability test (CKCUES test): a reliability study in persons with and without shoulder impingement syndrome , 2014, BMC Musculoskeletal Disorders.

[18]  B. Sennett,et al.  Prediction of In-Season Shoulder Injury From Preseason Testing in Division I Collegiate Football Players , 2014, Sports health.

[19]  R. Hetzler,et al.  Isokinetic peak torque ratios and shoulder injury history in adolescent female volleyball athletes. , 2008, Journal of athletic training.

[20]  B. Riemann,et al.  Hand-held dynamometer testing of the internal and external rotator musculature based on selected positions to establish normative data and unilateral ratios. , 2010, Journal of shoulder and elbow surgery.

[21]  B. Devitt,et al.  A Qualitative Investigation of Return to Sport After Arthroscopic Bankart Repair , 2015, The American journal of sports medicine.

[22]  P. Tomás-Carús,et al.  Shoulder Rotator Cuff Balance, Strength, and Endurance in Young Swimmers During a Competitive Season , 2013, Journal of strength and conditioning research.

[23]  R. Butler,et al.  Upper Quarter Y Balance Test: Reliability and Performance Comparison Between Genders in Active Adults , 2012, Journal of strength and conditioning research.

[24]  M. Kolber,et al.  Reliability, Minimal Detectable Change, and Normative Values for Tests of Upper Extremity Function and Power , 2010, Journal of strength and conditioning research.

[25]  W. Ben Kibler,et al.  Improvements in Shoulder Endurance Following a Baseball-Specific Strengthening Program in High School Baseball Players , 2013, Sports health.

[26]  E. Itoi,et al.  Position of immobilization after dislocation of the shoulder. A cadaveric study. , 1999, The Journal of bone and joint surgery. American volume.

[27]  J. Kennedy,et al.  Patterns of flexibility, laxity, and strength in normal shoulders and shoulders with instability and impingement , 1990, The American journal of sports medicine.

[28]  R. Bicknell,et al.  Neer Modification of Open Bankart Procedure: What are the Rates of Recurrent Instability, Functional Outcome, and Arthritis? , 2012, Clinical orthopaedics and related research.

[29]  T. A. Blackburn,et al.  Rehabilitation after ligamentous and labral surgery of the shoulder: guiding concepts. , 2000, Journal of athletic training.

[30]  M. Balke,et al.  Management of shoulder instability: the current state of treatment among German orthopaedic surgeons , 2016, Archives of Orthopaedic and Trauma Surgery.

[31]  H. Noga,et al.  Quantitative analysis of peak torque and power-velocity characteristics of shoulder rotator muscles after arthroscopic labral repair. , 2016, Journal of science and medicine in sport.

[32]  L. Funk,et al.  Serious shoulder injuries in professional soccer: return to participation after surgery , 2015, Knee Surgery, Sports Traumatology, Arthroscopy.

[33]  K. Wilk,et al.  Glenohumeral motion deficits: friend or foe? , 2013, International journal of sports physical therapy.

[34]  T. Ellenbecker,et al.  Concentric isokinetic shoulder internal and external rotation strength in professional baseball pitchers. , 1997, The Journal of orthopaedic and sports physical therapy.

[35]  J. Calhoun,et al.  Isokinetic testing of shoulder strength: normal values. , 1985, Archives of physical medicine and rehabilitation.

[36]  G. Fanton,et al.  Two-year outcome of arthroscopic bankart repair and electrothermal-assisted capsulorrhaphy for recurrent traumatic anterior shoulder instability. , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[37]  K. Wilk,et al.  Interval sport programs: guidelines for baseball, tennis, and golf. , 2002, The Journal of orthopaedic and sports physical therapy.

[38]  T. Ellenbecker.  Muscular strength relationship between normal grade manual muscle testing and isokinetic measurement of the shoulder internal and external rotators , 1996 .

[39]  A. Romeo,et al.  Arthroscopic Anterior Shoulder Stabilization of Collision and Contact Athletes , 2005, The American journal of sports medicine.

[40]  A. Shim,et al.  Concentric internal and eccentric external fatigue resistanc of the shoulder rotator muscles in female tennis players. , 2008, North American journal of sports physical therapy : NAJSPT.

[41]  Gerard Ee,et al.  Long term results of arthroscopic bankart repair for traumatic anterior shoulder instability , 2011, Journal of orthopaedic surgery and research.

[42]  C. Thigpen,et al.  The American Society of Shoulder and Elbow Therapists' consensus rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder. , 2010, The Journal of orthopaedic and sports physical therapy.

[43]  E. Alentorn-Geli,et al.  Return to sports after arthroscopic capsulolabral repair using knotless suture anchors for anterior shoulder instability in soccer players: minimum 5-year follow-up study , 2016, Knee Surgery, Sports Traumatology, Arthroscopy.

[44]  E. Hegedus,et al.  Clinician-friendly physical performance tests in athletes part 3: a systematic review of measurement properties and correlations to injury for tests in the upper extremity , 2015, British Journal of Sports Medicine.

[45]  Pierre Samozino,et al.  Reliability of shoulder rotators isokinetic strength imbalance measured using the Biodex dynamometer. , 2013, Journal of science and medicine in sport.

[46]  F. Balg,et al.  Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. , 2006, The Journal of bone and joint surgery. American volume.