Retrospective analysis of decision-making in post-traumatic posterior shoulder instability.

ABSTRACT

PURPOSE: This study aims to assess the clinical outcomes in the management of post-traumatic posterior shoulder instability (PSI) with a focus on the decision-making process for operative and conservative treatments. INTRODUCTION: PSI can result from traumatic events, impacting a patient's quality of life. This study delves to better indicate decision-making for operative indication of post-traumatic PSI patients. METHODS: Patients who sustained posterior shoulder dislocations were selected from a single surgeon's database within a five-year period. Cases of degenerative or genetically caused PSI were excluded, resulting in a cohort of 28. Patients were initially managed conservatively but indicated for surgery if they were unable to actively stabilize the shoulder or exhibited bony or cartilage defects confirmed through imaging. If conservative treatment did not yield significant improvements, it was classified as a failure, and operative intervention was recommended. The WOSI Score, ROM, and X-ray were employed to evaluate the success of treatment. RESULTS: Out of the 28 patients, 11 received conservative, seven immediate surgeries, and ten transitioned from conservative to operative treatment. The overall success rate showed 25 good to excellent results. In the persistent conservative treatment group, the initial WOSI score was significantly lower compared to the operative group. CONCLUSION: This study suggests that post-traumatic PSI can be successfully managed conservatively with initial low clinical symptoms (low WOSI score) and in the absence of absolute indications for operative treatment. When surgery is necessary, arthroscopic procedures proved effective in achieving good to excellent results in 16 out of 17 cases.