The role of structured physiotherapy in treating patients with atraumatic shoulder instability: Medium term results from a case series.

ABSTRACT

BACKGROUND: Consensus favours conservative treatment for atraumatic shoulder instability, but literature is scarce on the topic. We therefore prospectively assessed the results of structured physiotherapy for these patients. METHODS: Patient reported outcomes were recorded prior to physiotherapy and on discharge. Notes review identified patients re-referred for the same condition. RESULTS: N = 85. Review range was 12-72 months post-treatment. Median Oxford Shoulder Instability Score (OSIS) improved from 21 (range 2-47) to 39 (11-47). Median Western Ontario Shoulder Instability Index (WOSI) improved from 1117 (range 306-2028) to 485 (0-1569). Patients with posterior instability demonstrated better results compared with other groups (OSIS change, p = 0.025; WOSI change, p = 0.060). Quicker referral to physiotherapy gave improved outcomes (OSIS change, p = 0.004, rs = -0.4; WOSI change, p = 0.047, rs = 0.24). Twenty-one patients (24.7%) were re-referred, seven of them for repeat physiotherapy and 14 of them for surgery. Previous surgery significantly affected the possibility of a further referral (p < 0.001), and initial diagnosis was significantly correlated with further surgery (p = 0.032). DISCUSSION: Early referral to physiotherapy may produce better results. Patients with posterior instability responded better to physiotherapy. Previous surgery increased the risk of re-referral. Re-referred patients with posterior instability tended to be managed with further physiotherapy.