At this point there is only a limited quantity of low-quality research available on the efficacy of conservative therapy in preventing surgery in patients with shoulder instability. It is hard to draw definitive conclusions based on the research available, however there is a trend toward the following conclusions: patients with a traumatic or chronic instability should try conservative therapy for 3-4 months to increase shoulder stability and patients with traumatic instability should undergo surgical stabilization followed by rehab. Ultimately, it is the patient’s decision as to which treatment is best and results depend on the type of instability, activity level, patient history, and the goals of the patient.
1. Clinical Scenario: A 26 year-old patient with recurrent atraumatic shoulder instability approached us in the clinic and asked whether he should have shoulder surgery or try conservative rehab first. MRI and x-rays of the patient’s shoulder showed no signs of rotator cuff tear, a SLAP lesion, or a Bankart Lesion. The patient was in good health, had never tried physical therapy before, and had several shoulder dislocations and chronic pain over the past eight years. His orthopedic surgeon had recommended that he have a surgical stabilization procedure to reduce his recurrent dislocations.
2. Our clinically answerable question: Population: Patients with signs and symptoms of shoulder instability, including pain, subluxation, and dislocation. Intervention: Conservative physical therapy interventions for the strengthening and stabilization of the shoulder joint. Comparison: Patients that have undergone shoulder surgery. Outcome: Percent recurrence of subluxation or dislocation, and subjective reports of functional status and pain.
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