Dynamic brace is a good option to treat first anterior shoulder dislocation in season

A case report of recurrent annular ligament displacement in a pediatric patient

BACKGROUND

Annular ligament displacement (ALD) is a common pediatric condition whereby the annular ligament slips over the radius and remains trapped between the radial head and capitellum. It can be reduced with relative ease by performing passive pronation or supination with concomitant pressure over the radial head. However, ALD is more likely to recur after the initial incident, concerning for both the patient and caregivers.

PURPOSE

This article describes the successful conservative management of a 2 year, 4 month old female patient with recurrent ALD, having occurred six times in an 8 month period.

METHODS

The role of an orthosis, targeted exercises, and education for caregivers for treating recurrent ALD is discussed.

RESULTS

At each follow up and final 18 month follow up no ALD events had occurred.

CONCLUSIONS

Previous literature discussing treatment for recurrent ALD has examined teaching caregivers to reduce the elbow at home or teaching reductions via telehealth. However, there is a dearth of research around treating the issue so recurrence does not occur. This conservative intervention demonstrates a potential avenue for treating chronic recurrent ALD to eliminate subsequent events.

Decision Making of the In-season Athlete with Anterior Shoulder Instability

In-season management of anterior shoulder instability in athletes is a complex problem. Athletes often wish to play through their current season, though recurrent instability rates are high, particularly in contact sports. Athletes are generally considered safe to return to play when they are relatively pain-free, and their strength and range of motion match the uninjured extremity. If an athlete is unable to progress toward recovering strength and range of motion, surgical management is an option, though this is often a season-ending decision.

Protective Sport Bracing for Athletes With Mid-Season Shoulder Instability

CONTEXT

In-season glenohumeral instability is a common clinical dilemma faced by physicians who care for athletes. Both nonoperative and operative management of athletes with in-season glenohumeral instability have been well described. Functional bracing remains less understood as a treatment modality. This review aims to provide an update on the most recent literature regarding the use of functional bracing for shoulder instability.

EVIDENCE ACQUISITION

MEDLINE (PubMed and Ovid platforms), Web of Science, Embase, and Cochrane Database of Systemic Reviews were searched for articles available in English through June 1, 2021. The search terms shoulder brace, shoulder instability, athlete, in-season, glenohumeral instability, anterior shoulder instability, posterior shoulder instability, and bracing were used.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 3.

RESULTS

Research on the clinical outcomes of functional bracing remains mixed for patients with shoulder instability. Two studies have demonstrated improved return to play with functional bracing, while 1 study demonstrated no difference in return to play between braced athletes and nonbraced athletes with anterior instability. One previous study demonstrated that prophylactic use of bilateral shoulder stabilizing braces significantly decreased time lost due to injury in athletes with posterior instability. Previous biomechanical studies have demonstrated improved proprioception with brace wear as well as successful limitation of active shoulder range of motion.

CONCLUSION

Bracing in athletes with shoulder instability remains an important nonoperative treatment modality. While clinical benefits are yet to be validated through high-quality studies, preliminary results suggest a potential benefit to recovery, with minimal downsides. Nevertheless, the use of bracing remains an individual choice but is especially recommended in settings of high-risk sports for shoulder instability, such as football.

In-Season Management of Anterior Shoulder Instability

Anterior shoulder instability commonly occurs in young and active individuals, particularly those participating in contact or collision sports. At the intercollegiate level, rates of anterior instability have been reported to be 0.12 events per 1000 athlete exposures. The treatment of in-season athletes with anterior instability presents a challenge for the team physician. The desire to return to play within the same season with nonoperative management must be weighed against the increased risk of recurrence as well as athlete and team specific demands. The purpose of this chapter is to discuss the key considerations for the management of the athlete with anterior shoulder instability that occurs within the competitive season.