1
|
Warby SA, Ganderton C, Watson L, Pizzari T, Balster S, Hoy G, Barwood S, Kerr B, Lawrence S, Lenssen R, Rotstein A, Takla A, Civier O, Hughes M. Effect of a physiotherapy-directed rehabilitation programme on patients with multidirectional instability of the glenohumeral joint: a multimodal interventional MRI study protocol. BMJ Open 2024; 14:e071287. [PMID: 38373861 PMCID: PMC10882378 DOI: 10.1136/bmjopen-2022-071287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Altered neuromuscular control of the scapula and humeral head is a typical feature of multidirectional instability (MDI) of the glenohumeral joint, suggesting a central component to this condition. A previous randomised controlled trial showed MDI patients participating in the Watson Instability Program 1 (WIP1) had significantly improved clinical outcomes compared with a general shoulder strength programme. The aim of this paper is to outline a multimodal MRI protocol to identify potential ameliorative effects of the WIP1 on the brain. METHODS AND ANALYSIS Thirty female participants aged 18-35 years with right-sided atraumatic MDI and 30 matched controls will be recruited. MDI patients will participate in 24 weeks of the WIP1, involving prescription and progression of a home exercise programme. Multimodal MRI scans will be collected from both groups at baseline and in MDI patients at follow-up. Potential brain changes (primary outcome 1) in MDI patients will be probed using region-of-interest (ROI) and whole-brain approaches. ROIs will depict areas of functional alteration in MDI patients during executed and imagined shoulder movements (MDI vs controls at baseline), then examining the effects of the 24-week WIP1 intervention (baseline vs follow-up in MDI patients only). Whole-brain analyses will examine baseline versus follow-up voxel-wise measures in MDI patients only. Outcome measures used to assess WIP1 efficacy will include the Western Ontario Shoulder Index and the Melbourne Instability Shoulder Score (primary outcomes 2 and 3). Secondary outcomes will include the Tampa Scale for Kinesiophobia, Short Form Orebro, Global Rating of Change Score, muscle strength, scapular upward rotation, programme compliance and adverse events. DISCUSSION This trial will establish if the WIP1 is associated with brain changes in MDI. ETHICS AND DISSEMINATION Participant confidentiality will be maintained with publication of results. Swinburne Human Research Ethics Committee (Ref: 20202806-5692). TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN12621001207808).
Collapse
Affiliation(s)
- Sarah Ann Warby
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
| | - Charlotte Ganderton
- Nursing and Allied Health, Swinburne University of Technology Faculty of Health Arts and Design, Hawthorn, Victoria, Australia
| | - Lyn Watson
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
- Mill Park Physiotherapy, Melbourne, Victoria, Australia
| | - Simon Balster
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
- Department of Surgery, Monash University, Clayton, Victoria, Australia
| | - Shane Barwood
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Bonnie Kerr
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Sam Lawrence
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Ross Lenssen
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Andrew Rotstein
- Victoria House Medical Imaging, Melbourne, Victoria, Australia
| | - Annalaise Takla
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Oren Civier
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Matthew Hughes
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| |
Collapse
|
2
|
Waterman BR. Editorial Commentary: Urgency Toward Arthroscopic Bankart Repair Is Essential for Anterior Shoulder Dislocation: You Don't Have to Fix After the First Dislocation, but Definitely Before the Second! Arthroscopy 2023; 39:689-691. [PMID: 36740292 DOI: 10.1016/j.arthro.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 02/07/2023]
Abstract
While still hotly debated, primary arthroscopic management of the first-time anterior shoulder dislocation has an extensive list of known benefits: lower overall health care costs, improved patient-reported outcomes, a vast reduction in secondary instability, and higher quality-of-life measures. Yet, despite these meaningful contributions to health care quality, we continue to bypass the predictable success of an acute arthroscopic Bankart repair in order to tempt fate with "a trial" of nonoperative care for our young, high-risk collision athletes. Whether for the in-season athlete, the "early responder" with limited apprehension, subluxations with spontaneous reduction, or those stoically committed to nonsurgical care, we as physicians are often complicit in this shared risk taking and ceremonial weighing of the risks and benefits for treatment options after primary shoulder instability. Even just 1 additional episode of instability recurrence can double (or triple) the rate of glenohumeral bone loss. Furthermore, subsequent anterior shoulder instability compromises subjective shoulder function, heightens risk of secondary recurrence and/or revision, and increases the likelihood of requiring more advanced surgical management, such as with a Latarjet or other anterior bone block procedure. We must maintain a sense of urgency toward surgical treatment, particularly in young, high-demand athletes with persistent instability. To parrot the wisdom of our shoulder mentors, hear my humble plea: you don't have to fix the shoulder after the first anterior dislocation, but you should definitely do it before the second!
Collapse
|
3
|
Martins R, Quental C, Folgado J, Ângelo AC, de Campos Azevedo C. Influence of Graft Positioning during the Latarjet Procedure on Shoulder Stability and Articular Contact Pressure: Computational Analysis of the Bone Block Effect. BIOLOGY 2022; 11:biology11121783. [PMID: 36552292 PMCID: PMC9775173 DOI: 10.3390/biology11121783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
The Latarjet procedure is the most popular surgical procedure to treat anterior glenohumeral (GH) instability in the presence of large anterior glenoid bone defects. Even though the placement of the bone graft has a considerable influence on its efficacy, no clear indications exist for the best graft position. The aim of this study was to investigate the influence of the medial-lateral positioning of the bone graft on the contact mechanics and GH stability due to the bone block effect. Four finite element (FE) models of a GH joint, with a 20% glenoid bone defect, treated by the Latarjet procedure were developed. The FE models differed in the medial-lateral positioning of the bone graft, ranging from a flush position to a 4.5 mm lateral position with respect to the flush position. All graft placement options were evaluated for two separate shoulder positions. Anterior GH instability was simulated by translating the humeral head in the anterior direction, under a permanent compressive force, until the peak translation force was reached. Joint stability was computed as the ratio between the shear and the compressive components of the force. The lateralization of the bone graft increased GH stability due to the bone block effect after a 3 mm lateralization with respect to the flush position. The increase in GH stability was associated with a concerning increase in peak contact pressure due to the incongruous contact between the articulating surfaces. The sensitivity of the contact pressures to the medial-lateral positioning of the bone graft suggests a trade-off between GH stability due to the bone block effect and the risk of osteoarthritis, especially considering that an accurate and consistent placement of the bone graft is difficult in vivo.
Collapse
Affiliation(s)
- Rita Martins
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Carlos Quental
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
- Correspondence:
| | - João Folgado
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Ana Catarina Ângelo
- Hospital CUF Tejo, Av. 24 de Julho, 1350-352 Lisboa, Portugal
- Hospital dos SAMS de Lisboa, Rua Cidade de Gabela, 1849-017 Lisboa, Portugal
| | - Clara de Campos Azevedo
- Hospital CUF Tejo, Av. 24 de Julho, 1350-352 Lisboa, Portugal
- Hospital dos SAMS de Lisboa, Rua Cidade de Gabela, 1849-017 Lisboa, Portugal
| |
Collapse
|
4
|
Kjærbæk F, Juul-Kristensen B, Skou ST, Søndergaard J, Boyle E, Søgaard K, Liaghat B. The association between number of shoulder diagnoses and positive clinical tests with self-reported function and pain: A cross-sectional study of patients with hypermobile joints and shoulder complaints. Musculoskelet Sci Pract 2022; 62:102624. [PMID: 35944447 DOI: 10.1016/j.msksp.2022.102624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with hypermobility spectrum disorder (HSD) and shoulder complaints may suffer from symptoms related to shoulder instability, laxity, and hypermobility. It is currently unknown whether having a more complex clinical status with several diagnoses (i.e., anterior instability (AI), multidirectional instability (MDI), and/or symptomatic localised shoulder hypermobility (LSH), relates to higher functional impairments and pain. OBJECTIVES To investigate the associations between either ≤1, 2, or 3 clinical shoulder diagnoses (AI, MDI, and LSH) or the number (0-10) of positive clinical shoulder tests with shoulder function using the western Ontario shoulder instability index (WOSI, 0-2100, 0 = best) and pain intensity using numerical pain rating scale (NPRS, 0-10, 10 = worse). DESIGN Exploratory cross-sectional study. METHOD From a randomised controlled trial, baseline data from 100 participants with HSD and shoulder complaints for at least three months were included. Associations were investigated using linear regression models, adjusted for age, sex, body mass index, and hand dominance. RESULTS Compared with having ≤1 diagnosis, neither participants with two (WOSI 76.9, 95% CI -136.3, 290.0; NPRS 0.3, 95% CI -0.9, 1.5) nor three (WOSI 35.5, 95% CI -178.5, 249.6; NPRS 0.1, 95% CI -1.1, 1.3) clinical shoulder diagnoses had significantly worse shoulder function or pain. Likewise, the number of positive clinical shoulder tests was not associated with function (WOSI -20.8 95%CI (-55.3, 13.7)) or pain (NPRS -0.1 95%CI (-0.2, 0.1)). CONCLUSIONS In participants with HSD and shoulder complaints, having more additional shoulder diagnoses or increased number of positive shoulder tests were not related to functional impairments or pain intensities.
Collapse
Affiliation(s)
- Frederik Kjærbæk
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| |
Collapse
|
5
|
Novakofski KD, Melugin HP, Leland DP, Bernard CD, Krych AJ, Camp CL. Nonoperative management of anterior shoulder instability can result in high rates of recurrent instability and pain at long-term follow-up. J Shoulder Elbow Surg 2022; 31:352-358. [PMID: 34454036 DOI: 10.1016/j.jse.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Data on the long-term outcomes of nonoperative treatment of anterior shoulder instability are lacking, particularly for the US population. The purpose was to (1) describe the characteristics of patients with anterior shoulder instability treated nonoperatively, (2) assess the long-term outcomes of nonoperative management in a US population, and (3) identify risk factors for poor outcomes following nonoperative management. METHODS A geographic cohort of >500,000 subjects was used to identify patients treated nonoperatively for anterior shoulder instability. Only patients aged <40 years at the time of initial instability with minimum 10-year follow-up were included. Medical records were reviewed to obtain demographic characteristics, physical examination findings, clinical history data, imaging results, treatment details, and clinical and/or radiographic progression. Recurrent pain, recurrent instability, and the development of symptomatic osteoarthritis (OA) were the primary outcomes evaluated. RESULTS The study included 254 patients (73% male) with a median age of 19 years (range, 16-26 years) at the time of initial instability. At median 17-year follow-up, 37.5% experienced recurrent instability, 58.4% had recurrent pain, and 12.2% had symptomatic OA development. Factors associated with recurrent pain at final follow-up were multiple instability events prior to presentation (hazard ratio [HR], 2.43; P < .01) and increased pain at the initial visit (HRs of 0.79 for mild, 1.74 for moderate, and 1.39 for severe; P < .01); patients with multiple instability events prior to presentation also had an increased risk of recurrence (P < .01). Factors increasing the risk of the development of symptomatic OA included increased pain at the initial visit (P = .05), seizure disorder (HR, 27.01; P < .01), and smoking (HR, 5.15; P < .01). CONCLUSIONS At long-term follow-up of 17 years, a high rate of poor outcomes was observed following nonoperative management of anterior shoulder instability. Overall, 37.5% of patients experienced recurrent shoulder instability, 58.4% had recurrent shoulder pain, and 12.2% had symptomatic OA development. Risk factors associated with adverse clinical outcomes included increased pain at the initial visit, recurrent instability prior to presentation, seizure disorder, and smoking.
Collapse
Affiliation(s)
- Kira D Novakofski
- Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Heath P Melugin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Devin P Leland
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
6
|
Verweij LPE, van Spanning SH, Grillo A, Kerkhoffs GMMJ, Priester-Vink S, van Deurzen DFP, van den Bekerom MPJ. Age, participation in competitive sports, bony lesions, ALPSA lesions, > 1 preoperative dislocations, surgical delay and ISIS score > 3 are risk factors for recurrence following arthroscopic Bankart repair: a systematic review and meta-analysis of 4584 shoulders. Knee Surg Sports Traumatol Arthrosc 2021; 29:4004-4014. [PMID: 34420117 PMCID: PMC8595227 DOI: 10.1007/s00167-021-06704-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Determining the risk of recurrent instability following an arthroscopic Bankart repair can be challenging, as numerous risk factors have been identified that might predispose recurrent instability. However, an overview with quantitative analysis of all available risk factors is lacking. Therefore, the aim of this systematic review is to identify risk factors that are associated with recurrence following an arthroscopic Bankart repair. METHODS Relevant studies were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, CINAHL/Ebsco, and Web of Science/Clarivate Analytics from inception up to November 12th 2020. Studies evaluating risk factors for recurrence following an arthroscopic Bankart repair with a minimal follow-up of 2 years were included. RESULTS Twenty-nine studies met the inclusion criteria and comprised a total of 4582 shoulders (4578 patients). Meta-analyses were feasible for 22 risk factors and demonstrated that age ≤ 20 years (RR = 2.02; P < 0.00001), age ≤ 30 years (RR = 2.62; P = 0.005), participation in competitive sports (RR = 2.40; P = 0.02), Hill-Sachs lesion (RR = 1.77; P = 0.0005), off-track Hill-Sachs lesion (RR = 3.24; P = 0.002), glenoid bone loss (RR = 2.38; P = 0.0001), ALPSA lesion (RR = 1.90; P = 0.03), > 1 preoperative dislocations (RR = 2.02; P = 0.03), > 6 months surgical delay (RR = 2.86; P < 0.0001), ISIS > 3 (RR = 3.28; P = 0.0007) and ISIS > 6 (RR = 4.88; P < 0.00001) were risk factors for recurrence. Male gender, an affected dominant arm, hyperlaxity, participation in contact and/or overhead sports, glenoid fracture, SLAP lesion with/without repair, rotator cuff tear, > 5 preoperative dislocations and using ≤ 2 anchors could not be confirmed as risk factors. In addition, no difference was observed between the age groups ≤ 20 and 21-30 years. CONCLUSION Meta-analyses demonstrated that age ≤ 20 years, age ≤ 30 years, participation in competitive sports, Hill-Sachs lesion, off-track Hill-Sachs lesion, glenoid bone loss, ALPSA lesion, > 1 preoperative dislocations, > 6 months surgical delay from first-time dislocation to surgery, ISIS > 3 and ISIS > 6 were risk factors for recurrence following an arthroscopic Bankart repair. These factors can assist clinicians in giving a proper advice regarding treatment. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Lukas P. E. Verweij
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, Netherlands
| | - Sanne H. van Spanning
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
| | - Adriano Grillo
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, Netherlands
| | | | | | - Michel P. J. van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands ,Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| |
Collapse
|
7
|
Verweij LP, Baden DN, van der Zande JM, van den Bekerom MP. Assessment and management of shoulder dislocation. BMJ 2020; 371:m4485. [PMID: 33288499 DOI: 10.1136/bmj.m4485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Lukas Pe Verweij
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, Netherlands
| | - David N Baden
- Emergency Department, Diakonessenhuis, Utrecht, Netherlands
| | - Julia Mj van der Zande
- Department of Orthopaedic Surgery, Shoulder and Elbow unit, OLVG, Amsterdam, Netherlands
| | - Michel Pj van den Bekerom
- Department of Orthopaedic Surgery, Shoulder and Elbow unit, OLVG, Amsterdam, Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| |
Collapse
|
8
|
Comadoll SM, Landry Jarvis D, Yancey HB, Graves BR. The financial burden associated with multiple shoulder dislocations and the potential cost savings of surgical stabilization. JSES Int 2020; 4:584-586. [PMID: 32939490 PMCID: PMC7479037 DOI: 10.1016/j.jseint.2020.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Shoulder dislocation is a costly problem and can have a high risk for recurrent instability after initial dislocation based on well-defined patient characteristics. Patients with recurrent instability can be treated with shoulder stabilizing procedures. Although more costly, surgery may decrease the overall health care burden of managing a patient with multiple shoulder dislocations nonoperatively. Methods We performed a retrospective chart review of all patients who presented to the emergency department (ED) with a diagnosis of a shoulder dislocation at a level 1 academic trauma center during the year 2016. Patient information regarding the current dislocation episode, previous dislocations, shoulder surgeries, and postreduction follow-up was gathered. These data were then used to determine the average cost of an ED presentation for a shoulder dislocation episode as obtained from the hospital finance department. The average cost of shoulder stabilization surgery was used to conduct a cost-benefit analysis of operative vs. nonoperative management. Results Data were collected on 104 individuals who presented to the ED with shoulder dislocations. Of these, 65 were primary dislocations and 39 were recurrent dislocations. Twelve patients underwent shoulder stabilization surgery after their ED presentation. The average cost to the institution for an ED visit requiring the closed reduction of a shoulder dislocation was $2207 ($973.21 without sedation and $3744 with conscious sedation). The average cost of a shoulder stabilization procedure performed at this same institution was $7807. Discussion and conclusion Although shoulder stabilization has a higher cost on the front end, this intervention results in cost savings if it prevents 2-3 future shoulder dislocations resulting in ED visits. These findings suggest that, for patients with a high risk for recurrent instability, not only would stabilization surgery help prevent subsequent dislocation events but would also minimize health care costs.
Collapse
Affiliation(s)
- Shea M Comadoll
- Department of Orthopaedic Surgery, Wake Forest Baptist Hospital, Winston Salem, NC, USA
| | - D Landry Jarvis
- Department of Orthopaedic Surgery, Wake Forest Baptist Hospital, Winston Salem, NC, USA
| | - Hunter B Yancey
- Department of Orthopaedic Surgery, Wake Forest Baptist Hospital, Winston Salem, NC, USA
| | - Benjamin R Graves
- Department of Orthopaedic Surgery, Wake Forest Baptist Hospital, Winston Salem, NC, USA
| |
Collapse
|