Repetitive Microtrauma in Glenohumeral Joint during Sports Activities on Athlete, leading to Shoulder Instability: A Brief Review
DOI:
https://doi.org/10.31282/joti.v5n2.98Keywords:
microtrauma, glenohumeral joint, sport, athlete, shoulder instabilityAbstract
Background: Shoulder instability due to sports injuries may cause pain and create shoulder dysfunction, hampering
an athlete’s career. Therefore, an article regarding the management of shoulder instability is very important.
Methods: This study is a brief review regarding the current therapeutic concepts of shoulder instability, rehabilitation,
and when an athlete can return to sport.
Results: Sport that often relies on shoulder movement during active participation such as gymnastics, volleyball,
rugby, swimming, volleyball, and basketball may cause repetitive microtrauma which leads to shoulder instability.
Shoulder instability can be managed with a non surgical or surgical approach. The main non-surgical management
is adequate pain control, closed reduction, immobilization, and rehabilitation. To prevent recurrent dislocation, the
patients need to be advised to avoid falls and other shoulder injuries, avoid extreme sports, use protective gear when
participating in contact sports, and performed regular exercise. For able to return to sports, we advised that range of
motion and muscle strength should be nearly similar to healthy contralateral shoulder, and pain-free activities must
be achieved. Generally, it can be obtained within 2-3 weeks. In the case of surgery, the patients usually may return
to sports in 4 to 6 months after surgery, and the majority can resume their pre-injury activity level.
Conclusion: Athletes need to be disengaged in post-operative rehabilitation protocol to gain an optimal result.
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References
Mihata T, Gates J, McGarry MH, et al. Effect of rotator cuff muscle imbalance on forceful internal impingement and peel-back of the superior labrum: a cadaveric study. Am J Sports Med 2009; 37: 2222–2227.
Saccomanno MF, Fodale M, Capasso L, et al. Generalized joint laxity and multidirectional instability of the shoulder. Joints 2013; 1: 171–179.
Johnson SM, Robinson CM. Shoulder instability in patients with joint hyperlaxity. J Bone Joint Surg Am 2010; 92: 1545–1557.
Cuéllar R, Ruiz-Ibán MA, Cuéllar A. Anatomy and Biomechanics of the Unstable Shoulder. Open Orthop J 2017; 11: 919–933.
Keller RA, De Giacomo AF, Neumann JA, et al. Glenohumeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes: A Meta-Analysis and Systematic Review. Sports Health 2018; 10: 125–132.
Kuhn JE. A new classification system for shoulder instability. Br J Sports Med 2010; 44: 341–346.
Mansyur As, Widyahening Is, Sudarsono Ncahyani. Incidence of musculoskeletal injuries among Indonesian volleyball athletes during a national training and championship. Gazzetta Medica Italiana Archivio per le Scienze Mediche. 2021 Jul;180(7-8):374-379.
Sofu H. Recurrent anterior shoulder instability: Review of the literature and current concepts. World J Clin Cases 2014; 2: 676.
Huysmans PE, Haen PS, Kidd M, et al. The shape of the inferior part of the glenoid: a cadaveric study. J shoulder Elb Surg 2006; 15: 759–763.
Bradley JP, Baker CL 3rd, Kline AJ, et al. Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 100 shoulders. Am J Sports Med 2006; 34: 1061–1071.
Doukas WC, Speer KP. Anatomy, pathophysiology, and biomechanics of shoulder instability. Orthop Clin North Am 2001; 32: 381–91, vii.
Novi M, Nicoletti S. The Remplissage Technique for Hill – Sachs Lesions in Competitive Athletes : A Narrative Review. 2022; 152–160.
Thompson JC. Netter's concise atlas of orthopaedic anatomy. First edition. Teterboro, NJ : Icon Learning Systems, [2002] ©2002, https://search.library.wisc.edu/catalog/999947930402121.
Goetti P, Denard PJ, Collin P, et al. Shoulder biomechanics in normal and selected pathological conditions. EFORT Open Rev 2020; 5: 508–518.
Lugo R, Kung P, Ma CB. Shoulder biomechanics. Eur J Radiol 2008; 68: 16–24.
Zumstein MA, Jost B, Gerber C. Instability of the shoulder in athletes. Schweizerische Zeitschrift fur Sport und Sport 2005; 53: 27–35.
Walton J, Paxinos A, Tzannes A, et al. The unstable shoulder in the adolescent athlete. Am J Sports Med 2002; 30: 758–767.
Lizzio VA, Meta F, Fidai M, et al. Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability. Curr Rev Musculoskelet Med 2017; 10: 434–441.
Tannenbaum E, Sekiya JK. Evaluation and management of posterior shoulder instability. Sports Health 2011; 3: 253–263.
Hasebroock AW, Brinkman J, Foster L, et al. Management of primary anterior shoulder dislocations: a narrative review. Sport Med - Open 2019; 5: 31.
Alkaduhimi H, van der Linde JA, Flipsen M, et al. A systematic and technical guide on how to reduce a shoulder dislocation. Turkish J Emerg Med 2016; 16: 155–168.
Dong H, Jenner EA, Theivendran K. Closed reduction techniques for acute anterior shoulder dislocation: a systematic review and meta-analysis. Eur J trauma Emerg Surg Off Publ Eur Trauma Soc 2021; 47: 407–421.
Yuen M-C, Yap P-G, Chan Y-T, et al. An easy method to reduce anterior shoulder dislocation: the Spaso technique. Emerg Med J 2001; 18: 370 LP – 372.
Shah R, Chhaniyara P, Wallace WA, et al. Pitch-side management of acute shoulder dislocations: A conceptual review. BMJ Open Sport Exerc Med 2017; 2: 1–9.
Shinagawa K, Sugawara Y, Hatta T, et al. Immobilization in External Rotation Reduces the Risk of Recurrence After Primary Anterior Shoulder Dislocation: A Meta-analysis. Orthop J Sport Med 2020; 8: 2325967120925694.
Kavaja L, Lähdeoja T, Malmivaara A, et al. Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis. Br J Sports Med 2018; 52: 1498–1506.
Whelan DB, Kletke SN, Schemitsch G, et al. Immobilization in External Rotation Versus Internal Rotation After Primary Anterior Shoulder Dislocation: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2016; 44: 521–532.
Parnes N, Perrine J, Fish KJ. Step-by-step evaluation and treatment of shoulder dislocation. J Fam Pract 2021; 70: 367–402.
van Spanning SH, Verweij LPE, Priester-Vink S, et al. Operative Versus Nonoperative Treatment Following First-Time Anterior Shoulder Dislocation: A Systematic Review and Meta-Analysis. JBJS Rev; 9. Epub ahead of print September 2021. DOI: 10.2106/JBJS.RVW.20.00232.
Cheok CY, Mohamad JA, Ahmad TS. Pain relief for reduction of acute anterior shoulder dislocations: a prospective randomized study comparing intravenous sedation with intra-articular lidocaine. J Orthop Trauma 2011; 25: 5–10.
Sambandam SN, Khanna V, Gul A, et al. Rotator cuff tears: An evidence based approach. World J Orthop 2015; 6: 902–918.
Emond M, Le Sage N, Lavoie A, et al. Clinical factors predicting fractures associated with an anterior shoulder dislocation. Acad Emerg Med Off J Soc Acad Emerg Med 2004; 11: 853–858.
Boffano M, Mortera S, Piana R. Management of the first episode of traumatic shoulder dislocation. EFORT open Rev 2017; 2: 35–40.
Hohmann E, Tetsworth K, Glatt V. Open versus arthroscopic surgical treatment for anterior shoulder dislocation: a comparative systematic review and meta-analysis over the past 20 years. J shoulder Elb Surg 2017; 26: 1873–1880.
Frank RM, Saccomanno MF, McDonald LS, et al. Outcomes of arthroscopic anterior shoulder instability in the beach chair versus lateral decubitus position: a systematic review and meta-regression analysis. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 2014; 30: 1349–1365.
DeFroda S, Bokshan S, Stern E, et al. Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes. Curr Rev Musculoskelet Med 2017; 10: 442–451.
van der Linde JA, van Wijngaarden R, Somford MP, et al. The Bristow-Latarjet procedure, a historical note on a technique in comeback. Knee Surg Sports Traumatol Arthrosc 2016; 24: 470–478.
Aydin N, Enes Kayaalp M, Asansu M, et al. Treatment options for locked posterior shoulder dislocations and clinical outcomes. EFORT open Rev 2019; 4: 194–200.
Williams HLM, Evans JP, Furness ND, et al. It’s Not All About Redislocation: A Systematic Review of Complications After Anterior Shoulder Stabilization Surgery. Am J Sports Med 2019; 47: 3277–3283.
Schliemann B, Minkus M, Seybold D, et al. Conservative management of first-time traumatic anterior shoulder dislocation. Obere Extrem 2021; 16: 2–7.
Onks C, Silvis M, Loeffert J, et al. Conservative or surgical management for that shoulder dislocation? J Fam Pract 2021; 70: 80–85.
