Shoulder instability is a common injury for High School and College athletes. Recently, Dr. Arvesen, orthopedic surgeon and sports medicine specialist at OrthoTexas, participated in research to look at the frequency of these injuries, the symptoms, and the treatments available for them. His research and findings were subsequently published in an article in the Journal of Shoulder and Elbow Surgery.
Shoulder injuries in young athletes are usually the result of repetitive motion, which creates microtears in the labrum. Trauma, such as occurs in contact sports, falling on an outstretched arm, or heavy lifting that can also cause labral tears. A shoulder injury or instability is classified as either an anterior or posterior injury. With an anterior injury, the more common of the two, the pain is usually felt in the front of the shoulder, along the joint line, and there may be a feeling of instability, impingement or clicking or popping. Common triggers for this type of injury are throwing sports such as baseball, contact sports like football or basketball, or overhead sports such as volleyball. Weightlifters, swimmers, gymnasts and wrestlers are more prone to posterior shoulder injuries. This injury is often characterized by pain in the back of the shoulder or vague pain in the shoulder, popping, clicking or instability and feeling like the shoulder will dislocate.
For a long time anterior and posterior shoulder injuries have been treated in a similar way, but this new research shows that there are some important differences in symptoms and treatments for the two injuries. Athletes with anterior instability were found to more often complain of instability of the shoulder, up to 70% of people with this injury, whereas the primary complaint for someone with a posterior injury (in 96% of cases) was pain so significant that interfered with their ability to function.
Most patients in the study completed conservative treatment initially. Those with anterior instability had much more initial disability than those individuals with the posterior injury, however they saw greater improvement from non-operative care than those with a posterior shoulder injury. Those with a posterior individuals continued to have persistent pain and less improvement, which ultimately led to surgery for a more complete recovery.
The study concluded that posterior and anterior instability are separate injuries, requiring a different course of treatment. Those individuals with anterior shoulder injuries can often return to sport after completing a course of conservative treatments such as immobilization, anti-inflammatories and physical therapy, whereas those with posterior injuries have a more significant disability and often need surgical intervention to repair the shoulder and return to their sport. The good news is that surgical intervention for both anterior and posterior shoulder injuries has excellent outcomes and athletes are most often able to return to their pre-injury level of play.