Shoulder joint instability often results from traumatic injuries that occur in young athletes participating in contact sports, according to a literature review in the Journal of the American Academy of Orthopaedic Surgeons. Common causes include force or falling on an outstretched arm; a direct blow to the shoulder area; forceful throwing, lifting, or hitting; and contact with another player. Key statistics from studies of shoulder joint instability injuries in young athletes include the following:
• In 45% of shoulder joint instability injuries, young athletes lost more than 10 days from participation in sports activity.
• Young male athletes are at greatest risk for shoulder joint instability injuries and recurrence of injuries.
• In one study, the rate of athletes who reinjured their shoulder was higher in patients younger than 23 years (72%) than in those older than 30 years (27%).
• Young athletes aged 15 to 20 years who were treated nonsurgically had an injury recurrence rate of 87%.
• Shoulder arthritis occurred in up to 40% of athletes with recurring shoulder instability injuries. Nonsurgical management of shoulder joint instability injuries consists of brief shoulder immobilization and early rehabilitation. Points to consider with nonsurgical management include the following:
• Athletes should return to sports activity only when they achieve full pain-free motion.
• Motion-restricting braces or sleeves that prevent extreme overhead motion may help prevent recurring injuries among nonthrowing athletes but may limit function and level of play.
• Rehabilitation may help some athletes return to sports activity within 3 weeks after an initial injury. However, the risk of shoulder joint instability recurring is greater with early return to sports activity.
Surgical management tips include the following:
• Recurrent shoulder joint instability or an inability to perform sport-specific drills safely even with rehabilitation, activity modification, or bracing is an indication that surgical management options need to be considered.
• Early surgical stabilization removes the athlete from the competitive season and provides definitive management of shoulder joint instability, typically with unrestricted return to sports activity in 6 to 9 months.
• Athletes with bone loss, recurrent instability, an instability event that occurs at the end of the season, or an inability to perform sport-specific drills are candidates for surgical stabilization.
A team approach to return-to-competition decisions that includes the athlete, his or her parents and family, athletic training staff, the team physician, and coaching staff is recommended. The goal always should be to serve the best interests of the athlete and to achieve a stable shoulder with return of full range of motion and strength.
