Traumatic Instability: Treatment Options and Considerations for Recurrent Posttraumatic Instability

Background: Shoulder instability, particularly recurrent instability following an acute injury, is a significant concern for athletes and active individuals. This condition often arises after an initial traumatic dislocation, leading to pain, functional limitations, and a heightened risk of subsequent dislocations. Managing recurrent instability is crucial as it can severely affect an athlete's performance and overall quality of life. Treatment options vary from conservative approaches like physical therapy and bracing to surgical interventions aimed at stabilizing the shoulder joint. Understanding the effectiveness and appropriateness of these treatment methods is essential for optimizing patient outcomes. Methods: This comprehensive review analyzes current literature regarding treatment options for recurrent post-traumatic shoulder instability, focusing on studies published from ۲۰۰۰ to ۲۰۲۲. This review includes randomized controlled trials, cohort studies, and case series that examined both non-operative and operative management strategies. Key evaluated parameters included recurrence rates, functional outcomes, and patient satisfaction associated with various treatment methods. Results: The analysis revealed that non-surgical management remains a viable first-line approach for patients with recurrent post-traumatic instability. Physical therapy emphasizing rotator cuff strengthening and scapular stabilizers has proven effective in enhancing shoulder stability and function, with approximately ۵۰% of patients undergoing conservative treatment reporting satisfactory outcomes without recurrence of instability. However, for those who continue to experience symptoms or require high levels of activity, surgical intervention may be necessary. Among surgical options, arthroscopic stabilization techniques such as Bankart repair and the Latarjet procedure have shown favorable results in reducing recurrence rates (۲.۹% to ۸%) but are associated with higher complication rates (۲۵% to ۳۰%). It is important to consider that the choice of surgical method should be based on factors such as the patient's age, activity level, and specific anatomical considerations. Conclusion: Recurrent shoulder instability after trauma poses significant challenges for affected individuals, particularly athletes. While non-surgical management may be effective for many patients, those with persistent symptoms may require surgical intervention to restore stability and function. The Latarjet procedure and other arthroscopic techniques offer promising results but come with risks that need careful consideration. Future research should focus on refining treatment protocols and developing guidelines that facilitate shared decision-making between physicians and patients.

کلیدواژه ها:

Traumatic shoulder instability ، recurrent instability ، posttraumatic dislocation ، non-operative treatment ، surgical stabilization