Trends in management of shoulder instability: Indian perspectives

Abstract

Objectives: Shoulder instability is a commonly seen injury in orthopedics practice. The current survey aimed to assess strategies in the management of shoulder instability among orthopedic surgeons in India. Materials and Methods: A survey was created by a group of surgeons who are regularly managing shoulder instability and it was distributed among the various orthopedic surgeons from India. The questionnaire included brief details of surgeons and their experience, clinical assessment, management strategies, and the rehabilitation protocol. We also assess any difference in management strategies of Orthopaedic surgeon (OS group) as compared to fellowship trained sports surgeons/shoulder surgeons (FS group). Results: Ninety-seven orthopedic surgeons participated in the survey. Sixty-four percent were in the age group between 35 and 50 years. Forty-six percent of them were managing these injuries for more than 12 years. 37.5% of surgeons were from government academic institutes. Eighty percent of respondents treat first-time dislocation conservatively. The decision regarding the type of surgery is based on the percentage of bone loss, the number of dislocations, age of the patients as per the majority of respondents. Arthroscopic Bankart’s repair is the most commonly used procedure for anterior shoulder instability. The common criteria for return to sports include a glenohumeral range of motion, rotator strength, functional performance test, type of sports, and ability of the athlete to perform. Conclusion: Bankart’s repair is the most common procedure performed in patients with shoulder instability with minimal bone loss. Computer tomography scan is one of the preferred investigation modalities along with X-ray and magnetic resonance imaging in the first-time dislocation as per FS group. Remplissage in addition to Bankart’s repair is performed by a significantly higher number of participants from FS group as compared to OS group. Levelofevidence: Level V, expert opinion.