Reducing Fear and Kinesiophobia in a Patient With Recurrent Shoulder Instability and Failed Stabilization Surgeries: A Case Report.

Context: Kinesiophobia, defined as the fear of reinjury and movement, is a risk factor for recurrent shoulder instability and remains unchanged unless specifically treated in clinical practice. Fear of reinjury is a reason for athletes not returning to sport after shoulder instability or stabilization surgery. Although physical rehabilitation is commonly used to address deficits in strength and range of motion after shoulder stabilization surgery, there are few documented clinical strategies to address kinesiophobia in athletes after shoulder stabilization surgery.

Case presentation: This case report outlines the postoperative rehabilitation of a 23-year-old male who had undergone repeat Latarjet stabilization surgery, following previous failed Latarjet and arthroscopic stabilization surgeries and multiple episodes of instability. He presented with increased levels of kinesiophobia and decreased range of motion and strength following his Latarjet surgery.

Management and outcomes: As an adjunct to his physical rehabilitation, graded exposure to fear-eliciting images was used to decrease kinesiophobia and was measured with the Tampa Scale of Kinesiophobia 11-item questionnaire. Usual physical rehabilitation included progressive range of motion and strength exercises. Kinesiophobia decreased with a change in Tampa Scale of Kinesiophobia-11 scores from 33/44 (moderate kinesiophobia) to 24/44 (low kinesiophobia) during his rehabilitation, which is greater than the minimal detectable change of the Tampa Scale of Kinesiophobia-11 (5.6-5.9). The secondary outcome of shoulder strength improved to within 5% of the opposite side below shoulder height, although strength deficits remained overhead. Range of movement also improved; specifically, external rotation in neutral increased from 5° to 40°.

Conclusions: Motor imagery techniques such as graded exposure to fear eliciting images may be used in clinical practice as an adjunct to physical rehabilitation to decrease kinesiophobia in people with shoulder instability. Clinical rehabilitation could address the physical and psychological impact of shoulder instability using graded imagery. Future research could explore the use of fear-eliciting images on physiological and clinical outcomes.