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. 2016 Jun;136(6):741-6.
doi: 10.1007/s00402-016-2443-7. Epub 2016 Mar 14.

International survey and surgeon's preferences in diagnostic work-up towards treatment of anterior shoulder instability

Hanneke Weel  1 , Wouter Tromp  2 , Peter R Krekel  3 , Pietro Randelli  4 , Michel P J van den Bekerom  5 , Derek F P van Deurzen  5
Affiliations

International survey and surgeon's preferences in diagnostic work-up towards treatment of anterior shoulder instability

Hanneke Weel et al. Arch Orthop Trauma Surg. 2016 Jun.

Abstract

Purpose: Recurrent anterior shoulder instability after surgical treatment can be caused by bony defects. Several diagnostic tools have been designed to measure the extent of these bony lesions. Currently, there is no consensus which measurement tool to use and decide which type of surgery is most appropriate. We therefore performed an evaluation of agreement in surgeons' preference of diagnostic work-up and surgical treatment of anterior shoulder instability.

Methods: An international survey was conducted amongst orthopaedic shoulder surgeons. The survey contained questions about surgeons' experience, clinical and radiological examination and the subsequent treatment for anterior shoulder instability. Descriptive statistics were used to present the data, and percentages of responding surgeons were calculated.

Results: The questionnaire was completed by 197 delegates from 46 countries. 55 % of the respondents think evidence in current literature is sufficient on diagnostic work-up for anterior shoulder instability. Anamnestic, number of dislocations was most frequently asked (by 95 % of respondents), the most frequently used test is the apprehension test (91 %). For imaging, conventional X-ray in various directions was most performed, followed by MR arthrography and plane CT scan respectively. The responding surgeons perform surgery (labrum repair or Latarjet) in 51 % of the patients. A median of 25 % glenoid bone loss was given by the respondents, as cut-off from when to perform a bony repair.

Conclusion: Many different diagnostic examinations for assessing shoulder instability are used and a high variety is seen in the use of diagnostic tools. Also no consensus is seen in the use of different surgical options (arthroscopic and open procedures). This implies the need for more research on diagnostic imaging and the correlation with specific subsequent surgical treatment.

Level of evidence: Survey, level of evidence IV.

Keywords: Anterior instability; Diagnostic; Recurrence; Shoulder joint; Survey.

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Figures

Fig. 1
Fig. 1
Most asked patient characteristics. 1 Profession, 2 performing sports, 3 traumatic event, 4 number of dislocations
Fig. 2
Fig. 2
Most performed physical examination tests given in percentages (%)
See this image and copyright information in PMC

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