Rehabilitation after arthroscopic shoulder stabilisation: are we letting patients down by being too conservative?

Abstract

The glenohumeral joint is the most commonly dislocated joint in the body,1 primarily due to sports-related injuries, with up to 15% of contact athletes having experienced shoulder dislocation.2 Surgical stabilisation is a common treatment after dislocation, particularly in young males, as it reduces the risk of recurrent instability.3 Over 20,000 shoulder stabilisation procedures are performed annually in the USA, with increasing incidence over time.4 In Finland, a similar trend has been observed, with the incidence of stabilisation surgery increasing by 177% from 1997 to 2014, particularly among young and middle-aged adults.5 Despite the effectiveness of soft tissue surgical stabilisation, one-fourth of people undergoing surgery never return to their pre-injury sport and activities, and one-third report ongoing instability.6 While numerous functional, psychological and surgical factors contribute to these findings, >50% of cases have been attributed to shoulder-related causes (instability, apprehension, reduced athletic performance and pain).7 Patients experience a significant reduction in functional strength, range of motion (ROM) and neuromuscular control 4–6 months post-operatively,8 a critical period for returning to work and sport. These problems are modifiable and could be addressed by improved, evidence-based and criterion-based post-surgical rehabilitation protocols. This commentary explores the potential value of accelerated rehabilitation after arthroscopic shoulder stabilisation. The most recent consensus on a specific rehabilitation protocol after arthroscopic Bankart repair (ABR) was reached by the American Society of Shoulder …