Treatment of Initial Anterior Shoulder Instability in National Hockey League Players: A Survey of NHL Team Physicians

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2024 Dec 16

PMID 39678437

Authors

Neilen A Benvegnu

Ryan Gnandt

Michael Nammour

Neel Patel

William Schulz

Ryan Eads

Dharmesh Vyas

Affiliations

Soon will be listed here.

Abstract

Background: Managing an in-season anterior shoulder instability poses a special challenge for team physicians, as they need to balance the aim of promptly returning the athlete to play while mitigating the chances of recurrence and further injury to the shoulder.

Purpose: To investigate and report on the treatment preferences of National Hockey League (NHL) team physicians when managing in-season first-time anterior shoulder instability in professional hockey players.

Study Design: Cross-sectional study.

Methods: A survey consisting of 33 sport-specific questions focused on the treatment options and preferences for anterior shoulder instability in hockey players was developed, and 32 NHL team physicians were invited to anonymously complete the survey. Following the collection of the data, the distribution of the responses to each question was documented as counts and percentages.

Results: Of the 32 invited team physicians, 31 (97%) completed all (n = 28) or most (n = 3) of the survey. The mean experience of the respondents was 13 ± 11 years. A total of 28 (90%) respondents would attempt nonoperative treatment of an in-season initial anterior shoulder dislocation with an isolated soft tissue injury, while 28 (90%) would recommend operative treatment of the same injury with bony involvement. Of the 31 respondents, 30 (97%) utilized rehabilitation parameters rather than time from injury when determining whether a player could return to play. Of those parameters, clinical strength (100%), range of motion (87%), anterior apprehension (84%), and pain (65%) were the most utilized. For surgical management of an isolated soft tissue lesion, 28 (90%) of the respondents preferred arthroscopic repair, while 2 (7%) preferred open repair.

Conclusion: Of the 32 NHL team physicians surveyed, 28 preferred nonoperative management for the treatment of initial anterior shoulder dislocations with isolated soft tissue injuries, while initial operative management was preferred by the same number of team physicians for any injuries with bony involvement.

References

Liu J, Garcia G, Weeks K, Joseph J, Limpisvasti O, McFarland E . Treatment of Grade III Acromioclavicular Separations in Professional Baseball Pitchers: A Survey of Major League Baseball Team Physicians. Am J Orthop (Belle Mead NJ). 2018; 47(7). DOI: 10.12788/ajo.2018.0051. View

Okoroha K, Taylor K, Marshall N, Keller R, Fidai M, Mahan M . Return to play after shoulder instability in National Football League athletes. J Shoulder Elbow Surg. 2017; 27(1):17-22. DOI: 10.1016/j.jse.2017.07.027. View

Chen A, Hunt S, Hawkins R, Zuckerman J . Management of bone loss associated with recurrent anterior glenohumeral instability. Am J Sports Med. 2005; 33(6):912-25. DOI: 10.1177/0363546505277074. View

Harris J, Gupta A, Mall N, Abrams G, McCormick F, Cole B . Long-term outcomes after Bankart shoulder stabilization. Arthroscopy. 2013; 29(5):920-33. DOI: 10.1016/j.arthro.2012.11.010. View

Wilk K, Andrews J, Arrigo C . The abductor and adductor strength characteristics of professional baseball pitchers. Am J Sports Med. 1995; 23(6):778. DOI: 10.1177/036354659502300627. View

Cools A, Vanderstukken F, Vereecken F, Duprez M, Heyman K, Goethals N . Eccentric and isometric shoulder rotator cuff strength testing using a hand-held dynamometer: reference values for overhead athletes. Knee Surg Sports Traumatol Arthrosc. 2015; 24(12):3838-3847. DOI: 10.1007/s00167-015-3755-9. View

Dekker T, Goldenberg B, Lacheta L, Horan M, Millett P . Anterior Shoulder Instability in the Professional Athlete: Return to Competition, Time to Return, and Career Length. Orthop J Sports Med. 2020; 8(11):2325967120959728. PMC: 7645762. DOI: 10.1177/2325967120959728. View

Matheson G, Shultz R, Bido J, Mitten M, Meeuwisse W, Shrier I . Return-to-play decisions: are they the team physician's responsibility?. Clin J Sport Med. 2011; 21(1):25-30. DOI: 10.1097/JSM.0b013e3182095f92. View

Buss D, Lynch G, Meyer C, Huber S, Freehill M . Nonoperative management for in-season athletes with anterior shoulder instability. Am J Sports Med. 2004; 32(6):1430-3. DOI: 10.1177/0363546503262069. View

10.

Dwyer T, Petrera M, Bleakney R, Theodoropoulos J . Shoulder instability in ice hockey players: incidence, mechanism, and MRI findings. Clin Sports Med. 2013; 32(4):803-13. DOI: 10.1016/j.csm.2013.07.013. View

11.

Provencher M, Midtgaard K, Owens B, Tokish J . Diagnosis and Management of Traumatic Anterior Shoulder Instability. J Am Acad Orthop Surg. 2020; 29(2):e51-e61. DOI: 10.5435/JAAOS-D-20-00202. View

12.

Ma R, Brimmo O, Li X, Colbert L . Current Concepts in Rehabilitation for Traumatic Anterior Shoulder Instability. Curr Rev Musculoskelet Med. 2017; 10(4):499-506. PMC: 5685970. DOI: 10.1007/s12178-017-9449-9. View

13.

Swindell H, McCormick K, Tedesco L, Herndon C, Ahmad C, Levine W . Shoulder instability, performance, and return to play in National Hockey League players. JSES Int. 2020; 4(4):786-791. PMC: 7738589. DOI: 10.1016/j.jseint.2020.08.008. View

14.

Bottoni C, Smith E, Berkowitz M, Towle R, Moore J . Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomized clinical trial. Am J Sports Med. 2006; 34(11):1730-7. DOI: 10.1177/0363546506288239. View

15.

Cools A, Palmans T, Johansson F . Age-related, sport-specific adaptions of the shoulder girdle in elite adolescent tennis players. J Athl Train. 2014; 49(5):647-53. PMC: 4208869. DOI: 10.4085/1062-6050-49.3.02. View

16.

Itoi E, Lee S, Berglund L, Berge L, An K . The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am. 2000; 82(1):35-46. DOI: 10.2106/00004623-200001000-00005. View

17.

Anderson M, Mack C, Herzog M, Levine W . Epidemiology of Shoulder Instability in the National Football League. Orthop J Sports Med. 2021; 9(5):23259671211007743. PMC: 8113962. DOI: 10.1177/23259671211007743. View

18.

Petrera M, Patella V, Patella S, Theodoropoulos J . A meta-analysis of open versus arthroscopic Bankart repair using suture anchors. Knee Surg Sports Traumatol Arthrosc. 2010; 18(12):1742-7. DOI: 10.1007/s00167-010-1093-5. View

19.

Fabbriciani C, Milano G, Demontis A, Fadda S, Ziranu F, Mulas P . Arthroscopic versus open treatment of Bankart lesion of the shoulder: a prospective randomized study. Arthroscopy. 2004; 20(5):456-62. DOI: 10.1016/j.arthro.2004.03.001. View

20.

Burkhart S, De Beer J . Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000; 16(7):677-94. DOI: 10.1053/jars.2000.17715. View