Early Identification of Glenohumeral Pathomorphology to Prevent Recurrent Shoulder Instability

Military service members are the most at-risk population for shoulder instability and 80% of these individuals have a re-injury (recurrent instability). Of particular concern are military trainees who are 40X more likely to have a shoulder instability event than their civilian counterparts. The spectrum of shoulder instability includes shoulder subluxations (transient instability that maintains glenohumeral continuity) and frank dislocations (complete glenohumeral disassociation requiring reduction). Following a first-time shoulder instability event, both operative and non-operative management are routinely employed. Both treatment approaches yield outcomes that span the spectrum from complete success (no future instability events) to complete failure (recurrent instability events). Furthermore, there is no evidence to guide the optimal rehabilitation strategy (supervised versus self-managed rehabilitation). Thus, there is no clear indication for what treatment approach is superior and should be employed across the military. The ramifications of incorrect acute management of shoulder instability, will likely have long-term consequences for the individual. Improperly managed shoulders may lead to progressive articular cartilage damage, loss of humeral head or glenoid osseous support and labral-ligamentous injury. Collectively, these progressive sequelae increase the risk for recurrent shoulder instability events. Chronic recurrent instability results in increasing bone loss, higher surgical failure rates, and post-traumatic osteoarthritis. Conversely, immediate surgical stabilization following a single instability event may result in unnecessary surgery that could have been successfully managed with non-operative treatment. Due to the dearth of definitive evidence for the optimal initial method of treatment (operative versus non-operative), a large-scale trial is needed to optimize the outcomes for these most readiness-impairing and burdensome injuries. The findings of this study will inform military specific clinical practice guidelines (CPGs) that will lead to optimized management of shoulder instability in a young, physically active military population. Optimal management of shoulder instability will result in improved patient outcomes, maximize warfighter return to duty/activity (RTD/A) and mitigate re-injury in Service Members with shoulder instability. Collectively, the results of this study will result in improved Force medical readiness. This proposal also directly responds to the surgical and rehabilitation techniques and outcomes for soft tissue trauma of common musculoskeletal injuries for enhanced RTD/A techniques and outcomes for soft tissue trauma of common musculoskeletal injuries for enhanced RTD/A.