Atraumatic Shoulder Instability: Patient Characteristics, Co-morbidities & Disability

Background Atraumatic shoulder instability of the shoulder is well described and numerous extrinsic factors have been identified as having a negative influence on long-term shoulder function, including age, sex, smoking, and workers’ compensation status. Furthermore, physical factors such as acute or chronic pain, as well as psychological co-morbidities such as depression and suicidal thoughts are common in shoulder related conditions. Methods Patients with atraumatic shoulder instability were recruited from a review of outpatient logbook and inpatient rehabilitation center admission records. Average and worst pain VAS rates were recorded for acute and chronic shoulder pain. Disability was measured using the "Disability of the Arm and Hand" (DASH) score, as well as the Stanmore percentage of normal shoulder assessment (SPONSA). Depression was assessed using Becks Depression Inventory II (BDI-II) and further single psychological items were selected from other psychological assessment questionnaires. Results We included 64 patients, of which 51 (79.7%) were female. Mean VAS pain scores were in average 5.11 (SD 2.24) and 5.58 (SD 2.34) for acute and chronic shoulder pain respectively. A stepwise, multiple linear regression revealed that only chronic shoulder pain remained significantly related to disability (F(1,61)=46.13, p Conclusion In addition to socio-demographic factors, pain and psychological co-morbidities were found to have a negative impact on patient’s functional outcome. This study further supports the need for an MDT, holistic approach in the management of atraumatic shoulder instability patients with particular emphasis on chronic pain management and psychological support.