Bracing Options for Shoulder Instability

1. James Penna,MD Bracing OptionsforShoulder Instability

2. Case Study • Pat St. Jock sustains a shoulder dislocation during the first drill of the first practice of the season. The Athletic Trainer manages to reduce the shoulder before the ambulance arrives which greatly alleviates symptoms. The ER work-up is negative for fracture, they advise follow-up with Ortho in a couple of days. • 8am the following morning Pat is sitting in your office looking for advice on how to proceed.

3. What do we know? • 1st time dislocator • No fractures • Pat wants to play

4. Decision Support • Sport/Desired activity • Dominant Arm in Overhand athlete • Marine? • Physical Exam • !!!!Deltoid Function!!!! • X-rays • Are they enough?

5. MRI • Labral Tear • Bankart called it the ‘essential’ lesion • Cuff Tear • Glenoid Fracture • Bony Bankart • Humeral Head Fracture • Other?

10. That’s not Pat • “Changes on axial sequences suggestive of labral tearing. Recommend MR arthrogram for more definitive visualization.”

11. This is reality (Hypothetically) • Treat the patient • Immobilize • Rehabilitate • Return to activity • ?Brace

12. Immobilize

13. Immobilize

14. Immobilize

15. Which one? How Long? • No one has been able to reproduce the Japanese results. • ER is probably slightly better than traditional • But both stink • 40% recurrence for all comers • Much higher in college population • 1 week no different than 3 or 6

16. Personally • 2wks with pillow or moderate ER • Regular sling for Negative MRI • Strengthening program • Functional brace

17. Functional Bracing

18. Sully

19. Duke-Wyre

20. Sawa

21. Generic Neoprene

22. Other?

23. Evidence based • Limited • Just like the knee there seems to be a benefit to tactile contact • Improved Proprioception/Kinesthetic Sense • Improved Confidence

24. Well Why the Heck Not? • Recurrent instability can create trouble