Accuracy of the anterior apprehension test as a predictor of risk for redislocation after a first traumatic shoulder dislocation.
BACKGROUND
The treatment options for a first traumatic shoulder dislocation in a young patient are either nonoperative care or primary surgery. It would be valuable to find patient-specific assessments that could predict the risk for redislocation in these patients and thereby identify those who would benefit from primary surgery.


OBJECTIVE
The supine apprehension test, performed after completion of physical therapy in first traumatic shoulder dislocators, can predict risk for redislocation. Patients with a positive test would be at very high risk for redislocation and therefore would be candidates for primary surgery.


METHODS
Cohort study (prognosis); Level of evidence, 2.


METHODS
Men aged 17 to 27 years who sustained first traumatic shoulder dislocations were treated in a shoulder immobilizer for 4 weeks and then treated according to a physical therapy protocol. At the 6-week follow-up, an anterior apprehension test was performed to assess risk of redislocation. Follow-up of patients was done at 3 months, 6 months, 1 year, and 2 years. Follow-up continued yearly for up to another 2 years.


RESULTS
Fifty-two men with a mean age of 20.3 years (standard deviation, 2.5) participated. Seventy-nine percent were combat soldiers. Twenty-four participants (46.2%) sustained redislocation. The minimum follow-up period was 24 months (range, 24-48 months; mean, 39.6 months). Redislocations were sustained in 36.8% of participants with negative apprehension tests and 71.4% with positive tests (P = .03). The odds ratio was 4.285 (95% confidence interval, 1.129-16.266). The sensitivity of the apprehension test was 41.7% and the specificity was 85.7%.


CONCLUSIONS
The anterior apprehension test performed 6 to 9 weeks after a first traumatic dislocation is not a definitive tool to predict risk for recurrent dislocation. It can, however, categorize patients into groups at higher and lower risk for recurrence. The redislocation rate found in this study is less than that of previous reports.
Department of Orthopaedics, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel.
Ori
O
Safran
Charles
C
Milgrom
Denitsa R
DR
Radeva-Petrova
Saleh
S
Jaber
Aharon
A
Finestone
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D015331:Cohort Studies; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control / Q000601:surgery; D008297:Male; D008889:Military Personnel; D019637:Orthopedic Procedures; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012307:Risk Factors; D055502:Secondary Prevention; D012783:Shoulder Dislocation / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D013484:Supination; D016896:Treatment Outcome; D055815:Young Adult