title: International survey and surgeon's preferences in diagnostic work-up towards treatment of anterior shoulder instability.
abstract: OBJECTIVE
  Recurrent anterior shoulder instability after surgical treatment can be caused by bony defects. Several diagnostic tools have been designed to measure the extent of these bony lesions. Currently, there is no consensus which measurement tool to use and decide which type of surgery is most appropriate. We therefore performed an evaluation of agreement in surgeons' preference of diagnostic work-up and surgical treatment of anterior shoulder instability.
  
  
  METHODS
  An international survey was conducted amongst orthopaedic shoulder surgeons. The survey contained questions about surgeons' experience, clinical and radiological examination and the subsequent treatment for anterior shoulder instability. Descriptive statistics were used to present the data, and percentages of responding surgeons were calculated.
  
  
  RESULTS
  The questionnaire was completed by 197 delegates from 46 countries. 55 % of the respondents think evidence in current literature is sufficient on diagnostic work-up for anterior shoulder instability. Anamnestic, number of dislocations was most frequently asked (by 95 % of respondents), the most frequently used test is the apprehension test (91 %). For imaging, conventional X-ray in various directions was most performed, followed by MR arthrography and plane CT scan respectively. The responding surgeons perform surgery (labrum repair or Latarjet) in 51 % of the patients. A median of 25 % glenoid bone loss was given by the respondents, as cut-off from when to perform a bony repair.
  
  
  CONCLUSIONS
  Many different diagnostic examinations for assessing shoulder instability are used and a high variety is seen in the use of diagnostic tools. Also no consensus is seen in the use of different surgical options (arthroscopic and open procedures). This implies the need for more research on diagnostic imaging and the correlation with specific subsequent surgical treatment.
  
  
  METHODS
  Survey, level of evidence IV.
authors.affiliation: Department of Orthopaedics, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. h.weel@amc.nl.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Weel
authors.affiliation: BovenIJ Hospital, Amsterdam, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Tromp
authors.affiliation: Clinical Graphics, Delft, The Netherlands.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Krekel
authors.affiliation: 2nd Department of Orthopaedics, IRCCS Policlinico San Donato, Università degli Studi di Milano, Via Mangiagalli 30, San Donato Milanese, 20097, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Randelli
authors.affiliation: Department of Orthopaedics and Traumasurgery, Onze Lieve Vrouwe Gasthuis, Oosterpark, 91091 AC, Amsterdam, The Netherlands.
authors.forename: Michel P J
authors.initials: MP
authors.lastname: van den Bekerom
authors.affiliation: Department of Orthopaedics and Traumasurgery, Onze Lieve Vrouwe Gasthuis, Oosterpark, 91091 AC, Amsterdam, The Netherlands.
authors.forename: Derek F P
authors.initials: DF
authors.lastname: van Deurzen
mesh_terms: D019468:Disease Management; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012008:Recurrence; D012783:Shoulder Dislocation / Q000175:diagnosis* / Q000601:surgery; D012785:Shoulder Joint / Q000473:pathology* / Q000601:surgery; D066231:Surgeons; D011795:Surveys and Questionnaires
keywords: Anterior instability; Diagnostic; Recurrence; Shoulder joint; Survey