title: Physiotherapy treatment for atraumatic recurrent shoulder instability: early results of a specific exercise protocol using pathology-specific outcome measures.
abstract: BACKGROUND
  Recurrent shoulder instability is usually caused by a traumatic event resulting in structural pathology, although a small subgroup of patients experience symptomatic recurrent shoulder instability without trauma. These patients are usually treated non-operatively but limited evidence exists regarding effective conservative management. In particular, there is a lack of reproducible exercise regimes and none that have been tested with condition-specific outcome measures.
  
  
  METHODS
  A service evaluation was conducted over a 15-month period to assess our current treatment protocol used in the management of patients with atraumatic recurrent shoulder instability. The regime is reproducible with target-led progression milestones. Oxford Instability Shoulder Scores (OISS) and Western Ontario Shoulder Index (WOSI) scores were compared between baseline and final follow-up.
  
  
  RESULTS
  Eighteen consecutive patients were included with mean follow-up of 4.5 months (range 1.35 months to 11.77 months). A statistically significant improvement was seen in both outcome measures. Mean OISS improved by 16.67 points (confidence interval: 12.34 to 20.99; p < 0.001). Mean WOSI improved by 36.76% (confidence interval: 28.46 to 45.06; p < 0.001).
  
  
  CONCLUSIONS
  For this small group of patients with recurrent atraumatic shoulder instability, the Derby Shoulder Instability Programme produced significant improvements over the short term, with a high level of patient compliance. This is the first study to include pathology-specific patient-reported outcome measures to assess outcomes from a specific and reproducible exercise regime in this group of patients. The findings support further research to evaluate the exercise protocol in a larger group of patients over the longer term.
authors: Derby Teaching Hospitals NHS Foundation Trust, London Road Community Hospital, Derby, UK.
authors: Marcus
authors: M
authors: Bateman
authors: Derby Teaching Hospitals NHS Foundation Trust, London Road Community Hospital, Derby, UK.
authors: Benjamin E
authors: BE
authors: Smith
authors: Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, UK.
authors: Sally E
authors: SE
authors: Osborne
authors: School of Medicine, University of Nottingham, Nottingham, UK.
authors: Sally R
authors: SR
authors: Wilkes
keywords: atraumatic; exercise; instability; rehabilitation; shoulder