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Risk Factors for Failure of Nonoperative Treatment of Posterior Shoulder Labral Tears on Magnetic Resonance Imaging.

Publication ,  Journal Article
Christensen, DL; Elsenbeck, MJ; Wolfe, JA; Nickel, WN; Roach, W; Waltz, RA; Dickens, JF; LeClere, LE
Published in: Mil Med
September 18, 2020

INTRODUCTION: There are no reports in the literature describing risk factors for failure of nonoperative treatment of patients with posterior labral tears on magnetic resonance imaging (MRI). The purpose of this study is to identify risk factors for failure of nonoperative treatment in patients with an isolated posterior glenoid labral tear identified on MRI only. Patients with posterior labral tears on MRI who fail to improve with nonoperative treatment likely share a constellation of clinical history, physical exam, and radiographic findings. METHODS: One hundred and fifty-nine active duty military service members under the age of 40 with a posterior labral tear seen on MRI and who were clinically evaluated by a musculoskeletal trained physician were identified. We retrospectively evaluated their records ensuring a minimum of 2 years follow-up after MRI to identify surgical intervention for the posterior labral tear during this time period. Patients were stratified into two groups, those treated with any combination of nonoperative modalities and those treated with posterior labral repair surgery during the 2 years after the MRI. The electronic medical records were reviewed for clinical presentation and physical exam results. We measured multiple radiographic parameters, including glenoid version, size of the tear, and bone loss on MRI. Qualitative and quantitative data were compared between groups using Fisher's exact test and Student's t-test, respectively. This study was conducted under institutional review board approval. RESULTS: Of the 157 patients' shoulders in our study, 52% (n = 82) of patients with posterior labral tears underwent nonoperative treatment while 48% (n = 75) underwent surgery. The significant risk factors associated with surgery were a history of a specific injury, primary presenting complaint of instability, patient reported history of subluxation, inability to trust their shoulder with overhead activity, decreased strength with weight lifting, positive posterior load/shift exam, positive anterior apprehension, increased osseous glenoid retroversion, increased humeral head subluxation ratio, and anterior labral height (P < 0.05). Patients with a chief complaint of pain were much more likely to succeed with nonoperative treatment while those with instability underwent surgery more often. Ten (12.5%) of the surgical procedures included an anterior and posterior labral repair/stabilization procedure. CONCLUSION: Patients with an MRI confirmed posterior labral tear, which present with subjective complaints and physical exam maneuvers consistent with instability, appear less likely to be treated nonoperatively. Increased glenoid retroversion and posterior humeral head subluxation may also predispose patients toward surgical treatment. Additionally, posterior labral tears may extend into the anterior labrum more frequently than is recognized on MRI.

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Published In

Mil Med

DOI

EISSN

1930-613X

Publication Date

September 18, 2020

Volume

185

Issue

9-10

Start / End Page

e1556 / e1561

Location

England

Related Subject Headings

  • Strategic, Defence & Security Studies
  • Shoulder Joint
  • Shoulder
  • Rotator Cuff Injuries
  • Risk Factors
  • Retrospective Studies
  • Magnetic Resonance Imaging
  • Joint Instability
  • Humans
  • 4203 Health services and systems
 

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Christensen, D. L., Elsenbeck, M. J., Wolfe, J. A., Nickel, W. N., Roach, W., Waltz, R. A., … LeClere, L. E. (2020). Risk Factors for Failure of Nonoperative Treatment of Posterior Shoulder Labral Tears on Magnetic Resonance Imaging. Mil Med, 185(9–10), e1556–e1561. https://doi.org/10.1093/milmed/usaa122
Christensen, Daniel L., Michael J. Elsenbeck, Jared A. Wolfe, Walter N. Nickel, William Roach, Robert A. Waltz, Jonathan F. Dickens, and Lance E. LeClere. “Risk Factors for Failure of Nonoperative Treatment of Posterior Shoulder Labral Tears on Magnetic Resonance Imaging.Mil Med 185, no. 9–10 (September 18, 2020): e1556–61. https://doi.org/10.1093/milmed/usaa122.
Christensen DL, Elsenbeck MJ, Wolfe JA, Nickel WN, Roach W, Waltz RA, et al. Risk Factors for Failure of Nonoperative Treatment of Posterior Shoulder Labral Tears on Magnetic Resonance Imaging. Mil Med. 2020 Sep 18;185(9–10):e1556–61.
Christensen, Daniel L., et al. “Risk Factors for Failure of Nonoperative Treatment of Posterior Shoulder Labral Tears on Magnetic Resonance Imaging.Mil Med, vol. 185, no. 9–10, Sept. 2020, pp. e1556–61. Pubmed, doi:10.1093/milmed/usaa122.
Christensen DL, Elsenbeck MJ, Wolfe JA, Nickel WN, Roach W, Waltz RA, Dickens JF, LeClere LE. Risk Factors for Failure of Nonoperative Treatment of Posterior Shoulder Labral Tears on Magnetic Resonance Imaging. Mil Med. 2020 Sep 18;185(9–10):e1556–e1561.

Published In

Mil Med

DOI

EISSN

1930-613X

Publication Date

September 18, 2020

Volume

185

Issue

9-10

Start / End Page

e1556 / e1561

Location

England

Related Subject Headings

  • Strategic, Defence & Security Studies
  • Shoulder Joint
  • Shoulder
  • Rotator Cuff Injuries
  • Risk Factors
  • Retrospective Studies
  • Magnetic Resonance Imaging
  • Joint Instability
  • Humans
  • 4203 Health services and systems