Treatment of Initial Anterior Shoulder Instability in National Hockey League Players: A Survey of NHL Team Physicians

Background: Managing an in-season anterior shoulder instability poses a special challenge for team physicians, as they need to balance the aim of promptly returning the athlete to play while mitigating the chances of recurrence and further injury to the shoulder. Purpose: To investigate and report on the treatment preferences of National Hockey League (NHL) team physicians when managing in-season first-time anterior shoulder instability in professional hockey players. Study Design: Cross-sectional study. Methods: A survey consisting of 33 sport-specific questions focused on the treatment options and preferences for anterior shoulder instability in hockey players was developed, and 32 NHL team physicians were invited to anonymously complete the survey. Following the collection of the data, the distribution of the responses to each question was documented as counts and percentages. Results: Of the 32 invited team physicians, 31 (97%) completed all (n = 28) or most (n = 3) of the survey. The mean experience of the respondents was 13 ± 11 years. A total of 28 (90%) respondents would attempt nonoperative treatment of an in-season initial anterior shoulder dislocation with an isolated soft tissue injury, while 28 (90%) would recommend operative treatment of the same injury with bony involvement. Of the 31 respondents, 30 (97%) utilized rehabilitation parameters rather than time from injury when determining whether a player could return to play. Of those parameters, clinical strength (100%), range of motion (87%), anterior apprehension (84%), and pain (65%) were the most utilized. For surgical management of an isolated soft tissue lesion, 28 (90%) of the respondents preferred arthroscopic repair, while 2 (7%) preferred open repair. Conclusion: Of the 32 NHL team physicians surveyed, 28 preferred nonoperative management for the treatment of initial anterior shoulder dislocations with isolated soft tissue injuries, while initial operative management was preferred by the same number of team physicians for any injuries with bony involvement.