The effectiveness of rehabilitation for nonoperative management of shoulder instability: a systematic review.

A systematic review of published evidence on conservative management was conducted in Medline, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Database of Abstracts of Reviews of Effects (DARE), Allied & Alternative Medicine (AMED), PubMed, and Cochrane. For each article, two of the four reviewers conducted abstract selection and critical appraisal. Disagreements were resolved through consensus and third review, if required. Level of evidence and quality on a 24-item quantitative critical appraisal form were determined for all articles meeting selection criteria. Outcomes considered included recurrence of instability and return to premorbid function. Overall, the quantity and quality of evidence were low. Immobilization for three to four weeks followed by a structured 12-week rehabilitation program of range of motion and glenohumeral and scapular stability exercises for patients with primary dislocations to maximize return to premorbid activity level is supported by weak evidence. Level II evidence suggests that recurrence is lower in patients managed with surgical as compared with conservative management. Further research is required to delineate the optimal approach to rehabilitation and its role in secondary prevention.