Determinants of Pain Intensity and Magnitude of Incapability More Than Two Years after Arthroscopic Bankart Repair for Anterior Shoulder Instability

PurposeIndividuals treated with arthroscopic Bankart repair after anterior shoulder dislocations experience varied discomfort and incapability. The aim of this study was to determine the relative association of mental health and physical health factors with 1) magnitude of capability and 2) pain intensity 2 or more years after surgery.MethodsThis cross-sectional study evaluated 80 military patients that experienced one or more traumatic anterior shoulder dislocations a minimum of 2 years after arthroscopic Bankart repair without remplissage. We measured capability (Oxford Shoulder Instability Score), pain intensity using an 11-point ordinal scale, symptoms of anxiety (GAD-2), symptoms of depression (PHQ-2), catastrophic thinking (PCS-4), and kinesiophobia (Tampa scale for kinesiophobia-4). We also identified preoperative presence of a Hill-Sachs lesion on radiographs and postoperative occurrence of subluxation or a dislocation episode. A negative binominal regression analysis sought factors associated with magnitude of incapability and pain intensity.ResultsGreater incapability was strongly associated with both greater kinesiophobia (Regression Coefficient [RC] = -0.50; 95% Confidence Interval [CI] = -0.73 to -0.26; P = <0.01) and repeat surgery (RC = -0.27; 95% CI = -0.41 to -0.13; P = <0.01). Greater pain intensity was only strongly associated with greater kinesiophobia (RC = 0.25; 95% CI = 0.039 to 0.46; P = 0.021).ConclusionsThe observation that greater unhelpful thinking is associated with greater pain intensity and greater magnitude of incapability after a Bankart repair for anterior shoulder instability, whereas pathophysiological factors such as glenoid bone loss were not, emphasizes the degree to which mindset is associated with musculoskeletal health.