Impact of a cortisone injection on the efficacy of a non-operative treatment approach for anterior instability of the glenohumeral joint

The purpose of this case report is to describe the effects of a cortisone injection and a conservative, non-operative physical therapy approach in a patient with anterior instability of the glenohumeral joint. A 73-year-old, right-handed male was referred to physical therapy following a right shoulder subluxation, resulting in pain and decreased function in the right upper extremity. A baseline examination indicating significant pain and right shoulder dysfunction resulted in an initial Western Ontario Shoulder Instability Index (WOSI) score of 1619. The patient was seen for 22 visits divided into Phase I and Phase II. Phase II began following a cortisone injection received after visit 15. Physical Therapy intervention consisted of shoulder pendulum exercises, active ROM, Maitland mobilization, strengthening of rotator cuff and thoracic musculature, electrical stimulation and cryotherapy. WOSI scores at baseline, the conclusion of Phase I and II, and one month post discharge were recorded. They were 1487 (8% improvement), 116 (93% improvement), and 83 (95% improvement), respectively. Percent improvement was calculated based on the initial WOSI score. The patient's WOSI score at discharge (end of Phase II) was similar to his self-report of improvement (95%). Results of the WOSI at the conclusion of Phase I and Phase II suggest that the anti-inflammatory and analgesic effects of a cortisone injection were critical components in the patient's recovery. These findings may indicate the appropriateness of such an injection in cases with significant pain and inflammation when a more traditional, conservative approach to anterior glenohumeral joint instability proves ineffective.