Proprioceptive Deficits Following a Traumatic Anterior Shoulder Instability: A Systematic Review

Abstract

Background: Proprioception, our limb awareness in space, plays a vital role in maintaining shoulder stability through neuromuscular control. Following traumatic anterior instability (TAI), proprioceptive deficits can exist, potentially impairing upper limb function. However, the extent and nature of these deficits vary, with each injury potentially presenting unique proprioceptive deficit profiles. The aim of this systematic review were to summarize the available evidence on proprioceptive deficits following TAI, compared to healthy controls, or the contralateral upper-limb. Methods: Literature was searched in PubMed, Scopus, Academic Search Premier, and SportDiscus databases were systematically searched from inception until December 2024. Selected articles were systematically assessed, and the methodological quality was established using the JBI Critical Appraisal Checklist. Included articles focused on TAI and conscious proprioceptive testing, including comparison with healthy controls or the unaffected arm. Data was systematically extracted concerning study design, participant demographics, type of surgery and surgical status, proprioception sub-categories, proprioception outcome measures and study findings. Results: Fifteen studies met the inclusion criteria, with nine scoring five or higher on the JBI Critical Appraisal Checklist, indicating a low risk of bias. Proprioceptive deficits were observed in individuals with TAI before surgery and up to 6 months post-surgery, compared to the unaffected limb and or control group, though some studies reported no significant differences. Deficits, in general, were reported as resolved eight months post-surgery. Variability in results across studies emphasized the importance of evaluating the different sub-categories of proprioception in order to identify specific proprioception deficits in a population affected by TAI. Conclusion: This review confirms that proprioceptive deficits are present with TAI, across proprioception sub-categories. Deficits can be identified through different proprioception outcomes; However, proprioceptive outcomes vary based on testing methods, timings, and joint angles, for example. Future research should focus on developing consistent proprioceptive outcome measures to enhance clinical reliability and applicability for clinicians working in rehabilitation. Level of evidence: Level IV; Systematic Review