Rotator Cuff Weakness Is Not a Risk Factor for First-Time Anterior Glenohumeral Instability

BACKGROUND: Shoulder instability is a common problem in young athletes and can lead to pain and decreased ability to participate in high-level activities. Little is known about the modifiable risk factors for glenohumeral joint instability. HYPOTHESIS: Isometric shoulder strength at baseline would be a modifiable risk factor associated with subsequent first-time anterior instability events. STUDY DESIGN: Cohort study. METHODS: Study participants were freshmen entering the United States Military Academy in June 2006. All participants completed bilateral isometric strength evaluations with a hand-held dynamometer at baseline upon entry into the study. Variables measured included internal and external rotation at 0° (IR0, ER0) and internal and external rotation at 45° of abduction (IR45, ER45). All subjects were followed for subsequent glenohumeral joint instability events until graduation in May 2010. Independent t tests were used to analyze the data. RESULTS: Baseline strength data were available for 1316 shoulders with no prior history of instability, of which 26 went on to have an acute first-time anterior shoulder instability event while the individuals were at the academy. There were no significant differences in mean strength between shoulders that did not go on to develop instability (uninjured; n = 1290) and those that did develop anterior instability (injured; n = 26). The mean strength values in pounds of force for uninjured and injured shoulders, respectively, were as follows: IR0 (49.80 vs 49.29; P = .88), ER0 (35.58 vs 33.66; P = .27), IR45 (47.38 vs 46.93; P = .88), and ER45 (40.08 vs 38.98; P = .59). CONCLUSION: No association was found between isometric shoulder strength measures at baseline and subsequent first-time anterior glenohumeral joint instability within the high-risk athletic population studied in this prospective cohort.