Remove Screws to Cut Pain

A small percentage of patients who have their shoulder instability treated with an open Latarjet procedure still have some anterior pain. It is not clear why, but a new study suggests that screw removal can help.

In the study, “Screw Removal Can Resolve Unexplained Anterior Pain Without Recurrence of Shoulder Instability After Open Latarjet Procedures,” published online in The American Journal of Sports Medicine, the researchers hypothesized that the pain was most likely due to soft tissue impingement against the screw heads. This was confirmed in their analysis when out of 21 shoulders with unexplained anterior pain, 14 of them had the pain completely eliminated after the screws were removed. The additional 7 shoulders experienced at least a reduction in pain.

For the study, the researchers retrospectively reviewed the clinical and radiographic records of 461 consecutive shoulders treated by open Latarjet procedures for anterior instability between 2002 and 2014. The 21 shoulders that had unexplained anterior pain afterwards had the screws removed at 29 ±37 months.

According to the data collected, the screw removal completely alleviated the pain in 14 shoulders (67%; pVAS improvement, 6.4 ±1.8; median, 6; range, 3-8) and reduced pain in the remaining 7 (33%; pVAS improvement, 2.4 ± 1.4; median, 2: range, 1-5). After the screw removal, two recurrences of instability were reported, but they were not related to the removal of the screws.

Mobility also improved: in active forward elevation (171˚± 14˚), external rotation with the elbow at the side (61˚± 12˚), external rotation with the arm at 90˚of abduction (67˚± 13˚) an in internal rotation, with only 2 shoulders limited to T12 spine segment.

The researchers wrote, “The present findings confirm that unexplained anterior pain after Latarjet procedures can be related to the screws used to fix bone blocks, which can safely be alleviated or reduced by screw removal.”