SIRSI · Shoulder Instability - Return to Sport after Injury

Metadata only. The shoulder answer to ACL-RSI, and built from it: the authors took the knee scale and swapped the joint. Twelve items covering confidence in the shoulder, fear of reinjury and the emotions around going back.

It measures the half of return-to-sport that strength testing cannot see. An athlete can pass every objective criterion and still not go back.

After traumatic shoulder instability, operative or not, from mid-rehabilitation onward. Not saved for the discharge visit, because a low score found then is a problem you no longer have time to treat.

Run it beside WOSI, not instead of it. WOSI gives you the shoulder, SIRSI gives you the athlete.

Twelve items. The original used a 10 cm visual analogue scale anchored extremely to not at all. Later papers describe a 0 to 10 scale instead, and that disagreement is unresolved.

Total is the sum of the twelve item values divided by 120, expressed as a percentage. Range 0–100. Higher is better.

A validated 5-item short form exists, one item per domain.

Strength, apprehension on examination, range, bone loss or recurrence risk in itself. It is one half of a return-to-sport conversation and the other half is objective.

It also does not clear anyone. "Do not use SIRSI as a clearance tool by itself."

The cut-point our library carries is 55, derived by ROC analysis in a post-stabilisation cohort: AUC 0.87, sensitivity 77%, specificity 100% for return to sport. A commonly quoted value of 56 was used before anyone derived it, so prefer 55 and say where it came from.

No MCID and no MDC exist for this scale. Neither does a published test-retest ICC. Internal consistency is reported at Cronbach α 0.84. Track the score over time against itself and do not dress a change up as clinically meaningful.

What the evidence doesn't settle: the response format, whether the scale has three factors or four, and whether 55 transfers outside surgical cohorts.