1
|
Chiddarwar V, de Zoete RMJ, Dickson C, Lathlean T. Effectiveness of combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis. Br J Sports Med 2023; 57:1498-1508. [PMID: 37451706 DOI: 10.1136/bjsports-2022-106422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To investigate the effectiveness, risk of recurrence and return to activity (RTA) of surgery combined with exercise-based interventions (EBI) versus EBI alone after traumatic anterior shoulder dislocation (ASD). DESIGN Systematic review and meta-analysis. DATA SOURCES Systematic literature search (MEDLINE, Web of Science, Scopus, Google Scholar). ELIGIBILITY Studies focused on EBI or EBI as a part of postoperative care for adults with an ASD, written in English, and published after 1990. We excluded diagnostic, assessment-based studies on individuals experiencing recurrent shoulder dislocations, concomitant shoulder injury, animal or cadaveric studies. Primary outcomes were dislocation RTA. Secondary outcomes were self-reported outcome measures, strength and range of motion. Random-effects meta-analysis was used to estimate the effect of EBI (SMD; Hedges' g, RR). The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence. RESULTS Sixty studies were included (n=3598); seven were meta-analysed (n=345). The mean age of participants in the included studies was 26.71±9.19 and 56% of those included were male. Of the 60 studies included in the systematic review, 29 were fair quality (48.3%), 15 studies were good quality (25%) and 16 studies were poor quality (26.7%), (k=0.66). Individuals who underwent EBI alone were 2.03 times more likely to experience recurrent instability than individuals who underwent EBI in conjunction with surgery (RR 2.03, 95% CI 1.03 to 3.97). Individuals who underwent EBI with surgery appeared 1.81 times more likely to RTA than those who underwent EBI alone, although results were not statistically significant (RR 1.81, 95% CI 0.96 to 3.43). CONCLUSIONS Surgery combined with EBI is more effective in reducing the risk of recurrence and possibly increasing RTA than EBI alone after traumatic ASD.
Collapse
Affiliation(s)
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Timothy Lathlean
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| |
Collapse
|
2
|
Ergün M, Yörük İ, Köyağasioğlu O. Simultaneous bilateral shoulder dislocation during pilates reformer exercise: A case report. Physiother Theory Pract 2023; 39:667-674. [PMID: 35040716 DOI: 10.1080/09593985.2021.2024312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Simultaneous bilateral shoulder dislocations are extremely rare occurrences and are rarely associated with exercise. CASE DESCRIPTION We present an unusual case of bilateral simultaneous shoulder dislocation which occurred during an unsupervised Pilates Reformer exercise session. A 41-year-old female felt sudden severe pain and forward displacement in both shoulders during abduction and external rotation. Bilateral anterior shoulder dislocation was confirmed with initial X-rays in the emergency department. Spontaneous reduction of the right shoulder was observed in the emergency room and then the left side was reduced under general anesthesia. Physical therapy modalities, exercises for shoulder girdle and core strength were implemented as conservative management. The patient returned to desk work and had pain-free range of motion with satisfactory strength on both sides in the fourth week and performed daily life activities without any symptoms in the tenth week. CONCLUSION This case highlights the importance of training under supervision of an exercise instructor, even if it is considered a "so-called safe" exercise method.
Collapse
Affiliation(s)
- Metin Ergün
- Department of Sports Medicine, Ege University Faculty of Medicine, Kazımdirik Mahallesi, Üniversite Caddesi, Bornova, Turkey
| | - İhsan Yörük
- Department of Sports Medicine, Ege University Faculty of Medicine, Kazımdirik Mahallesi, Üniversite Caddesi, Bornova, Turkey
| | - Ogün Köyağasioğlu
- Department of Sports Medicine, Kayseri City Hospital, Şeker Mahallesi Muhsin Yazıcıoğlu Bulvarı, Kayseri Turkey
| |
Collapse
|
3
|
Monk AP, Crua E, Gatenby GC, Walsh AJ, Stanley JC, Rosenfeldt MP, Twaddle BC, Walsh SJ. Clinical outcomes following open anterior shoulder stabilization for glenohumeral instability in the young collision athlete. J Shoulder Elbow Surg 2022; 31:1474-1478. [PMID: 35051538 DOI: 10.1016/j.jse.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior glenohumeral instability occurs most commonly in those aged 15-29, with 72% of individuals younger than 22 years suffering recurrent episodes; collision athletes are at particular risk. In the setting of subcritical glenoid bone loss, arthroscopic Bankart repair is widely used despite concerns of recurrent dislocations when compared with open techniques. Furthermore, indications for bone-block procedures are evolving with the Latarjet procedure being favored amongst recent authors as a primary stabilization method in elite and contact athletes. OBJECTIVE To determine the efficacy of open modified Bankart stabilization in treating anterior glenohumeral instability in young collision athletes. METHODS This was a retrospective review of outcomes of consecutive patients aged 15-20 years who underwent unilateral or bilateral open stabilization for recurrent anterior glenohumeral instability over a 7-year period (2007-2015). The cohort was selected as recent literature suggests that this is the group with the highest redislocation rate and poorest outcomes. Outcome assessments included redislocation rate, return to sport, pain score, patient-related satisfaction scores, and the Western Ontario Shoulder Instability Index. RESULTS A total of 60 patients (55 male: 5 female) of mean age 18 years (range: 15-20 years) were available for follow-up at 7 years. All but 3 were competitive athletes with 18 competing regionally and 9 internationally; rugby union and rugby league represent the most common sports. Fifty-five of 60 (92%) have returned to their desired level of sport with 62% of athletes returning to their previous level of competition sport and 1 retuning at a higher level. The mean postoperative pain score was 2.5/10. The mean time to return to play was 14 months (range: 5-48 months). Eight of 60 shoulders reported redislocation (13%), 7 of these being traumatic dislocations after return to high-impact sporting activities. At 7 years of follow-up, 4 of 60 shoulders (7%) had undergone revision surgery. CONCLUSION Young collision athletes represent a challenging cohort of instability patients. This study of open modified Bankart in young collision sport athletes revealed excellent outcomes with 92% return to sport and a low revision rate. The results from this cohort rival those of arthroscopic repair. The open procedure described here in this 7-year series represents a robust, reliable technique that could be considered as an alternative to arthroscopic Bankart due to concern for recurrence, while avoiding potential morbidity and complication of bone-block procedures. There is still a role for the open modified Bankart procedure in treating traumatic anterior instability.
Collapse
Affiliation(s)
- A Paul Monk
- Unisports Orthopaedics, Auckland, New Zealand
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Hurley ET, Matache BA, Wong I, Itoi E, Strauss EJ, Delaney RA, Neyton L, Athwal GS, Pauzenberger L, Mullett H, Jazrawi LM. Anterior Shoulder Instability Part I-Diagnosis, Nonoperative Management, and Bankart Repair-An International Consensus Statement. Arthroscopy 2022; 38:214-223.e7. [PMID: 34332055 DOI: 10.1016/j.arthro.2021.07.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to establish consensus statements via a modified Delphi process on the diagnosis, nonoperative management, and Bankart repair for anterior shoulder instability. METHODS A consensus process on the treatment using a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability. RESULTS The independent factors identified in the 2 statements that reached unanimous agreement in diagnosis and nonoperative management were age, gender, mechanism of injury, number of instability events, whether reduction was required, occupation, sport/position/level played, collision sport, glenoid or humeral bone-loss, and hyperlaxity. Of the 3 total statements reaching unanimous agreement in Bankart repair, additional factors included overhead sport participation, prior shoulder surgery, patient expectations, and ability to comply with postoperative rehabilitation. Additionally, there was unanimous agreement that complications are rare following Bankart repair and that recurrence rates can be diminished by a well-defined rehabilitation protocol, inferior anchor placement (5-8 mm apart), multiple small-anchor fixation points, treatment of concomitant pathologies, careful capsulolabral debridement/reattachment, and appropriate indications/assessment of risk factors. CONCLUSION Overall, 77% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the aspects of patient history that should be evaluated in those with acute instability, the prognostic factors for nonoperative management, and Bankart repair. Furthermore, there was unanimous consensus on the steps to minimize complications for Bankart repair, and the placement of anchors 5-8 mm apart. Finally, there was no consensus on the optimal position for shoulder immobilization. LEVEL OF EVIDENCE Level V, expert opinion.
Collapse
Affiliation(s)
- Eoghan T Hurley
- NYU Langone Health, New York, New york, USA; Sports Surgery Clinic, Dublin, Ireland.
| | | | - Ivan Wong
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eiji Itoi
- Tohoku University School of Medicine, Sendai, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Como CJ, Rothrauff BB, Alexander PG, Lin A, Musahl V. Common animal models lack a distinct glenoid labrum: a comparative anatomy study. J Exp Orthop 2021; 8:63. [PMID: 34401967 PMCID: PMC8368311 DOI: 10.1186/s40634-021-00383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Development and validation of an animal model of labral healing would facilitate translation of novel surgical and biological strategies to improve glenolabral healing. The purpose of this study was to characterize the anatomic and histological properties of the shoulder labrum in rat, rabbit, dog, pig, goat, and humans. Given the demonstrated similarities in size and structural morphology in other joints, it was hypothesized that the goat glenoid with surrounding capsulolabral complex would most closely resemble that of humans in terms of dimensions and structure, as observed grossly and histologically. Methods Cadaveric glenohumeral joints from rats (n = 8), New Zealand white rabbits (n = 13), Mongrel dogs (n = 9), Spanish goats (n = 10), Yorkshire pigs (n = 10), and humans (n = 9) were freshly harvested. Photographs were taken of the glenoid with its surrounding capsulolabral complex. Linear dimensions of the glenoid articular surface were measured. It was determined where the capsulolabral complex was continuous with, or recessed from, the articular glenoid surface. The glenoid was divided into 6 equal segments radiating out toward 12, 2, 4, 6, 8, and 10 o’clock positions. Samples were sectioned and stained with Safranin O/Fast green and Mallory Trichrome. Insertion of the capsulolabral tissue onto the glenoid was qualitatively assessed and compared with gross morphology. Results Dimensions of the goat glenoid most closely paralleled dimensions of the human glenoid. A capsulolabral complex was continuous with the glenoid surface from ~ 9 to 12 o’clock in the rats, 7 to 12 o’clock in rabbits, 5 to 12 o’clock in the dogs, and 9 to 12 o’clock in goats, 6 to 12 o’clock in pigs, and 2 to 8 o’clock in humans. In contrast to humans, no other species demonstrated an organized fibrocartilaginous labrum either macroscopically or histologically. Conclusion The animals in the present study did not possess a discrete fibrocartilaginous labrum by gross or histological evaluation, as directly compared to humans. While models using these animals may be acceptable for examining other shoulder pathologies, they are not adequate to evaluate labral pathology. Level of evidence Basic Science Study; Anatomy and Histology; Cadaveric Animal Model. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-021-00383-6.
Collapse
Affiliation(s)
- Christopher J Como
- Department of Orthopaedic Surgery, University of Pittsburgh, 3350 Terrace Street, Pittsburgh, PA, 15213, USA.
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, 3350 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Peter G Alexander
- Department of Orthopaedic Surgery, University of Pittsburgh, 3350 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh, 3350 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, 3350 Terrace Street, Pittsburgh, PA, 15213, USA
| |
Collapse
|
6
|
Zheng Y, Wang H, Wang H, Xu J, Chen P. The efficacy of a phone assistance nursing program for functional outcomes in patients after shoulder instability surgery: A protocol for randomized controlled trial. Medicine (Baltimore) 2020; 99:e22756. [PMID: 33120779 PMCID: PMC7581063 DOI: 10.1097/md.0000000000022756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE We conduct this research protocol for the assessment of the effect of phone-assisted care programs on functional outcomes in patients receiving shoulder instability surgery. METHODS This is a randomized controlled, single center trial which will be implemented from October 2020 to December 2021. This trial is conducted according to the SPIRIT Checklist of randomized researches. It was authorized via the Ethics Committee of the First People's Hospital of Xiangyang city affiliated to Hubei Medical College (XY234-026). Ninety participants who undergo shoulder instability surgery are analyzed. Patients are randomly divided into control group (standard management group, with 45 patients) and study group (the phone program group, with 45 patients). In control group, the exercises at home are not monitored. Whereas in study group, patients are asked about their at-home activities, and the extra coaching sessions are provided to patients on self-care, exercise guidance, and the importance of exercise at home, and then answers to their questions. The primary outcome is the range of motion of the shoulder joint, and the pain arcs are determined through the range of motion. The extra assessments include the shoulder functional outcome, pain, and the quality of life. All the analysis needed in this study is implemented with SPSS (IBM, Chicago, USA) for Windows Version 19.0. RESULTS The clinical outcome variables between groups are shown in Table. CONCLUSION This investigation can offer a reliable basis for the effectiveness of phone assistance nursing program in patients after shoulder instability surgery. TRIAL REGISTRATION NUMBER researchregistry6010.
Collapse
Affiliation(s)
| | | | | | | | - Ping Chen
- Department of Gynaecology and Obstetrics, the First People's Hospital of Xiangyang City Affiliated to Hubei Medical College, Hubei, China
| |
Collapse
|
7
|
Hagesæter AN, Løvold T, Juul-Kristensen B, Blomquist J, Hole R, Eshoj H, Magnussen LH. Feasibility of the SINEX program for patients with traumatic anterior shoulder instability. Pilot Feasibility Stud 2020; 6:148. [PMID: 33042568 PMCID: PMC7541274 DOI: 10.1186/s40814-020-00679-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 09/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background An optimal treatment for traumatic anterior shoulder instability (TASI) remains to be identified. A shoulder instability neuromuscular exercise (SINEX) program has been designed for patients with TASI, but has not yet been tested in patients eligible for surgery. The purpose of this study was to investigate and evaluate the feasibility and safety of the SINEX program for patients diagnosed with TASI and eligible for surgery. Methods A feasibility study with an experimental, longitudinal design using both quantitative and qualitative research methods. A total of seven participants underwent the SINEX program, a 12-week exercise program including physiotherapist-supervised sessions. Feasibility data on recruitment, retention, compliance, acceptability and safety was collected through observation and individual semi-structured interviews. Clinical tests and self-report questionnaires were completed at baseline and 12 weeks follow-up. Clinical assessments included apprehension and relocation tests, shoulder joint position sense (SJPS), shoulder sensorimotor control measured by center of pressure path length (COPL) on a force platform, isometric strength measured by Constant Score-Isometric Maximal Voluntary Contraction (CS-iMVC), self-report questionnaires including Western Ontario Shoulder Instability Index (WOSI), Tampa Scale of Kinesiophobia (TSK) and Global Perceived Effect questionnaire (GPE). Results With one participant recruited every 2 weeks, the recruitment rate was 50% lower than expected. Two of seven participants achieved compliance, defined as at least 66% completion of the scheduled home exercises and at least 50% attendance for the physiotherapist supervised sessions. Barriers for successful compliance were (1) inability to take along exercise equipment when travelling, (2) sick leave, (3) holidays and (4) lack of time/busy days. Four adverse events occurred, one of which was related to the intervention (patellar redislocation). All participants expressed satisfaction with the intervention and felt safe during the exercises. All participants improved in the GPE. Change greater than minimal detectable change (MDC) was reported in four participants in some of the outcome assessments. One of the seven participants declined surgery. Conclusion Further assessment is required on several areas before performing an RCT evaluating the efficacy of the SINEX program for patients with TASI considered eligible for surgery. No adverse events suggest that the program is safe, but patients with general hypermobility may need additional adjustments to prevent adverse events in other areas of the body. Trial registration ClinicalTrials.gov: NCT04152304, retrospectively registered
Collapse
Affiliation(s)
- Amalie Nilssen Hagesæter
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tonje Løvold
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jesper Blomquist
- Department of Orthopedic Surgery, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Randi Hole
- Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Henrik Eshoj
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Liv Heide Magnussen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
8
|
Eshoj HR, Rasmussen S, Frich LH, Hvass I, Christensen R, Boyle E, Jensen SL, Søndergaard J, Søgaard K, Juul-Kristensen B. Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial. Orthop J Sports Med 2020; 8:2325967119896102. [PMID: 32064291 PMCID: PMC6993151 DOI: 10.1177/2325967119896102] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background: There is an important gap in knowledge about the effectiveness of nonoperative treatment (exercise) for patients with traumatic primary and recurrent anterior shoulder dislocations (ASDs). Purpose/Hypothesis: The purpose of this study was to assess the efficacy and safety of physical therapist–supervised, shoulder instability neuromuscular exercise (SINEX) versus self-managed, home-based, standard care shoulder exercise (HOMEX) in patients with traumatic ASDs. The hypothesis was that SINEX would have a larger effect and fewer adverse events compared with HOMEX. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 56 participants with radiographically verified, trauma-initiated primary or recurrent ASDs and self-reported decreased shoulder function were randomized to 12 weeks of either SINEX or HOMEX. The SINEX program consisted of 7 exercises, individually progressing from basic (2 × 20 repetitions each day) to elite (2 × 10 repetitions, 3 times weekly). The HOMEX program included 5 shoulder exercises performed 3 times weekly (2 × 10 repetitions). The primary outcome was the Western Ontario Shoulder Instability Index (WOSI) score, ranging from 0 (best possible) to 2100. The between-group minimal clinically important difference at 12 weeks was 250 points. Secondary outcomes included WOSI subdomain scores, patient-reported ratings of kinesiophobia and pain, objective shoulder function, patient satisfaction, and number of adverse events. Results: The between-group mean difference in the WOSI total score at 12 weeks significantly favored SINEX over HOMEX (–228.1 [95% CI, –430.5 to –25.6]). SINEX was furthermore superior to HOMEX in most of the secondary outcomes (3/4 subdomains of the WOSI and pain level during the past 7 days as well as clinical signs of anterior shoulder instability). Also, although not statistically significant, less than half the proportion of the SINEX patients compared with the HOMEX patients (3/27 [11%] vs 6/24 [25%], respectively; P = .204) underwent or were referred for shoulder stabilizing surgery. Satisfaction with both exercise programs was high, and no serious adverse events were reported. Conclusion: Neuromuscular shoulder exercise (SINEX) was superior to standard care exercise (HOMEX) in patients with traumatic ASDs. Further long-term follow-ups on treatment effects are needed. Registration: NCT02371928 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Henrik Rode Eshoj
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Sten Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Henrik Frich
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Inge Hvass
- Shoulder Section, Department of Orthopaedic Surgery, South-West Jutland Hospital, Esbjerg, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Rheumatology Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Steen Lund Jensen
- Shoulder Section, Department of Orthopaedic Surgery, Aalborg University Hospital, Farsoe, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
9
|
Eshoj H, Rasmussen S, Frich LH, Jensen SL, Søgaard K, Juul-Kristensen B. Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study. BMC Musculoskelet Disord 2019; 20:59. [PMID: 30736761 PMCID: PMC6368725 DOI: 10.1186/s12891-019-2444-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/30/2019] [Indexed: 01/16/2023] Open
Abstract
Background Patients with non-operated traumatic primary anterior shoulder dislocation (PASD) are assumed to have less shoulder impairment than patients with recurrent anterior shoulder dislocations (RASD). This may impact treatment decision strategy. The aim was to study whether patients with non-operated traumatic PASD have less shoulder impairment than those with RASD. Methods In a cross-sectional study baseline data from patients with PASD and RASD in a randomised controlled trial of non-operative shoulder exercise treatment were used. Shoulder function was self-reported (Western Ontario Shoulder Instability (WOSI), Tampa Scale of Kinesiophobia (TSK), General Health (EQ-5D-VAS), Numeric Pain Rating Scale (NPRS)), and measured (Constant-Murley shoulder Score (CMS total), CMS - Range of Motion (CMS-ROM, CMS – strength, proprioception, clinical tests). Results In total, 56 patients (34 (28 men) with PASD and 22 (21 men) with RASD) (mean age 26 years) participated. WOSI total was 1064 and 1048, and TSK above 37 (indicating high re-injury fear) was present in 33 (97%) and 21 (96%) of the groups with PASD and RASD, with no group difference. CMS total (66.4 and 70.4), CMS-ROM (28.7 and 31.5), CMS-strength (injured shoulder: 7.6 kg and 9.1 kg), proprioception and clinical tests were the same. Furthermore, 26 (76%) with PASD and 13 (59%) with RASD reported not to have received non-operative shoulder treatment. Conclusions Non-operated patients with PASD and self-reported shoulder trouble three-six weeks after initial injury do not have less shoulder impairment (self-reportedly or objectively measured) than non-operated patients RASD and self-reported shoulder trouble three-six weeks after their latest shoulder dislocation event.
Collapse
Affiliation(s)
- Henrik Eshoj
- Quality of Life Research Center, Department of Hematology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000, Odense, Denmark. .,Department of Sports Science and Clinical Biomechanics, University of Southern, Campusvej 55, DK-5230, Odense, Denmark.
| | - Sten Rasmussen
- Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark, Hobrovej 18-22, DK-9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Lars Henrik Frich
- Department of Orthopaedics and Traumatology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark
| | - Steen Lund Jensen
- Department of Clinical Medicine, Aalborg University, Hobrovej 18-22, DK-9000, Aalborg, Denmark.,Shoulder sector, Orthopaedic Department, Aalborg University Hospital, Farsoe, Denmark
| | - Karen Søgaard
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern, Campusvej 55, DK-5230, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern, Campusvej 55, DK-5230, Odense, Denmark
| |
Collapse
|
10
|
Abstract
Shoulder joint dislocation is the most common joint dislocation seen in the emergency department.Traumatic dislocation may cause damage to the soft-tissues surrounding the shoulder joint and sometimes to the bone. The treatment, which aims at restoration of a fully functioning, pain-free and stable shoulder, includes either conservative or surgical management preceded by closed reduction of the acute dislocation.Conservative management usually requires a period of rest, generally involving immobilisation of the arm in a sling, even though it is still debated whether to immobilise the shoulder in internal or external rotation.Operative management, with no significant differences in term of re-dislocation rates between open and arthroscopic repair, incorporates soft-tissue reconstructions and/or bony procedures and is recommended in young male adults engaged in highly demanding physical activities.At our institution, non-operative management is favoured particularly for patients with multi-directional instability or soft-tissue laxity. Conservative measures are often preferred in older patients or younger patients that are not actively engaged in overhead activities. Immediate surgery on all first-time dislocations may subject many patients to surgery who would not have had any future subluxation.For these reasons, initially we will always try physical therapy and activity modification for the vast majority of our patients. Cite this article: EFORT Open Rev 2017;2:35-40.DOI: 10.1302/2058-5241.2.160018.
Collapse
Affiliation(s)
- Michele Boffano
- Oncology and Reconstructive Department, CTO Hospital, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Stefano Mortera
- Oncology and Reconstructive Department, CTO Hospital, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Raimondo Piana
- Oncology and Reconstructive Department, CTO Hospital, AOU Citta' della Salute e della Scienza, Turin, Italy
| |
Collapse
|
11
|
Eshoj H, Rasmussen S, Frich LH, Hvass I, Christensen R, Jensen SL, Søndergaard J, Søgaard K, Juul-Kristensen B. A neuromuscular exercise programme versus standard care for patients with traumatic anterior shoulder instability: study protocol for a randomised controlled trial (the SINEX study). Trials 2017; 18:90. [PMID: 28245853 PMCID: PMC5331774 DOI: 10.1186/s13063-017-1830-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/08/2017] [Indexed: 12/25/2022] Open
Abstract
Background Anterior shoulder dislocation is a common injury and may have considerable impact on shoulder-related quality of life (QoL). If not warranted for initial stabilising surgery, patients are mostly left with little to no post-traumatic rehabilitation. This may be due to lack of evidence-based exercise programmes. In similar, high-impact injuries (e.g. anterior cruciate ligament tears in the knee) neuromuscular exercise has shown large success in improving physical function and QoL. Thus, the objective of this trial is to compare a nonoperative neuromuscular exercise shoulder programme with standard care in patients with traumatic anterior shoulder dislocations (TASD). Methods/design Randomised, assessor-blinded, controlled, multicentre trial. Eighty patients with a TASD will be recruited from three orthopaedic departments in Denmark. Patients with primary or recurrent anterior shoulder dislocations due to at least one traumatic event will be randomised to 12 weeks of either a standardised, individualised or physiotherapist-supervised neuromuscular shoulder exercise programme or standard care (self-managed shoulder exercise programme). Patients will be stratified according to injury status (primary or recurrent). Primary outcome will be change from baseline to 12 weeks in the patient-reported QoL outcome questionnaire, the Western Ontario Shoulder Instability Index (WOSI). Discussion This trial will be the first study to compare the efficacy and safety of two different nonoperative exercise treatment strategies for patients with TASD. Moreover, this is also the first study to investigate nonoperative treatment effects in patients with recurrent shoulder dislocations. Lastly, this study will add knowledge to the shared decision-making process of treatment strategies for clinical practice. Trial registration ClinicalTrials.gov, identifier: NCT02371928. Registered on 9 February 2015 at the National Institutes of Health Clinical Trials Protocol Registration System. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1830-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Henrik Eshoj
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. .,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. .,Odense Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.
| | - Sten Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Henrik Frich
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
| | - Inge Hvass
- Shoulder Sector, Orthopedic Department, South-West Jutland Hospital, Esbjerg, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Steen Lund Jensen
- Shoulder Sector, Orthopaedic Department, Aalborg University Hospital, Farsoe, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health Sciences, Bergen University College, Bergen, Norway
| |
Collapse
|
12
|
Baker HP, Tjong VK, Dunne KF, Lindley TR, Terry MA. Evaluation of Shoulder-Stabilizing Braces: Can We Prevent Shoulder Labrum Injury in Collegiate Offensive Linemen? Orthop J Sports Med 2016; 4:2325967116673356. [PMID: 27975072 PMCID: PMC5140042 DOI: 10.1177/2325967116673356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Shoulder injuries remain one of the most common injuries among collegiate football athletes. Offensive linemen in particular are prone to posterior labral pathology. Purpose: To evaluate the efficacy of shoulder bracing in collegiate offensive linemen with respect to injury prevention, severity, and lost playing time. Study Design: Cohort study; Level of evidence, 3. Methods: Offensive linemen at a single collegiate institution wore bilateral shoulder-stabilizing braces for every contact practice and game beginning in the spring of 2013. Between spring of 2007 and fall of 2012, offensive linemen did not wear any shoulder braces. Player injury data were collected for all contact practices and games throughout these time periods to highlight differences with brace use. Results: Forty-five offensive linemen (90 shoulders) participated in spring and fall college football seasons between 2007 and 2015. There were 145 complete offensive linemen seasons over the course of the study. Offensive linemen not wearing shoulder braces completed 87 seasons; offensive linemen wearing shoulder braces completed 58 seasons. Posterior labral tear injury rates were calculated for players who wore the shoulder braces (0.71 per 1000 athlete-exposures) compared with shoulders of players who did not wear the braces (1.90 per 1000 athlete-exposures). The risk ratio was 0.46 (95% CI, 0.16-1.30; P = .14). Mean time (contact practices and games) missed due to injury was significant, favoring less time missed by players who used braces (8.7 vs 36.60 contact practices and games missed due to injury; P = .0019). No significant difference in shoulder labral tears requiring surgery was found for brace use compared with no brace use. Conclusion: Shoulder-stabilizing braces were shown not to prevent posterior labral tears among collegiate offensive lineman, although they were associated with less time lost to injury. The results of this study have clinical significance, indicating that wearing a shoulder brace provides a protective factor for offensive linemen.
Collapse
Affiliation(s)
- Hayden P Baker
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin F Dunne
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tory R Lindley
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael A Terry
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
13
|
Conservative treatment of traumatic shoulder instability: a case series study. Musculoskelet Surg 2015; 99:133-7. [PMID: 25982089 DOI: 10.1007/s12306-015-0373-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this case series study was to evaluate the efficacy of a rehabilitative approach to restoring stability, range of motion, and function of shoulder joint in non-operated adults presenting a first episode of traumatic anterior shoulder dislocation. METHODS In this case series study, we evaluated patients aged from 20 to 44 years, with diagnosis of first episode of traumatic anterior shoulder dislocation. All participants underwent a conservative treatment protocol, lasting 3 months. The primary outcome measure was the Rowe score for instability. Follow-up evaluations were done at 3, 6, 12, and 24 months. RESULTS We evaluated 32 participants mean aged 27.94 ± 2.23 years. At the baseline (T 0), the participants had a mean Rowe score of instability of 44.53 ± 7.00 SD, where 81.25% had a poor score and 18.75% had a fair score. At 24 months (T 4), the Rowe score for instability was 79.84 ± 6.66 SD. 21.88% of patients had a fair score, 71.87% had a good score, and 6.25% had an excellent score. CONCLUSIONS We showed that our rehabilitative approach seems to be effective in the conservative management of shoulder instability in adults with first episode of traumatic anterior shoulder dislocation, not involved in sport activity, and not overhead workers.
Collapse
|
14
|
Staged Approach for Rehabilitation Classification: Shoulder Disorders (STAR-Shoulder). Phys Ther 2015; 95:791-800. [PMID: 25504491 DOI: 10.2522/ptj.20140156] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 11/25/2014] [Indexed: 11/17/2022]
Abstract
Shoulder disorders are a common musculoskeletal problem causing pain and functional loss. Traditionally, diagnostic categories are based on a pathoanatomic medical model aimed at identifying the pathologic tissues. However, the pathoanatomic model may not provide diagnostic categories that effectively guide treatment decision making in rehabilitation. An expanded classification system is proposed that includes the pathoanatomic diagnosis and a rehabilitation classification based on tissue irritability and identified impairments. For the rehabilitation classification, 3 levels of irritability are proposed and defined, with corresponding strategies guiding intensity of treatment based on the physical stress theory. Common impairments are identified and are used to guide specific intervention tactics with varying levels of intensity. The proposed system is conceptual and needs to be tested for reliability and validity. This classification system may be useful clinically for guiding rehabilitation intervention and provides a potential method of identifying relevant subgroups in future research studies. Although the system was developed for and applied to shoulder disorders, it may be applicable to classification and rehabilitation of musculoskeletal disorders in other body regions.
Collapse
|
15
|
[Rehabilitation concepts and return to sport after interventions on the shoulder]. DER ORTHOPADE 2014; 43:256-64. [PMID: 24604157 DOI: 10.1007/s00132-013-2149-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Rehabilitation of athletes following surgical interventions for shoulder injuries is of utmost importance for recovery and return to sport. OBJECTIVES The aim was to determine adequate concepts for rehabilitation following shoulder surgery in athletes. METHODS A selective literature search was carried out in PubMed and a review of the available concepts is given taking personal experiences as well as national and international recommendations into consideration. RESULTS This article presents the basic principles of functional rehabilitation, the kinetic chain and the different phases in rehabilitation. Specific rehabilitation concepts and return to sport strategies following traumatic dislocation, superior labrum anterior to posterior (SLAP) lesions and rotator cuff tears are presented. There is little high-level scientific evidence available for the treatment of these patients and most concepts are based on clinical experience and expert opinion. CONCLUSION Rehabilitation of athletes with shoulder injuries requires a broad consensus strategy with respect to the next steps. Individual concepts for rehabilitation should take surgical and patient-specific criteria into consideration. Further research is urgently required to develop evidence-based recommendations.
Collapse
|