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Thacher RR, Varady NH, Khilnani T, Camp CL, Dines JS. Current Concepts on the Management of Shoulder Instability in Throwing Athletes. Curr Rev Musculoskelet Med 2024; 17:353-364. [PMID: 38918331 PMCID: PMC11336015 DOI: 10.1007/s12178-024-09910-1] [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] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE OF REVIEW The management of shoulder instability in throwing athletes remains a challenge given the delicate balance between physiologic shoulder laxity facilitating performance and the inherent need for shoulder stability. This review will discuss the evaluation and management of a throwing athlete with suspected instability with a focus on recent findings and developments. RECENT FINDINGS The vast majority of throwing athletes with shoulder instability experience subtle microinstability as a result of repetitive microtrauma rather than episodes of gross instability. These athletes may present with arm pain, dead arms or reduced throwing velocity. Recent literature reinforces the fact that there is no "silver bullet" for the management of these athletes and an individualized, tailored approach to treatment is required. While initial nonoperative management remains the hallmark for treatment, the results of rehabilitation protocols are mixed, and some patients will ultimately undergo surgical stabilization. In these cases, it is imperative that the surgeon be judicious with the extent of surgical stabilization as overtightening of the glenohumeral joint is possible, which can adversely affect athlete performance. Managing shoulder instability in throwing athletes requires a thorough understanding of its physiologic and biomechanical underpinnings. Inconsistent results seen with surgical stabilization has led to a focus on nonoperative management for these athletes with surgery reserved for cases that fail to improve non-surgically. Overall, more high quality studies into the management of this challenging condition are warranted.
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Affiliation(s)
- Ryan R Thacher
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Tyler Khilnani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - Joshua S Dines
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Röthlisberger D, Rashid MS, Ruijs P, Zumstein MA. Paget-Schroetter Syndrome in a Patient With Posterior Shoulder Subluxation: A Case Report. Clin J Sport Med 2024:00042752-990000000-00189. [PMID: 38810123 DOI: 10.1097/jsm.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 04/28/2024] [Indexed: 05/31/2024]
Abstract
ABSTRACT Paget-Schroetter syndrome describes a primary thrombosis of the subclavian vein induced by effort. In most cases, the clinical presentation includes painful swelling, discoloration, and visible collateral circulation in the arm. Paget-Schroetter syndrome is treated with anticoagulation, rest, and physical therapy. In certain cases, invasive treatment such as thrombolysis and decompression surgery (first rib resection) may be necessary. We present the case of a 28-year-old healthy male patient with effort-induced deep vein thrombosis of the upper extremity after posterior shoulder subluxation. Anticoagulation, rest, and physical therapy were used to treat the patient, who became asymptomatic and was able to resume normal activities without restriction. To our knowledge, this is the first case of effort-induced upper extremity deep vein thrombosis after posterior shoulder subluxation. Paget-Schroetter syndrome is rare diagnosis that requires vigilance during musculoskeletal assessment for shoulder pain and swelling. The early detection, radiological confirmation, and prompt initiation of treatment are essential to successful management of Paget-Schroetter syndrome. The impact of associated posterior shoulder subluxation remains unclear.
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Affiliation(s)
| | - Mustafa S Rashid
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland
- Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Peter Ruijs
- Department of Radiology, Sonnenhof Hospital, Bern, Switzerland; and
| | - Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Bern, Switzerland
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland
- Shoulder and Elbow, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
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Fernández-Matías R, Lluch-Girbés E, Bateman M, Requejo-Salinas N. Assessing the use of the frequency, etiology, direction, and severity classification system for shoulder instability in physical therapy research - A scoping review. Phys Ther Sport 2024; 66:76-84. [PMID: 38359729 DOI: 10.1016/j.ptsp.2024.01.010] [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] [Received: 06/12/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE The aim of this study is to review the implementation of the Frequency, Etiology, Direction, and Severity (FEDS) classification for shoulder instability by the physical therapy scientific community since its publication in 2011. METHODS A systematic search was conducted on January 10, 2024 in the MEDLINE, EMBASE, SPORTDiscus, Scopus, Web of Science, Cochrane, and SciELO databases, as well as Google Scholar. Studies investigating physical therapy interventions in people with shoulder instability, and reporting selection criteria for shoulder instability were considered eligible. A narrative synthesis was conducted. RESULTS Twenty-six studies were included. None reported using the FEDS classification as eligibility criteria for shoulder instability. Only 42% of the studies provided data of all four criteria of the FEDS classification. The most reported criterion was direction (92%), followed by etiology (85%), severity (65%), and frequency (58%). The most common reported descriptor for profiling shoulder instability was "dislocation" (83.3%), followed by "first-time" (66.7%), "anterior" (62.5%), and "traumatic" (59.1%). Regarding other instability classifications, only one study (4%) used the Thomas & Matsen classification, and two (8%) the Stanmore classification. CONCLUSIONS The FEDS classification system has not been embraced enough by the physical therapy scientific community since its publication in 2011.
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Affiliation(s)
- Rubén Fernández-Matías
- Doctoral School, Department of Physical Therapy, Universitat de Valencia, Valencia, Spain
| | | | - Marcus Bateman
- Derby Shoulder Unit, Orthopaedic Outpatient Department, Royal Derby Hospital, Derby, United Kingdom
| | - Néstor Requejo-Salinas
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain
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Warby SA, Ganderton C, Watson L, Pizzari T, Balster S, Hoy G, Barwood S, Kerr B, Lawrence S, Lenssen R, Rotstein A, Takla A, Civier O, Hughes M. Effect of a physiotherapy-directed rehabilitation programme on patients with multidirectional instability of the glenohumeral joint: a multimodal interventional MRI study protocol. BMJ Open 2024; 14:e071287. [PMID: 38373861 PMCID: PMC10882378 DOI: 10.1136/bmjopen-2022-071287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Altered neuromuscular control of the scapula and humeral head is a typical feature of multidirectional instability (MDI) of the glenohumeral joint, suggesting a central component to this condition. A previous randomised controlled trial showed MDI patients participating in the Watson Instability Program 1 (WIP1) had significantly improved clinical outcomes compared with a general shoulder strength programme. The aim of this paper is to outline a multimodal MRI protocol to identify potential ameliorative effects of the WIP1 on the brain. METHODS AND ANALYSIS Thirty female participants aged 18-35 years with right-sided atraumatic MDI and 30 matched controls will be recruited. MDI patients will participate in 24 weeks of the WIP1, involving prescription and progression of a home exercise programme. Multimodal MRI scans will be collected from both groups at baseline and in MDI patients at follow-up. Potential brain changes (primary outcome 1) in MDI patients will be probed using region-of-interest (ROI) and whole-brain approaches. ROIs will depict areas of functional alteration in MDI patients during executed and imagined shoulder movements (MDI vs controls at baseline), then examining the effects of the 24-week WIP1 intervention (baseline vs follow-up in MDI patients only). Whole-brain analyses will examine baseline versus follow-up voxel-wise measures in MDI patients only. Outcome measures used to assess WIP1 efficacy will include the Western Ontario Shoulder Index and the Melbourne Instability Shoulder Score (primary outcomes 2 and 3). Secondary outcomes will include the Tampa Scale for Kinesiophobia, Short Form Orebro, Global Rating of Change Score, muscle strength, scapular upward rotation, programme compliance and adverse events. DISCUSSION This trial will establish if the WIP1 is associated with brain changes in MDI. ETHICS AND DISSEMINATION Participant confidentiality will be maintained with publication of results. Swinburne Human Research Ethics Committee (Ref: 20202806-5692). TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN12621001207808).
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Affiliation(s)
- Sarah Ann Warby
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
| | - Charlotte Ganderton
- Nursing and Allied Health, Swinburne University of Technology Faculty of Health Arts and Design, Hawthorn, Victoria, Australia
| | - Lyn Watson
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
- Mill Park Physiotherapy, Melbourne, Victoria, Australia
| | - Simon Balster
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
- Department of Surgery, Monash University, Clayton, Victoria, Australia
| | - Shane Barwood
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Bonnie Kerr
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Sam Lawrence
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Ross Lenssen
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Andrew Rotstein
- Victoria House Medical Imaging, Melbourne, Victoria, Australia
| | - Annalaise Takla
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Oren Civier
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Matthew Hughes
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Griffin J, Jaggi A, Daniell H, Chester R. A systematic review to compare physiotherapy treatment programmes for atraumatic shoulder instability. Shoulder Elbow 2023; 15:448-460. [PMID: 37538527 PMCID: PMC10395403 DOI: 10.1177/17585732221080730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 08/05/2023]
Abstract
Background Optimal physiotherapy treatment is uncertain for atraumatic shoulder instability (ASI), the primary aim of this systematic scoping review was to compare physiotherapy treatment programmes for people with ASI. The secondary aims were to evaluate outcome measures used and to compare the effectiveness of these programmes. Methods CINAHL, EMBASE and Medline databases were searched for studies, except single case studies, published between 1950 and July 2021. 12 critical appraisal items covered three domains; internal validity, transferability to wider population and reporting. Results Ten studies were included; one randomised controlled trial, 6 cohort studies and 3 case series. There were 491 participants. Treatment programmes included education, movement re-education, static posture correction, shoulder muscle strengthening, functional training, and adjuncts. All studies used patient reported outcome measures (PROMs), 7 of which reported a statistically significant improvement (p < 0.05) post-treatment. There was no clear relationship between programmes and outcomes. PROMs specific to shoulder instability were all found to detect statistically significant differences post-treatment. Discussion There does not appear to be one optimal physiotherapy treatment programme for ASI. Future studies should use PROMs that are valid in the shoulder instability population and use more outcome measures that are specific to impairments being targeted.
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Affiliation(s)
- Jake Griffin
- Bexley MSK, Oxleas NHS Foundation Trust, Erith and District Hospital, Erith, DA8 3EE, UK
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
| | - Anju Jaggi
- Physiotherapy Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, London, UK
| | - Helena Daniell
- Physiotherapy Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
| | - Rachel Chester
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
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Watson L, Hoy G, Wood T, Pizzari T, Balster S, Barwood S, Warby SA. Posterior Shoulder Instability in Tennis Players: Aetiology, Classification, Assessment and Management. Int J Sports Phys Ther 2023; V18:769-788. [PMID: 37425109 PMCID: PMC10324327 DOI: 10.26603/001c.75371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/14/2023] [Indexed: 07/11/2023] Open
Abstract
Background Micro-traumatic posterior shoulder instability (PSI) is an often missed and misdiagnosed pathology presenting in tennis players. The aetiology of micro-traumatic PSI in tennis players is multifactorial, including congenital factors, loss of strength and motor control, and sport-specific repetitive microtrauma. Repetitive forces placed on the dominant shoulder, particularly combinations of flexion, horizontal adduction, and internal rotation contribute to the microtrauma. These positions are characteristic for kick serves, backhand volleys, and the follow-through phase of forehands and serves. The aim of this clinical commentary is to present an overview of the aetiology, classification, clinical presentation, and treatment of micro-traumatic PSI, with a particular focus on tennis players. Level of Evidence 5.
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Affiliation(s)
- Lyn Watson
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
| | - Gregory Hoy
- Melbourne Orthopaedic Group, 33 The Avenue Windsor, Victoria, Australia, 3181
- Monash University, Department of Surgery, Monash Medical Centre Level 5, Block E 246 Clayton Road Clayton, Victoria, Australia, 3168
- Glenferrie Private Hospital, 25 Linda Crescent, Hawthorn, Victoria, Australia, 3122
| | - Timothy Wood
- Glenferrie Private Hospital, 25 Linda Crescent, Hawthorn, Victoria, Australia, 3122
| | - Tania Pizzari
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
- Mill Park Physiotherapy, 22/1 Danaher Dr, South Morang, Victoria, Australia, 37522
- La Trobe University, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, Corner of Kingsbury Drive and Plenty Road Bundoora, Victoria, Australia, 3080
| | - Simon Balster
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
| | - Shane Barwood
- Melbourne Orthopaedic Group, 33 The Avenue Windsor, Victoria, Australia, 3181
| | - Sarah Ann Warby
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
- La Trobe University, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, Corner of Kingsbury Drive and Plenty Road Bundoora, Victoria, Australia, 3080
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Stokes DJ, McCarthy TP, Frank RM. Physical Therapy for the Treatment of Shoulder Instability. Phys Med Rehabil Clin N Am 2023; 34:393-408. [PMID: 37003660 DOI: 10.1016/j.pmr.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Shoulder instability is the separation of the humeral head from the glenoid. Injury to the static and dynamic stabilizers can result in instability. Anterior shoulder instability is the predominant form of instability. It is usually a result of trauma. Posterior shoulder instability often presents with an insidious onset of pain. Multidirectional instability of the shoulder is symptomatic laxity in more than one plane of motion. The primary goal of rehabilitation is to restore pain-free mobility, strength, and functioning. Rehabilitation implements range of motion and strengthening exercises to restore proprioceptive control and scapular kinematics.
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Zeng Z, Liu M, Liu Y. Anatomy features of the shoulder joint in asymptomatic chinese Han adults. BMC Musculoskelet Disord 2023; 24:73. [PMID: 36709290 PMCID: PMC9883949 DOI: 10.1186/s12891-023-06172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 01/18/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To evaluate the shoulder anatomical characteristics in asymptomatic Chinese adults. METHODS The prospective study enrolled individuals without shoulder pain at Beijing Tiantan Hospital Affiliated to Capital Medical University between January 2019 and January 2020. Six radiographic parameters were measured and analyzed, including glenoid plane to the acromion (GA), glenoid plane to the lateral aspect of the humeral head (GH), acromion index (AI), lateral acromial angle (LAA), acromion-humeral interval (AHI), and critical shoulder angle (CSA). RESULTS 103 participants (51 males and 52 females) were enrolled. The mean values of GA, GH, AI, CSA, LAA, and AHI were 32.88 ± 5.68 mm, 47.16 ± 4.82 mm, 0.70 ± 0.11, 37.45 ± 6.00°, 6.32 ± 3.99°, and 9.611.86 mm, respectively. Females had lower GA (30.78 ± 5.06 vs. 35.01 ± 5.51 mm, P < 0.001) and GH (44.28 ± 3.67 vs. 50.11 ± 4.02 mm, P < 0.001) than males and LAA was significantly smaller in the Bigliani flat type compared with the curved type and the hooked type (5.07 ± 2.31° vs 12.33 ± 5.46°vs 10.00 ± 3.37, P = 0.001). CONCLUSIONS Females had lower GA and GH than males in asymptomatic Chinese Han adults. Asymptomatic Chinese Han subjects with Bigliani flat type had lower LAA. CSA appears lager in Chinese Han individuals. Curve type of acromion performed lager LAA. The results may help establish an anatomical model of the shoulder joint and elucidate the anatomy features of the shoulder joint in asymptomatic Chinese Han adults.
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Affiliation(s)
- Zheng Zeng
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Miaomiao Liu
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Arguello AM, Till SE, Reinholz AK, Okoroha KR, Barlow JD, Camp CL. Managing Shoulder Instability in the Overhead Athlete. Curr Rev Musculoskelet Med 2022; 15:552-560. [PMID: 36223035 PMCID: PMC9789295 DOI: 10.1007/s12178-022-09796-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Shoulder instability in the overhead athlete is a difficult problem because of the balance between necessary laxity for athletic movements and stability of the joint. The purpose of this review is to provide an overview of the clinical evaluation of shoulder instability in the overhead athlete and present evidence-based management strategies for each subtype of shoulder instability, including novel techniques and outcomes. RECENT FINDINGS Recent investigation has shown that throwers and other overhead athletes are more likely to present with subtle subluxation events rather than discrete dislocations as their primary symptom. While overhead athletes with discrete anterior dislocation events are likely to begin with non-operative management, many progress on to surgical intervention. Surgical management of glenohumeral joint instability continues to pose challenges due to the potential for over-tensioning for the sake of stability at the expense of the adaptive laxity that often confers performance benefits in the overhead athlete. Novel, individualized, and sport/position specific approaches are needed to address this complex issue. The optimal management of shoulder instability in the overhead athlete continues to be a controversial topic due to the complex work-up, an increasing number of surgical options with varying indications, and low volume of high-quality studies comparing any of the treatment options. The Anterior Shoulder Instability International Consensus Group guidelines from February 2022 offer the most updated guidelines on work-up and management. Overall, high-quality randomized controlled trials are required to determine the optimal treatment for specific pathologies and aid in creating patient-centered management plans.
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Affiliation(s)
- Alexandra M Arguello
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sara E Till
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anna K Reinholz
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA.
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Watson L, Pizzari T, Balster S, Lenssen R, Warby SA. Advances in the Non-Operative Management of Multidirectional Instability of the Glenohumeral Joint. J Clin Med 2022; 11:5140. [PMID: 36079068 PMCID: PMC9456769 DOI: 10.3390/jcm11175140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
Multidirectional instability (MDI) of the glenohumeral joint refers to symptomatic subluxations or dislocations in more than one direction. The aetiology of MDI is multifactorial, which makes the classification of this condition challenging. A shoulder rehabilitation program is the initial recommended treatment for MDI, however available rehabilitation programs have varying levels of evidence to support their effectiveness. In 2016, we published the details of an evidence-based program for MDI that has been evaluated for efficacy in two single-group studies and a randomised controlled trial. In 2017, we published a clinical commentary on the aetiology, classification, and treatment of this condition. The aim of this paper is to provide an update on the components of these publications with a particular focus on new advances in the non-operative management of this condition.
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Affiliation(s)
- Lyn Watson
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Corner of Kingsbury Drive and Plenty Road Bundoora, Bundoora, VIC 2080, Australia
- Mill Park Physiotherapy, 22/1 Danaher Dr, South Morang, VIC 3752, Australia
| | - Simon Balster
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Ross Lenssen
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Sarah Ann Warby
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Corner of Kingsbury Drive and Plenty Road Bundoora, Bundoora, VIC 2080, Australia
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11
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Rehabilitation for atraumatic shoulder instability in circus arts performers: delivery via telehealth. J Shoulder Elbow Surg 2022; 31:e246-e257. [PMID: 34861406 DOI: 10.1016/j.jse.2021.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Watson Instability Program (WIP1) is current best evidence for conservative management of atraumatic shoulder instability, but it is unknown if this program can be effectively delivered via tele-consultation. The purpose of this longitudinal pre-post intervention study was to determine the effects of the WIP1 on patient-reported outcome measures, scapular position, shoulder strength, and handstand stability in student circus performers with atraumatic shoulder instability when delivered via tele-consultation. METHODS Student circus performers aged between 15 and 35 years from the National Institute of Circus Arts were recruited. A 12-week shoulder exercise program was delivered via tele-consultation during the Melbourne, Australia COVID-19 (coronavirus disease 2019) lockdown. The primary outcome measures were the Western Ontario Shoulder Instability Index score and the Melbourne Instability Shoulder Scale score. Secondary outcomes measures included the Orebro Musculoskeletal Pain Questionnaire, the Tampa Scale for Kinesiophobia, and physical assessment measures including strength via handheld dynamometry, scapular position using an inclinometer, and handstand stability via center-of-pressure fluctuation. Patient-reported outcomes were collected at baseline and 6-week, 12-week, 6-month, and 9-month time points, and physical outcomes were measured at baseline and 9-month time points. A repeated-measures mixed model (with effect sizes [ESs] and 95% confidence intervals [CIs]) was used to analyze patient-reported outcomes, handstand data, strength, and scapular measures. Significance was set at P < .05. RESULTS Twenty-three student circus arts performers completed the study. Significant improvements were found in both Western Ontario Shoulder Instability Index scores (effect size [ES], 0.79 [95% CI, 0.31-1.33] at 6 weeks; ES, 1.08 [95% CI, 0.55-1.6] at 12 weeks; ES, 1.17 [95% CI, 0.62-1.78] at 6 months; and ES, 1.31 [95% CI, 0.74-1.95] at 9 months; P < .001) and Melbourne Instability Shoulder Scale scores (ES, 0.70 [95% CI, 0.22-1.22] at 6 weeks; ES, 0.83 [95% CI, 0.34-1.37] at 3 months; ES, 0.98 [95% CI, 0.46-1.54] at 6 months; and ES, 0.98 [95% CI, 0.43-1.50] at 9 months; P < .001), as well as Orebro Musculoskeletal Pain Questionnaire scores at all follow-up time points. The Tampa Scale for Kinesiophobia scores reached significance at 6 weeks and 12 weeks. Following rehabilitation, we found statistically significant increases in shoulder strength in all positions tested and increased scapular upward rotation measured at end-of-range abduction, as well as during loaded external rotation. The affected arm showed greater instability than the unaffected arm with a significant intervention effect on the affected arm showing a greater consistent anterior-posterior movement pattern. CONCLUSION In a group of circus performers with atraumatic shoulder instability, treatment with the WIP1 via telehealth resulted in clinically and statistically significant improvements in shoulder symptoms and function.
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12
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Kreulen RT, Spiker AM, Heinlein SA, Cosgarea AJ. Evidence-Based Musculoskeletal Care for Swimmers: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202204000-00002. [PMID: 35385413 DOI: 10.2106/jbjs.rvw.21.00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Swimming is a popular activity with numerous health benefits. » Swimming involves complex biomechanical movements that, especially if performed incorrectly, can lead to musculoskeletal injuries. » The shoulder is the most commonly affected joint, although lower-extremity and spine injuries have also been reported.
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Affiliation(s)
- R Timothy Kreulen
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Andrea M Spiker
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Andrew J Cosgarea
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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13
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Bishop ME, Patel H, Erickson BJ, Dodson CC. Multidirectional instability in female athletes. ANNALS OF JOINT 2022; 7:10. [PMID: 38529164 PMCID: PMC10929405 DOI: 10.21037/aoj-20-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/03/2020] [Indexed: 03/27/2024]
Abstract
Multidirectional instability (MDI) of the shoulder is characterized by generalized shoulder capsular laxity and symptomatic shoulder instability in more than one direction with one direction of instability as inferior. Generalized ligamentous laxity and specifically shoulder laxity, has been associated with female athletes. While males are at a higher risk of shoulder instability due to a number of extrinsic risk factors including participation in higher risk contact/collision activities, females are particularly susceptible to MDI due to their association with increased joint laxity. Patients with MDI often have a loose patulous capsule and display altered glenohumeral and scapulothoracic mechanics. The mainstay of treatment is physical therapy focusing on strengthening the dynamic stabilizers of the shoulder. In cases of failed rehabilitation, operative management most frequently includes either open or arthroscopic capsular shift with reasonably good outcomes and return to sport. Sex-related differences concerning shoulder instability risk and pathophysiology may influence treatment decisions and outcome measures. An understanding of the factors concerning shoulder instability specific to the female athlete is important in management and prevention of injury.
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Affiliation(s)
| | - Heli Patel
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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Philp F, Faux-Nightingale A, Woolley S, de Quincey E, Pandyan A. Evaluating the clinical decision making of physiotherapists in the assessment and management of paediatric shoulder instability. Physiotherapy 2021; 115:46-57. [DOI: 10.1016/j.physio.2021.12.330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/21/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
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Coulthard C, Cairns MC, Williams D, Hughes B, Jaggi A. Management of atraumatic shoulder instability in physiotherapy (MASIP): a survey of physiotherapy practice. BMC Musculoskelet Disord 2021; 22:840. [PMID: 34592969 PMCID: PMC8485495 DOI: 10.1186/s12891-021-04677-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of atraumatic shoulder instability (ASI) on patients can be extensive, its management complex, with a biopsychosocial approach recommended. Currently how physiotherapists manage ASI is unknown or the extent to which current clinical practice aligns with existing evidence. At the time of this study no national guidelines or consensus to direct practice existed. METHODS A cross-sectional electronic survey was distributed between July-September 2018, targeting UK-based physiotherapists managing shoulder pathology. Respondents were invited to describe their management of ASI, and rate their awareness and utilisation of various treatment techniques on a Likert-scale; median and interquartile ranges were calculated. Free text survey items were analysed using quantitative content analysis (QCA) to identify codes and categories. Means and percentages were calculated to summarise QCA and descriptive data. RESULTS Valid survey responses were analysed (n = 135). Respondents had between 2 and 39 years of physiotherapy experience (mean = 13.9 years); the majority (71.1 %) reported that ASI made up < 10 % of their caseload. Only 22.9 % (n = 31/135) of respondents reported feeling 'very confident' in managing ASI; the majority feeling 'somewhat confident' (70.4 %, n = 95/135) or 'not confident' (6.7 %, n = 9/135). The majority of respondents (59.3 %) used an ASI classification system, > 90 % citing the Stanmore Classification. Physiotherapists adapted their management according to clinical presentation, responding to differing biopsychosocial needs of the patient scenario. Most respondents (> 80 %) did not use a protocol to guide their management. Exercise was the most utilised management approach for ASI, followed by education; novel treatment strategies, including cortical rehabilitation, were also reported. CONCLUSION Findings indicate physiotherapists utilise a wide range of treatment strategies and respond to biopsychosocial cues when managing patients with ASI. The majority reported not being very confident in managing this condition, however only a minority use rehabilitation protocols to support their management. Some interventions that respondents reported using lacked evidence to support their use in ASI management and further research regarding effectiveness is required. Guidelines have been published since this survey; the impact of these will need evaluating to determine their effectiveness in the future.
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Affiliation(s)
- Caroline Coulthard
- Surrey iMSK Service, Ashford and St. Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK.
| | - Mindy C Cairns
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Deborah Williams
- The Shoulder & Elbow Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ben Hughes
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, WN6 9EP, UK
| | - Anju Jaggi
- The Shoulder & Elbow Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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Kłaptocz P, Solecki W, Grzegorzewski A, Błasiak A, Brzóska R. Effectiveness of conservative treatment of multidirectional instability of the shoulder joint. Literature review and meta-analysis. POLISH JOURNAL OF SURGERY 2021; 94:6-11. [DOI: 10.5604/01.3001.0015.2415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<br><b>Introduction:</b> Multidirectional shoulder instability (MDI) occurs when the shoulder is dislocating in at least two directions. The patient usually experiences pain with apprehension and a clicking sensation inside the joint. So far, a few classification scales of shoulder instability have been made. Despite this fact, MDI is highly problematic for clinicians in diagnosis and treating.</br>
<br><b>Aim:</b> This article presents the current trends in the conservative treatment of multidirectional instability, assess effectiveness of rehabilitation and indicates the directions of MDI research.</br>
<br><b>Material and methods:</b> In order to find current literature and conduct a critical analysis, the following scientific database was used: Cochrane Library, Physiotherapy Evidence Database (PEDro), MEDLINE and PubMed. We chose four articles which included a comparison of conservative and operative treatment, and four which evaluate the effectiveness of rehabilitation.</br>
<br><b>Results:</b> Low quality evidence shows priority of surgical treatment over conservative treatment. The protocol developed by Watson obtains a statistically significant advantage over the Burkhead and Rockwood protocol.
Discussion: The effectiveness of rehabilitation reaches different levels. Rehabilitation should last from 3 to 12 months. If rehabilitation does not achieve a sufficient effect, arthroscopic methods of reducing the volume of the articular capsule should be considered. Due to the small number of scientific reports and their quality, the obtained data should be interpreted with caution. Much further research is required to create a precise and most effective algorithm.</br>
<br><b>Conclusion:</b> Rehabilitation exercises play an important role in the treatment of multidirectional instability of the shoulder joint, especially when the patient has not had an injury. Exercise types and load should be dosed individually. At present, the protocol described by Watson is the most effective.</br>
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Affiliation(s)
- Patryk Kłaptocz
- Shoulder and Upper Limb Department, St. Łukasz, Bielsko-Biala, Poland
| | - Wojciech Solecki
- Shoulder and Upper Limb Department, St. Łukasz, Bielsko-Biala, Poland
| | | | - Adrian Błasiak
- Shoulder and Upper Limb Department, St. Łukasz, Bielsko-Biala, Poland
| | - Roman Brzóska
- Shoulder and Upper Limb Department, St. Łukasz, Bielsko-Biala, Poland
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Ganderton C, Kinsella R, Watson L, Pizzari T. Getting more from standard rotator cuff strengthening exercises. Shoulder Elbow 2020; 12:203-211. [PMID: 32565922 PMCID: PMC7285972 DOI: 10.1177/1758573219888829] [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: 07/21/2019] [Revised: 09/16/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND A simple modification to standard rotator cuff exercises using an additional resistance band around the scapula has been recommended in the clinical setting, postulated to encourage activation of the posterior scapular stabilisers and increase rotator cuff activation. The aim of this clinical laboratory study was to compare scapular and rotator cuff muscle activation between standard and modified exercises. METHODS Electromyographic data were collected from 10 healthy adults via surface and intramuscular electrodes from the scapular and rotator cuff muscles. Internal and external rotation exercises of the shoulder with the arm abducted to 0°, 45° and 90° were performed using one handheld resistance band (standard) or two bands with the additional band applied to the scapula (modified). RESULTS Activation of the trapezii and rhomboid muscles during the modified exercises at 0° and 45° of abduction was significantly greater when compared to the standard exercises (P < 0.05). No significant differences were found in rotator cuff muscle activation. DISCUSSION Applying resistance to the posterior scapula increases activation of some scapular stabilising muscles particularly in lower ranges of abduction. This study provides preliminary evidence that this simple modification can elicit greater scapular muscle activity, potentially producing enhanced exercise outcomes with minimal additional effort.
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Affiliation(s)
- C Ganderton
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia,Department of Health Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - R Kinsella
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia,Physiotherapy Department, St Vincent’s Hospital, Melbourne, Australia
| | - L Watson
- Melbourne Shoulder Group, Melbourne, Australia
| | - T Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia,T Pizzari, La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
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Structured Rehabilitation Program for Multidirectional Shoulder Instability in a Patient with Ehlers-Danlos Syndrome. Case Rep Orthop 2020; 2020:8507929. [PMID: 32089933 PMCID: PMC7021465 DOI: 10.1155/2020/8507929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/27/2019] [Accepted: 01/21/2020] [Indexed: 01/18/2023] Open
Abstract
Patients with Ehlers-Danlos syndrome (EDS) present many musculoskeletal disorders. The purpose of this case report was to describe the effectiveness of a scapular motor control program for a patient with multidirectional severe shoulder instability due to EDS, with 6-month follow-up. The patient was a 14-year-old female with EDS hypermobile type who suffered recurrent shoulder dislocation. Her chief complaints were bilateral shoulder discomfort and instability during writing motion. In the early part of intervention, she was prescribed exercise therapy for multidirectional instability (MDI) with orthosis. In the latter part of intervention, she was instructed in the scapular motor control program. Active and passive range of motion (ROM), sulcus sign, and Rowe score for shoulder instability were measured at baseline and at 3, 6, and 12 months after interventions. The shoulder ROM and instability score were improved after 6-month intervention. The findings from this report indicate that the scapular motor control program for shoulder instability would be effective even for patients with EDS hypermobile type. A patient who could not increase passive ROM due to dislocation is also able to achieve fair function of the shoulder joint instead of increasing active ROM. These positive outcomes indicate the possibility of benefit from the scapular motor control program for an MDI patient with EDS as a conservative treatment.
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Kitagawa T, Matsui N, Nakaizumi D. Impact of combination of therapeutic exercise and psychological intervention for a patient with first-time traumatic shoulder dislocation. J Phys Ther Sci 2019; 31:850-854. [PMID: 31645818 PMCID: PMC6801349 DOI: 10.1589/jpts.31.850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] A young female with first-time traumatic shoulder dislocation showed a good
outcome at the 1 year follow-up in returning to work and sports after undergoing a
combination of exercise therapy and psychological intervention. [Participant and Methods]
A 24-year-old female who worked as an occupational therapist and played badminton for
recreation had dislocated her shoulder in a fall. We evaluated her compliance with
home-exercise, range of motion, return to work, fear of movement, sports activity level,
and instability of shoulder joint using the modified Rowe score at each timepoint
necessary. During early sessions of the physical therapy, the range of motion and
instability score for the shoulder joint were poor. We treated her using a phase-based
approach, and subsequently, added the Watson program to restore normal kinematics. Because
of a psychological problem during middle sessions of the physical therapy, we provided
psychological education and support. [Results] At the final session of the therapy, her
compliance with home-exercise was good. She had achieved almost a full range of motion.
The fear of movement decreased, and she could play sports again. The modified Rowe score
improved from 5 to 85. [Conclusion] As a conservative treatment for patients with
first-time traumatic shoulder instability, a combination of therapeutic exercise and
psychological intervention may be useful.
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Affiliation(s)
- Takashi Kitagawa
- Department of Physical Therapy, School of Health Sciences, Shinshu University: 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan
| | - Nobumasa Matsui
- Department of Rehabilitation, Japanese Red Cross Kanazawa Hospital, Japan
| | - Dai Nakaizumi
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Japan
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Bleichert S, Renaud G, MacDermid J, Watson L, Faber K, Lenssen R, Saulnier M, Phillips P, Evans T, Sadi J. Rehabilitation of symptomatic atraumatic degenerative rotator cuff tears: A clinical commentary on assessment and management. J Hand Ther 2018. [PMID: 28641732 DOI: 10.1016/j.jht.2017.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical Commentary. INTRODUCTION Atraumatic rotator cuff (RC) disease, is one of the most common cause of shoulder pain, which encompasses a continuum from tendinopathy to full thickness cuff tears. Extrinsic, intrinsic and environmental factors have been implicated in the pathophysiology of this disorder, affecting the clinical presentation of symptoms including pain and irritability. Successful rehabilitation of symptomatic atraumatic degenerative rotator cuff (SADRC) tears must address the underlying mechanisms causing dysfunction and correct modifiable factors. PURPOSE OF THE STUDY The purpose of this paper is to review the shoulder complex anatomy, introduce atraumatic degenerative RC pathology, differentiate between symptomatic and asymptomatic degenerative RC tears, propose an assessment and introduce the Rotator Cuff Protocol 1 (RCP1) designed by the clinical reasoning of one of the lead authors (LW) as a rehabilitation management approach for those clients who present with SADRC tears. METHODS/RESULTS/DISCUSSION N/A for clinical commentary. CONCLUSIONS The ability to identify SADRC tears should consider shoulder anatomy, extrinsic, intrinsic and environmental factors, and the consideration for the natural history of atraumatic partial and full thickness tears in the general population. A thorough clinical history and examination, which includes shoulder symptom modification tests, allows the examiner to determine at what phase the patient may start their exercise program. The RCP1 is a program that has been used clinically by many therapists and clients over the years and research is underway to test this protocol in atraumatic rotator cuff disease including SADRC tears. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Sarah Bleichert
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Genevieve Renaud
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Lyn Watson
- LifeCare Prahran Sports Medicine Centre and Melbourne Orthopaedic Group, Melbourne, Australia
| | - Ken Faber
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ross Lenssen
- LifeCare Prahran Sports Medicine Centre and Melbourne Orthopaedic Group, Melbourne, Australia
| | - Marie Saulnier
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paul Phillips
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Tyler Evans
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jackie Sadi
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.
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Watson L, Balster S, Warby SA, Sadi J, Hoy G, Pizzari T. A comprehensive rehabilitation program for posterior instability of the shoulder. J Hand Ther 2018. [PMID: 28641736 DOI: 10.1016/j.jht.2017.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Posterior shoulder instability is recognised as being less prevalent than anterior instability, however the diagnosis of this pathology is easily overlooked or missed and this may contribute to an underestimation of prevalence. Recently, there has been increasing recognition of this condition and consequently a greater requirement for knowledge of diagnostic procedures and treatment directions. Currently there is limited research into the conservative management of posterior instability, although it is recommended as first-line treatment prior to surgical review, particularly in those with an atraumatic instability mechanism. The aim of this paper is to outline a comprehensive rehabilitation program for the conservative management of posterior instability with a focus on scapular and humeral head control. The information provided includes extensive written information, flowcharts, figures and a table of management parameters that will provide therapists with adequate detail to replicate the program in the clinical setting.
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Affiliation(s)
- Lyn Watson
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia; LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia; Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - Simon Balster
- LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia; Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - Sarah Ann Warby
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia; LifeCare Prahran Sports Medicine Centre, Prahran, Victoria, Australia; Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | | | - Greg Hoy
- Melbourne Orthopedic Group, Melbourne, Victoria, Australia
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.
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Multidirectional instability of the glenohumeral joint: Etiology, classification, assessment, and management. J Hand Ther 2018; 30:175-181. [PMID: 28576345 DOI: 10.1016/j.jht.2017.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/04/2017] [Accepted: 03/24/2017] [Indexed: 02/03/2023]
Abstract
Multidirectional instability of the shoulder is a type of glenohumeral joint shoulder instability. There are discrepancies in the definition and classification of this condition, which can make diagnosis and treatment selection challenging. Knowledge of contributing factors, the typical clinical presentation, and current best evidence for treatment options can assist in the diagnosis and appropriate treatment selection for this pathology. The purpose of this article is to present an overview of the current literature regarding the etiology, classification, assessment, and management of multidirectional instability of the glenohumeral joint.
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Watson L, Balster S, Lenssen R, Hoy G, Pizzari T. The effects of a conservative rehabilitation program for multidirectional instability of the shoulder. J Shoulder Elbow Surg 2018; 27:104-111. [PMID: 28947382 DOI: 10.1016/j.jse.2017.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Conservative management is commonly recommended as the first-line treatment for multidirectional instability (MDI) of the shoulder. Despite this, the evidence for efficacy of treatment is limited, and until recently, guidance for clinicians on conservative rehabilitation programs has been inadequate. This study evaluated the effectiveness of a physiotherapy-led exercise program for participants with MDI. METHODS In a single-group study design, 43 participants (16 male, 27 female; mean age, 19.8 years, standard deviation, 4.9 years) diagnosed with MDI undertook a 12-week exercise program. Primary outcome measures were the Melbourne Instability Shoulder Score, Western Ontario Shoulder Instability Index, and Oxford Shoulder Instability Score. Secondary outcomes were strength and scapular position. All measures were taken at baseline and repeated at the conclusion of the program. Test differences before and after rehabilitation were evaluated with dependent t tests and single-group effect size calculations (standardized mean difference [SMD]) to provide a measure of the magnitude of the difference. RESULTS Large effects were found between pre- and postrehabilitation scores on all functional instability questionnaires, with the Western Ontario Shoulder Instability Index demonstrating the largest effect (SMD, -3.04). Scapular upward rotation improved significantly in the early ranges of abduction (0°-60°), with moderate to large effects (SMDs, 0.54-0.95). All strength measures significantly improved, with large differences identified (SMDs, 0.69-2.08). CONCLUSION The identified improvement in functional status, shoulder muscle strength, and scapular positioning after rehabilitation allows greater confidence in the value of conservative management of MDI and informs further research by way of clinical trials in the area.
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Affiliation(s)
- Lyn Watson
- LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia; La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia; Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Simon Balster
- LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia; Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Ross Lenssen
- LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia; La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia; Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Greg Hoy
- Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia.
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