Comparison of 2 Exercise Rehabilitation Programs for Multidirectional Instability of the Glenohumeral Joint: A Randomized Controlled Trial (original) (raw)
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Background: Conservative management is commonly recommended as the first-line treatment for mul-tidirectional 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. Level of evidence: Level IV; Case Series; Treatment Study
Physical Therapy in Sport, 2016
Study Design: Systematic review Objectives: To identify the best evidenced-based approach for the conservative rehabilitation of patients with posterior glenohumeral instability. Background: Posterior glenohumeral instability is more common than previously thought. Proper management is imperative to control symptoms and maximize function. Methods: We conducted an electronic search, up to November 2014, for Englishlanguage studies involving rehabilitation of posterior shoulder instability. A manual search of reference lists of included articles and previously published reviews was also performed. Results: Five studies met the review inclusion criteria. Most studies demonstrated that rotator cuff and posterior deltoid strengthening could reduce instability recurrence and pain, and increase function, mainly in those with atraumatic posterior instability without previous surgery. These studies were mainly case series or retrospective designs Conclusions: Rotator cuff and posterior deltoid strengthening may help with symptommanagement and functioning in those with posterior glenohumeral instability. Further research is needed to detect statistically significant outcomes from conservative treatment.
BMJ open, 2024
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).
Advances in the Non-Operative Management of Multidirectional Instability of the Glenohumeral Joint
Journal of Clinical Medicine
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.
Nonoperative rehabilitation for traumatic and atraumatic glenohumeral instability
Shoulder Instability: A Comprehensive Approach, 2012
Glenohumeral joint instability is a common pathology encountered in the orthopaedic and sports medicine setting. A wide range of symptomatic shoulder instabilities exist ranging from subtle subluxations due to contributing congenital factors to dislocations as a result of a traumatic episode. Non-operative rehabilitation is utilized in patients diagnosed with shoulder instability to regain their previous functional activities through specific strengthening exercises, dynamic stabilization drills, neuromuscular training, proprioception drills, scapular muscle strengthening program and a gradual return to their desired activities. The specific rehabilitation program should be varied based on the type and degree of shoulder instability present and desired level of function. The purpose of this paper is to outline the specific principles associated with non-operative rehabilitation for each of the various types of shoulder instability and to discuss the specific rehabilitation program for each pathology type.
Polish Journal of Surgery, 2021
Introduction: 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. Aim: This article presents the current trends in the conservative treatment of multidirectional instability, assess effectiveness of rehabilitation and indicates the directions of MDI research. Material and methods: 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. Results: Low quality evidence shows priority of s...
Multidirectional instability of the shoulder: Current concepts and theories - A clinical perspective
OBJECTIVES: To evaluate the effect of rotator cuff strengthening and stabilization exercises on multidirectional instability (MDI) of the shoulder. DATA SOURCES: The electronic databases MEDLINE, CINAHL, AMED, EMBASE, Sciencedirect (Elsevier) were searched without date restrictions. Manual Hand searching of key journals and scanning the reference lists of identified articles was performed. REVIEW METHODS: All English language, interventional studies assessing the effects of exercises on MDI were included. A descriptive approach to reviewing was undertaken as no randomised control trials could be found. The second section was devoted to understanding the theoretical concepts underpinning the management of MDI using stabilisation exercises and suggestions for a clinical program for enhancing stability in MDI. RESULTS: Four studies were included in this review. Though the methodological quality of these was poor, all of these placed emphasis on retraining the rotator cuff and the scapu...
The Rehabilitation Treatment in Glenohumeral Instability
Romanian Medical Journal, 2016
The glenohumeral instability is a frequent pathology especially in athletes, but it may also affect sedentary people, because the glenohumeral joint has a high degree of mobility, but a smaller stability. The main symptoms are represented by pain, slipping of the shoulder and sudden weakness of the arm. We must evaluate also the neurological signs, because secondary shoulder instability can appear in patients with stroke or nerve lesions. The functional limitations include reduced motion, muscle weakness and pain that interferes with activities of daily living. The rehabilitation treatment has important goals as reduction of pain, restoration of full range of motion, correction of muscle strength deficits and return to full activity free of symptoms.