At long-term follow-up many first-time male traumatic shoulder dislocators remain symptomatic

Safran, Ori; Beyth, Shaul; Milgrom, Charles; Milgrom, Yael; Nir, Dana; Finestone, Aharon S.

doi:10.1016/j.jsams.2023.03.008

Cited by 2 publications

(2 citation statements)

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“…Patients with recurrent ASD have been shown to exhibit increased kinesiophobia, 7,8 and persistent avoidance of certain daily and sport-related activities. 9 Increased activation of brain networks regulating motor resistance, cognitive control of movement, anxiety, and emotional regulation has been elicited in patients with anterior shoulder instability when visually presented with movements associated with anterior shoulder apprehension. 33 Given these findings, it would seem that patients with ASD may benefit from psychological-based interventions such as graded exposure which has been successfully used among patients with chronic low back pain.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the decreased rate of ASD and the clinically meaningful improvement in most outcome measures, the subject remained affected by shoulder instability as manifested by a relatively high WOSI score, a positive apprehension test and the recurrence of kinesiophobia at follow-up. While long-term disability and persistent apprehension have been documented years after surgical stabilization of the shoulder, 9,34 incorporating additional elements into ABT should be considered. Exercises in this case report were performed solely in the supine lying position.…”

Section: Discussionmentioning

confidence: 99%

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Apprehension-Based Training: A Novel Treatment Concept for Anterior Shoulder Dislocation – A Case Report

Rabin,

Noyman,

Yaakobi

et al. 2024

International Journal of Sports Physical Therapy

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Background and Purpose Conservative management of anterior shoulder dislocation (ASD) is associated with greater recurrence compared with surgical management. Current rehabilitation protocols may not adequately challenge shoulder stability to encourage adaptive coping strategies. Apprehension-based training (ABT) is a new treatment concept derived from the supine moving apprehension test (SMAT), a previously validated performance measure among patients with ASD. The purpose of this case report is to describe the application of ABT in a patient with recurrent ASD. Study Design Case report Case Description The subject was a 23-year-old male with bilateral recurrent ASD. The subject underwent a 17-week exercise program involving gradual exposure to increased anterior instability loads based on the SMAT movement pattern. The Western Ontario Shoulder Instability Index (WOSI), Patient-Specific Functional Scale (PFPS), Tampa Scale of Kinesiophobia, SMAT, shoulder internal and external rotation muscle strength were measured via hand-held dynomometry before and after training. Outcomes Following treatment, clinically meaningful gains in quality of life (WOSI) and shoulder function (PSFS) were noted. Kinesiophobia decreased, SMAT and shoulder internal rotator strength increased beyond their respective minimal detectable change. Four months after treatment, quality of life and shoulder function remained improved, and the subject reported a reduced rate of ASD. Discussion Apprehension-based training involving gradual exposure to shoulder instability loads may hold potential for improving the management of patients with ASD. Further testing of this concept is warranted. Level of Evidence 4, single case report

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%