Diagnosis and management of atraumatic shoulder instability

Bateman, Marcus; Jaiswal, Anuj; Tambe, Amol

doi:10.1016/j.jajs.2018.05.009

Cited by 12 publications

(21 citation statements)

References 52 publications

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“…Atraumatic shoulder instability is associated with underlying dysfunction of the joint capsule, where laxity can lead to symptomatic instability. 3 In such cases, conservative management, such as physiotherapy rehabilitation, is recommended with surgery as the limited resort. 22 Physical therapy of patients with the loose shoulder is aimed at strengthening the rotator cuff to maximize the concavity-compression mechanism and stabilizing the scapula to stabilize the glenoid platform.…”

Section: Discussionmentioning

confidence: 99%

The infraspinatus muscle activity during pitching motion in baseball players with shoulder instability

Kotoshiba

Urabe

Hara³

et al. 2021

JSES International

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Background Shoulder microinstability is often overlooked, which can be problematic, especially in overhead athletes. The slipping phenomenon is defined as posterior or lateral sliding of the humeral head in an elevated arm. When the shoulder is close to the end range of stability, the infraspinatus is highly activated and keeps the shoulder in the glenoid cavity. This study aimed to examine the characteristic physical function and infraspinatus activity during the pitching motion in baseball pitchers with shoulder instability. Methods Twenty-one male baseball pitchers participated and were divided into 2 groups based on radiograph findings at zero position: slipped (group S) and nonslipped (group N) groups. Physical function using Hara test and infraspinatus muscle activity during pitching were evaluated. Results The infraspinatus muscle activity during the acceleration phase was significantly greater in group S (59.5 ± 33.0%MVC) than in group N (33.0 ± 16.9%MVC) ( P < .05). Positive rate of the Hara test in group S was significantly high in the loose test and elbow push test. Conclusions This study shows that baseball pitchers with slipping phenomenon have capsular laxity and scapular instability that indicate high infraspinatus muscle activity during the acceleration phase. Therefore, repetitive pitching with hyperactivity of the infraspinatus on the slipping shoulder may cause fatigue and dysfunction.

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Section: Discussionmentioning

confidence: 99%

The infraspinatus muscle activity during pitching motion in baseball players with shoulder instability

Kotoshiba

Urabe

Hara³

et al. 2021

JSES International

View full text Add to dashboard Cite

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“…Shoulder instability is associated with pain, decreased movement and limited function. A plausible reason for the poor prognosis is inaccurate diagnosis which may result in inappropriate treatment selection which occurs despite the availability of multiple classification systems [ 4 – 10 ], diagnostic/assessment guidelines [ 11 , 12 ] and management/treatment pathways [ 10 , 13 ]…”

Section: Introductionmentioning

confidence: 99%

Implications for the design of a Diagnostic Decision Support System (DDSS) to reduce time and cost to diagnosis in paediatric shoulder instability

Philp

Faux-Nightingale

Woolley

et al. 2021

BMC Med Inform Decis Mak

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Background Currently the diagnosis of shoulder instability, particularly in children, is difficult and can take time. These diagnostic delays can lead to poorer outcome and long-term complications. A Diagnostic Decision Support System (DDSS) has the potential to reduce time to diagnosis and improve outcomes for patients. The aim of this study was to develop a concept map for a future DDSS in shoulder instability. Methods A modified nominal focus group technique, involving three clinical vignettes, was used to elicit physiotherapists decision-making processes. Results Twenty-five physiotherapists, (18F:7 M) from four separate clinical sites participated. The themes identified related to ‘Variability in diagnostic processes and lack of standardised practice’ and ‘Knowledge and attitudes towards novel technologies for facilitating assessment and clinical decision making’. Conclusion No common structured approach towards assessment and diagnosis was identified. Lack of knowledge, perceived usefulness, access and cost were identified as barriers to adoption of new technology. Based on the information elicited a conceptual design of a future DDSS has been proposed. Work to develop a systematic approach to assessment, classification and diagnosis is now proposed. Trial Registraty This was not a clinical trial and so no clinical trial registry is needed.

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“…Consequently patients with ASI usually require a range of specialised assessment and treatment strategies to aid their management [ 6 , 14 ]. Whilst physiotherapy is advocated, if this fails, surgery may be considered [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Management has historically been directed by expert opinion through clinical commentaries and consensus studies [ 13 , 14 , 16 ], rather than high quality evidence [ 17 , 18 ]. Some authors suggest using classification systems to help guide clinical practice to help direct management [ 7 , 8 , 19 , 20 ], which was echoed in a recent Delphi study of posterior shoulder instability [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Management of atraumatic shoulder instability in physiotherapy (MASIP): a survey of physiotherapy practice

Coulthard

Cairns

Williams

et al. 2021

BMC Musculoskelet Disord

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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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Diagnosis and management of atraumatic shoulder instability

Cited by 12 publications

References 52 publications

The infraspinatus muscle activity during pitching motion in baseball players with shoulder instability

The infraspinatus muscle activity during pitching motion in baseball players with shoulder instability

Implications for the design of a Diagnostic Decision Support System (DDSS) to reduce time and cost to diagnosis in paediatric shoulder instability

Management of atraumatic shoulder instability in physiotherapy (MASIP): a survey of physiotherapy practice

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