Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study

Eshøj, Henrik; Rasmussen, Sten; Frich, Lars Henrik; Jensen, Steen Lund; Søgaard, Karen; Juul-Kristensen, Birgit

doi:10.1186/s12891-019-2444-0

Cited by 20 publications

(24 citation statements)

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“…31,42 This may lead to recurrent ASDs and symptoms for longer periods, 3 reduced participation in physical activity, and decreased shoulder-related quality of life. 16,37,44 Diverging strategies exist as to the optimum treatment for this group. For young, active male patients with primary traumatic ASDs, 2 systematic reviews have concluded that shoulder stabilizing surgery with postsurgical shoulder rehabilitation was superior to nonsurgical standard care treatment only in reducing the risk of recurrent ASDs.…”

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confidence: 99%

Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial

Eshøj

Rasmussen

Frich

et al. 2020

Orthopaedic Journal of Sports Medicine

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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 Â 20 repetitions each day) to elite (2 Â 10 repetitions, 3 times weekly). The HOMEX program included 5 shoulder exercises performed 3 times weekly (2 Â 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 ). 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 ¼ .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).A traumatic anterior shoulder dislocation (ASD) is a common athletic injury among young, active patients. 34 The annual incidence of primary traumatic ASDs is between 11.2 and 26.2 per 100,000 people. 30,32,52 Patients with primary traumatic ASDs are prone to recurrent ASDs because

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confidence: 99%

Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial

Eshøj

Rasmussen

Frich

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Characteristics of the patients in the two groups were similar (Table 1) [23]. The two-way ANCOVA demonstrated that PPTs were not different between first-time and recurrent ASD for any of the tested muscles, crude analysis , F (4, 265) = 0.27, p = 0.90, adjusted for sex and age, F (4,263) = 0.29, p = 0.88 ( Figure 2).…”

Section: Resultsmentioning

confidence: 80%

“…This was a secondary analysis of cross-sectional data from a randomized controlled trial (RCT) [23]. Reporting was conducted according to the STROBE guidelines for crosssectional studies [24].…”

Section: Methodsmentioning

confidence: 99%

Pressure pain sensitivity in patients with traumatic first-time and recurrent anterior shoulder dislocation: a cross-sectional analysis

Liaghat

Eshøj

Juul-Kristensen

et al. 2019

Scandinavian Journal of Pain

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Background and aimsTraumatic anterior shoulder dislocation (ASD) is frequent in active populations and associated with a 39% higher risk of recurrent dislocation, which may cause persistent shoulder problems, pain, and impaired shoulder-related quality of life. While local and distant pressure pain sensitivity has been demonstrated in other shoulder conditions, little is known about the link between pressure pain sensitivity and ASD. The interesting aspect is whether recurrent dislocation – resulting in symptoms of longer duration – is associated with more pronounced pressure pain sensitivity, or if presence of pressure pain sensitivity may be part of the reasons why patients develop recurrent dislocation. Therefore, this study aimed at evaluating whether patients with recurrent ASD display greater pressure pain sensitivity and more painful body sites than patients with first-time ASD.MethodsThis was a cross-sectional analysis of baseline data from a randomized controlled trial including 34 patients with first-time ASD [82% male, mean (SD) age 26 (7) years] and 22 patients with recurrent ASD [96% male, mean (SD) age 25 (5) years]. Patients were assessed as follows: (1) assessment of local and distant pressure pain sensitivity evaluated by pressure pain thresholds (PPTs) using a handheld algometer on mm. trapezius superior, levator scapula, pectorales major, deltoideus, and tibialis anterior, (2) pain intensity at rest during the previous 24 h, (3) number of ASD, and (4) number of painful body sites on a region-divided body chart.ResultsThe PPTs were not significantly different between first-time and recurrent ASD [mean (SD) kPa for m. trapezius superior 264 (110) vs. 261 (88), m. levator scapula 301 (157) vs. 325 (163), m. pectorales major 234 (163) vs. 269 (130), m. deltoideus 290 (166) vs. 352 (173), m. tibialis anterior 420 (202) vs. 449 (184)], two-way ANCOVA, adjusted for sex and age, F (4,263) = 0.29, p = 0.88. For both groups, the PPTs were lower at the shoulder sites than at m. tibialis anterior (difference 117–184 kPa, 95% CI range 33–267). Females had lower PPTs than males (difference 124 kPa, 95% CI 64−183). The number (SD) of painful body sites were 2.2 (1.9) for first-time ASD and 2.6 (5.4) for recurrent ASD, with no between-group differences, one-way ANCOVA, adjusted for sex and age, F (1, 52) = 0.24, p = 0.63. There was a strong correlation between PPTs at the shoulder and lower leg, r = 0.84, p < 0.01.ConclusionsThis study demonstrated no differences in local and distant pressure pain sensitivity or number of painful body sites between patients with first-time and recurrent ASD. Females had lower PPTs than males, and a strong correlation was found between PPTs at the shoulder and lower leg.ImplicationsPatients with first-time and recurrent ASD seem to have similar pressure pain sensitivity, but lower PPTs compared to existing normative data, suggesting that it is relevant to evaluate the status of the pain system in these patients to prevent triggering or worsening of their symptoms. However, it remains unanswered how these changes affect the patients’ ability to undergo rehabilitation, symptom response and long-term shoulder function.

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“…Based on the injury mechanism of shoulder dislocations, age and symptoms, traumatic shoulder dislocation may be compared with anterior cruciate ligament (ACL) tear in the knee, and rehabilitation principles may be based on the same neuromuscular exercise principles [ 32 ]. Rehabilitation of patients with ACL injuries includes the simulation of real-case sport activity scenarios via proactive and reactive exercises [ 42 ], a component SINEX only incorporated to some extent (few exercises, and only within limited ROM with low resistance).…”

Section: Discussionmentioning

confidence: 99%

“…The test has shown satisfactory inter-tester reliability, with acceptable sensitivity and specificity to detect anterior instability [ 30 , 31 ]. A relocation test was also used to assess anterior glenohumeral instability, and although the test has good specificity [ 30 ], it is less reliable between examiners [ 32 ].…”

Section: Methodsmentioning

confidence: 99%

Feasibility of the SINEX program for patients with traumatic anterior shoulder instability

Hagesæter

Løvold

Juul-Kristensen

et al. 2020

Pilot Feasibility Stud

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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

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Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study

Cited by 20 publications

References 50 publications

Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial

Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial

Pressure pain sensitivity in patients with traumatic first-time and recurrent anterior shoulder dislocation: a cross-sectional analysis

Feasibility of the SINEX program for patients with traumatic anterior shoulder instability

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