The association between crawling as a first mode of mobilisation and the presentation of atraumatic shoulder instability: a retrospective cohort study

Abstract

Background and purpose To investigate if there is an association between whether an infant crawls as their first mode of mobilisation and the subsequent presentation of atraumatic shoulder instability. Patients and methods A retrospective cohort of 50 consecutive patients who had presented to a national specialist centre for shoulder instability with a diagnosis of atraumatic instability was compared with a cohort of 50 participants who did not have shoulder instability. Primary outcomes were presence of atraumatic shoulder instability and whether or not the patient crawled as their first mode of mobility. A Pearson chi-squared test was used to evaluate associations. Results There was a significant association between crawling and shoulder instability ( X2(1) ≥ 11.93, p = 0.001) with a higher prevalence of non-crawlers in the group with shoulder instability compared to the control group. Interpretation There may be an association between developmental milestones and atraumatic shoulder instability. It cannot be concluded from this study whether association is causal and additional research is needed to further investigate this relationship. Asking patients presenting with shoulder instability about their developmental milestones as part of a full subjective history could guide a more targeted sensorimotor rehabilitation programme.

“Learn the Signs. Act Early.”: Updates and Implications for Physical Therapists

“…Many of these results have been replicated in precrawling infants provided with precocious locomotor experience using a baby walker or a powered mobility device 41–43. Empirical studies investigating differences between individuals who crawled and those who never crawled are rare; a comprehensive literature search located only 3 published articles and these were of questionable quality* 44–46. As a final point, several studies investigating the transition from crawling to walking suggest that upright mobility provides numerous advantages over crawling for exploration and social interaction 47–52.…”

“…[41][42][43] Empirical studies investigating differences between individuals who crawled and those who never crawled are rare; a comprehensive literature search located only 3 published articles and these were of questionable quality * . [44][45][46] As a final point, several studies investigating the transition from crawling to walking suggest that upright mobility provides numerous advantages over crawling for exploration and social interaction. [47][48][49][50][51][52] Overall, the literature on crawling does not substantiate its role as an essential motor skill.…”

“…Finally, a recent study investigated crawling history in a group of teenage and adult patients with atraumatic shoulder instability and a group of "normal" adults and found a higher prevalence of noncrawlers in the shoulder instability group. 46 However, the groups varied on several characteristics in addition to shoulder instability. The "normal" group was considerably older and was composed of therapists who worked at the clinic-and recall of infant developmental milestones in adulthood may be suspect.…”

“…Moreover, the noncrawler group included not only children who never crawled but also children who crawled for less than 2 months, showed difficulty with crawling, or demonstrated atypical or “lazy” crawling patterns, as reported by parents. Finally, a recent study investigated crawling history in a group of teenage and adult patients with atraumatic shoulder instability and a group of “normal” adults and found a higher prevalence of noncrawlers in the shoulder instability group 46. However, the groups varied on several characteristics in addition to shoulder instability.…”

Inversion of Central Venous Ports in Children Under Six Years Old: A Retrospective Analysis of 154 Oncology Patients

“…Considering the puncture site of the subclavian vein, the CVP was implanted closer to the shoulder joint than that performed via the internal jugular vein approach. Moreover, younger children experience frequent rotational movements of the shoulders (such as during crawling), which may increase the likelihood of CVPs near the shoulder joint moving readily within the pocket and potentially flipping over [ 26 ]. In addition, based on the guidelines provided by the American Academy of Pediatrics, babies start waking between 9 and 18 months, which means the younger group (under two years old) will exhibit a higher frequency of crawling compared to the older group (≥two years old) [ 27 ].…”