Format

Send to

Choose Destination

See 1 citation in J Shoulder Elbow Surg 2018:

J Shoulder Elbow Surg. 2018 Jan;27(1):104-111. doi: 10.1016/j.jse.2017.07.002. Epub 2017 Sep 22.

The effects of a conservative rehabilitation program for multidirectional instability of the shoulder.

Author information

1
LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia; La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia; Melbourne Orthopaedic Group, Windsor, VIC, Australia.
2
LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia; Melbourne Orthopaedic Group, Windsor, VIC, Australia.
3
Melbourne Orthopaedic Group, Windsor, VIC, Australia.
4
La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia. Electronic address: t.pizzari@latrobe.edu.au.

Abstract

BACKGROUND:

Conservative management is commonly recommended as the first-line treatment for multidirectional 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.

KEYWORDS:

Physiotherapy; atraumatic instability; exercise therapy; glenohumeral; hypermobility; laxity; nonoperative; subluxation

PMID:
28947382
DOI:
10.1016/j.jse.2017.07.002
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center