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Published in: MUSCULOSKELETAL SURGERY 2/2015

01-08-2015 | Original Article

Conservative treatment of traumatic shoulder instability: a case series study

Authors: I. Riccio, A. de Sire, C. Latte, F. Pascarella, F. Gimigliano

Published in: MUSCULOSKELETAL SURGERY | Issue 2/2015

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Abstract

Purpose

The aim of this case series study was to evaluate the efficacy of a rehabilitative approach to restoring stability, range of motion, and function of shoulder joint in non-operated adults presenting a first episode of traumatic anterior shoulder dislocation.

Methods

In this case series study, we evaluated patients aged from 20 to 44 years, with diagnosis of first episode of traumatic anterior shoulder dislocation. All participants underwent a conservative treatment protocol, lasting 3 months. The primary outcome measure was the Rowe score for instability. Follow-up evaluations were done at 3, 6, 12, and 24 months.

Results

We evaluated 32 participants mean aged 27.94 ± 2.23 years. At the baseline (T 0), the participants had a mean Rowe score of instability of 44.53 ± 7.00 SD, where 81.25 % had a poor score and 18.75 % had a fair score. At 24 months (T 4), the Rowe score for instability was 79.84 ± 6.66 SD. 21.88 % of patients had a fair score, 71.87 % had a good score, and 6.25 % had an excellent score.

Conclusions

We showed that our rehabilitative approach seems to be effective in the conservative management of shoulder instability in adults with first episode of traumatic anterior shoulder dislocation, not involved in sport activity, and not overhead workers.
Literature
1.
go back to reference Zacchilli MA, Owens BD (2010) Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am 92(3):542–549PubMedCrossRef Zacchilli MA, Owens BD (2010) Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am 92(3):542–549PubMedCrossRef
3.
go back to reference Nordqvist A, Petersson CJ (1995) Incidence and causes of shoulder girdle injuries in an urban population. J Shoulder Elb Surg 4:107–112CrossRef Nordqvist A, Petersson CJ (1995) Incidence and causes of shoulder girdle injuries in an urban population. J Shoulder Elb Surg 4:107–112CrossRef
4.
go back to reference Matsen FA 3rd, Harryman DT 2nd, Sidles JA (1991) Mechanics of gleno-humeral instability. Clin Sports Med 10(4):783–788PubMed Matsen FA 3rd, Harryman DT 2nd, Sidles JA (1991) Mechanics of gleno-humeral instability. Clin Sports Med 10(4):783–788PubMed
5.
go back to reference Pope EJ, Ward JP, Rokito AS (2011) Anterior shoulder instability—a history of arthroscopic treatment. Bull NYU Hosp Jt Dis 69(1):44–49PubMed Pope EJ, Ward JP, Rokito AS (2011) Anterior shoulder instability—a history of arthroscopic treatment. Bull NYU Hosp Jt Dis 69(1):44–49PubMed
6.
go back to reference Thomas SC, Matsen FA 3rd (1989) An approach to the repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability. J Bone Joint Surg Am 71(4):506–513PubMed Thomas SC, Matsen FA 3rd (1989) An approach to the repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability. J Bone Joint Surg Am 71(4):506–513PubMed
7.
go back to reference Lippit SB, Harryman DT, Sidles JA, Matsen FA 3rd (1991) Diagnosis and management of AMBRII syndrome. Tech Orthop 6:61–73CrossRef Lippit SB, Harryman DT, Sidles JA, Matsen FA 3rd (1991) Diagnosis and management of AMBRII syndrome. Tech Orthop 6:61–73CrossRef
8.
go back to reference Tahta M, Akmeşe R, Özberk ZN, Coşkun OO, Işik Ç, Korkusuz F, Bozkurt M (2013) Muscle strength and function of shoulders with Bankart lesion after successful arthroscopic treatment: inter limb comparison 24 months after surgery. Arch Orthop Trauma Surg 133(12):1711–1718. doi:10.1007/s00402-013-1859-6 PubMedCrossRef Tahta M, Akmeşe R, Özberk ZN, Coşkun OO, Işik Ç, Korkusuz F, Bozkurt M (2013) Muscle strength and function of shoulders with Bankart lesion after successful arthroscopic treatment: inter limb comparison 24 months after surgery. Arch Orthop Trauma Surg 133(12):1711–1718. doi:10.​1007/​s00402-013-1859-6 PubMedCrossRef
10.
11.
go back to reference Milano G, Grasso A, Santagada DA, Saccomanno MF, Deriu L, Fabbriciani C (2010) Comparison between metal and biodegradable suture anchors in the arthroscopic treatment of traumatic anterior shoulder instability: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 18(12):1785–1791. doi:10.1007/s00167-010-1212-3 PubMedCrossRef Milano G, Grasso A, Santagada DA, Saccomanno MF, Deriu L, Fabbriciani C (2010) Comparison between metal and biodegradable suture anchors in the arthroscopic treatment of traumatic anterior shoulder instability: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 18(12):1785–1791. doi:10.​1007/​s00167-010-1212-3 PubMedCrossRef
12.
go back to reference Ahmed I, Ashton F, Robinson CM (2012) Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence. J Bone Joint Surg Am 94:1308–1315. doi:10.2106/JBJS.J.01983 PubMedCrossRef Ahmed I, Ashton F, Robinson CM (2012) Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence. J Bone Joint Surg Am 94:1308–1315. doi:10.​2106/​JBJS.​J.​01983 PubMedCrossRef
13.
go back to reference Chahal J, Marks PH, Macdonald PB, Shah PS, Theodoropoulos J, Ravi B, Whelan DB (2012) Anatomic Bankart repair compared with non operative treatment and/or arthroscopic lavage for first-time traumatic shoulder dislocation. Arthroscopy 28(4):565–575. doi:10.1016/j.arthro.2011.11.012 PubMedCrossRef Chahal J, Marks PH, Macdonald PB, Shah PS, Theodoropoulos J, Ravi B, Whelan DB (2012) Anatomic Bankart repair compared with non operative treatment and/or arthroscopic lavage for first-time traumatic shoulder dislocation. Arthroscopy 28(4):565–575. doi:10.​1016/​j.​arthro.​2011.​11.​012 PubMedCrossRef
14.
go back to reference Monk AP, Garfjeld Roberts P, Logishetty K, Price AJ, Kulkarni R, Rangan A, Rees JL (2013) Evidence in managing traumatic anterior shoulder instability: a scoping review. Br J Sports Med. doi:10.1136/bjsports-2013-092296 PubMed Monk AP, Garfjeld Roberts P, Logishetty K, Price AJ, Kulkarni R, Rangan A, Rees JL (2013) Evidence in managing traumatic anterior shoulder instability: a scoping review. Br J Sports Med. doi:10.​1136/​bjsports-2013-092296 PubMed
15.
go back to reference Tillander B, Lysholm M, Norlin R (1998) Multidirectional hyperlaxity of the shoulder: results of treatment. Scand J Med Sci Sports 8:421–425PubMedCrossRef Tillander B, Lysholm M, Norlin R (1998) Multidirectional hyperlaxity of the shoulder: results of treatment. Scand J Med Sci Sports 8:421–425PubMedCrossRef
16.
18.
go back to reference Ide J, Maeda S, Yamaga M, Morisawa K, Takagi K (2003) Shoulder strengthening exercise with an orthosis for multidirectional shoulder instability: quantitative evaluation of rotational shoulder strength before and after the exercise program. J Shoulder Elb Surg 12:342–345CrossRef Ide J, Maeda S, Yamaga M, Morisawa K, Takagi K (2003) Shoulder strengthening exercise with an orthosis for multidirectional shoulder instability: quantitative evaluation of rotational shoulder strength before and after the exercise program. J Shoulder Elb Surg 12:342–345CrossRef
19.
go back to reference Illyes A, Kiss J, Kiss RM (2009) Electromyographic analysis during pull, forward punch, elevation and overhead throw after conservative treatment or capsular shift at patient with multidirectional shoulder joint instability. J Electromyogr Kinesiol 19:e438–e447. doi:10.1016/j.jelekin.2008.09.008 PubMedCrossRef Illyes A, Kiss J, Kiss RM (2009) Electromyographic analysis during pull, forward punch, elevation and overhead throw after conservative treatment or capsular shift at patient with multidirectional shoulder joint instability. J Electromyogr Kinesiol 19:e438–e447. doi:10.​1016/​j.​jelekin.​2008.​09.​008 PubMedCrossRef
20.
go back to reference Misamore GW, Sallay PI, Didelot W (2005) A longitudinal study of patients with multidirectional instability of the shoulder with seven- to ten-year follow-up. J Shoulder Elb Surg 14:466–470CrossRef Misamore GW, Sallay PI, Didelot W (2005) A longitudinal study of patients with multidirectional instability of the shoulder with seven- to ten-year follow-up. J Shoulder Elb Surg 14:466–470CrossRef
21.
go back to reference Burkhead WZ, Rockwood CA (1992) Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am 74:890–896PubMed Burkhead WZ, Rockwood CA (1992) Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am 74:890–896PubMed
22.
go back to reference Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, Kobayashi M (2003) A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study. J Shoulder Elb Surg 12(5):413–415CrossRef Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, Kobayashi M (2003) A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study. J Shoulder Elb Surg 12(5):413–415CrossRef
23.
go back to reference Itoi E, Hatakeyama Y, Sato T, Kido T, Minagawa H, Yamamoto N, Wakabayashi I, Nozaka K (2007) Immobilization in external rotation after shoulder dislocation reduces the risk of recurrence. A randomized controlled trial. J Bone Joint Surg Am 89(10):2124–2131PubMedCrossRef Itoi E, Hatakeyama Y, Sato T, Kido T, Minagawa H, Yamamoto N, Wakabayashi I, Nozaka K (2007) Immobilization in external rotation after shoulder dislocation reduces the risk of recurrence. A randomized controlled trial. J Bone Joint Surg Am 89(10):2124–2131PubMedCrossRef
24.
go back to reference Codman EA (1934) The shoulder, vol 36, 2nd edn. Thomas Todd Co, Boston, pp 262–312 Codman EA (1934) The shoulder, vol 36, 2nd edn. Thomas Todd Co, Boston, pp 262–312
25.
go back to reference Rowe CR (1988) Evaluation of the shoulder. In: The shoulder. Churchill Livingstone, New York, pp 631–637 Rowe CR (1988) Evaluation of the shoulder. In: The shoulder. Churchill Livingstone, New York, pp 631–637
26.
go back to reference Shibata H, Gotoh M, Mitsui Y, Kai Y, Nakamura H, Kanazawa T, Okawa T, Higuchi F, Shirahama M, Shiba N (2014) Risk factors for shoulder re-dislocation after arthroscopic Bankart repair. J Orthop Surg Res 4(9):53. doi:10.1186/s13018-014-0053-z CrossRef Shibata H, Gotoh M, Mitsui Y, Kai Y, Nakamura H, Kanazawa T, Okawa T, Higuchi F, Shirahama M, Shiba N (2014) Risk factors for shoulder re-dislocation after arthroscopic Bankart repair. J Orthop Surg Res 4(9):53. doi:10.​1186/​s13018-014-0053-z CrossRef
28.
go back to reference Tanaka Y, Okamura K, Imai T (2010) Effectiveness of external rotation immobilization in highly active young men with traumatic primary anterior shoulder dislocation or subluxation. Orthopedics 33(9):670. doi:10.3928/01477447-20100722-07 PubMed Tanaka Y, Okamura K, Imai T (2010) Effectiveness of external rotation immobilization in highly active young men with traumatic primary anterior shoulder dislocation or subluxation. Orthopedics 33(9):670. doi:10.​3928/​01477447-20100722-07 PubMed
29.
go back to reference McConnell J, Donnelly C, Hamner S, Dunne J, Besier TJ (2011) Effect of shoulder taping on maximum shoulder external and internal rotation range in uninjured and previously injured overhead athletes during a seated throw. Orthop Res 29(9):1406–1411. doi:10.1002/jor.21399 CrossRef McConnell J, Donnelly C, Hamner S, Dunne J, Besier TJ (2011) Effect of shoulder taping on maximum shoulder external and internal rotation range in uninjured and previously injured overhead athletes during a seated throw. Orthop Res 29(9):1406–1411. doi:10.​1002/​jor.​21399 CrossRef
30.
go back to reference Paterson WH, Throckmorton TW, Koester M, Azar FM, Kuhn JE (2010) Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. J Bone Joint Surg Am 92(18):2924–2933. doi:10.2106/JBJS.J.00631 PubMedCrossRef Paterson WH, Throckmorton TW, Koester M, Azar FM, Kuhn JE (2010) Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. J Bone Joint Surg Am 92(18):2924–2933. doi:10.​2106/​JBJS.​J.​00631 PubMedCrossRef
32.
go back to reference Whelan DB, Litchfield R, Wambolt E, Dainty KN, Joint Orthopaedic Initiative for National Trials of the Shoulder (JOINTS) (2014) External rotation immobilization for primary shoulder dislocation: a randomized controlled trial. Clin Orthop Relat Res 472(8):2380–2386. doi:10.1007/s11999-013-3432-6 PubMedCrossRef Whelan DB, Litchfield R, Wambolt E, Dainty KN, Joint Orthopaedic Initiative for National Trials of the Shoulder (JOINTS) (2014) External rotation immobilization for primary shoulder dislocation: a randomized controlled trial. Clin Orthop Relat Res 472(8):2380–2386. doi:10.​1007/​s11999-013-3432-6 PubMedCrossRef
Metadata
Title
Conservative treatment of traumatic shoulder instability: a case series study
Authors
I. Riccio
A. de Sire
C. Latte
F. Pascarella
F. Gimigliano
Publication date
01-08-2015
Publisher
Springer Milan
Published in
MUSCULOSKELETAL SURGERY / Issue 2/2015
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI
https://doi.org/10.1007/s12306-015-0373-0

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