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Functional outcome and quality of life after rehabilitation for voluntary posterior shoulder dislocation: a prospective blinded cohort study

  • Giovanni Merolla
  • Elisa De Santis
  • Ann M. J. Cools
  • Giuseppe Porcellini
Original Article

Abstract

Background

Voluntary posterior instability of the shoulder is a rare condition in which the patient is able to cause a subluxation by voluntary muscle activation. A shoulder rehabilitation program aimed to correct abnormal muscle patterns and restore correct scapular motion may provide good results and improve the quality of life of these patients.

Methods

Fifteen subjects (six males, nine females; mean age 19 years) underwent physical examination and clinical tests [Disability of the Arm, Shoulder and Hand (DASH) score, Shoulder Pain and Disability Index (SPADI), and modified Rowe score] and compiled the patient global assessment (PGA). Articular or rotator cuff lesions were excluded by X-rays and MRI. The rehabilitation program included three phases: (1) assessment and correction of abnormal muscle patterns, (2) restoration of correct scapular motion, and (3) strengthening of scapular and posterior glenohumeral muscles. Follow-up was at 3, 6, 12, and 24 months.

Results

DASH and SPADI scores improved significantly at 3 (p < 0.01), 6 (p < 0.009), 12 (p < 0.001), and 24 months (p < 0.001). The Rowe score was fair at 3 months and good at 6, 12, and 24 months. Active flexion, abduction, and external rotation increased at all follow-up points (p < 0.01), whereas internal rotation remained unchanged (p > 0.05). PGA values were high. Compliance was good without serious adverse events reported during the treatment. A correlation was found between age and DASH changes (Spearman’s ρ −0.56; p = 0.0455).

Conclusions

Our findings stress the value of a rehabilitation program that teaches subjects with voluntary instability how to correct abnormal muscle patterns to restore scapular motion, and the importance of adopting home rehabilitation exercises as a part of the normal lifestyle.

Keywords

Shoulder Voluntary instability Rehabilitation Scapula 

Notes

Acknowledgments

We are grateful to Dr. Silvia Modena for the language revision (www.silviamodena.com). We are also grateful to Dr. Elisabetta Fabbri (U.O. Ricerca ed Innovazione, AUSL della Romagna Ambito Territoriale di Rimini, Italy) for the precious professional support in the statistical analysis.

Conflict of interest

None.

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Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Giovanni Merolla
    • 1
    • 2
  • Elisa De Santis
    • 2
  • Ann M. J. Cools
    • 3
  • Giuseppe Porcellini
    • 1
  1. 1.Unit of Shoulder and Elbow SurgeryD. Cervesi HospitalCattolicaItaly
  2. 2.Biomechanics Laboratory “Marco Simoncelli”D. Cervesi HospitalCattolicaItaly
  3. 3.Department of Rehabilitation Sciences and PhysiotherapyGhent UniversityGhentBelgium

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