Effectiveness of combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis

Abstract

ObjectiveTo investigate the effectiveness, risk of recurrence and return to activity (RTA) of surgery combined with exercise-based interventions (EBI) versus EBI alone after traumatic anterior shoulder dislocation (ASD).DesignSystematic review and meta-analysis.Data sourcesSystematic literature search (MEDLINE, Web of Science, Scopus, Google Scholar).EligibilityStudies focused on EBI or EBI as a part of postoperative care for adults with an ASD, written in English, and published after 1990. We excluded diagnostic, assessment-based studies on individuals experiencing recurrent shoulder dislocations, concomitant shoulder injury, animal or cadaveric studies. Primary outcomes were dislocation RTA. Secondary outcomes were self-reported outcome measures, strength and range of motion. Random-effects meta-analysis was used to estimate the effect of EBI (SMD; Hedges’ g, RR). The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence.ResultsSixty studies were included (n=3598); seven were meta-analysed (n=345). The mean age of participants in the included studies was 26.71±9.19 and 56% of those included were male. Of the 60 studies included in the systematic review, 29 were fair quality (48.3%), 15 studies were good quality (25%) and 16 studies were poor quality (26.7%), (k=0.66). Individuals who underwent EBI alone were 2.03 times more likely to experience recurrent instability than individuals who underwent EBI in conjunction with surgery (RR 2.03, 95% CI 1.03 to 3.97). Individuals who underwent EBI with surgery appeared 1.81 times more likely to RTA than those who underwent EBI alone, although results were not statistically significant (RR 1.81, 95% CI 0.96 to 3.43).ConclusionsSurgery combined with EBI is more effective in reducing the risk of recurrence and possibly increasing RTA than EBI alone after traumatic ASD.

Shoulder & Elbow

“…A systematic review was undertaken by researchers in Adelaide (Australia) , where a total of 60 studies involving 3,598 participants were included in the review and seven studies with 345 patients were included in a meta-analysis. 4 The primary objective was to determine the impact of these interventions on dislocation recurrence, and secondary outcomes included self-reported measures, strength, and range of motion. The participants had an average age of 26.71 years, with 56% being male.…”

Mediating the Connection: The Role of Pain in the Relationship between Shoulder Muscle Strength, Joint Position Sense, and Sub-Acromial Impingement Syndrome

“…Shoulder muscle strength and proprioception, while distinct in their functions, collectively play a pivotal role in the overall function and stability of the shoulder joint [9,10]. Shoulder muscle strength is the foundation of shoulder stability and movement [11,12]. The muscles surrounding the shoulder joint, including the rotator cuff muscles, deltoids, and scapular stabilizers, work together to control and execute precise movements while bearing the load of the upper limb [13].…”