Evidence-based conservative rehabilitation for posterior glenohumeral instability: A systematic review

McIntyre, Kelli; Belanger, A; Dhir, Jasdeep; Somerville, Lyndsay; Watson, Lyndsey F.; Willis, Myles; Sadi, Jackie

doi:10.1016/j.ptsp.2016.06.002

Cited by 24 publications

(27 citation statements)

References 37 publications

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“…As inferior instability is the quintessential mark of MDI, typically patients will report symptoms carrying a heavy bag by their side or a backpack on the affected side [ 32 ]. Patients who report symptoms primarily with combinations of flexion, horizontal flexion and adduction (e.g., taking off a tight top by crossing the arms across the chest, driving, pushing a heavy door, push-ups) often have a predominance of posterior instability while symptoms in abduction and external rotation (ER) can indicate anterior instability [ 32 , 60 , 61 ]. Patients with MDI commonly present with rotator cuff pain, impingement (internal and sub-acromial) and bursitis, which are secondary to glenohumeral instability and poor scapular mechanics [ 3 , 62 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…A recent randomised controlled trial adhering to recommendations for diagnosing MDI [ 9 ] based their MDI diagnosis on the following criteria: A positive sulcus sign for inferior instability [ 3 , 57 , 59 , 68 ]. A positive test for at least one direction (anterior and/or posterior), for at least two of three following tests: Anterior and posterior draw tests in (10°–30°) abduction [ 57 , 60 , 68 ]. Anterior and posterior draw tests in (80°–120°) abduction [ 57 , 60 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

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Advances in the Non-Operative Management of Multidirectional Instability of the Glenohumeral Joint

Watson¹,

Pizzari

Balster³

et al. 2022

JCM

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Multidirectional instability (MDI) of the glenohumeral joint refers to symptomatic subluxations or dislocations in more than one direction. The aetiology of MDI is multifactorial, which makes the classification of this condition challenging. A shoulder rehabilitation program is the initial recommended treatment for MDI, however available rehabilitation programs have varying levels of evidence to support their effectiveness. In 2016, we published the details of an evidence-based program for MDI that has been evaluated for efficacy in two single-group studies and a randomised controlled trial. In 2017, we published a clinical commentary on the aetiology, classification, and treatment of this condition. The aim of this paper is to provide an update on the components of these publications with a particular focus on new advances in the non-operative management of this condition.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Advances in the Non-Operative Management of Multidirectional Instability of the Glenohumeral Joint

Watson¹,

Pizzari

Balster³

et al. 2022

JCM

Self Cite

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“…The clinical evaluation was based on the Constant shoulder score [28], which is associated with an objective evaluation of shoulder stability. The mean difference (Constant) between the involved and the not involved shoulder was reported.…”

Section: Clinical and Radiographic Assessmentmentioning

confidence: 99%

Surgical and Rehabilitative Treatment of Misdiagnosed Posterior Dislocation of the Shoulder: Case Series

Pavone

Caruso

Chisari

et al. 2018

JFMK

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Abstract:Background: Posterior gleno-humeral joint (GHJ) dislocation is a rare injury accounting for 2.7-3% of all shoulder dislocations. Early detection is the key for an effective treatment. Poor clinical outcomes or prosthetic solutions depend on the severity of the lesions at the time of trauma and worsening of the McLaughlin lesion during the months when the dislocation remains unrecognized or untreated. The aim of the study is to report our experience in treating, and clinically and radiographically evaluate the outcomes of, four neglected posterior GHJ dislocations. Methods: Four patients with inveterate posterior dislocation of the shoulder were evaluated. In three cases, the technique of McLaughlin was performed, and in one case, plication of the subscapularis tendon was performed. During the follow up, patients were clinically evaluated using the Constant shoulder score; an imaging investigation, using X-ray integrated with computed tomography(CT) and magnetic resonance imaging (MRI), was assessed. Results: Following the Constant criteria, treated shoulders reported an excellent outcome with an average score of 91. The mean score of untreated shoulders was 92.5. The humeral appearance that resulted was radiographically well-structured. Surgical treatment with McLaughlin lesion or transposition of the subscapularis were satisfactory from a subjective and objective point of view. To perform surgery soon as possible after the traumatic episode is considered a positive prognostic factor.

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“…If posterior instability is suspected after a clinical examination, physical therapy should be offered to the patient. Physical therapy is focused on strengthening the rotator cuff, posterior deltoid, and the scapular stabilizers through resisted external rotation exercises [ 21 ]. This program can reduce instability recurrence and pain and increase function, mainly in those with atraumatic posterior instability [ 21 ].…”

Section: Conservative Treatmentmentioning

confidence: 99%

Soft tissue-based surgical techniques for treatment of posterior shoulder instability

2017

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Posterior shoulder instability is a rare clinical condition that encompasses different degrees of severity including various possible pathologies involving the labrum, capsule, bony lesions, and even locked posterior dislocation. When focusing on soft tissue involvement, the diagnosis of posterior instability may be difficult to make because frequently patients report vague symptoms not associated with a clear history of traumatic shoulder dislocation. Pathological soft tissue conditions associated with posterior instability in most cases are related to posterior labral tear and/or posterior capsular detensioning/tear. The diagnosis can be facilitated by physical examination using specific clinical tests (i. e., jerk test, Kim test, and reinterpreted O’Brien test) together with appropriate imaging studies (i. e., magnetic resonance arthrography). Arthroscopy may help in a complete evaluation of the joint and allows for the treatment of soft tissue lesions in posterior instability. Caution is warranted in the case of concomitant posterior glenoid chondral defect as a potential cause of poor outcome after soft tissue repair in posterior instability.

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Evidence-based conservative rehabilitation for posterior glenohumeral instability: A systematic review

Cited by 24 publications

References 37 publications

Advances in the Non-Operative Management of Multidirectional Instability of the Glenohumeral Joint

Advances in the Non-Operative Management of Multidirectional Instability of the Glenohumeral Joint

Surgical and Rehabilitative Treatment of Misdiagnosed Posterior Dislocation of the Shoulder: Case Series

Soft tissue-based surgical techniques for treatment of posterior shoulder instability

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