Dislocation, Shoulder, Instability, Joint, Musculoskeletal Injury, Pediatric ALL, Shoulder Injuries
Conditions
Brief summary
The aim of this study is to identify factors responsible for recurrent shoulder instability in children. Shoulder instability, i.e. complete or partial dislocation of the shoulder joint, is common in children, resulting in pain and disability. Recurrent instability can damage the shoulder joint resulting in the premature development of arthritis. Rehabilitation approaches are preferred over surgical methods for the growing child e.g. physiotherapy to restore movement and prevent further instability. Existing rehabilitation procedures are based on addressing factors assumed to be responsible for instability e.g. physiotherapists may try to increase shoulder stability by building up the shoulder muscles to compensate for the damaged ligaments. It is evident however that the mechanisms of shoulder instability are not well understood, as failure rates for physiotherapy are high, with 70% - 90% of children continuing to suffer recurrent instability. This is an observational, cross-sectional study of children (aged 8 to 18) presenting with shoulder instability of any origin, traumatic or atraumatic (n=15) and an age-matched sample (n=15) with no history of shoulder problems. Muscle activity and movement pattern differences will be measured using non-invasive 3D motion capture and surface electromyography, to identify factors responsible for instability. Only a single visit to the site will be required (The Orthotic Research & Locomotor Assessment Unit (ORLAU) based at The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust in Oswestry.). If investigators better understand the mechanisms associated with instability, physiotherapy interventions to reduce dislocations and disability can be better targeted. If specific patterns of activity associated with instability are identified, these could be addressed through personalised and improved exercise prescription and rehabilitation. Additionally, causes of instability for which physiotherapy may not be appropriate may be identified, therefore ensuring patients are referred to the correct service in a timely manner, improving patient outcomes and allocating physiotherapy resources more appropriately. Participants will be recruited from musculoskeletal/orthopaedic outpatient clinics. This study is funded by the Private Physiotherapy Education Foundation.
Interventions
OTHER3D movement analysis with surface electromyography
Single measurement session of 3D movement analysis with surface electromyography for upper limb movements
Sponsors
University of Liverpool
University of Aberdeen
Bournemouth University
Keele University
Robert Jones and Agnes Hunt Orthopaedic and District NHS Trust
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
8 Years to 18 Years
Healthy volunteers
Yes
Inclusion criteria
Shoulder instability participants * Children aged between 8 to 18 years of age * Subjective reports of instability with additionally symptomatic instability in the clinical assessment criteria below * Symptomatic instability on clinical assessment in at least one direction, confirmed by a positive clinical finding (apprehension, guarding, laxity) during the sulcus, apprehension or anterior and posterior shift load tests. * All forms of instability including multidirectional instability, atraumatic and traumatic subluxations and dislocations. * Children presenting with an initial or recurrent episode of instability * Children undergoing current management or rehabilitation for their shoulder at the time of the study * Patients with surgically managed shoulder instability who have since had a further episode of shoulder instability Age matched controls \- Children aged between 8 to 18 years of age
Exclusion criteria
Shoulder instability participants * Children with co-existing neurological pathologies or deficits * Surgically managed patients who have not had episodes of instability following the intervention Age matched controls * Any previous presentation to a health care professional with a diagnosis of shoulder instability * Children with a previous shoulder injury within the last 3 months on the arm being assessed that has not resolved * Children with co-existing neurological pathologies or deficits * Children who have had a previous surgical intervention on the arm being assessed * Children currently undergoing or awaiting medical management, diagnostic investigations or rehabilitation on the arm being assessed
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Shoulder Instability Episodes (Subluxation and Dislocations) | One year | Number of shoulder instability episodes (subluxation and dislocations) |
| Kinematics | On admission | Kinematic variables related to the movement tasks - Flexion |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Kinetics | On admission | Kinetic variables related to the movement tasks |
| Surface Electromyography | On admission | Muscle activity patterns related to the movement tasks |
Countries
United Kingdom
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Shoulder Instability Participants Participants with previous a previous episode(s) of shoulder instability
3D movement analysis with surface electromyography: Single measurement session of 3D movement analysis with surface electromyography for upper limb movements | 15 |
| Age Matched Controls (no Instability) Participants with no previous a previous episode(s) of shoulder instability
3D movement analysis with surface electromyography: Single measurement session of 3D movement analysis with surface electromyography for upper limb movements | 15 |
| Total | 30 |
Baseline characteristics
| Characteristic | Age Matched Controls (no Instability) | Total | Shoulder Instability Participants |
|---|---|---|---|
| Age, Categorical <=18 years | 15 Participants | 30 Participants | 15 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 13.3 years STANDARD_DEVIATION 3.1 | 13.6 years STANDARD_DEVIATION 3 | 13.9 years STANDARD_DEVIATION 2.9 |
| Race and Ethnicity Not Collected | — | 0 Participants | — |
| Region of Enrollment United Kingdom | 15 participants | 30 participants | 15 participants |
| Sex: Female, Male Female | 7 Participants | 16 Participants | 9 Participants |
| Sex: Female, Male Male | 8 Participants | 14 Participants | 6 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 15 | 0 / 15 |
| other Total, other adverse events | 0 / 15 | 0 / 15 |
| serious Total, serious adverse events | 0 / 15 | 0 / 15 |
Outcome results
Primary
Kinematics
Kinematic variables related to the movement tasks - Flexion
Time frame: On admission
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Shoulder Instability Participants | Kinematics | TH rotation | 100 degrees |
| Shoulder Instability Participants | Kinematics | GHJ elevation plane | 74 degrees |
| Shoulder Instability Participants | Kinematics | SCJ elevation | 11 degrees |
| Shoulder Instability Participants | Kinematics | GHJ elevation angle | 101 degrees |
| Shoulder Instability Participants | Kinematics | TS protraction | 25 degrees |
| Shoulder Instability Participants | Kinematics | GHJ rotation | 89 degrees |
| Shoulder Instability Participants | Kinematics | TH elevation angle | 133 degrees |
| Shoulder Instability Participants | Kinematics | ACJ protraction | 32 degrees |
| Shoulder Instability Participants | Kinematics | TS rotation | 39 degrees |
| Shoulder Instability Participants | Kinematics | ACJ rotation | 16 degrees |
| Shoulder Instability Participants | Kinematics | TH elevation plane | 92 degrees |
| Shoulder Instability Participants | Kinematics | ACJ tilt | 31 degrees |
| Shoulder Instability Participants | Kinematics | TS tilt | 29 degrees |
| Shoulder Instability Participants | Kinematics | SCJ protraction | 25 degrees |
| Age Matched Controls (no Instability) | Kinematics | TS tilt | 33 degrees |
| Age Matched Controls (no Instability) | Kinematics | SCJ elevation | 11 degrees |
| Age Matched Controls (no Instability) | Kinematics | TH elevation plane | 94 degrees |
| Age Matched Controls (no Instability) | Kinematics | TH elevation angle | 130 degrees |
| Age Matched Controls (no Instability) | Kinematics | TH rotation | 99 degrees |
| Age Matched Controls (no Instability) | Kinematics | TS protraction | 24 degrees |
| Age Matched Controls (no Instability) | Kinematics | TS rotation | 40 degrees |
| Age Matched Controls (no Instability) | Kinematics | SCJ protraction | 24 degrees |
| Age Matched Controls (no Instability) | Kinematics | GHJ elevation plane | 74 degrees |
| Age Matched Controls (no Instability) | Kinematics | GHJ elevation angle | 91 degrees |
| Age Matched Controls (no Instability) | Kinematics | GHJ rotation | 100 degrees |
| Age Matched Controls (no Instability) | Kinematics | ACJ protraction | 34 degrees |
| Age Matched Controls (no Instability) | Kinematics | ACJ rotation | 17 degrees |
| Age Matched Controls (no Instability) | Kinematics | ACJ tilt | 32 degrees |
Primary
Number of Shoulder Instability Episodes (Subluxation and Dislocations)
Number of shoulder instability episodes (subluxation and dislocations)
Time frame: One year
Secondary
Kinetics
Kinetic variables related to the movement tasks
Time frame: On admission
Secondary
Surface Electromyography
Muscle activity patterns related to the movement tasks
Time frame: On admission