dynamic posterior humeral head subluxation pre-osteoarthritis pre-osteoarthritis of the shoulder
Conditions
Interventions
The purpose of the exercise therapy program is to increase the range of motion 
internal rotation and strengthen the posterior rotator cuff musculature of the 
disabled shoulder. By strengthening the posterior cuff stability, the 
transverse force couple will be restored and pain and function are improved. 
The protocolized training will consist of a supervised (high load strength 
training) and unsupervised program (light load training) to achieve the optimal 
effect. The training protocol was achieved through consensus with expert 
shoulder orthopedic surgeons and physiotherapists. 
Supervised: At least once weekly patients will visit the physiotherapy practice 
where they will perform a supervised exercise therapy program consisting of the 
following exercises to 1) increase the restricted glenohumeral internal 
rotation due to a combination of muscle and posterior capsular stiffness(10) 
and 2) strengthening the infraspinatus and teres minor which would 
hypothetically restore the transverse force couple and the posterior 
instability: 
1. Crossbody stretch(14, 15) 
2. Based on the 8-12 repetition maximum the training intensity of the following 
exer-cises is determined
a. Pully standing external rotation at shoulder abducted 0° and 
b. Pully standing external rotation at shoulder abducted 90°(16), 
Sponsors
VieCuri Medisch Centrum
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: Patients diagnosed with Walch B0 and Walch B1 primary glenohumeral arthritis are eligible for inclusion in this study. Patients that are eligible for enrollment in this study are those that meet the following inclusion criteria: • History of shoulder pain without a previous shoulder dislocation • At least findings on physical shoulder examination: o Restricted glenohumeral internal rotation in abduction as compared to the contralateral side. o Posterior glenohumeral instability based on eighter a positive Jerk test or Posterior thumb test. o Reduced strength of the infraspinatus and teres minor muscle as compared to the contralateral shoulder without the suspicion of a rotator cuff tear • Primary osteoarthritis with the exception of Walch B1 primary osteoarthritis • Absence of rotator cuff tears based on physical examination and CT scan
Exclusion criteria
Exclusion criteria: A potential subject who meets any of the following criteria will be excluded from participation in this study: • Inability to understand, read or write the Dutch language. • Current exercise treatment for the shoulder • Previous corticosteroid injection of the shoulder in the last 3 months
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| To measure the effectiveness of the personalized physiotherapy program, daily assessment of a patient functioning is measured using the Patient Specific Functional Scale on a daily basis. | — |
Secondary
| Measure | Time frame |
|---|---|
| • Shoulder functioning using the Patient Specific Functional Scale daily • Pain of the shoulder in rest and during activities using the Visual Analogue Scale daily • Pain acceptability daily • Training log-book, each training sessionDuring training sessions: • Muscle strength using a dynamometer • Shoulder functioning using Constant-Murley score • Glenohumeral passive range of motion using a goniometer • Adverse training responseat baseline, 3, 6 and 12 months. • Shoulder functioning using the Patient Specific Functional Scale • Pain of the shoulder in rest and during activities using the Visual Analogue Scale • Quality of life using the EQ-5D-5L • Shoulder functioning using the DASH and Oxford shoulder score • Adherence to therapy: Nr of sessions attended, Nr of exercises performed at appropriate intensity, numer of unsupervised sessions • Volumetric quantification of the rotator cuff on CT • Force vector analysis | — |
Countries
Netherlands
Contacts
Public ContactF. Hollman
VieCuri Medisch Centrum
Outcome results
None listed