Shoulder Instability in Children: Muscle Activity and Movement

Completed

Conditions: Musculoskeletal Injury
Instability, Joint
Shoulder Injuries
Pediatric ALL
Dislocation, Shoulder

Interventions: Other: 3D movement analysis with surface electromyography

Registration Number: NCT04311216

Lead Sponsor: Robert Jones and Agnes Hunt Orthopaedic and District NHS Trust

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.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 30

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

Study & Design

Study Type: OBSERVATIONAL

Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Age matched controls (no instability)	3D movement analysis with surface electromyography	Participants with no previous a previous episode(s) of shoulder instability
Shoulder instability participants	3D movement analysis with surface electromyography	Participants with previous a previous episode(s) of shoulder instability

Primary Outcome Measures

Name	Time	Method
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 Outcome Measures

Name	Time	Method
Surface Electromyography	On admission	Muscle activity patterns related to the movement tasks
Kinetics	On admission	Kinetic variables related to the movement tasks