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The American Journal of Sports Medicine May 2023Multiple studies have compared redislocation rates after stabilization and immobilization for patients experiencing a traumatic, first-time anterior shoulder dislocation... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Multiple studies have compared redislocation rates after stabilization and immobilization for patients experiencing a traumatic, first-time anterior shoulder dislocation (ASD).
PURPOSE
To systematically review the literature to compare rates of recurrent instability and subsequent instability surgery in patients undergoing treatment for a first-time ASD with surgical stabilization versus shoulder immobilization.
STUDY DESIGN
Systematic review and meta-analysis; Level of evidence, 1.
METHODS
A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify level 1 randomized studies that compared outcomes of surgical stabilization versus immobilization for treatment of primary ASD. The following search phrase was used: (glenohumeral OR anterior shoulder) AND (conservative OR nonoperative OR nonsurgical OR physiotherapy) AND (Bankart OR repair OR stabilization OR surgical OR surgery OR arthroscopic OR arthroscopy) AND (instability OR dislocation). Patients with soft tissue disruption alone as well as those with additional minor bony lesions (Hill-Sachs, Bankart) were included. Recurrent instability and subsequent instability surgery rates, the Western Ontario Shoulder Instability Index (WOSI), and range of motion were evaluated.
RESULTS
A total of 5 studies met inclusion criteria, including 126 patients undergoing surgical stabilization (mean age, 23.6 years; range, 15.0-39.0 years) and 133 patients undergoing treatment with sling immobilization only (mean age, 23.1 years; range, 15.0-31.0 years). Mean follow-up was 59.7 months. Overall, 6.3% of operative patients experienced recurrent instability at latest follow-up compared with 46.6% of nonoperative patients ( < .00001). Similarly, 4.0% of operative patients underwent a subsequent instability surgery compared with 30.8% of nonoperative patients ( < .00001). These same trends were demonstrated when data were isolated to nonoperative patients immobilized in internal rotation. When comparing the operative and nonoperative groups at latest follow-up, 1 study found significantly improved WOSI scores among operative patients ( = .035) and 1 study found significantly improved abducted external rotation in nonoperative patients ( = .02).
CONCLUSION
Patients, particularly active men in their 20s and 30s, undergoing treatment for a first-time ASD with a surgical stabilization procedure can be expected to experience significantly lower rates of recurrent instability and a significantly decreased need for a future stabilization procedure when compared with patients treated nonoperatively.
Topics: Male; Humans; Young Adult; Adult; Shoulder Joint; Shoulder; Joint Instability; Randomized Controlled Trials as Topic; Shoulder Dislocation; Arthroscopy; Recurrence
PubMed: 35148222
DOI: 10.1177/03635465211065403 -
International Journal of Environmental... Aug 2022Handball is a team sport involving a great physical demand from its practitioners in which a high number of injuries occur, affecting individual and collective... (Review)
Review
Handball is a team sport involving a great physical demand from its practitioners in which a high number of injuries occur, affecting individual and collective performance. Knowledge of the injuries is of great importance for their prevention. The objective of the present study was to identify, locate and compare the most frequent injuries and injury mechanisms in handball practice. It was carried out following the Preferred Informed Item for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The source of data collection was direct consultation of the PubMed and Medline databases. Several keywords were used for the documentary retrieval, and the quality of the studies that were selected was evaluated. Of the 707 studies retrieved, only 27 were considered appropriate for the review, and quality scores were obtained that ranged from 10 to 26 points, out of a maximum of 28. The most frequent injuries in handball players are located in the lower limbs (thigh, knee and ankle), and in the shoulder in the upper limbs. Regarding the playing position, the players who play over the 6-m line are the most affected by injuries, while the women players have a higher probability of injury. Most injuries occur during competition.
Topics: Athletic Injuries; Female; Humans; Knee Joint; Lower Extremity; Male; Shoulder; Sports
PubMed: 36078403
DOI: 10.3390/ijerph191710688 -
Topics in Stroke Rehabilitation Jan 2018Background Shoulder subluxation is a common post-stroke complication affecting up to 80% of the stroke subjects. The pathomechanics at the skeletal level does not... (Review)
Review
Background Shoulder subluxation is a common post-stroke complication affecting up to 80% of the stroke subjects. The pathomechanics at the skeletal level does not provide the structural base for the neural-motor recovery. The management of subluxed shoulder has always been a challenge, complicating the motor and functional recovery. Objective To review the available studies of rehabilitation interventions for reduction of subluxed shoulder and to explore the evidence for impact of subluxation on motor recovery. Method PubMed, the Cochrane Central Register of Controlled Trials, DORIS, PEDro, and OTseeker databases were searched using the keywords: Stroke and Shoulder and Subluxation. The experimental, quasi-experimental, and single group studies investigated the rehabilitation methods to reduce the subluxation were selected. A narrative synthesis of the findings from the selected studies was carried out. Result 2717 studies were identified and 22 studies (14 RCTs or controlled trials and 8 pre-post-single group studies) were finally selected for the review. The rehabilitation intervention: Functional electrical stimulation (FES)/electrical stimulation (11), orthosis/support (07), taping (02), and robotic training and other methods (02) were reviewed. FES is effective in reducing subluxation in acute stage. Shoulder support or orthosis while in situ may reduce the subluxation temporarily. X-ray was the most commonly used assessment tool for the subluxation. Implication of the rehabilitation technique on motor recovery has not been investigated. Conclusion No technique could effectively reduce the subluxation and facilitate the upper limb recovery. Further studies integrating the usual motor training and the subluxation rehabilitation are warranted. Future trials using more precise and valid tool such as ultrasonography are also needed.
Topics: Databases, Bibliographic; Humans; Paresis; Recovery of Function; Shoulder; Stroke; Stroke Rehabilitation
PubMed: 29017429
DOI: 10.1080/10749357.2017.1383712 -
Physical Therapy in Sport : Official... Nov 2021To analyze the effectiveness of shoulder injury prevention programs in overhead athletes. (Review)
Review
OBJECTIVE
To analyze the effectiveness of shoulder injury prevention programs in overhead athletes.
DESIGN
Systematic Review.
METHODS
CINAHL, Embase, PubMed, and SPORTDiscus electronic databases were searched from database inception through December 2020 for randomized controlled or prospective cohort studies that implemented shoulder injury prevention programs in overhead athletes and reported shoulder injury incidence rates.
RESULTS
Seven studies fulfilled the inclusion criteria. Two studies reported on odds ratios (OR) that resulted in a reduction of shoulder injuries in overhead athletes following shoulder strengthening and flexibility exercises (OR, 0.72; 95% CI; 0.52, 0.98; OR, 0.22; 95% CI; 0.06, 0.75). One study reported on hazard ratio (HR) that resulted in a reduction of shoulder injuries following stretching of the posterior capsule (HR, 0.36; 95% CI; 0.13, 0.95).
CONCLUSION
There is limited research surrounding the effectiveness of shoulder injury prevention programs in overhead athletes specific to injury reduction. Only three studies reported a favorable effect in terms of injury prevention, with only one study at low risk of bias. At present, no conclusions can be made regarding the effectiveness of shoulder injury prevention programs in the overhead athlete.
Topics: Athletes; Athletic Injuries; Humans; Prospective Studies; Shoulder; Shoulder Injuries; Sports
PubMed: 34560586
DOI: 10.1016/j.ptsp.2021.09.004 -
BMC Musculoskeletal Disorders Aug 2016Frozen shoulder is a common yet poorly understood musculoskeletal condition, which for many, is associated with substantial and protracted morbidity. Understanding the... (Review)
Review
BACKGROUND
Frozen shoulder is a common yet poorly understood musculoskeletal condition, which for many, is associated with substantial and protracted morbidity. Understanding the pathology associated with this condition may help to improve management. To date this has not been presented in a systematic fashion. As such, the aim of this review was to summarise the pathological changes associated with this primary frozen shoulder.
DATABASES
Medline, Embase, CINAHL, AMED, BNI and the Cochrane Library, were searched from inception to 2nd May, 2014. To be included participants must not have undergone any prior intervention. Two reviewers independently conducted the; searches, screening, data extraction and assessment of Risk of Bias using the Cochrane Risk of Bias Assessment Tool for non-Randomised Studies of Interventions (ACROBAT-NRSI). Only English language publications reporting findings in humans were included. The findings were summarised in narrative format.
RESULTS
Thirteen observational studies (involving 417 shoulders) were included in the review. Eight studies reported magnetic resonance imaging or arthrography findings and 5 recorded histological findings. When reported mean ages of the participants ranged from 40.0 to 59.8 years. Duration of symptoms ranged from 0 to 30 months. The majority of studies (n = 7) were assessed to be of moderate risk of bias, two studies at high risk and the remaining four were rated as low risk of bias. Study characteristics were poorly reported and there was widespread variety observed between studies in respect of data collection methods and inclusion criteria employed. Pathological changes in the anterior shoulder joint capsule and related structures were commonly reported. Imaging identified pathological changes occurring in the coracohumeral ligament, axillary fold and rotator interval. Obliteration of the subcoracoid fat triangle also appeared to be pathognomonic. Histological studies were inconclusive but suggested that immune, inflammatory and fibrotic changes where associated with primary frozen shoulder.
CONCLUSIONS
This systematic review presents a summary of what is currently known about the tissue pathophysiology of primary frozen shoulder. Further studies that use standardised inclusion and exclusion criteria and investigate changes in naïve tissue at different stages of the condition are required.
Topics: Adult; Arthrography; Bursitis; Humans; Ligaments, Articular; Magnetic Resonance Imaging; Middle Aged; Shoulder Joint; Shoulder Pain
PubMed: 27527912
DOI: 10.1186/s12891-016-1190-9 -
BMC Musculoskeletal Disorders Jan 2021This study aims to compare conservative versus surgical management for patients with full-thickness RC tear in terms of clinical and structural outcomes at 1 and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study aims to compare conservative versus surgical management for patients with full-thickness RC tear in terms of clinical and structural outcomes at 1 and 2 years of follow-up.
METHODS
A comprehensive search of CENTRAL, MEDLINE, EMBASE, CINAHL, Google Scholar and reference lists of retrieved articles was performed since the inception of each database until August 2020. According to the Cochrane Handbook for Systematic Reviews of Interventions, two independent authors screened all suitable studies for the inclusion, extracted data and assessed risk of bias. Only randomised controlled trials comparing conservative and surgical management of full-thickness RC tear in adults were included. The primary outcome measure was the effectiveness of each treatment in terms of Constant-Murley score (CMS) and VAS pain score at different time points. The secondary outcome was the integrity of the repaired tendon evaluated on postoperative MRI at different time points. The GRADE guidelines were used to assess the critical appraisal status and quality of evidence.
RESULTS
A total of six articles met the inclusion criteria. The average value of CMS score at 12 months of follow-up was 77.6 ± 14.4 in the surgery group and 72.8 ± 16.5 in the conservative group, without statistically significant differences between the groups. Similar results were demonstrated at 24 months of follow-up. The mean of VAS pain score at 12 months of follow-up was 1.4 ± 1.6 in the surgery group and 2.4 ± 1.9 in the conservative group. Quantitative synthesis showed better results in favour of the surgical group in terms of VAS pain score one year after surgery (- 1.08, 95% CI - 1.58 to - 0.58; P < 0.001).
CONCLUSIONS
At a 2-year follow-up, shoulder function evaluated in terms of CMS was not significantly improved. Further high-quality level-I randomised controlled trials at longer term follow-up are needed to evaluate whether surgical and conservative treatment provide comparable long-term results.
Topics: Adult; Humans; Arthroscopy; Randomized Controlled Trials as Topic; Rotator Cuff; Rotator Cuff Injuries; Shoulder; Shoulder Pain; Treatment Outcome
PubMed: 33419401
DOI: 10.1186/s12891-020-03872-4 -
Musculoskeletal Science & Practice Oct 2022To report the characteristics of exercise interventions and ascertain their effectiveness compared to surgery on quality of life, disability, and pain for people with... (Meta-Analysis)
Meta-Analysis Review
QUESTIONS
To report the characteristics of exercise interventions and ascertain their effectiveness compared to surgery on quality of life, disability, and pain for people with large to massive rotator cuff tendon tears (L-MRCTTs).
DESIGN
Systematic review with meta-analysis of randomised controlled trials (RCTs).
PARTICIPANTS
Adults with L-MRCTTs defined as; >5 cm, 2 or more tendons.
INTERVENTION
Exercise as an intervention for L-MRCTTs.
OUTCOME MEASURES
Primary: quality of life, disability, and pain. Secondary: range of motion (ROM). The Consensus on Exercise Reporting Template (CERT) was used to extract data on the individual characteristics of each exercise intervention. The Cochrane Risk of Bias Tool V2 was used to assess study quality with the certainty of evidence assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
RESULTS
Five trials (n = 297 participants, average age 66.7 years, 55% male) were included in analysis. Three trials compared exercise to another non-surgical intervention and 2 trials compared exercise to surgery. At 12 months a significant improvement in pain of 0.47 (95% CI 0.07-0.88, I = 53%, REM) favoured the surgical group and a significant improvement in shoulder external rotation ROM of 9° (95% CI 2.16-16.22, I = 0%, FEM) favoured the exercise group. The median CERT score was 7/19 (range 4-12). The certainty of evidence was low or very low across all outcomes.
CONCLUSION
A paucity of high-quality research on the role of exercise in the management of L-MRCTTs exists with substantial discrepancies in the reporting of the exercise interventions in the published research.
Topics: Adult; Aged; Female; Humans; Male; Quality of Life; Rotator Cuff; Rotator Cuff Injuries; Shoulder; Shoulder Pain
PubMed: 35724568
DOI: 10.1016/j.msksp.2022.102597 -
Arthroscopy : the Journal of... Sep 2020To perform a meta-analysis of the current evidence in the literature comparing arthroscopic Bankart repair versus conservative management for first-time anterior... (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
To perform a meta-analysis of the current evidence in the literature comparing arthroscopic Bankart repair versus conservative management for first-time anterior shoulder dislocation.
METHODS
A literature search of the MEDLINE, Embase, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Prospective studies comparing arthroscopic Bankart repair versus conservative management as treatment for first-time anterior shoulder dislocation were included. Recurrence, further treatment, and return to play were compared, with all statistical analysis performed using Review Manager, version 5.3. P < .05 was considered statistically significant.
RESULTS
Ten prospective studies with 569 patients were included. Arthroscopic Bankart repair resulted in a lower rate of total recurrent instability (9.7% vs 67.4, I = 0, P < .0001) and further surgical treatment for anterior shoulder instability (5.9% vs 46.7%, I = 0, P < .0001). Additionally, arthroscopic Bankart repair resulted in a higher rate of return to play (92.8% vs 80.8%, I = 0, P = .002).
CONCLUSIONS
Arthroscopic Bankart repair resulted in a 7-fold lower recurrence rate and a higher rate of return to play than conservative management. Thus, arthroscopic Bankart repair may be advisable to perform routinely in patients with first-time dislocation who participate in sports.
LEVEL OF EVIDENCE
Level II, systematic review of Level I and II studies.
Topics: Arthroplasty; Arthroscopy; Conservative Treatment; Humans; Joint Dislocations; Joint Instability; Prospective Studies; Recurrence; Shoulder; Shoulder Dislocation; Shoulder Joint; Sports; Treatment Outcome
PubMed: 32389771
DOI: 10.1016/j.arthro.2020.04.046 -
Scientific Reports Nov 2020To determine whether subacromial space (i.e. acromiohumeral distance; AHD, and/or occupation ratio percentage) differs between people with subacromial pain syndrome... (Meta-Analysis)
Meta-Analysis
To determine whether subacromial space (i.e. acromiohumeral distance; AHD, and/or occupation ratio percentage) differs between people with subacromial pain syndrome (SAPS) and those without. To investigate whether there is a correlation between subacromial space and pain or disability in adults with SAPS and whether temporal changes in pain or disability are accompanied by changes in subacromial space. Systematic review and meta-analysis. Fifteen studies with a total of 775 participants were included. Twelve studies were of high quality and three studies were of moderate quality using the modified Black and Downs checklist. There was no between group difference in AHD in neutral shoulder position (mean difference [95% CI] 0.28 [-0.13 to 0.69] mm), shoulder abduction at 45° (-0.02 [-0.99 to 0.96] mm) or 60° (-0.20 [-0.61 to 0.20] mm). Compared to the control group, a greater occupation ratio in neutral shoulder position was demonstrated in participants with SAPS (5.14 [1.87 to 8.4] %). There was no consistent pattern regarding the correlation between AHD and pain or disability in participants with SAPS, and no consistent increase in subacromial space with improvement in pain or disability over time. The results suggest that surgical (e.g. sub-acromial decompression) and non-surgical (e.g. manual therapy, taping, stretching and strengthening) management of subacromial pain syndrome should not focus solely on addressing a potential decrease in subacromial space, but also on the importance of other biopsychosocial factors.
Topics: Acromion; Humans; Shoulder; Shoulder Impingement Syndrome; Shoulder Pain
PubMed: 33244115
DOI: 10.1038/s41598-020-76704-z -
Sports Health 2018Pitching injuries in youth baseball are increasing in incidence. Poor pitching mechanics in young throwers have not been sufficiently evaluated due to the lack of a... (Review)
Review
CONTEXT
Pitching injuries in youth baseball are increasing in incidence. Poor pitching mechanics in young throwers have not been sufficiently evaluated due to the lack of a basic biomechanical understanding of the "normal" youth pitching motion.
OBJECTIVE
To provide a greater understanding of the kinetics and kinematics of the youth baseball pitching motion.
DATA SOURCES
PubMed, MEDLINE, and SPORTDiscus databases were searched from database inception through February 2017.
STUDY SELECTION
A total of 10 biomechanical studies describing youth pitching mechanics were included.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 3.
DATA EXTRACTION
Manual extraction and compilation of demographic, methodology, kinetic, and kinematic variables from the included studies were completed.
RESULTS
In studies of healthy youth baseball pitchers, progressive external rotation of the shoulder occurs throughout the start of the pitching motion, reaching a maximum of 166° to 178.2°, before internally rotating throughout the remainder of the cycle, reaching a minimum of 13.2° to 17°. Elbow valgus torque reaches the highest level (18 ± 4 N·m) just prior to maximum shoulder external rotation and decreases throughout the remainder of the pitch cycle. Stride length is 66% to 85% of pitcher height. In comparison with a fastball, a curveball demonstrates less elbow varus torque (31.6 ± 15.3 vs 34.8 ± 15.4 N·m).
CONCLUSION
Multiple studies show that maximum elbow valgus torque occurs just prior to maximum shoulder external rotation. Forces on the elbow and shoulder are greater for the fastball than the curveball.
Topics: Baseball; Biomechanical Phenomena; Child; Elbow; Humans; Kinetics; Lower Extremity; Rotation; Shoulder; Torque; Upper Extremity; Youth Sports
PubMed: 29090988
DOI: 10.1177/1941738117738189