Shoulder instability in children: muscle activity and movement
Research type
Research Study
Full title
Shoulder instability in children: understanding muscle activity and movement pattern differences
IRAS ID
271729
Contact name
Fraser Philp
Contact email
Sponsor organisation
Keele University
Clinicaltrials.gov Identifier
Duration of Study in the UK
1 years, 11 months, 31 days
Research summary
Research 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 we do not fully understand the mechanisms of shoulder instability 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, RJAH).
If we better understand the mechanisms associated with instability, we can better target physiotherapy interventions to reduce dislocations and disability. If we identify specific patterns of activity associated with instability, these could be addressed through personalised and improved exercise prescription and rehabilitation. Additionally, we may identify causes of instability for which physiotherapy may not be appropriate, 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.
Summary of Results:
For our study we recruited 30 children and adolescents in total. There were 15 children with shoulder instability and 15 without. We measured the movements made at their shoulder girdle joints and the activity of their muscles which controlled the joints. We also kept in contact with them for a year to see if any of them had any further episodes of instability.
Overall, we found that young people with shoulder instability used their muscles and moved their arms in ways that were different to those without shoulder instability. Young people with shoulder instability got their arm in a similar position to those without instability, but used their shoulder blade in a different way to achieve this. For young people with shoulder instability the muscles which controlled the shoulder blade were also working harder compared to those without shoulder instability.
Exploratory analysis of factors which may contribute to recurrent instability identified some muscle activity patterns associated with participants who had a high number of instability episodes. However, this was in a small number of participants and identified features were specific to the individual and task being carried out. Overall the number of recurrent instability episodes were higher for the shoulder instability group than the control group. Between subgroups of shoulder instability, those with no history of trauma had a higher total number of dislocations and subluxations than the traumatic group.REC name
West Midlands - South Birmingham Research Ethics Committee
REC reference
20/WM/0021
Date of REC Opinion
2 Mar 2020
REC opinion
Further Information Favourable Opinion