A Neuromuscular Exercise Program for Patients With Anterior Shoulder Instability
Condition: Shoulder Dislocation; Musculoskeletal Diseases
MeSH terms: Joint Dislocations; Musculoskeletal Diseases; Shoulder Dislocation
Study type: Interventional

Summary: 
      This study is designed to investigate the efficacy and safety of a supervised neuromuscular
      exercise program versus a standard home exercise program for patients with post-traumatic
      symptomatic anterior shoulder instability.

      Participants with at least one week of symptom duration are randomly assigned to either a
      12-week structured, supervised Shoulder Instability Neuromuscular EXercise (SINEX) program
      versus a standard HOMe EXercise (HOMEX) program.

      The H1-hypothesis is that the SINEX program results in a greater increase in quality of life
      and physical function than the HOMEX program at the primary endpoint at three months
      follow-up from baseline
    

Detailed description: 
      A common, and very painful, injury for individuals in their second and third decades is a
      traumatic dislocated shoulder. This injury accounts for almost 50% of all joint dislocations
      registered in the emergency departments. Due to post-traumatic laxity and injuries to the
      surrounding shoulder tissue, one major problem is the risk of developing a chronic recurrent
      instable shoulder affecting patients both physically and psychologically decreasing their
      overall quality of life.

      Biomechanically, proprioceptive changes and decreased sensorimotor control are found in
      patients with post-traumatic shoulder instability inhibiting the ability to control and
      stabilize the glenohumeral joint. In other similar musculoskeletal disorders, recent studies
      clearly shows positive effects of progressive neuromuscular exercise.

      Finally, no studies have yet investigated the effect of a structured, physical
      exercise-training regime based on neuromuscular principles targeting the shoulder joint.

      This trial is performed as a randomized, assessor-blinded, controlled multi-center trial with
      cooperation from various shoulder outpatient clinics located at different hospitals in The
      Region of Southern and Northern Denmark.
    

Intervention name(s): Neuromuscular exercise program; Standard home exercise program
Intervention type(s): Other; Other
Intervention description(s): Exercises can be individually progressed from basic to elite level.
Low load exercises are performed every day with 2 sets of 20-25 repetitions whereas high load exercises are performed three times per week with 2 sets of 8-12 repetitions.
Exercises are progressed using the following components: arm-position, load, speed, open/closed eyes, stable/unstable surfaces.
Patients have online access to instructions and video recordings of all exercises and progression levels. Patients are trained to continuously evaluate their own shoulder function and to adjust the exercise levels themselves at home.
Supervision will be given two times a week for the first two weeks and then once a week for the remaining period.; Strengthening of the rotator cuff muscles are performed with the use of elastic bands (shoulder internal and external rotation besides abduction in scapular plane) whereas mobility/strengthening exercise for the scapular muscles are performed through weight-bearing positions and movements of the upper extremity.
All exercises are performed three times a week with 2 sets of 10 repetitions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Shoulder; Instability; Neuromuscular; Physiotherapy; Exercise; Dislocation; Recurrence