Neuromuscular Re-education In Adolescents With Complex Shoulder Instability

The shoulder is one of the most complex joints in the body, requiring both stability and mobility for proper function. It requires a careful balance of joint stability and freedom of movement, which is dependent upon the coordination of various muscle groups to organize proper scapulohumeral rhythm for the most efficient movement. In the case of individuals with complex shoulder instability, there are often two separate but related problems: 1) neuromuscular dysfunction (scapular dyskinesis), and 2) shoulder instability (glenohumeral joint). Both problems can work against each other in a negative cycle which must be interrupted to facilitate recovery. PURPOSE: To determine if use of multi-modal neuromuscular re-education techniques will result in increased shoulder stability and improved function that will reduce the need for surgical intervention or improve post-surgical outcomes. METHODS: Retrospective chart review of 14 patients who completed occupational therapy using multi-modal neuromuscular re-education techniques for shoulder instability. Data collected includes demographics, injury history, functional limitations, physical limitations, physical exam, number of visits, therapy interventions used, and complementary services used. Descriptive statistics with non-parametric Wilcoxon signed ranks tests were used to assess functional outcomes. RESULTS: Shoulder range of motion (abduction (Z = -2.666, p = .008) and flexion (Z = -2.666, p = .008)) and self-reported shoulder physical function and symptoms (QuickDASH scores (Z = -2.028, p = .043)) improved significantly from pre-to-post evaluation. Pre and post median Abduction ROM were 95° (IQR 53°-120.5°) and 170° (IQR 145°-170.5°), respectively. Pre and post median Flexion ROM were 100° (IQR 72°-139°) and 170° (IQR 145.3°-175.0°), respectively. Pre and post median QuickDASH scores were 61.36 (IQR 34.10-68.18) and 29.55 (IQR 16.45-42.04), respectively. CONCLUSION: Multi-modal neuromuscular re-education techniques, including use of kinesiology tape and rigid tape, functional electrical stimulation, and upper extremity exoskeleton, as well as complementary services, resulted in increased shoulder stability and improved function.