Shoulder instability

Background: Effectiveness of any individualized therapeutic modality in improving the range of motion of shoulder in adhesive capsulitis is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound and End range mobilization over Cryotherapy and Stretching as a treatment program in improvement of active range of motion in patients with adhesive capsulitis of shoulder. Methods: Forty subjects diagnosed to have adhesive capsulitis were randomly assigned to two groups. Subjects in Group I received Ultrasound and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. ROM‘s of shoulder in abduction and external rotation were the outcome measures considered. Results: Statistical analysis was done considering p<0.05 as statistically significant and the‗t‘ values were estimated. It was found that ultrasound when combined with end range mobilization had a value of 3.4498 in comparison to 1.7773 of cryotherapy combined with stretching group. Conclusion: Ultrasound with end range mobilization produced a better result than cryotherapy with stretching and therefore can be recommended in the treatment of second stage adhesive capsulitis of shoulder.

Background: Effectiveness of any individualized therapeutic modality in improving the range of motion of shoulder in adhesive capsulitis is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound and End range mobilization over Cryotherapy and Stretching as a treatment program in improvement of active range of motion in patients with adhesive capsulitis of shoulder. Methods: Forty subjects diagnosed to have adhesive capsulitis were randomly assigned to two groups. Subjects in Group I received Ultrasound and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. ROM‘s of shoulder in abduction and external rotation were the outcome measures considered. Results: Statistical analysis was done considering p&lt;0.05 as statistically significant and ...

The glenohumeral joint has the most mobility of any in the body, and contact between the humeral head and glenoid labrum contributes to its stability. Patients with recurrent dislocations may have bone defects in one or both of these surfaces, due to the presence of a Bankart lesion or an engaging Hill-Sachs lesion. We present a case of an adult whose left shoulder required intervention following a 10-year history of chronic, recurrent glenohumeral dislocation. Our assessment revealed a large Bankart lesion combined with a large Hill-Sachs lesion. We performed an open surgery with bone augmentation of the glenoid osseous defect using a tricortical autogenous bone graft harvested from the iliac crest. Intra-operative assessment showed adequate stability without intervention for the humeral head defect. The technical aspect of the surgery is described together with the clinical outcomes of the patient. We briefly review therapeutic options for glenohumeral osseous defects described in the literature.

Traditionally, surgical stabilization of the unstable shoulder has been performed through an open incision. Arthroscopic Bankart repair with suture anchors is now widely considered the treatment of choice for anterior shoulder instability in patients who have failed conservative management. Many different factors have now been elucidated for adequate treatment of glenohumeral instability. Because of technical advances in instability repair combined with an increased understanding of factors that lead to recurrent instability, the outcomes following arthroscopic Bankart repair have significantly improved and approach those of open techniques.

Purpose Disruption in the balance of shoulder stability can produce a widely varied spectrum of clinical symptoms , ranging from minor shoulder instability to frank shoulder dislocation, followed by recurrent instability. In this study, a series of patients suffering from minor shoulder instability, all with clinical signs of preoperative subacromial impingement associated with instability, were treated. The shoulder instability alone was addressed, with the aim of eliminating the clinical symptoms of subacro-mial impingement and pain. Material In this study, 20 patients with minor shoulder instability, presenting with subacromial impingement symptoms, underwent arthroscopic treatment to address capsule-labral pathology. All patients underwent a preop-erative assessment by one independent physiotherapist, using Constant and WOSI scores, as well as the Castagna test, on both the affected and non-affected sides. The Hawkins test and subacromial pain in 90°of abduction and internal rotation were also evaluated. All patients followed the same rehabilitation protocol by a second physiotherapist. All patients were followed up at 6, 12 and 24 months postoperatively by the same independent physiotherapist. Results We observed that 20/20 patients had a positive Hawkins sign at [20°of internal rotation preoperatively, while 4/19 had a positive Hawkins sign-all with less pain-at the 24-month follow-up (P \ 0.0001). Moreover, 20/20 had a positive Castagna test preoperatively, while 1/20 had a positive Castagna test at the 24-month follow-up. In terms of shoulder scores, at 24 months, the Constant score had improved from a median value of 70 (51-91) preoperatively to a median value of 91 (86-100). The median WOSI score was 48.3 (12.7-78.6) preopera-tively and improved to 84.9 (39.5-98.5) at 24 months postoperatively. Conclusion Minor shoulder instability is an intra-articular pathology presenting with extra-articular subacromial impingement symptoms. By treating the intra-articular pathology, the extra-articular symptoms can be relieved in the vast majority of patients. Level of evidence III.