Movement control in patients with shoulder instability: a comparison between patients after open surgery and nonoperated patients

被引:16
作者
Arzi, Harel [1 ]
Krasovsky, Tal [2 ]
Pritsch, Moshe [1 ]
Liebermann, Dario G. [3 ]
机构
[1] Chaim Sheba Med Ctr, Dept Orthoped Surg, IL-52621 Tel Hashomer, Israel
[2] McGill Univ, Dept Phys & Occupat Therapy, Montreal, PQ, Canada
[3] Tel Aviv Univ, Sackler Fac Med, Dept Phys Therapy, Stanley Steyer Sch Hlth Profess, IL-69978 Ramat Aviv, Israel
关键词
Smoothness; kinesthesis; arm kinematics; shoulder instability; open surgery; ANTERIOR INSTABILITY; JOINT; PROPRIOCEPTION; DISLOCATION; KINEMATICS;
D O I
10.1016/j.jse.2013.09.021
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
Background: Open surgery to correct shoulder instability is deemed to facilitate recovery of static and dynamic motor functions. Postoperative assessments focus primarily on static outcomes (e. g., repositioning accuracy). We introduce kinematic measures of arm smoothness to assess shoulder patients after open surgery and compare them with nonoperated patients. Performance among both groups of patients was hypothesized to differ. Postsurgery patients were expected to match healthy controls. Methods: All participants performed pointing movements with the affected/dominant arm fully extended at fast, preferred, and slow speeds (36 trials per subject). Kinematic data were collected (100 Hz, 3 seconds), and mixed-design analyses of variance (group, speed) were performed with movement time, movement amplitude, acceleration time, and model-observed similarities as dependent variables. Nonparametric tests were performed for number of velocity peaks. Results: Nonoperated and postsurgery patients showed similarities at preferred and faster movement speeds but not at slower speed. Postsurgery patients were closer to maximally smoothed motion and differed from healthy controls mainly during slow arm movements (closer to maximal smoothness, larger movement amplitude, shorter movement time, and lower number of peaks; i.e., less movement fragmentation). Conclusions: Arm kinematic analyses suggest that open surgery stabilizes the shoulder but does not necessarily restore normal movement quality. Patients with recurrent anterior shoulder instability (RASI) seem to implement a "safe'' but nonadaptive mode of action whereby preplanned stereotypical movements may be executed without depending on feedback. Rehabilitation of RASI patients should focus on restoring feedback-based movement control. Clinical assessment of RASI patients should include higher order kinematic descriptors. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.
引用
收藏
页码:982 / 992
页数:11
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