Shoulder Instability in Children: Muscle Activity and Movement

Shoulder Instability in Children: Understanding Muscle Activity and Movement Pattern Differences

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 the mechanisms of shoulder instability are not well understood, 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 (ORLAU) based at The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust in Oswestry.).

If investigators better understand the mechanisms associated with instability, physiotherapy interventions to reduce dislocations and disability can be better targeted. If specific patterns of activity associated with instability are identified, these could be addressed through personalised and improved exercise prescription and rehabilitation. Additionally, causes of instability for which physiotherapy may not be appropriate may be identified, 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.

Study Overview

• Status: Recruiting
• Conditions: Shoulder Injuries; Pediatric ALL; Musculoskeletal Injury; Instability, Joint; Dislocation, Shoulder
• Intervention / Treatment: Other: 3D movement analysis with surface electromyography

• Study Type: Observational
• Enrollment (Anticipated): 30

Contacts and Locations

• Study Contact: Name: Fraser D Philp, PhD; Phone Number: 01782734563; Email: f.d.philp@keele.ac.uk
• Study Contact Backup: Name: Sarah Jarvis, MSc; Phone Number: 01691 404532; Email: sarah.jarvis7@nhs.net

Study Locations

• United Kingdom
  • Oswestry, United Kingdom, SY10 7AG
    • Recruiting
    • The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust
    • Contact: Fraser D Philp, PhD; Phone Number: 017827334563; Email: f.d.philp@keele.ac.uk
    • Contact: Sarah Jarvis, MSc; Phone Number: 01691404532; Email: sarah.jarvis7@nhs.net

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 8 years to 18 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

This study will consist children aged between eight and 18 years of age. The two groups will include children with (shoulder instability participants) and without shoulder instability (age matched contols).

Description

Inclusion Criteria:

Shoulder instability participants

• Children aged between 8 to 18 years of age
• Subjective reports of instability with additionally symptomatic instability in the clinical assessment criteria below
• Symptomatic instability on clinical assessment in at least one direction, confirmed by a positive clinical finding (apprehension, guarding, laxity) during the sulcus, apprehension or anterior and posterior shift load tests.
• All forms of instability including multidirectional instability, atraumatic and traumatic subluxations and dislocations.
• Children presenting with an initial or recurrent episode of instability
• Children undergoing current management or rehabilitation for their shoulder at the time of the study
• Patients with surgically managed shoulder instability who have since had a further episode of shoulder instability

Age matched controls

- Children aged between 8 to 18 years of age

Exclusion Criteria:

Shoulder instability participants

• Children with co-existing neurological pathologies or deficits
• Surgically managed patients who have not had episodes of instability following the intervention

Age matched controls

• Any previous presentation to a health care professional with a diagnosis of shoulder instability
• Children with a previous shoulder injury within the last 3 months on the arm being assessed that has not resolved
• Children with co-existing neurological pathologies or deficits
• Children who have had a previous surgical intervention on the arm being assessed
• Children currently undergoing or awaiting medical management, diagnostic investigations or rehabilitation on the arm being assessed

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Shoulder instability participants; Participants with previous a previous episode(s) of shoulder instability	Other: 3D movement analysis with surface electromyography; Single measurement session of 3D movement analysis with surface electromyography for upper limb movements
Age matched controls (no instability); Participants with no previous a previous episode(s) of shoulder instability	Other: 3D movement analysis with surface electromyography; Single measurement session of 3D movement analysis with surface electromyography for upper limb movements

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of shoulder instability episodes (subluxation and dislocations)	Number of shoulder instability episodes (subluxation and dislocations)	One year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Kinematics	Kinematic variables related to the movement tasks	On admission
Kinetics	Kinetic variables related to the movement tasks	On admission
Surface electromyography	Muscle activity patterns related to the movement tasks	On admission

Collaborators and Investigators

• Sponsor: Robert Jones and Agnes Hunt Orthopaedic and District NHS Trust
• Collaborators: University of Liverpool; University of Aberdeen; Bournemouth University; Keele University

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2021
• Primary Completion (Anticipated): January 31, 2024
• Study Completion (Anticipated): January 31, 2024

Study Registration Dates

• First Submitted: March 11, 2020
• First Submitted That Met QC Criteria: March 13, 2020
• First Posted (Actual): March 17, 2020

Study Record Updates

• Last Update Posted (Actual): February 1, 2022
• Last Update Submitted That Met QC Criteria: January 31, 2022
• Last Verified: October 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Joint Dislocations; Wounds and Injuries; Shoulder Injuries; Joint Instability; Shoulder Dislocation
• Other Study ID Numbers: RL1812

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No
• IPD Plan Description: The anonymised final trial dataset and anonymised 3D movement data files will be stored on the Keele University Data repository where they will be assigned a DOI. The anonymised data will be available subject to an appropriate request for research and academic use.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No