title: Functional outcome and quality of life after rehabilitation for voluntary posterior shoulder dislocation: a prospective blinded cohort study.
abstract: BACKGROUND
  Voluntary posterior instability of the shoulder is a rare condition in which the patient is able to cause a subluxation by voluntary muscle activation. A shoulder rehabilitation program aimed to correct abnormal muscle patterns and restore correct scapular motion may provide good results and improve the quality of life of these patients.
  
  
  METHODS
  Fifteen subjects (six males, nine females; mean age 19 years) underwent physical examination and clinical tests [Disability of the Arm, Shoulder and Hand (DASH) score, Shoulder Pain and Disability Index (SPADI), and modified Rowe score] and compiled the patient global assessment (PGA). Articular or rotator cuff lesions were excluded by X-rays and MRI. The rehabilitation program included three phases: (1) assessment and correction of abnormal muscle patterns, (2) restoration of correct scapular motion, and (3) strengthening of scapular and posterior glenohumeral muscles. Follow-up was at 3, 6, 12, and 24 months.
  
  
  RESULTS
  DASH and SPADI scores improved significantly at 3 (p < 0.01), 6 (p < 0.009), 12 (p < 0.001), and 24 months (p < 0.001). The Rowe score was fair at 3 months and good at 6, 12, and 24 months. Active flexion, abduction, and external rotation increased at all follow-up points (p < 0.01), whereas internal rotation remained unchanged (p > 0.05). PGA values were high. Compliance was good without serious adverse events reported during the treatment. A correlation was found between age and DASH changes (Spearman's ρ -0.56; p = 0.0455).
  
  
  CONCLUSIONS
  Our findings stress the value of a rehabilitation program that teaches subjects with voluntary instability how to correct abnormal muscle patterns to restore scapular motion, and the importance of adopting home rehabilitation exercises as a part of the normal lifestyle.
authors.affiliation: Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, RN, Italy, giovannimerolla@hotmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Merolla
authors.forename: Elisa
authors.initials: E
authors.lastname: De Santis
authors.forename: Ann M J
authors.initials: AM
authors.lastname: Cools
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Porcellini
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001676:Biofeedback, Psychology; D026241:Exercise Movement Techniques; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D010349:Patient Compliance; D011187:Posture; D011446:Prospective Studies; D011788:Quality of Life; D016059:Range of Motion, Articular; D020127:Recovery of Function; D055070:Resistance Training; D012399:Rotation; D012720:Severity of Illness Index; D012783:Shoulder Dislocation / Q000503:physiopathology / Q000534:rehabilitation*; D012785:Shoulder Joint / Q000503:physiopathology; D016037:Single-Blind Method; D055815:Young Adult