Samenvatting

Abstract


Main question

What is the best evidence based exercise treatment protocol for shoulder instability and rotator cuff injuries in athletes performing overhead activities and what is the best measurement tool used to determine the athlete's present level after recovery?

Background

Athletes performing overhead activities with repetitive use of the upper limb above the horizontal plane produce irritation and inflammation of the rotator cuff and shoulder joint, and are thus vulnerable and prone to develop injury. One of the treatment forms that are well known and often used by physiotherapists to resolve the complaints, is conservative physiotherapy in form of active exercises.

What is not present is the knowledge of best evidence based exercise programme for shoulder injuries in the overhead athlete. In addition it appears to be difficult to compare the outcome of treatment methods due to the many different scoring systems that attempt to quantify the results of treatment.

Method

Cochrane, Medline, PubMed, Cinahl, SportDiscus, SumSearch databases were searched using keywords as: athlete, overhead sports, rotator cuff, shoulder instability, treatment, effects, best evidence, treatment protocol. Studies were eligible if they were systematic reviews, randomised clinical trials, and controlled clinical trials containing information about exercise therapy for athletes performing overhead activities suffering from shoulder instability and/or rotator cuff injuries.

Results

After meeting the inclusion criteria, seven clinical trials underwent a quality assessment using the PEDro scale. Due to the limited findings concerning clinical trials with full relevancy for this systematic review, a decision was made to include eight narrative reviews and one systematic review as back-up information. These were assessed for its quality by a self-made narrative review scale and the appraising a systematic review scale. A data extraction form containing the relevant information from the studies was then made and comparison among the studies were done according to the relevant issues. The information from the seven clinical trials in this systematic review is valued as most reliable due to the fact that there is no way to know if the narrative reviews constitute scientific material.

Conclusion

Results from the seven clinical trials show a weak but positive trend for conservative treatment programs for managing shoulder instability. Specifically, positive effects were noted with respect to decreasing recurrence rate of instability, promoting the return to pre-morbid work or sport activity, and decreasing or resolving symptoms associated with instability. Although weak, the trend was best supported by a program of immobilisation for three weeks followed by a twelve-week program of ROM, glenohumeral and scapular stabilisation exercises. The existing measurement tools that are available for the injured overhead athlete covers different domains with focus on several items such as function, pain, strength, range of motion and quality of life. These are all items necessary to consider in order to determine whether or not pre-morbid level has been achieved. Ultimately it is the individual's perception of changes in health status that provides the most valuable and important indicator to the success of treatment.