Effect of Using the Modified Milch Technique on Quality of Life in Patients with Anterior Dislocation of the Shoulder Joint.

Objective: To evaluate the effect of the Milch technique on quality of life (QoL) in patients with anterior dislocation of the shoulder joint. Methods: A total of 126 patients undergoing manual reduction for anterior dislocation of the shoulder in our hospital from January 2021 to January 2022 were prospectively enrolled in this study. The randomized number table method was used to divide patients into the study group (63 patients) and the control group (63 patients). The study group was treated with a modified Milch technique while the control group was treated with the Hippocratic method. Success rate and complications were compared to evaluate the effectiveness of manual reduction. Clinical assessment of shoulder function included the Constant-Murley Score and visual analog scale (VAS) before, during and after manual reduction. Results: The success rate of primary and secondary reduction in the study group was significantly higher than in the control group (87.30% vs 61.90, respectively; P = .001; 11.11% vs 25.40%, respectively; P = .038). The failure rate in the study group was significantly lower than in the control group (1.59% vs 12.70%, respectively; P = .015). The time required for reduction in the study and control groups was 58.87 ± 7.92 seconds and 93.09 ± 8.01 seconds, respectively; a significant difference (t = -24.113; P < .001). There was no statistically significant difference in VAS scores before and during reduction in the 2 groups. After reduction, VAS scores in the study group were significantly lower than in the control group (1.02 ± 0.01 vs 1.14 ± 0.26, respectively; P < .001). There were no significant differences in pain level, activities of daily living, joint range of motion or muscle strength between the 2 groups before and after reduction (P > .05). After reduction, health status, emotional function, mental health, physiological function, physiological function, physical pain, vitality and social function scores in the study group were significantly higher than in the control group (P < .05). There were 4 avulsion fractures and 2 humeral fractures in the control group; no complications occurred in the study group, with a significant difference (χ2 = 6.289; P = .012). Conclusion: The Milch technique can improve the QoL in patients with anterior dislocation of the shoulder, and the success rate of the reduction is high.

The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: A randomized controlled trial.

PURPOSE: To investigate the effect of functional electrical stimulation (FES) for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients. METHOD: A total of 50 hemiplegic patients with shoulder subluxation and shoulder pain were included in the study. The patients were randomly divided into the study and control groups. All patients were put on a rehabilitation program using conventional methods while the study group patients were additionally applied FES to supraspinatus and posterior deltoid muscles. The shoulder pain of all patients during resting, passive range of motion (PROM) and active range of motion (AROM) was measured with the visual analog scale (VAS) while the shoulder subluxation levels were evaluated with the classification developed by Van Langenberghe and by using the millimetric measurements on anteroposterior shoulder X-ray before and after the physical treatment and rehabilitation program and compared. RESULTS: Comparison of the resting AROM vs. PROM VAS value changes showed no significant difference between the groups. There was a significant difference between the two groups for the amount of change in shoulder subluxation in favor of the study group. CONCLUSIONS: The results of our study have shown that applying FES treatment to the supraspinatus and posterior deltoid muscles in addition to conventional treatment when treating the subluxation in hemiplegic patients is more beneficial than conventional treatment by itself.

Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life.

OBJECTIVE: To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia. DESIGN: Prospective, open label design. SETTING: The outpatient services of a large teaching rehabilitation hospital in The Netherlands. SUBJECTS: Fifteen stroke survivors with chronic (> six months) hemiplegia and a therapy-resistant painful shoulder with subluxation. All patients suffered from clinically relevant shoulder pain, as assessed by a score of at least 4 out of 10 on a numerical rating scale. Shoulder subluxation was indicated by at least 1/2 fingerbreadth of glenohumeral separation on palpation. INTERVENTION: Six hours of P-NMES per day for a total of six weeks. MAIN OUTCOME MEASURES: Shoulder pain (Brief Pain Inventory), shoulder subluxation (clinical and radiographic), shoulder pain-free external rotation (hand-held goniometer), motor impairment (Fugl-Meyer Motor test) and quality of life (SF-36) were assessed before treatment, after six weeks of intramuscular stimulation, at three months and six months follow-up. RESULTS: A significant reduction in pain was found on the Brief Pain Inventory. Pain reduction was still present at six months follow-up. All domains, in particular bodily pain, of the SF-36 showed improvement in the short term. After six months of follow-up, bodily pain was still strongly and significantly reduced, whereas social functioning and role physical demonstrated a nonsignificant improvement of more than 10% compared with baseline. CONCLUSION: This pilot suggests that P-NMES potentially reduces shoulder pain in chronic hemiplegia. To establish the clinical value of P-NMES in treating hemiplegic shoulder pain a randomized controlled trial is needed.

Efficacy of electrical stimulation in preventing or reducing subluxation of the shoulder after stroke: a meta-analysis.

After stroke, up to 81% of individuals develop shoulder subluxation, a condition frequently associated with poor upper limb function. Recently, electrical stimulation has been applied to shoulder muscles to treat shoulder subluxation. The purpose of this meta-analysis was to examine the efficacy of surface electrical stimulation for the prevention or reduction of shoulder subluxation after stroke. A meta-analysis of all eligible randomised or quasi-randomised trials of electrical stimulation for the treatment of shoulder subluxation identified by computerised and hand searches of the literature was carried out. The primary outcome measure of interest was subluxation. Seven (four early and three late) trials met the inclusion criteria. The mean PEDro score out of 10 for quality of the methods was 5.8 for the four early trials and 4.3 for the three late trials. Data were pooled when subluxation was measured in millimetres. Analysis found that, when added to conventional therapy, electrical stimulation prevented on average 6.5mm of shoulder subluxation (weighted mean difference, 95% CI 4.4 to 8.6) but only reduced it by 1.9mm (weighted mean difference, 95% CI -2.3 to 6.1) compared with conventional therapy alone. Therefore, evidence supports the use of electrical stimulation early after stroke for the prevention of, but not late after stroke for the reduction of, shoulder subluxation.

Chiropractic management of a professional hockey player with recurrent shoulder instability.

OBJECTIVE: To describe the clinical management of recurrent shoulder instability in a professional hockey player by using chiropractic management and rehabilitation exercises. CLINICAL FEATURES: A 23-year-old professional hockey player with recurrent left shoulder pain and instability. He had two previous unsuccessful shoulder operations to correct the instability. He reported that the shoulder "slips out" in positions of abduction and external rotation or when the left arm is moved suddenly above shoulder height. The patient was still playing hockey professionally at the time of the initial visit and did not want to have to take time off for another surgery, so he chose to attempt a conservative approach. INTERVENTION AND OUTCOME: The patient had undergone strength training for rehabilitation after each of the previous two shoulder operations and had very strong rotator cuff and scapular musculature. Proprioceptive testing revealed a poor response in the left shoulder compared with the right shoulder. Two subjective outcome measures were used to determine the effectiveness of the treatment protocol in reducing the symptoms of recurrent shoulder instability. Much of the treatment focused on proprioceptive training, soft tissue mobilization, and improving joint function. CONCLUSION: This case demonstrates the potential benefit of chiropractic management and proprioceptive exercises to decrease the symptoms of recurrent shoulder instability.

Damage of the long thoracic and dorsal scapular nerve after traumatic shoulder dislocation: case report and review of the literature.

A judo injury resulted in an anterior shoulder dislocation with a concomitant lesion of the long thoracic and the dorsal scapula nerve. This injury led to loss of function and extreme instability of the shoulder. Stabilization of the glenohumeral joint was successfully accomplished by surgery. The athlete declined further operative approaches to stabilize the scapula. The patient was able to return to the former level of athletic activity.

[Electrotherapy of pain relief using the Tenzcare stimulator. A clinico-experimental study]. / Elektrotherapie zur Schmerzbekämpfung unter Verwendung des Tenzcare-Stimulators. Eine klinisch-experimentelle Studie.

Electrotherapy was introduced into the aftercare programme for patients with serial rib fractures in the acute stage, shoulder injuries or fractures of the radius. Electrical stimulation was carried out with the Tenzcare Nr. 6240 apparatus. The results were significantly better in each of the three groups than in the respective control group. Patients after thorax trauma complained less of pain in the acute phase: there was less pulmonary secretion on X-ray and, on average, their blood gas values returned to normal three days earlier. None of them required assisted respiration. Patients with shoulder injuries or fractures of the radius complained less frequently of pain during physio-therapy after removal of their plaster casts. They attained their optimum range of movement on average ten and eight days earlier, respectively than the controls.