Posterior glenohumeral dislocations are rare, comprising only 4 percent of all shoulder dislocations. While early and accurate diagnosis of a posterior dislocation increases the likelihood of success with non-operative management, traditional rehabilitation may not adequately address the sensorimotor deficits that are evident following dislocation. Restoration of the sensorimotor system is critical to successfully return a throwing athlete safely to sports. The use of functional neuromuscular rehabilitation (FNR) attempts to address deficits in the compromised sensorimotor system. With a good understanding of the specific demands placed on the overhead athlete’s shoulder, knowledge of glenohumeral and scapulothoracic joints’ biome-chanics, respect for the athlete’s level of symptoms and pain, adherence to soft tissue healing, and application of a rehabilitation program that incorporates FNR, an athlete can successfully return to a high level of competition following an acute posterior glenohumeral dislocation.
Zakariya Nawasreh, David Logerstedt, Adam Marmon and Lynn Snyder-Mackler
Context: Manual perturbation training improves knee functional performance and mitigates abnormal gait in patients with anterior cruciate ligament (ACL) rupture. However, manual perturbation training is time- and labor-intensive for therapists. Objective: To investigate whether perturbation training administered using a mechanical device can provide effects similar to manual training on clinical measures and knee biomechanics after ACL rupture. Design: Prospective cohort (therapeutic) study. A 2 × 2 analysis of variance was used for statistical analysis. Setting: A clinical and biomechanical laboratory. Patients: Eighteen level I/II patients with acute ACL ruptures participated in this preliminary study. Intervention: Nine patients received mechanical perturbation training on an automated mechanical device (mechanical group), and 9 patients received manual perturbation training (manual group). Outcome Measures: Patients completed performance-based testing (quadriceps strength and single-legged hop tests), patient-reported questionnaires (Knee Outcome Survey-Activities of Daily Living Scale, Global Rating Score, and International Knee Documentation Committee 2000), and 3-dimensional gait analysis before (pretesting) and after (posttesting) training. Results: There was no significant group-by-time interaction found for all measures (P ≥ .18). Main effects of time were found for International Knee Documentation Committee 2000 (pretesting: 69.10 [10.95], posttesting: 75.14 [7.19]), knee excursion during weight-acceptance (pretesting: 16.01° [3.99°]; posttesting: 17.28° [3.99°]) and midstance (pretesting: 14.78° [4.13°]; posttesting: 16.92° [4.53°]) and external knee-flexion moment (pretesting: 0.43 [0.11] N m/kg/m; posttesting: 0.48 [0.11] N m/kg/m) (P ≤ .04). After accounting for pretesting groups’ differences, the mechanical group scored significantly higher on triple hops (mechanical: 96.73% [6.65%]; manual: 84.97% [6.83%]) and 6-m timed hops (mechanical: 102.07% [9.50%]; manual: 91.21 [9.42%]) (P ≤ .047) compared with manual group. Conclusion: The clinical significance of this study is the mechanical perturbation training produced effects similar to manual training, with both training methods were equally effective at improving patients’ perception of knee function and increasing knee excursion and external flexion moment during walking after acute ACL rupture. Mechanical perturbation training is a potential treatment to improve patients’ functional and biomechanical outcomes after ACL rupture.