A new study is presenting data that, after arthroscopic Bankart repair, rehabilitation should include treatment approaches for improving scapular control and proprioceptive sense.
Is Scapular Control, Proprioceptive Sense Part of Shoulder Rehab?
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Secondary#proprioceptivesense#scapularcontrol#shoulderrehabilitation
“Scapular kinesia is an important component of glenohumeral rhythm and shoulder stability. No studies have evaluated scapular dyskinesis and its relationship to shoulder proprioception in patients who have undergone arthroscopic Bankart repair (ABR),” the researchers wrote in “Scapular Dyskinesis, Shoulder Joint Position Sense, and Functional Level After Arthroscopic Bankart Repair”.
The study which investigated scapular dyskinesis, proprioception and functional level after arthroscopic Bankart Repair was published online in the Orthopaedic Journal of Sports Medicine on August 2, 2021.
The researchers enrolled 13 male patients who had been treated by their doctor with arthroscopic Bankart repair and 13 healthy patients who were, for the purposes of this study, the control group. They were all matched for age and sex. The mean age was 30 years.
The researchers measured the levels of scapular dyskinesis using a combination of the lateral scapular slide test and the scapular dyskinesis test. They calculated proprioception using the active angle reproduction test with a smartphone goniometer application. They also measured the functional level using the upper-quarter Y-balance test for dynamic stability, and the Rowe score and Walch-Duplay score for quality of life and return to activities of daily living.
Overall, the researchers found the presence of static scapular dyskinesis in the neutral position, at 45˚of abduction, and at 90˚of abduction as well as evidence that the presence of dynamic scapular dyskinesis was higher in the arthroscopic Bankart repair group versus the control group (p ≤.04 for all).
Also, shoulder joint position sense (absolute error) at 40˚and 100˚of shoulder elevation and shoulder functional level according to the Rowe score were worse in the arthroscopic Bankart repair patients than in the control group (p ≤.02 for all).
The researchers reported dynamic scapular dyskinesis was negatively correlated to shoulder joint position sense at 40˚of shoulder elevation (r = -0.64; p = .01). Static scapular movement determined by the lateral scapular slide test had a moderate association to the Rowe score (r = 0.58; p = .03).
“Scapular kinematics and proprioception should be evaluated after arthroscopic Bankart Repair. Treatment approaches to improve scapular control and proprioceptive sense should be included in the rehabilitation program for patients after arthroscopic Bankart Repair.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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