Electrical muscle stimulation for the treatment of functional posterior shoulder instability

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Pathological muscle activation patterns can generate a force imbalance of stabilizing shoulder muscles and result in non-controllable, arm-position dependent functional posterior shoulder instability (FPSI). Affected patients are typically adolescents who suffer from severe repetitive shoulder dislocations leading to functional impairment, constant feeling of instability, and pain. Conventional treatment options including conservative as well as surgical interventions are often ineffective, creating a need for treatment alternatives. An experimental conservative treatment protocol based on electrical muscle stimulation showed promising results in a pilot trial involving patients suffering from FPSI after previously failed conventional treatment. The goal of the proposed project is to evaluate the general applicability and effectiveness of this experimental treatment alternative in a multi-centric, randomized controlled trial. Study participants will be allocated randomly to the experimental or control intervention, each consisting of 18 standardized one-hour training sessions evenly distributed over the course of 6 weeks. A longitudinal comparison of the pre-defined subjective and objective outcome parameters will be performed. After reaching the primary endpoint (Western Ontario Shoulder Instability Index at 3 months), optional bi-directional cross-over is permitted. The proposed project challenges the current treatment paradigms for FPSI and will help to evaluate and potentially establish a much-needed new treatment option for patients suffering from this debilitating pathology.