Electrical muscle stimulation for the treatment of functional posterior shoulder instability

病理性肌肉激活模式可产生稳定肩部肌肉的力不平衡，导致不可控的、臂位依赖的功能性后肩不稳定（FPSI）。受影响的患者通常是青少年，他们患有严重的重复性肩膀脱位，导致功能损害，持续的不稳定感和疼痛。传统的治疗方案，包括保守和手术干预往往是无效的，创造了对治疗方案的需求。一项基于电肌肉刺激的实验性保守治疗方案在一项涉及先前常规治疗失败的FPSI患者的试点试验中显示出有希望的结果。该项目的目标是在一项多中心随机对照试验中评估这种实验性治疗方案的一般适用性和有效性。研究参与者将被随机分配到实验或控制干预组，每个组由18个标准化的一小时训练课程组成，平均分布在6周的课程中。将对预先定义的主观和客观结果参数进行纵向比较。在达到主要终点（3个月时的西安大略省肩部不稳定指数）后，允许选择双向交叉手术。拟议的项目挑战了FPSI目前的治疗模式，并将有助于评估和潜在地为患有这种使人衰弱的病理的患者建立急需的新治疗选择。

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.