Rehabilitation of a glenohumeral instability utilizing the body blade

Abstract

Traditional rehabilitation for shoulder dislocation has a success rate of only 20%. The body blade has been hypothesized to strengthen the muscles stabilizing the shoulder girdle by training the contractile tissues directly and also indirectly affecting the joint and surrounding noncontractile tissues when responding to rapid positional changes and mechanical energy. Shoulder dislocation negatively affects both the active (musculature) and passive (joint and ligaments) stabilizers of the glenohumeral joint. Therefore, the purpose of this case report was to evaluate the efficacy of therapeutic exercise using the body blade in the conservative management of an individual with glenohumeral instability. The patient, an 18-year-old male, dislocated his left shoulder after a wave crashed on top of him. Intervention included therapeutic exercise using the body blade. Measures were taken at examination, re-evaluation (6th visit), and discharge (11th visit). According to the 11-point numeric pain rating scale, worst pain was reduced from 4 to 0. Glenohumeral ROM measures at discharge were all within normal range except external rotation (deficit of 10 degrees), compared to the initial ROM deficits of 10–35% of noninvolved values. Post intervention strength, as assessed by handheld dynamometry, revealed deficits only in scapular retraction compared to the uninvolved side (21% compared to an initial deficit of 39%). Other muscle groups showing deficits from 20% to 40% at initial examination exceeded the comparative strength of the other limb at discharge. The SPADI and WOSI scores were reduced from 13 to 0 and 482 to 46, from initial examination to discharge, respectively. Furthermore 6 months post episode of care the patient reported no recurrent dislocation of the involved shoulder. The success rate of an exercise program with individuals who have dislocated their glenohumeral joint is poor. After 11 visits of physical therapy using the body blade the patient improved in ROM, strength, and function.