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  • Physical Therapy Achieves Faster Outcomes Than Surgery for Common Type of Shoulder Dislocation

    Acromio-clavicular (AC) joint dislocations—even moderate-to-severe cases—may be better-treated through nonsurgical approaches, according to a new study from Canada that found better short-term outcomes, faster return-to-work rates, and fewer complications among individuals who received physical therapy only.

    The study aimed to compare outcomes among patients who received hook plate fixation surgery—a common surgical technique—with patients who received nonoperative care including using a sling for 4 weeks and then participating in a "standard physiotherapy regimen" of active and passive exercise followed by resistance and strengthening exercises for 6 weeks after injury. Progress in several areas was measured at discharge, 6 weeks, 3 months, 6 months, 1 year, and 2 years.

    When researchers analyzed results from 83 patients treated between 2008 and 2010, they found that the 43 participants who received the nonoperative care averaged scores on the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire that were significantly better than the surgery group at 6 weeks and 2 months. After that, DASH scores were similar, with both groups reporting improvements. Results were published in the November Journal of Orthopaedic Trauma (abstract only available for free).

    The nonoperative group also experienced faster return-to-work rates, with 75% of those patients returning to work in 3 months, compared with 43% of the surgery patients. Another plus for the nonoperative group: complications were less prevalent, with only 2 patients reporting problems. Among the surgery group, 14 complications were recorded, including plate loosenings, clavicular fracture, and a deep wound infection.

    The only areas that seemed to favor surgery had to do with imaging and aesthetics. Because the hook plate is designed to return the joint to its preinjury position, radiographs of the joints of the surgery group were better than the nonsurgical group in terms of coraco-clavicular distance. Similarly, because all individuals in the nonsurgical group had a displaced distal clavicle, participants in the physical therapy-only approach tended to be less satisfied with the look of their shoulder after 1 year.

    Principal investigator Michael McKee, MD, believes that surgery's ability to create a shoulder that "appears more symmetrical and pleasing to the eye" is just about the only thing that would make going under the knife a preferable option.

    "While satisfaction with the appearance of the shoulder should be a consideration, I believe surgeons should think twice before recommending surgery for an AC joint dislocation—regardless of the severity," McKee said in a press release. "Patients who forgo surgery return to work sooner, experience less disability during the first months after injury, and have fewer complications."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • I can attend and confirm this research. I separated my AC joint from a road bike accident and skipped the surgery option thinking, as a PT student, that therapy would be superior to surgery. This was especially true due to the fact that surgery would put me back on my clinical affiliations, placing me a year behind if I underwent surgery. I've self rehab'ed my shoulder, can do a full push up without pain and am working on increasing strength. I'll graduate in December and the only reason I still consider surgery is for aesthetic purposes. Other than that, my shoulder is fully functional in my high demanding life as a manual physical therapy student. Looking forward to graduating in December!!

      Posted by Pablo Estrada -> BIWa@J on 10/28/2015 6:18 PM

    • My cousin dislocated his shoulder playing baseball growing up. This really had affected him as an adult. I think physical therapy and surgery has really been able to help him get the use of his arm back more.

      Posted by Paige Smith on 11/19/2015 12:50 PM

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