Control strategies to re-establish glenohumeral stability after shoulder injury

BACKGROUND Muscles are important "sensors of the joint instability". The aim of this study was to identify the neuro-motor control strategies adopted by patients with anterior shoulder instability during overhead shoulder elevation in two planes. METHODS The onset, time of peak activation, and peak magnitude of seven shoulder muscles (posterior deltoid, bilateral upper trapezius, biceps brachii, infraspinatus, supraspinatus and teres major) were identified using electromyography as 19 pre-operative patients with anterior shoulder instability (mean 27.95 years, SD = 7.796) and 25 age-matched asymptomatic control subjects (mean 23.07 years, SD = 2.952) elevated their arm above 90 degrees in the sagittal and coronal planes. RESULTS Temporal characteristics of time of muscle onsets were significantly different between groups expect for teres major in the coronal plane (t = 1.1220, p = 0.2646) Patients recruited the rotator cuff muscles earlier and delayed the onset of ipsilateral upper trapezius compared with subjects (p<0.001) that control subjects. Furthermore, significant alliances existed between the onsets of infraspinatus and supraspinatus (sagittal: r = 0.720; coronal: r = 0.756 at p<0.001) and ipsilateral upper trapezius and infraspinatus (sagittal: r = -0.760, coronal: r = -0.818 at p<0.001). The peak activation of all seven muscles occurred in the mid-range of elevation among patients with anterior shoulder instability whereas subjects spread peak activation of all 7 muscles throughout range. Peak magnitude of patients' infraspinatus muscle was six times higher (sagittal: t = -8.6428, coronal: t = -54.1578 at p<0.001) but magnitude of their supraspinatus was lower (sagittal: t = 36.2507, coronal: t = 35.9350 at p<0.001) that subjects. CONCLUSIONS Patients with anterior shoulder instability adopted a "stability before mobility" neuro-motor control strategy to initiate elevation and a "stability at all cost" strategy to ensure concavity compression in the mid-to-150 degrees of elevation in both sagittal and coronal planes.