Each year within Canada and the US, more than 30,000 children and adolescents will have an injury to their shoulder resulting in a shoulder dislocation. Although the current practice is to manage this initial dislocation without surgery, the vast majority of these children and adolescents will, unfortunately continue to have instability episodes of their shoulder. Recurrent instability can cause damage to the bones and cartilage that form the shoulder resulting in potentially more difficult surgical stabilization, and possibly long-term sequela. To that effect, there is increasing interest to consider early surgical stabilization in this population. This pilot randomized controlled trial (RCT) will evaluate the feasibility of conducting a larger RCT assessing the effect of early arthroscopic stabilization compared to rehabilitation on the rate of repeat shoulder dislocations (recurrent instability), pain, and shoulder function among adolescents (aged 12-18 years) with first-time shoulder dislocations. These patients will be followed for one year.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
2
Early arthroscopic stabilization with Bankart repair
Rehabilitation including a period of immobilization followed by physical therapy
McMaster University
Hamilton, Ontario, Canada
Rate of recurrent shoulder dislocation
Recurrent shoulder dislocations will be defined as an episode of repeat anterior shoulder dislocation either requiring reduction by medical personnel, an x-ray confirming anterior dislocation of the shoulder, or the requirement of surgical management of recurrent instability.
Time frame: 12 months
Visual Analogue Scale
100-point pain scale, range 0-100, higher score indicates worse pain.
Time frame: 12 months
Pediatric and Adolescent Shoulder and Elbow Survey
The Pediatric and Adolescent Shoulder and Elbow Survey has recently been adopted as a shoulder and elbow function scale designed specifically for children and adolescents aged 10-18, and has shown to be well received and understood in this age group. The total score - 100 maximum points - is weighted 50% for pain and 50% for function.
Time frame: 12 months
Euro-Qol 5 Dimensions Youth
The Euro-Qol 5 Dimensions Youth comprises 5 dimensions of health (mobility, self-care \[looking after myself\], usual activities, pain/discomfort, and anxiety/depression \[feeling worried, sad or unhappy\]). Score range 0-100, higher score indicating worse outcomes.
Time frame: 12 months
Rate of adverse events (other than recurrent shoulder dislocations)
Defined as any symptom, sign, illness, or experience that develops or worsens in severity during the course of this study.
Time frame: 12 months
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