Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

Dr. Joy C. Macdermid

Abstract

Abstract

Introduction: Shoulder pain and disability, particularly acromioclavicular joint (ACJ) and rotator cuff (RC) injuries, are common in a physically active population. Determining operative or rehabilitative treatment plans involve multiple treatment choices influenced by the injury grade and treatment goals, such as return to sport. This thesis investigates the management of treatment for AC and RC injuries

Method: The first study is a scoping review that uses the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) to synthesize 32 studies involving athletes who have undergone conservative or operative treatment for their Rockwood grade III ACJ injuries by evaluating shoulder function outcomes and return to sport (RTS). The second study is a secondary data analysis from a prospective cohort of 343 patients with RC injuries and examines the differences in shoulder function, using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, based on sex and age within a one year follow up.

Results: Study One indicates a slight preference for conservative treatments for ACJ injuries from patient reported outcomes, with surgical treatment preferred for younger athletes. However, they both had similar function scores and RTS for surgical and conservative treatments. Study Two determined that males and older adults had lower disability scores post-surgery.

Discussion: The studies provide insight into the complexities of patient care, patient goals, and the importance of evidence-based clinical practices. Patient-centric experiences is paramount into understanding how to deliver the best rehabilitation protocol.

Summary for Lay Audience

Summary for Lay Audience

Shoulder joint injuries in athletes are a common occurrence due to the activities in which they are involved. To determine the severity of the injury, x-ray and ultrasound testing is used to see the displacement of the bone and joints. The acromioclavicular joint (ACJ) is a shoulder joint that is susceptible to injury and can tear or fracture. Rockwood is a scale from 1-6 that determines how severe the ACJ injury is. Type/grade III on the Rockwood scale is a controversial area as determining whether the conservative approach or surgical approach is more warranted is still an ongoing debate. Treatment options are given to the patient and are ultimately determined through collaboration between the patient and healthcare professional. The first approach is conservative treatment, which includes physical therapy (PT) using exercises, slings, and muscle therapy. The second approach is surgical, which encompasses a variety of techniques such as reconstruction, transferring neighbouring ligaments, and the use of pins and wires for support. When deciding which treatment approach to take, it is important for patients to be educated on the pros and cons of each approach, known as knowledge translation (KT), and should consider Return to sport (RTS) as an important factor. Patients who have undergone either approach will report on how their shoulders work after their treatment – how fast they can RTS is an important indicator of the treatment’s success. Through this research, it was determined that both surgical/operative and conservative methods are successful and that RTS is determined on a case-by-case basis. Sex and age effect shoulder surgery recovery time concerning rotator cuff (RC) injuries. It was determined that older men had the highest function post-operation after 1 year from analysing the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, evaluating basic functions of their shoulders post-surgery from 3-12 months.

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