Abstract
ObjectiveTo describe the clinical characteristics of patients with hypermobility spectrum disorders (HSD) and shoulder complaints with or without mechanical symptoms, and to compare characteristics between these groups. DesignA cross-sectional study. SettingPrimary care. ParticipantsOne-hundred patients with HSD and shoulder complaints for at least 3 months were included from primary care (N=100). InterventionsNot applicable. Main Outcome MeasuresMedical history, self-reported (shoulder pain and function, discomfort due to other symptoms, fatigue, fear of movement, quality of life) and objective (strength, range of motion, proprioception) characteristics were collected by physiotherapists. Mechanical symptoms (yes/no) were defined as self-reported shoulder instability, subluxation, and/or laxity. ResultsSixty-seven reported mechanical symptoms. Patients in both groups reported impairments related to shoulder pain, function, fatigue, fear of movement, and quality of life. Patients with mechanical symptoms were younger (mean, 35.1 years [95% CI, 32.3-37.9 years] vs 43.3 years [95% CI, 38.4-48.1 years]), had longer symptom duration (median, 46 months [95% CI, 36-66 months] vs 24 months [95% CI, 9-56 months]), reported a previous shoulder dislocation (25% [95% CI, 16-37] vs 3% [95% CI, 0-16]), experienced that their shoulder was loose (64% [95% CI, 52-76] vs 15% [95% CI, 5-32]), and reported discomfort due to other symptoms (odds ratio, 1.48 [95% CI, 1.17-1.87]). Furthermore, a larger proportion had received supplemental treatment (analgesic medication, steroid injection/surgery). ConclusionsBoth groups with HSD and shoulder complaints presented with substantial shoulder-related impairments. Two-thirds reported mechanical symptoms, were younger, and more severely impaired than those without mechanical symptoms. These findings highlight the importance of managing mechanical shoulder symptoms to fully address the patients’ impairments.
Highlights
Main Outcome Measure(s): Medical history, self-reported and objective characteristics were collected by physiotherapists
The mean age for all patients was 37.8, while patients with mechanical symptoms were younger (means 35.1 (32.3; 37.9) vs. 43.3 (38.4; 48.1))
Items no 5 (“How much clicking, cracking, or snapping do you experience in your shoulder?”) and 8 (“How much feeling of instability or looseness do you experience in your shoulder?”), which are directly related to experiencing mechanical symptoms showed the largest group differences
Summary
This descriptive study used baseline data from a randomised controlled trial (RCT) on patients with HSD and persistent shoulder complaints (The Shoulder-MOBILEX study),[25] approved by the Regional Committees on Health Research Ethics for Southern Denmark (31 May 2017, S-20170066) and registered with Clinicaltrials.gov (8 Mar 2019, NCT03869307). We included a range of potentially relevant clinical characteristics due to the descriptive nature of the study. To reduce bias, these variables were selected and described in our preregistered statistical analysis plan (Open Science Framework, 19 Dec 2020). The study was conducted in primary care within the Region of Southern Denmark, representing the general patient population in Denmark. The clinical assessments and selfreported measures were completed in-person at baseline of the RCT at two sites (Esbjerg Municipality Rehabilitation Centre, Esbjerg, Denmark, and at University of Southern Denmark, Odense, Denmark), by one of four blinded physiotherapists
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