THE EFFECT OF SHOULDER IMMOBILIZATION ON BALANCE IN THE COMMUNITY-DWELLING ELDERLY POPULATION.

Abstract

Purpose/Hypothesis: It has been estimated that approximately one-third of adults 65 years and older are likely to experience a fall. A common fracture of the elderly population is the proximal humeral fracture that typically occurs when falling on an outstretched hand. Standard treatment of the non-displaced stable fracture involves external immobilization of the shoulder with a sling that anchors the upper extremity to the trunk. The purpose of this study is to examine the effect of shoulder immobilization on balance as measured by the Berg Balance Scale (BBS). Number of Subjects: Twenty-seven subjects participated in the study. The subjects were recruited by word of mouth to family and acquaintances of the investigators. Men and women age 65 years or older who were English speaking, able to follow directions, and living independently in the community were eligible to participate. Subjects were excluded if they had a history of CVA, TIA, Parkinson's disease, lower extremity joint replacement or upper extremity immobilization within the past month. Materials/Methods: The BBS was administered twice to each participant. After completing a health questionnaire and signing the Informed Consent, the subject chose a colored chip to determine if they would wear the sling during the first or second trial. The sling was fitted on the side of the dominant hand and the subject was given 2 minutes to accommodate to the device prior to testing. The same investigator administered both tests to each subject and the subject was not informed of their score until both testing sessions were completed. Results: The Wilcoxon matched pairs signed rank test was performed on the data indicating a significant difference between pairs (P=0.0074). A total of 18 out of 27 subjects demonstrated a difference between the first and second test. In considering those 18 subjects, 14 scored lower on the BBS with the sling as compared to no sling. Conclusions: This study investigated the impact of shoulder immobilization on balance in the community-dwelling elderly population. The results indicate that immobilizing the shoulder has a negative impact on balance as measured by the BBS. It should be noted that out of the 14 subjects who scored lower on the BBS with the sling, 12 of those subjects were tested with the sling on first. It is possible that the subject scored higher on the second trial due to previous experience taking the test. Clinical Relevance: Fractures of the proximal end of the humerus are fairly common in the elderly population. Initial treatment of the non-displaced stable fracture involves immobilizing the shoulder with a sling that anchors the arm to the trunk. Typically, physical therapy is not initiated until the patient is ready for range of motion exercises to the shoulder. If shoulder immobilization places the individual at a greater risk for falls due to the impact on balance, earlier physical therapy intervention such as balance sreening may be indicated.