Randomized Controlled Trial

. 2017 Feb 28;18(1):90.

doi: 10.1186/s13063-017-1830-x.

A neuromuscular exercise programme versus standard care for patients with traumatic anterior shoulder instability: study protocol for a randomised controlled trial (the SINEX study)

Henrik Eshoj^{1

2

3}, Sten Rasmussen^{4

5}, Lars Henrik Frich⁶, Inge Hvass⁷, Robin Christensen⁸, Steen Lund Jensen⁹, Jens Søndergaard¹⁰, Karen Søgaard¹¹, Birgit Juul-Kristensen^{11

12}

Affiliations

¹ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. heshoj@health.sdu.dk.
² Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. heshoj@health.sdu.dk.
³ Odense Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark. heshoj@health.sdu.dk.
⁴ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁵ Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark.
⁶ Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark.
⁷ Shoulder Sector, Orthopedic Department, South-West Jutland Hospital, Esbjerg, Denmark.
⁸ Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
⁹ Shoulder Sector, Orthopaedic Department, Aalborg University Hospital, Farsoe, Denmark.
¹⁰ Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
¹¹ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
¹² Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health Sciences, Bergen University College, Bergen, Norway.

PMID: 28245853
PMCID: PMC5331774
DOI: 10.1186/s13063-017-1830-x

Randomized Controlled Trial

A neuromuscular exercise programme versus standard care for patients with traumatic anterior shoulder instability: study protocol for a randomised controlled trial (the SINEX study)

Henrik Eshoj et al. Trials. 2017.

. 2017 Feb 28;18(1):90.

doi: 10.1186/s13063-017-1830-x.

Authors

Affiliations

¹ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. heshoj@health.sdu.dk.
² Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. heshoj@health.sdu.dk.
³ Odense Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark. heshoj@health.sdu.dk.
⁴ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁵ Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark.
⁶ Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark.
⁷ Shoulder Sector, Orthopedic Department, South-West Jutland Hospital, Esbjerg, Denmark.
⁸ Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
⁹ Shoulder Sector, Orthopaedic Department, Aalborg University Hospital, Farsoe, Denmark.
¹⁰ Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
¹¹ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
¹² Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health Sciences, Bergen University College, Bergen, Norway.

PMID: 28245853
PMCID: PMC5331774
DOI: 10.1186/s13063-017-1830-x

Abstract

Background: Anterior shoulder dislocation is a common injury and may have considerable impact on shoulder-related quality of life (QoL). If not warranted for initial stabilising surgery, patients are mostly left with little to no post-traumatic rehabilitation. This may be due to lack of evidence-based exercise programmes. In similar, high-impact injuries (e.g. anterior cruciate ligament tears in the knee) neuromuscular exercise has shown large success in improving physical function and QoL. Thus, the objective of this trial is to compare a nonoperative neuromuscular exercise shoulder programme with standard care in patients with traumatic anterior shoulder dislocations (TASD).

Methods/design: Randomised, assessor-blinded, controlled, multicentre trial. Eighty patients with a TASD will be recruited from three orthopaedic departments in Denmark. Patients with primary or recurrent anterior shoulder dislocations due to at least one traumatic event will be randomised to 12 weeks of either a standardised, individualised or physiotherapist-supervised neuromuscular shoulder exercise programme or standard care (self-managed shoulder exercise programme). Patients will be stratified according to injury status (primary or recurrent). Primary outcome will be change from baseline to 12 weeks in the patient-reported QoL outcome questionnaire, the Western Ontario Shoulder Instability Index (WOSI).

Discussion: This trial will be the first study to compare the efficacy and safety of two different nonoperative exercise treatment strategies for patients with TASD. Moreover, this is also the first study to investigate nonoperative treatment effects in patients with recurrent shoulder dislocations. Lastly, this study will add knowledge to the shared decision-making process of treatment strategies for clinical practice.

Trial registration: ClinicalTrials.gov, identifier: NCT02371928 . Registered on 9 February 2015 at the National Institutes of Health Clinical Trials Protocol Registration System.

Keywords: Dislocation; Instability; Neuromuscular exercise; Nonoperative treatment; Physiotherapy; Shoulder.

PubMed Disclaimer

Figures

**Fig. 1**
Flowchart of the Shoulder Instability Neuromuscular Exercise (SINEX) study

See this image and copyright information in PMC

Cited by

Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study.
Eshoj H, Rasmussen S, Frich LH, Jensen SL, Søgaard K, Juul-Kristensen B. Eshoj H, et al. BMC Musculoskelet Disord. 2019 Feb 8;20(1):59. doi: 10.1186/s12891-019-2444-0. BMC Musculoskelet Disord. 2019. PMID: 30736761 Free PMC article.
Conservative management following closed reduction of traumatic anterior dislocation of the shoulder.
Braun C, McRobert CJ. Braun C, et al. Cochrane Database Syst Rev. 2019 May 10;5(5):CD004962. doi: 10.1002/14651858.CD004962.pub4. Cochrane Database Syst Rev. 2019. PMID: 31074847 Free PMC article.
Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial.
Eshoj HR, Rasmussen S, Frich LH, Hvass I, Christensen R, Boyle E, Jensen SL, Søndergaard J, Søgaard K, Juul-Kristensen B. Eshoj HR, et al. Orthop J Sports Med. 2020 Jan 30;8(1):2325967119896102. doi: 10.1177/2325967119896102. eCollection 2020 Jan. Orthop J Sports Med. 2020. PMID: 32064291 Free PMC article.
Muscles Functioning as Primary Shoulder Movers Aid the Rotator Cuff Muscles in Increasing Active Glenohumeral Stiffness.
Nicolozakes CP, Schmulewitz JS, Ludvig D, Baillargeon EM, Danziger MS, Seitz AL, Perreault EJ. Nicolozakes CP, et al. Ann Biomed Eng. 2025 Jun;53(6):1328-1343. doi: 10.1007/s10439-025-03683-5. Epub 2025 Mar 18. Ann Biomed Eng. 2025. PMID: 40100611
Current Concepts in Rehabilitation for Traumatic Anterior Shoulder Instability.
Ma R, Brimmo OA, Li X, Colbert L. Ma R, et al. Curr Rev Musculoskelet Med. 2017 Dec;10(4):499-506. doi: 10.1007/s12178-017-9449-9. Curr Rev Musculoskelet Med. 2017. PMID: 29038953 Free PMC article. Review.

See all "Cited by" articles

References

1. Longo UG, et al. Management of primary acute anterior shoulder dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy. 2014;30(4):506–22. doi: 10.1016/j.arthro.2014.01.003. - DOI - PubMed
1. Sofu H, et al. Recurrent anterior shoulder instability: review of the literature and current concepts. World J Clin Cases. 2014;2(11):676–82. doi: 10.12998/wjcc.v2.i11.676. - DOI - PMC - PubMed
1. Kroner K, Lind T, Jensen J. The epidemiology of shoulder dislocations. Arch Orthop Trauma Surg. 1989;108(5):288–90. doi: 10.1007/BF00932317. - DOI - PubMed
1. Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am. 2010;92(3):542–9. doi: 10.2106/JBJS.I.00450. - DOI - PubMed
1. Romeo AA, Cohen BS, Carreira DS. Traumatic anterior shoulder instability. Orthop Clin North Am. 2001;32(3):399–409. doi: 10.1016/S0030-5898(05)70209-1. - DOI - PubMed

Publication types

Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Associated data

Actions
- Search in PubMed
- Search in ClinicalTrials.gov

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- ClinicalTrials.gov
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

A neuromuscular exercise programme versus standard care for patients with traumatic anterior shoulder instability: study protocol for a randomised controlled trial (the SINEX study)

Affiliations

A neuromuscular exercise programme versus standard care for patients with traumatic anterior shoulder instability: study protocol for a randomised controlled trial (the SINEX study)

Authors

Affiliations

Abstract

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Abstract

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Associated data

Related information

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical