1
|
Rebolledo BJ, Nwachukwu BU, Konin GP, Coleman SH, Potter HG, Warren RF. Posterior Humeral Avulsion of the Glenohumeral Ligament and Associated Injuries: Assessment Using Magnetic Resonance Imaging. Am J Sports Med 2015; 43:2913-7. [PMID: 26443535 DOI: 10.1177/0363546515606427] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lesions associated with posterior humeral avulsion of the glenohumeral ligament (HAGL) can lead to persistent symptoms related to posterior shoulder instability and can be commonly missed or delayed in diagnosis. PURPOSE To identify and characterize the MRI findings in patients with a posterior HAGL lesion. STUDY DESIGN Case series; Level of evidence, 4. METHODS This retrospective case series included 27 patients (28 shoulders) identified by search through the senior authors' databases, with cross-reference to their institutional radiologic communication system for MRI review. Baseline patient demographic data were collected, including age and sex. All posterior HAGL lesions were identified on MRI and characterized as partial, complete, or floating lesions. All acute glenohumeral pathologic changes concurrent with the posterior HAGL were documented. Chondrolabral retroversion of the injured shoulder was measured on axial MRI. RESULTS The average age of the identified cohort was 33.6 years (range, 15-81 years), and 23 patients were male (86%). Posterior HAGL injuries were found to be complete tears (71%), partial tears (25%), and floating lesions (4%); concomitant bony HAGL avulsion was found in 7% of injuries. Additional traumatic glenohumeral disorders occurred in 93% of cases. The most common concurrent injuries were reverse Hill-Sachs lesions (36%), anterior Bankart lesions (29%), and posterosuperior rotator cuff tears (25%). Notably, concomitant anterior labral or capsular injury was found in 50% of patients, signifying bidirectional disruption of the capsule. In addition, increased chondrolabral version was found in this cohort (10.2° ± 3.7° retroversion). CONCLUSION This study depicts the high association of combined injury with posterior HAGL lesions and increased chondrolabral retroversion. Findings on MRI related to a posterior HAGL injury could potentially be masked by additional injury and may occur with mechanisms that also lead to anterior glenohumeral disorders.
Collapse
Affiliation(s)
- Brian J Rebolledo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Gabrielle P Konin
- Division of Magnetic Resonance Imaging and Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Struan H Coleman
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Hollis G Potter
- Division of Magnetic Resonance Imaging and Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Russell F Warren
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
2
|
Ricchetti ET, Ciccotti MC, O'Brien DF, DiPaola MJ, DeLuca PF, Ciccotti MG, Williams GR, Lazarus MD. Outcomes of arthroscopic repair of panlabral tears of the glenohumeral joint. Am J Sports Med 2012; 40:2561-8. [PMID: 23024151 DOI: 10.1177/0363546512460834] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Combined lesions of the glenoid labrum involving tears of the anterior, posterior, and superior labrum have been infrequently reported in the literature. PURPOSE To evaluate the clinical outcomes of arthroscopic repair of these lesions in a general population using validated scoring instruments, presence of complications, and need for revision surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS Fifty-eight patients who had arthroscopic labral repair of tears involving the anterior, posterior, and superior labrum (defined as a panlabral repair) were identified at our institution by retrospective review. All patients underwent arthroscopic labral repair with suture anchor fixation by a uniform approach and with a standardized postoperative protocol. Forty-four patients had a minimum 16-month postoperative follow-up. Outcomes were assessed postoperatively by the American Shoulder and Elbow Surgeons (ASES) score and the Penn Shoulder score. Complications were also documented, including need for revision surgery. RESULTS The mean age at the time of surgery was 32 years (range, 15-55 years) in the 44 patients. Presenting shoulder complaints included pain alone (40%), instability alone (14%), or pain and instability (45%). Mean number of anchors per repair was 7.9 (range, 5-12). Mean follow-up was 42 months (range, 16-78 months). Mean ± standard deviation ASES score at final follow-up was 90.1 ± 17.7 (range, 22-100), and mean Penn Shoulder score was 90.2 ± 15.3 (range, 38-100). Three of the 4 patients with outcome scores of 70 or less at final follow-up had undergone prior surgery. Thirteen postoperative complications (30%) occurred, with 3 (7%) requiring a second surgery. Five patients (11%) had an instability event following panlabral repair, but only 1 of these patients (2%) required revision surgery for a recurrent labral tear. CONCLUSION Combined tears of the anterior, posterior, and superior glenoid labrum represent a small but significant portion of labral injuries. Arthroscopic repair of these injuries can be performed with good postoperative outcomes and a low rate of recurrent labral injury.
Collapse
Affiliation(s)
- Eric T Ricchetti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Ohio, USA.
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Le Lievre HMJ, Murrell GAC. Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis. J Bone Joint Surg Am 2012; 94:1208-16. [PMID: 22760389 DOI: 10.2106/jbjs.j.00952] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND One management strategy for the treatment of idiopathic adhesive capsulitis, or frozen shoulder, is arthroscopic capsular release. While there are long-term data regarding nonoperative treatment and good short-term outcomes following a release for idiopathic adhesive capsulitis, little is known about the outcomes five years or more after arthroscopic capsular release. METHODS Patients with idiopathic adhesive capsulitis treated with a circumferential arthroscopic capsular release of the glenohumeral joint by a single surgeon were assessed with use of patient-reported pain scores, shoulder functional scores with use of a Likert scale, and shoulder range of motion at the preoperative evaluation and at one, six, twelve, twenty-four, and fifty-two weeks and a mean of seven years after surgery. RESULTS At a mean follow-up of seven years (range, five through thirteen years), forty-three patients (forty-nine shoulders) had significant improvement with regard to pain frequency and severity, patient-reported shoulder function, stiffness, and difficulty in completing activities compared with the findings at the initial presentation (p < 0.001) and the one-year follow-up evaluation (p < 0.01 to p < 0.001). Shoulder motion also improved (p < 0.001) and was comparable with that of the contralateral shoulder. There were no complications. CONCLUSIONS Patients with idiopathic adhesive capsulitis treated with an arthroscopic capsular release had early significant improvements in shoulder range of motion, pain frequency and severity, and function. These improvements were maintained and/or enhanced at seven years. In contrast to results reported for nonoperative treatment, shoulder range of motion at seven years was equivalent to that in the contralateral shoulder.
Collapse
Affiliation(s)
- Hugh M J Le Lievre
- Orthopaedic Research Institute, St George Hospital, University of New South Wales, Kogarah NSW 2217, Australia
| | | |
Collapse
|
4
|
Abstract
In comparison with anterior shoulder instability, posterior instability is uncommon, occurring in 2% to 10% of cases, and covering a wide clinical spectrum ranging from locked posterior dislocation to the often subclinical recurrent posterior subluxation (RPS). With increased clinical awareness, imaging advances such as magnetic resonance arthrography, and the development of specific provocative physical examination tests, the identification of RPS in the athletic population is improving. This article describes the anatomic-based arthroscopic approach to treatment of RPS, which allows for enhanced identification and repair of intra-articular pathology including posterior capsular laxity, complete or incomplete detachment of the posterior capsulolabral complex, and inferior capsular tears. While postoperative results are generally good to excellent after stabilization for RPS, there is room for improvement.
Collapse
|
5
|
Tokish JM, McBratney CM, Solomon DJ, Leclere L, Dewing CB, Provencher MT. Arthroscopic repair of circumferential lesions of the glenoid labrum. J Bone Joint Surg Am 2009; 91:2795-802. [PMID: 19952240 DOI: 10.2106/jbjs.h.01241] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Symptomatic pan-labral or circumferential (360 degrees ) tears of the glenohumeral labrum are an uncommon injury. The purpose of the present study was to report the results of surgical treatment of circumferential lesions of the glenoid labrum with use of validated outcome instruments. METHODS From July 2003 to May 2006, forty-one shoulders in thirty-nine patients (thirty-four men and five women) with a mean age of 25.1 years were prospectively enrolled in a multicenter study and were managed for a circumferential (360 degrees ) lesion of the glenoid labrum. All patients had a primary diagnosis of pain and recurrent shoulder instability, and all underwent arthroscopic repair of the circumferential labral tear with a mean of 7.1 suture anchors. The outcomes for thirty-nine of the forty-one shoulders were assessed after a mean duration of follow-up of 31.8 months on the basis of the rating of pain and instability on a scale of 0 to 10, a physical examination, and three outcome instruments (the Single Assessment Numeric Evaluation score, the modified American Shoulder and Elbow Surgeons score, and the Short Form-12 score). RESULTS Significant improvement was noted in terms of the mean pain score (from 4.3 to 1.1), the mean instability score (from 7.3 to 0.2), the mean modified American Shoulder and Elbow Surgeons score (from 55.5 to 89.6), the mean Short Form-12 score (from 75.7 to 90.0), and the mean Single Assessment Numeric Evaluation score (from 36.7 to 88.5). Six shoulders required revision surgery because of recurrent instability (two), recalcitrant biceps tendinitis (two), or postoperative tightness (two). All patients returned to their preinjury activity level. CONCLUSIONS Pan-labral or circumferential lesions are an uncommon yet extensive injury of the glenohumeral joint that may result in recurrent instability and pain. The present study demonstrates that arthroscopic capsulolabral repair with suture anchor fixation can restore the stability of the glenohumeral joint and can provide a reliable improvement in subjective and objective outcome measures.
Collapse
Affiliation(s)
- John M Tokish
- Department of Orthopedics, 10th Medical Group, The United States Air Force Academy, Colorado Springs, CO 80840, USA.
| | | | | | | | | | | |
Collapse
|
6
|
Gambill ML, Mologne TS, Provencher MT. Dislocation of the long head of the biceps tendon with intact subscapularis and supraspinatus tendons. J Shoulder Elbow Surg 2006; 15:e20-2. [PMID: 17126231 DOI: 10.1016/j.jse.2005.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 09/12/2005] [Indexed: 02/01/2023]
Affiliation(s)
- M Lucas Gambill
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA 92134-1112, USA
| | | | | |
Collapse
|
7
|
Paxinos A, Walton J, Rütten S, Müller M, Murrell GAC. Arthroscopic stabilization of superior labral (SLAP) tears with biodegradable tack: outcomes to 2 years. Arthroscopy 2006; 22:627-34. [PMID: 16762701 DOI: 10.1016/j.arthro.2006.01.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 10/21/2005] [Accepted: 01/21/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE This prospective study aimed to document the pain and functional outcomes, over time, of patients whose SLAP lesions had been repaired with biodegradable tacks. METHODS Superior labral tears were identified in 24 patients from a cohort of 500 patients who had shoulder problems sufficiently disabling to warrant arthroscopic evaluation and management. These labral tears were arthroscopically repaired with 1 to 3 biodegradable tacks (mean, 1.6). Before surgery, all patients completed a questionnaire regarding their shoulder pain and function and were given a systematic clinical examination. To observe their postoperative outcomes over time, the same assessments were made at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years after surgery. RESULTS After labral reattachment, decreases were noted in the patients' mean shoulder pain scores at rest (64% at 3 months), at night (76% at 3 months), and with activity (73% at 6 months). The most significant reductions in mean scores occurred between 6 and 12 weeks (P < .001). Patient-perceived weakness, instability, and stiffness scores also improved from week 6. The ranking of the patients' "overall problem" reduced from an average ranking of "severe" to "mild" by the third preoperative month (P < .001) and was still at this level by the time of their 2-year follow-up appointment. Activity levels for 22 of 24 patients returned to their preinjury levels by 6 months after surgery. CONCLUSIONS Arthroscopically delivered biodegradable tacks effectively managed superior labral tears and, on average, resulted in a near-complete improvement of pain and recovery of function by 3 months. These good outcomes did not improve further or deteriorate at the 2-year follow-up appointment. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Anastasios Paxinos
- Sports Medicine and Shoulder Service and Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, Australia
| | | | | | | | | |
Collapse
|
8
|
Devgan LL, Gill HS, Faustin C, Park HB, McFarland EG. Posterior dislocation in a voluntary subluxator: a case report. Med Sci Sports Exerc 2006; 38:613-7. [PMID: 16679973 DOI: 10.1249/01.mss.0000210210.40694.df] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Posterior instability of the shoulder is an uncommon occurrence. Its etiology has been classified as traumatic or atraumatic and its type as voluntary (individual can subluxate the shoulder posteriorly) or involuntary. Typically, patients with posterior voluntary instability do not have a history of trauma, can be treated successfully with physical therapy; and undergo surgery if the instability becomes symptomatic or develops an involuntary component. We present a patient with voluntary posterior subluxation who developed a symptomatic posterior instability after a traumatic event. PATIENT PRESENTATION This patient was unable to return to his preinjury function despite nonoperative interventions, including rehabilitation, and required operative treatment of his posterior labrum lesion. This patient had a rare combination of voluntary, atraumatic instability that coexisted with traumatic posterior shoulder instability. CONCLUSION This case emphasizes the importance of recognizing this constellation of instability patterns and documents that traumatic posterior instability, even in the presence of preexisting voluntary posterior subluxations, may require operative intervention in young, active individuals.
Collapse
Affiliation(s)
- Lara L Devgan
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD 21224-2780, USA
| | | | | | | | | |
Collapse
|
9
|
Clinical Diagnosis of a Superior Glenoid Labrum Cyst with Suprascapular Nerve Entrapment (GLEN Lesion). TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2005. [DOI: 10.1097/01.bte.0000170070.67295.a4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Diwan DB, Murrell GAC. An evaluation of the effects of the extent of capsular release and of postoperative therapy on the temporal outcomes of adhesive capsulitis. Arthroscopy 2005; 21:1105-13. [PMID: 16171636 DOI: 10.1016/j.arthro.2005.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate effects of the extent of surgical release and of postoperative physiotherapy on the outcomes of this procedure. TYPE OF STUDY Case-controlled cohort study. METHODS Pain and range of motion scores were compared preoperatively, operatively, and at 1, 6, 12, 24, 52, and 104 weeks postoperatively, in 2 temporal cohorts of patients with adhesive capsulitis. The first cohort (n = 18) underwent a 155 degrees +/- 40 degrees (mean +/- SEM) standard anteroinferior arthroscopic capsule release of the shoulder (ACR-S) and rehabilitation. The second cohort (n = 22) underwent capsular release that was extended an additional 65 degrees +/- 65 degrees posteriorly, a portion of the intra-articular part of the subscapularis tendon was divided, and the patients had a modified earlier, supervised postoperative physical therapy program (ACR-M). RESULTS In both cohorts, there was a significant reduction in pain 1 week after surgery, which was maintained at all time-points (P < .05). More gains in intraoperative range of forward flexion (121 degrees v 150 degrees), abduction (114 degrees v 146 degrees) and external rotation (55 degrees v 68 degrees) were obtained in the ACR-M cohort (P < .001). Six weeks after surgery, external and internal rotation regressed to preoperative levels in the ACR-S cohort; 2 of them required a re-release. This regression was not observed in the ACR-M cohort. There was no instability or weakness in lift-off power in either cohort. CONCLUSIONS This is a level IV study of 2 nonrandomized cohorts where simultaneous changes in surgical technique and rehabilitation were introduced to the ACR-M cohort. Arthroscopic capsular release for adhesive capsulitis resulted in significant reductions in pain by 1 week in both cohorts. A more extensive capsular release with division of the intra-articular portion of subscapularis improved intraoperative motion. Gains in internal and external rotation were lost postoperatively in the ACR-S cohort, but were preserved when an extended surgical release and an early, supervised postoperative physical therapy program was initiated in the ACR-M cohort. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Divya Bhargav Diwan
- Sports Medicine and Shoulder Service, Orthopedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, Australia
| | | |
Collapse
|
11
|
Abstract
Recurrent posterior shoulder instability is an uncommon, debilitating condition in young adults that is being diagnosed with increasing frequency. Although a number of predisposing factors have been identified, their relative importance remains poorly understood. Poor results have been reported following operative intervention to treat recurrent posterior instability with nonanatomic techniques. The more recent development of lesion-specific surgery has improved clinical results, particularly when that surgery has been performed arthroscopically. Operative treatment is therefore being increasingly recommended at an earlier stage to patients who do not respond to supervised rehabilitation programs.
Collapse
Affiliation(s)
- C Michael Robinson
- Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SU, United Kingdom.
| | | |
Collapse
|
12
|
Goubier JN, Iserin A, Duranthon LD, Vandenbussche E, Augereau B. A 4-portal arthroscopic stabilization in posterior shoulder instability. J Shoulder Elbow Surg 2003; 12:337-41. [PMID: 12934026 DOI: 10.1016/s1058-2746(03)00039-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to present an arthroscopic stabilization technique with 4 portals for posterior instability used in 11 patients (13 shoulders). There were 7 male and 4 female patients. All patients had an arthroscopic labral suture with anchors and capsular plication with 4 portals. The follow-up period averaged 34 months. No complication or recurrence of instability was noted. A moderate loss of range of motion was noted in 4 shoulders and moderate pain in 2 shoulders. All patients were satisfied. According to the literature, the rate of recurrence of instability is currently lower than 12% when a labral suture and capsular plication are performed. Our results for pain and range of motion are similar to those described in recent publications. However, we think that the 4-portal technique allows a facilitated access to the posteroinferior part of the glenoid and reduces the rate of postoperative instability.
Collapse
Affiliation(s)
- J-N Goubier
- Service de Chirurgie Orthopédique et Traumatologique, Urgences Mains, Hôpital Bichat-Claude Bernard, Paris, France.
| | | | | | | | | |
Collapse
|
13
|
Williams RJ, Strickland S, Cohen M, Altchek DW, Warren RF. Arthroscopic repair for traumatic posterior shoulder instability. Am J Sports Med 2003; 31:203-9. [PMID: 12642253 DOI: 10.1177/03635465030310020801] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The role of arthroscopic repair in the treatment of posterior shoulder instability remains poorly defined. PURPOSE To evaluate the results of arthroscopic repair of posterior Bankart lesions. STUDY DESIGN Retrospective review. METHODS Records were reviewed of 27 shoulders (26 patients). All of the patients were male with a mean age of 28.7 years; in all cases symptoms were preceded by a traumatic event. Fourteen of the patients had 2+ to 3+ posterior translation noted under preoperative anesthesia. The posterior capsulolabral complex was found to be detached from the glenoid rim in all cases; bioabsorbable tack fixation was used for repair. RESULTS At a mean follow-up of 5.1 years, no patients demonstrated a range of motion deficit. Muscle weakness (grade 4/5) in external rotation was noted in two patients (8%). There was no instability greater than 1+ in the anterior, posterior, or inferior directions. The mean L'Insalata shoulder score was 90.0 +/- 13.9. The mean SF-36 physical and mental component scores were 50.4 +/- 7 and 53.9 +/- 9, respectively. Symptoms of pain and instability were eliminated in 24 patients (92%). Two patients (8%) required additional surgery after arthroscopic repair of the posterior Bankart lesion. Radiographs demonstrated that there had been no progressive glenohumeral joint degeneration. CONCLUSIONS Arthroscopic repair of the posterior capsulolabral complex is an effective means of eliminating symptoms of pain and instability associated with posterior Bankart lesions of traumatic origin.
Collapse
Affiliation(s)
- Riley J Williams
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, Cornell University Medical College, New York, New York, USA
| | | | | | | | | |
Collapse
|
14
|
Walton J, Paxinos A, Tzannes A, Callanan M, Hayes K, Murrell GAC. The unstable shoulder in the adolescent athlete. Am J Sports Med 2002; 30:758-67. [PMID: 12239016 DOI: 10.1177/03635465020300052401] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Shoulder dislocation and subluxation occur frequently in athletes, with peaks in the second and sixth decades. The majority of traumatic dislocations are in the anterior direction. The most frequent complication of shoulder dislocation is recurrence--a complication that occurs much more often in the adolescent population. The dynamic (muscular) and static (predominantly capsuloligamentous and labral) restraints to shoulder instability are now well defined. Recent surgical procedures for shoulder instability have become less interventional and have focused on restoring disrupted static restraints. The aim of rehabilitation is to enhance the dynamic muscular and proprioceptive restraints to shoulder instability.
Collapse
Affiliation(s)
- Judie Walton
- Sports Medicine and Shoulder Service and the Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, Australia
| | | | | | | | | | | |
Collapse
|
15
|
Bryant L, Shnier R, Bryant C, Murrell GAC. A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears. J Shoulder Elbow Surg 2002; 11:219-24. [PMID: 12070492 DOI: 10.1067/mse.2002.121923] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This prospective study was undertaken to compare the ability of clinical estimation, diagnostic ultrasonography, magnetic resonance imaging, and arthroscopy to estimate the size of rotator cuff tears. Estimates of rotator cuff tear size were compared with the findings at open operation in 33 consecutive patients with a presumptive diagnosis of rotator cuff tear. Arthroscopy estimates of rotator cuff tear size correlated best with actual tear size (Pearson correlation coefficient r = 0.92; P <.001). Magnetic resonance imaging (r = 0.74; P <.001) was similar to ultrasonography (r = 0.73; P <.001). Estimates of rotator cuff tear size after clinical assessment alone had weaker correlation coefficients (r = 0.41; P =.02) than the other methods. Each method underestimated rotator cuff tear size by 12%, 30%, 33%, and 38%, respectively. No method was able to determine the size of partial-thickness rotator cuff tears (r < 0.02).
Collapse
Affiliation(s)
- Lawrence Bryant
- St George Hospital Campus, University of New South Wales, Sydney, Australia
| | | | | | | |
Collapse
|
16
|
Paxinos A, Walton J, Tzannes A, Callanan M, Hayes K, Murrell GA. Advances in the management of traumatic anterior and atraumatic multidirectional shoulder instability. Sports Med 2002; 31:819-28. [PMID: 11583106 DOI: 10.2165/00007256-200131110-00004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Dislocation of the shoulder is a common and often disabling injury to an athlete. Most shoulder dislocations are traumatic in origin, occur in the anterior direction and result in stretching and detachment of the anterior capsule and labrum. The most frequent adverse sequel of shoulder dislocation is recurrence--an event that occurs most commonly in active individuals and less frequently with age. In the past, many operative procedures failed to address the anatomical disruptions of shoulder instability. Recently, an enhanced understanding of shoulder instability pathoanatomy and significant technological advances have resulted in surgical procedures for shoulder instability that are less interventional and have focused on restoring disrupted static constraints.
Collapse
Affiliation(s)
- A Paxinos
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Australia
| | | | | | | | | | | |
Collapse
|
17
|
Metcalf MH, Duckworth DG, Lee SB, Sidles JA, Smith KL, Harryman DT, Matsen FA. Posteroinferior glenoplasty can change glenoid shape and increase the mechanical stability of the shoulder. J Shoulder Elbow Surg 1999; 8:205-13. [PMID: 10389074 DOI: 10.1016/s1058-2746(99)90130-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The treatment of recurrent posterior glenohumeral instability remains an unsolved clinical problem. Although various types of capsulorraphy have been advocated, outcome studies indicate that it is difficult to achieve a balance between stability and mobility. Alterations of the bony glenoid for posterior instability have been proposed, but are not well understood from a mechanical perspective. This investigation had 2 purposes: (1) to determine in a cadaver model if posteroinferior glenoplasty can change the shape of the glenoid, and (2) to determine if altering the shape of the glenoid can increase the mechanical stability of the glenohumeral joint. We determined the effective glenoid shape in 7 normal cadaver glenoids by tracking the path of the center of the humeral head as it was translated across the glenoid face in 8 different directions. These determinations enabled us to calculate the maximum effective slope of the glenoid in each direction. We then determined the mechanical stability of the glenoids in each of the 8 directions by measuring the tangential force required to dislocate the shoulder under a 50-N compressive load. The ratio of the dislocating force to the compressive load was defined as the stability ratio. All measurements were repeated after a standardized posteroinferior glenoplasty was performed. Posteroinferior glenoplasty increased the posteroinferior glenoid depth from 3.8 +/- 0.6 mm to 7.0 +/- 1.8 mm and shifted the center of the humeral head an average of 2.2 mm anteriorly and 1.8 mm superiorly. These changes in dimension could be directly visualized as an immediate mechanical consequence of the glenoplasty procedure, particularly because of the insertion of the bone wedge. Glenoplasty increased the posteroinferior glenoid slope from 0.55 +/- 0.07 to 0.83 +/- 0.12 and increased the posteroinferior stability ratio from 0.47 +/- 0.10 to 0.81 +/- 0.17. This is a more than 70% increase in the tangential force that can be resisted before dislocation. The increase can be quantitatively understood as a direct mechanical consequence of the altered shape of the glenoid concavity. These numbers indicate that, in this cadaveric model, posteroinferior glenoplasty results in defined changes in the effective glenoid shape and in the mechanical stability of the glenohumeral joint. However, this study does not establish the role of this procedure in the clinical management of posterior glenohumeral instability.
Collapse
Affiliation(s)
- M H Metcalf
- Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle 98195-6500, USA
| | | | | | | | | | | | | |
Collapse
|
18
|
Affiliation(s)
- J Weinberg
- Johns Hopkins University, Department of Orthopedic Surgery, Baltimore, Maryland, USA
| | | |
Collapse
|