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Malmberg C, Andreasen KR, Bencke J, Hölmich P, Barfod KW. Anterior-posterior glenohumeral translation in shoulders with traumatic anterior instability: a systematic review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:477-493. [PMID: 37928995 PMCID: PMC10625004 DOI: 10.1016/j.xrrt.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Reports of glenohumeral translation in shoulders with traumatic anterior instability have been presented. The aim of this systematic review was to investigate anterior-posterior translation in shoulders with traumatic anterior instability. Methods This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies including patients aged ≥15 years with previous traumatic anterior shoulder dislocation or subluxation were included. The outcome was anterior-posterior glenohumeral translation. A search of PubMed, Embase, and Cochrane library was performed on July 17, 2022. Two reviewers individually screened titles and abstracts, reviewed full text, extracted data, and performed quality assessment. Results Twenty studies (582 unstable shoulders in total) of varying quality were included. There was a lack of standardization and unity across studies. Radiography, ultrasound, computed tomography, magnetic resonance imaging, motion tracking, instrumentation, and manual testing were used to assess the glenohumeral translation. The glenohumeral translation in unstable shoulders ranged from 0.0 ± 0.8 mm to 11.6 ± 3.7 mm, as measured during various motion tasks, arm positions, and application of external force. The glenohumeral translation was larger or more anteriorly directed in unstable shoulders than in stable when contralateral healthy shoulders or a healthy control group were included in the studies. Several studies found that the humeral head was more anteriorly located on the glenoid in the unstable shoulders. Conclusion This systematic review provides an overview of the current literature on glenohumeral translation in traumatic anterior shoulder instability. It was not able to identify a threshold for abnormal translation in unstable shoulders, due to the heterogeneity of data. The review supports that not only the range of translation but also the direction hereof as well as the location of the humeral head on the glenoid seem to be part of the pathophysiology. Technical development and increased attention to research methodology in recent years may provide more knowledge and clarity on this topic in the future.
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Affiliation(s)
- Catarina Malmberg
- Department of Orthopedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Kristine Rask Andreasen
- Department of Orthopedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Jesper Bencke
- Department of Orthopedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
- Human Movement Analysis Laboratory, Department of Orthopedic Surgery, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Per Hölmich
- Department of Orthopedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Kristoffer Weisskirchner Barfod
- Department of Orthopedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
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Orhan Ö, Sezgin EA, Özer M, Ataoğlu MB, Kanatlı U. Does glenoid bone loss accompany posterior shoulder instability with only labral tear? A magnetic resonance imaging-based study. J Shoulder Elbow Surg 2023; 32:2066-2073. [PMID: 37507000 DOI: 10.1016/j.jse.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/07/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The primary aim of this study was to investigate bone loss in the glenoid with magnetic resonance imaging in posterior shoulder instability with only a labral tear. METHODS A total of 76 patients operated on because of posterior and anteroposterior shoulder instability only with a labral tear between 2006 and 2019 (n = 40 and n = 36, respectively) were included in this study. The instability type, a presence of an additional superior labrum anteroposterior (SLAP) lesion, the number of dislocations, and the magnetic resonance imaging-based measurements (the glenoid diameter and the bone defect size in the glenoid, the Hill-Sachs lesion [HSL] and the reverse HSL [rHSL] length, the angle and the arc length of HSL and rHSL, and the humerus head diameter and its area) were analyzed. RESULTS The size of the anterior glenoid defect, the rHSL measurements (length, angle, and arc length), and the ratio of the anterior glenoid defect size to the glenoid diameter were significantly higher for anteroposterior instability (P < .01) cases. There was no significant difference (P = .49, .64, and .82, respectively) for the presence of an additional SLAP pathology, the glenoid diameter, the posterior glenoid defect, and the ratio of the posterior glenoid defect size to the glenoid diameter in posterior and anteroposterior instability groups. The increased number of dislocations was associated with increased rHSL length and total arc length (P = .04 and .03, respectively). An additional SLAP lesion in posterior shoulder instabilities was not associated with the bone defect size (P = .29). CONCLUSION Although the posterior shoulder instability with only a labral tear is likely to cause a bone defect, we have shown that the instability is not expected to be caused by the bone defect. Therefore, this study points out that only soft tissue repair without considering the bone defect could be promising in this patient group.
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Affiliation(s)
- Özlem Orhan
- Department of Orthopedics and Traumatology, Medical Faculty of Harran University, Şanlıurfa, Turkey.
| | - Erdem Aras Sezgin
- Department of Orthopedics and Traumatology, Aksaray University Training and Education Hospital, Aksaray, Turkey
| | - Mustafa Özer
- Department of Orthopedics and Traumatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | | | - Ulunay Kanatlı
- Department of Orthopedics and Traumatology, Medical Faculty of Gazi University, Ankara, Turkey
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Gomes E, Andrade R, Valente C, Santos JV, Nunes J, Carvalho Ó, Correlo VM, Silva FS, Oliveira JM, Reis RL, Espregueira-Mendes J. Inconsistency in Shoulder Arthrometers for Measuring Glenohumeral Joint Laxity: A Systematic Review. Bioengineering (Basel) 2023; 10:799. [PMID: 37508826 PMCID: PMC10376824 DOI: 10.3390/bioengineering10070799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
There is no consensus on how to measure shoulder joint laxity and results reported in the literature are not well systematized for the available shoulder arthrometer devices. This systematic review aims to summarize the results of currently available shoulder arthrometers for measuring glenohumeral laxity in individuals with healthy or injured shoulders. Searches were conducted on the PubMed, EMBASE, and Web of Science databases to identify studies that measure glenohumeral laxity with arthrometer-assisted assessment. The mean and standard deviations of the laxity measurement from each study were compared based on the type of population and arthrometer used. Data were organized according to the testing characteristics. A total of 23 studies were included and comprised 1162 shoulders. Populations were divided into 401 healthy individuals, 278 athletes with asymptomatic shoulder, and 134 individuals with symptomatic shoulder. Sensors were the most used method for measuring glenohumeral laxity and stiffness. Most arthrometers applied an external force to the humeral head or superior humerus by a manual-assisted mechanism. Glenohumeral laxity and stiffness were mostly assessed in the sagittal plane. There is substantial heterogeneity in glenohumeral laxity values that is mostly related to the arthrometer used and the testing conditions. This variability can lead to inconsistent results and influence the diagnosis and treatment decision-making.
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Affiliation(s)
- Eluana Gomes
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
| | - Renato Andrade
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, 4200-450 Porto, Portugal
| | - Cristina Valente
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
| | - J Victor Santos
- Centre for Microelectromechanical Systems (CMEMS-UMINHO), Campus Azurém, University of Minho, 4800-058 Guimarães, Portugal
| | - Jóni Nunes
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Serviço de Ortopedia e Traumatologia do Hospital de Santa Maria Maior, 4750-333 Barcelos, Portugal
- School of Medicine, University of Minho, 4710-057 Braga, Portugal
| | - Óscar Carvalho
- Centre for Microelectromechanical Systems (CMEMS-UMINHO), Campus Azurém, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS Associate Laboratory, University of Minho, 4800-058 Guimarães, Portugal
| | - Vitor M Correlo
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
- Pro2B, Consultoria e Gestão de Projetos, AvePark-Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
| | - Filipe S Silva
- Centre for Microelectromechanical Systems (CMEMS-UMINHO), Campus Azurém, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS Associate Laboratory, University of Minho, 4800-058 Guimarães, Portugal
| | - J Miguel Oliveira
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
| | - Rui L Reis
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
| | - João Espregueira-Mendes
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
- School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
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Boileau P, Clowez G, Bouacida S, Walch G, Trojani C, Schwartz DG. The Arthroscopic Trillat Procedure Is a Valuable Treatment Option for Recurrent Anterior Instability in Young Athletes With Shoulder Hyperlaxity. Arthroscopy 2023; 39:948-958. [PMID: 36368519 DOI: 10.1016/j.arthro.2022.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this study is to report the outcomes of the all-arthroscopic Trillat procedure, combined with capsular plication, for the treatment of recurrent anterior instability in young athletes with shoulder hyperlaxity (external rotation >90°). METHODS We performed a retrospective evaluation of patients with recurrent anterior instability and shoulder hyperlaxity who underwent an arthroscopic Trillat between 2009 and 2019. Patients with concomitant rotator cuff lesions or voluntary or multidirectional instability were excluded. The osteotomized coracoid was fixed above the subscapularis with a cannulated screw or a suture button; a capsular plication was systematically associated. We followed patients with x-rays, computed tomography scans, and Subjective Shoulder Value, visual analog scale, Walch, Constant, and Rowe scores. Mean follow-up was 56 months (24-145). RESULTS Twenty-eight consecutive patients (30 shoulders) with a mean age of 25 years were identified, and all met criteria. The main finding under arthroscopy was a "loose shoulder" with anteroinferior capsular redundancy and no or few (10%) labrum tears, glenoid erosion (13%), or Hill-Sachs lesions (10%). At last follow-up, 90% of the shoulders (27/30) were stable, and 79% (19/24) of the patients practicing sports returned to their preinjury activity level. The Walch-Duplay and Rowe scores improved from 54 (38-68) to 81 (4-100) and 55 (30-71) to 84 (45-100), respectively, P < .001. CONCLUSIONS The arthroscopic Trillat is an effective procedure for the treatment of recurrent anterior instability in young athletes with shoulder hyperlaxity but no substantial humeral or glenoid bone loss, allowing return to overhead/contact sports. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice-Locomoteur & Sports, Nice, France.
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Posterior Glenoid Bone Loss and Instability: An Evidence-based Approach to Diagnosis and Management. J Am Acad Orthop Surg 2023; 31:429-439. [PMID: 36848487 DOI: 10.5435/jaaos-d-22-00060] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 12/13/2022] [Indexed: 03/01/2023] Open
Abstract
Posterior glenohumeral instability is an underappreciated cause of disability that may necessitate surgical intervention to allow functional glenoid restoration. However, posterior glenoid bone abnormalities, when sufficiently severe, may contribute to persistent instability despite a well-performed capsulolabral repair. Recognition and understanding of these lesions is critical to both surgical decision making and execution of the surgical plan. Numerous procedures have been described to address posterior instability including recent developments in arthroscopic grafting techniques. The purpose of this article was to provide an evidence-based strategy for diagnosis and management of posterior shoulder instability and glenoid bone loss.
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Inoue J, Takenaga T, Tsuchiya A, Okubo N, Takeuchi S, Takaba K, Nozaki M, Kobayashi M, Fukushima H, Kato J, Murakami H, Yoshida M. Ultrasound Assessment of Anterior Humeral Head Translation in Patients With Anterior Shoulder Instability: Correlation With Demographic, Radiographic, and Clinical Data. Orthop J Sports Med 2022; 10:23259671221101924. [PMID: 35837445 PMCID: PMC9274420 DOI: 10.1177/23259671221101924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Ultrasonography can be used to quantitatively assess anterior humeral head
translation (AHHT) at different degrees of shoulder abduction. Risk factors
for recurrent shoulder instability have been identified. Hypothesis: It was hypothesized that the number of dislocations or glenoid or humeral
bone loss would be associated with more AHHT as measured using
ultrasound. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 39 patients who underwent surgery for anterior shoulder
instability were prospectively studied. Ultrasound assessment of AHHT was
performed immediately after general anesthesia was induced. The upper arm
was placed at 0°, 45°, and 90° of abduction, and a 40-N anterior force was
applied to the proximal third of the arm. The distance from the posterior
edge of the glenoid to that of the humeral head was measured at each
abduction angle using ultrasound with and without a 40-N anterior force, and
the AHHT was calculated. The differences in translation at each shoulder
angle were compared. Additionally, the authors investigated the association
between AHHT and demographic, radiographic, and clinical data. Results: Compared with the AHHT at 0° of abduction (5.29 mm), translation was
significantly larger at 45° of abduction (8.90 mm; P <
.01) and 90° of abduction (9.46 mm; P < .01). The mean
translation was significantly larger in female patients than in male
patients at all degrees of abduction (P ≤ .036 for all).
There was no correlation between AHHT at any abduction angle and number of
dislocations, clinical data, or radiographic data (including bone loss). Conclusion: Ultrasound assessment of AHHT showed larger amounts of laxity at 45° and 90°
than at 0° of abduction. Anterior glenohumeral laxity was greater in female
than male patients. Glenoid or humeral bone loss did not correlate with
AHHT, thereby clarifying that bone loss has no direct effect on measurements
of capsular laxity in neutral rotation.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Atsushi Tsuchiya
- Arthroscopy and Sports Medicine Center, Meitetsu Hospital, Nagoya, Japan
| | - Norio Okubo
- Department of Orthopedic Surgery, Meitetsu Hospital, Nagoya, Japan
| | - Satoshi Takeuchi
- Department of Orthopedic Surgery, Toyohashi Medical Center, Toyohashi, Japan
| | - Keishi Takaba
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Makoto Kobayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Hiroaki Fukushima
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Jiro Kato
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahito Yoshida
- Department of Musculoskeletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
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An improved quantitative ultrasonographic technique could assess anterior translation of the glenohumeral joint accurately and reliably. Knee Surg Sports Traumatol Arthrosc 2021; 29:2595-2605. [PMID: 33554273 DOI: 10.1007/s00167-021-06459-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/18/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE Since poor repeatability of the load and shift test using a grading scale has been reported, an objective and quantitative method to assess anterior translation should be established to assess glenohumeral joint function. The purpose of this study was to assess the accuracy and repeatability of the ultrasonographic techniques to quantify anterior translation of the glenohumeral joint. METHODS Eight fresh-frozen cadaveric shoulders were used. For the standard technique, the ultrasound transducer was positioned on the anterolateral aspect of the shoulder viewing the coracoid process, glenoid, and humeral head. For the revised technique, the transducer was positioned on the anterior aspect of the shoulder, perpendicular to the scapular plane, viewing the conjoint tendon, glenoid, and humeral head. During the load and shift test, the distance between anterior edges of the glenoid and the humeral head was measured. The difference between distances before and after applying an anterior load was calculated as an anterior translation and compared with the anterior translation assessed using a motion tracking system. The repeatability and accuracy of both techniques were analyzed statistically. RESULTS Intra- and inter-observer repeatability was good-excellent for both ultrasonographic techniques (ICC, 0.889-0.998). The revised technique achieved a stronger correlation to the anterior translations obtained using the motion tracking system (R = 0.810-0.913, p < 0.001) than the standard technique (R = 0.619-0.806, p < 0.001). CONCLUSION Better accuracy and repeatability was found in the revised technique than the standard technique. The revised technique will be useful to determine the individual laxity and modify the treatment plan and return-to-sports protocol. LEVEL OF EVIDENCE III.
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Moroder P, Plachel F, Van-Vliet H, Adamczewski C, Danzinger V. Shoulder-Pacemaker Treatment Concept for Posterior Positional Functional Shoulder Instability: A Prospective Clinical Trial. Am J Sports Med 2020; 48:2097-2104. [PMID: 32667266 PMCID: PMC7364790 DOI: 10.1177/0363546520933841] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pathological muscle activation patterns of the external rotators and periscapular muscles can result in posterior positional functional shoulder instability (PP-FSI). In several patients, physical therapy and surgical treatment are not successful. PURPOSE The shoulder-pacemaker treatment concept was evaluated prospectively in patients with PP-FSI and previously failed conventional therapy attempt. STUDY DESIGN Case series; Level of evidence, 4. METHODS A negative selection of 24 consecutive cases of noncontrollable PP-FSI in 16 patients with previously failed conventional therapy were included in this prospective study. The shoulder-pacemaker treatment consisted of an electrical muscle stimulation-based therapy protocol with 9 to 18 one-hour treatment sessions. Two patients were excluded because of nonadherence to the training schedule, leaving a final study cohort of 21 cases in 14 patients. Follow-up included assessment of clinical function, impairment during daily activities and sports, satisfaction, Western Ontario Shoulder Instability Index (WOSI), Rowe score, and Subjective Shoulder Value at 0 weeks, 2 weeks, 4 weeks, 3 months, 6 months, 12 months, and 24 months after intervention. RESULTS WOSI, Subjective Shoulder Value, and Rowe score showed a highly significant improvement at all time points of follow-up (P < .001). Young age (P = .005), low weight (P = .019), shoulder activity level (P = .003), unilateral affliction (P = .046), and higher baseline WOSI score (P = .04) were associated with a better treatment effect. Cases with increased glenoid retroversion, posterior scapulohumeral decentering, and dysplastic bony glenoid shape showed a trend toward shorter treatment effect duration. No complications during the intervention or follow-up period were observed. CONCLUSION The shoulder-pacemaker therapy concept is an effective treatment with rapid improvement and sustained outcome over the course of 2 years in patients with noncontrollable PP-FSI with previously failed conventional treatment. Young and more athletic patients with lower weight and unilateral pathology respond best to the treatment.
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Affiliation(s)
- Philipp Moroder
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité–Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany,Philipp Moroder, MD, Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité–Universitaetsmedizin Berlin, Augustenburgerplatz 1, Berlin 13353, Germany ()
| | - Fabian Plachel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité–Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | | | | | - Victor Danzinger
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité–Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
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Moroder P, Danzinger V, Maziak N, Plachel F, Pauly S, Scheibel M, Minkus M. Characteristics of functional shoulder instability. J Shoulder Elbow Surg 2020; 29:68-78. [PMID: 31378683 DOI: 10.1016/j.jse.2019.05.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 05/04/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this prospective study was to provide an in-detail description of the characteristics of FSI. METHODS In the year 2017, a total of 36 consecutive cases of FSI presenting to our outpatient clinic were prospectively collected. Diagnostic investigation included a pathology-specific questionnaire, standardized clinical scores, clinical examination, psychological evaluation, video and dynamic fluoroscopy documentation of the instability mechanism, as well as magnetic resonance imaging (MRI). In a final reviewing process, the material from all collected cases was evaluated and, according to the observed pattern, different subtypes of FSI were determined and compared. RESULTS Based on the pathomechanism, positional FSI (78%) was distinguished from nonpositional FSI (22%). Controllable positional FSI was observed in 6% of all cases and noncontrollable positional FSI in 72%, whereas controllable and noncontrollable nonpositional FSI were each detected in 11% of the cases. The different subtypes of FSI showed significant differences in all clinical scores (Western Ontario Shoulder Instability Index: P = .002, Rowe Score: P = .001, Subjective Shoulder Value: P = .001) and regarding functional impairment (shoulder stability: P < .001, daily activities: P = .001, sports activities: P < .001). Seventy-eight percent had posterior, 17% anterior, and 6% multidirectional instability. Although several patients showed constitutional glenoid shape alterations or soft tissue hyperlaxity, only few patients with acquired minor structural defects were observed. CONCLUSION FSI can be classified into 4 subtypes based on pathomechanism and volitional control. Depending on the subtype, patients show different degrees of functional impairment. The majority of patients suffer from unidirectional posterior FSI.
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Affiliation(s)
- Philipp Moroder
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
| | - Victor Danzinger
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Nina Maziak
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Fabian Plachel
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Stephan Pauly
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Markus Scheibel
- Department for Shoulder and Elbow Surgery, Schulthess Clinic, Zürich, Switzerland
| | - Marvin Minkus
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Shafshak TS, Abdelhamid MM, Amer MA. Proximal neuropathies in patients with poststroke shoulder pain. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2019. [DOI: 10.4103/err.err_58_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Whitehead NA, Mohammed KD, Fulcher ML. Does the Beighton Score Correlate With Specific Measures of Shoulder Joint Laxity? Orthop J Sports Med 2018; 6:2325967118770633. [PMID: 29770343 PMCID: PMC5946643 DOI: 10.1177/2325967118770633] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Evaluation of shoulder joint laxity is an important component of the shoulder examination, especially in the setting of shoulder instability. Measures of generalized joint laxity, particularly the Beighton score, are often recorded and used to help make management decisions in these cases. However, no evidence is available to show that the Beighton score corresponds to specific measures of shoulder joint laxity. Purpose To assess the correlation between the Beighton score and validated measures of shoulder joint laxity. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 160 participants (age range, 16-35 years) with no history of shoulder joint abnormality were examined. The Beighton score, glenohumeral external rotation (standing and lying), glenohumeral abduction, and the sulcus sign were recorded. The relationship between the Beighton score and each measure of shoulder joint laxity was assessed. Results A high proportion of participants (34%) had a Beighton score of 4 or higher. Rates of positive shoulder laxity tests were lower (11%-19%). A positive Beighton score was a poor predictor of abnormal shoulder laxity, with low sensitivity (range, 0.40-0.48) and low positive predictive values (range, 0.13-0.31). Spearman correlation coefficients demonstrated poor correlation between the Beighton score and all measures of shoulder joint laxity when assessed as continuous variables (range, 0.29-0.45). Conclusion The Beighton score has poor correlation with specific measures of shoulder joint laxity and should not be considered equivalent to these tests as a method of clinical assessment.
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Affiliation(s)
- Noah A Whitehead
- School of Population Health, University of Auckland, New Zealand.,Axis Sports Medicine Specialists, Auckland, New Zealand
| | - Khalid D Mohammed
- Elmwood Orthopaedics, Christchurch, New Zealand.,Christchurch School of Medicine, University of Otago, New Zealand.,Christchurch Public Hospital, Christchurch, New Zealand
| | - Mark L Fulcher
- School of Population Health, University of Auckland, New Zealand.,Axis Sports Medicine Specialists, Auckland, New Zealand
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Cotter EJ, Hannon CP, Christian D, Frank RM, Bach BR. Comprehensive Examination of the Athlete's Shoulder. Sports Health 2018; 10:366-375. [PMID: 29443643 PMCID: PMC6044121 DOI: 10.1177/1941738118757197] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Context: Shoulder pain and dysfunction are common, with patients presenting complaints
to both primary and orthopaedic physicians. History and physical examination
remain essential to creating a differential diagnosis, even as noninvasive
imaging has improved. Evidence Acquisition: Literature was obtained through keyword searches based on the pathology in
question (eg, rotator cuff) and the keywords physical
examination using PubMed from January 1, 1980, through
September 20, 2017. Additional evidence was obtained through screening
references from articles identified through the PubMed searches. Study Design: Clinical review. Level of Evidence: Level 3. Results: A total of 7817 articles were screened for relevance. Several physical
examination maneuvers have been described for each specific pathology. The
Neer sign has a 75% sensitivity for subacromial impingement (SAI), while the
Hawkins-Kennedy test has an 80% sensitivity. The painful arc test has an 80%
specificity for SAI. The apprehension test has a hazard ratio of 2.96 for
anterior shoulder instability. The Jobe test has a sensitivity of 52.6% and
a specificity of 82.4% for full-thickness supraspinatus tears, confirmed on
arthroscopy. The lag sign is highly sensitive and specific for combined
full-thickness supraspinatus and infraspinatus tears at 97% and 93%,
respectively. The Speed test has a sensitivity of 54% and specificity of 81%
for biceps pathology. The anterior slide test and O’Brien active compression
test have been described for superior labrum anterior posterior tears with
inconsistent reliability. The cross-body adduction test has a sensitivity of
77% and a specificity of 79% for acromioclavicular joint pathology. Conclusion: Several physical examination maneuvers can isolate specific pathology of the
shoulder, with widely ranging sensitivity and specificity.
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Affiliation(s)
- Eric J Cotter
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Charles P Hannon
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - David Christian
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Rachel M Frank
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Bernard R Bach
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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13
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Morita W, Tasaki A. Intra- and inter-observer reproducibility of shoulder laxity tests: Comparison of the drawer, modified drawer and load and shift tests. J Orthop Sci 2018; 23:57-63. [PMID: 28988877 DOI: 10.1016/j.jos.2017.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 09/09/2017] [Accepted: 09/18/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Conventional tests of shoulder laxity have been shown to have poor reliability due to the difficulty in palpating the subtle movements of the shoulder joint beneath the musculature. Modified drawer test that is performed while the soft tissues surrounding the shoulder are loosened has been proposed to facilitate glenohumeral joint movement and improve reliability. We hypothesised that the modified drawer test would have an improved intra- and inter-observer reproducibility in comparison to the drawer and load and shift tests. Correlation of shoulder laxity measured by these tests with generalized joint laxity was also assessed. METHODS Forty healthy volunteers underwent bilateral shoulder examination in the clinic using the three tests for anterior and posterior laxity assessment by a consultant shoulder surgeon and a resident. The examination was repeated three months later by the same examiners in the same cohort. Intra- and inter- observer reproducibility was calculated using Kappa values. The correlation of shoulder with generalized joint laxity was also investigated. RESULTS The modified drawer test showed significantly improved intra-observer reproducibility compared to the drawer test, but not to the load and shift (κ = 0.173, -0.042, and 0.009, respectively). There were no significant differences in the inter-observer reproducibility between the three tests (κ = 0.054, 0.055, and 0.056, respectively). Moderate correlation was noted between shoulder and generalized joint laxity when modified drawer test was used (r = 0.417). CONCLUSIONS The modified drawer test improves intra- but not inter- observer reproducibility compared to the drawer test. Shoulder laxity assessed by the modified test correlated to generalized joint laxity. The modified drawer test has an improved reproducibility and correlation to generalized joint laxity over the conventional tests.
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Affiliation(s)
- Wataru Morita
- Department of Orthopaedic Surgery, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo 104-8560, Japan.
| | - Atsushi Tasaki
- Department of Orthopaedic Surgery, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo 104-8560, Japan
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Díaz Heredia J, Ruiz Iban MA, Ruiz Diaz R, Moros Marco S, Gutierrez Hernandez JC, Valencia M. The Posterior Unstable Shoulder: Natural History, Clinical Evaluation and Imaging. Open Orthop J 2017; 11:972-978. [PMID: 28979602 PMCID: PMC5611895 DOI: 10.2174/1874325001711010972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 11/27/2022] Open
Abstract
Background: There is a low incidence of posterior instability which is present in only 2% to 10% of all unstable shoulders. The posterior instable shoulder includes different manifestations like fixed dislocation, recurrent subluxation or dislocation. Methods: Research and online content related to posterior instability is reviewed. Natural history, clinical evaluation and imaging are described. Results: An awareness of the disorder, together with a thoughtful evaluation, beginning with the clinical history, usually leads to proper diagnosis. An appropriate physical exam, taking in account hyperlaxity and specific tests for posterior instability should be done. Conclusion: Posterior shoulder instability is an uncommon condition and is challenging to diagnose. There is not a single injury that is responsible for all cases of recurrent shoulder dislocation or subluxation, and the presence of soft tissue lesions or bone alterations should be evaluated, with the use of adequate simple radiology and multiplanar imaging.
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Affiliation(s)
- Jorge Díaz Heredia
- Unidad de Hombro y Codo. Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Miguel Angel Ruiz Iban
- Unidad de Hombro y Codo. Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Raquel Ruiz Diaz
- Unidad de Hombro y Codo. Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Santos Moros Marco
- Servicio de Traumatología y Cirugía Ortopédica, Clínica MAZ, Zaragoza, Spain
| | - Juan Carlos Gutierrez Hernandez
- Unidad de Hombro y Codo. Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Maria Valencia
- Unidad de Hombro y Codo. Servicio de Traumatología y Cirugía Ortopédica. Fundación Jimenez Diaz, Madrid, Spain
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15
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Valencia Mora M, Ibán MÁR, Heredia JD, Gutiérrez-Gómez JC, Diaz RR, Aramberri M, Cobiella C. Physical Exam and Evaluation of the Unstable Shoulder. Open Orthop J 2017; 11:946-956. [PMID: 29114336 PMCID: PMC5646139 DOI: 10.2174/1874325001711010946] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/09/2016] [Accepted: 10/28/2016] [Indexed: 01/03/2023] Open
Abstract
Background: The clinical evaluation of the patient with shoulder instability can be challenging. The pathological spectrum ranges from the straightforward “recurrent anterior dislocation” patient to the overhead athlete with a painful shoulder but not clear instability episodes. Advances in shoulder arthroscopy and imaging have helped in understanding the anatomy and physiopathology of the symptoms. The aim of this general article is to summarize the main examination manoeuvres that could be included in an overall approach to a patient with a suspicion of instability. Material and Methods: In order to achieve the above-mentioned objective, a thorough review of the literature has been performed. Data regarding sensibility and specificity of each test have been included as well as a detailed description of the indications to perform them. Also, the most frequent and recent variations of these diagnostic tests are included. Results: Laxity and instability should be considered separately. For anterior instability, a combination of apprehension, relocation and release tests provide great specificity. On the other hand, multidirectional or posterior instability can be difficult to diagnose especially when the main complain is pain. Conclusion: A detailed interview and clinical examination of the patient are mandatory in order to identify a shoulder instability problem. Range of motion of both shoulders, clicking of catching sensations as well as pain, should be considered together with dislocation and subluxation episodes. Specific instability and hyperlaxity tests should be also performed to obtain an accurate diagnosis.
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16
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Donohue MA, Brelin AM, LeClere LE. Management of First-Time Shoulder Dislocation in the Contact Athlete. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Diagnosis and treatment of anteroinferior capsular redundancy associated with anterior shoulder instability using an open Latarjet procedure and capsulorrhaphy. Knee Surg Sports Traumatol Arthrosc 2016; 24:3756-3764. [PMID: 26003480 DOI: 10.1007/s00167-015-3621-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE There is a paucity of data detailing management of anterior capsular redundancy (ACR) when using the Latarjet procedure for unidirectional instability. This study aimed to describe the surgical management and to assess the clinical profile of patients presenting with anterior capsular redundancy [ACR(+)] with anterior shoulder instability. METHODS Seventy-seven patients who had a Latarjet procedure were followed for a 55-month period. Per-operative ACR was assessed during surgery. ACR was considered present if the inferior capsular flap of a Neer T-shaft capsulorrhaphy was able to cover the superior capsular flap with the arm in the neutral position. Patients with ACR(+) received an additional Neer capsulorrhaphy, while patients with ACR(-) did not. This per-operative finding was correlated with demographics, clinical, radiological pre-operative data and surgical outcome. RESULTS Patients presenting with a per-operative ACR(+) were significantly associated with a sulcus sign (P < 0.001), a Beighton score >4 (P < 0.01), a low-energy instability history (P < 0.05), a predominant history of subluxations (P < 0.05), fewer Hill-Sachs lesion (P < 0.05) and a female gender (P < 0.05), but not significantly with external rotation >85°. Open standard Latarjet procedures with Neer capsulorrhaphy in ACR(+) patients showed excellent or good results and stability rate of 95 %. All patients except four who presented with a new dislocation after surgery were satisfied with their outcome. Thirteen patients (16 %) had a persistent apprehension sign at the last follow-up. ACR(+) and ACR(-) groups did not show significant difference in the mean values of Rowe, Walch-Duplay and Constant-Murley scores. CONCLUSION ACR correlated with a sulcus sign, Beighton score and instability history. In anterior shoulder instability associated with ACR, the Latarjet procedure with a Neer capsulorrhaphy appears a satisfactory treatment alternative to arthroscopic or open capsular shift. It decreased apprehension in comparison with Latarjet procedures without capsular repair. LEVEL OF EVIDENCE Cases series, treatment study, Level IV.
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18
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Multidirektionale Schulterinstabilität. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0045-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Ropars M, Cretual A, Thomazeau H, Kaila R, Bonan I. Volumetric definition of shoulder range of motion and its correlation with clinical signs of shoulder hyperlaxity. A motion capture study. J Shoulder Elbow Surg 2015; 24:310-6. [PMID: 25193487 DOI: 10.1016/j.jse.2014.06.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/10/2014] [Accepted: 06/19/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder hyperlaxity (SHL) is assessed with clinical signs. Quantification of SHL remains difficult, however, because no quantitative definition has yet been described. With use of a motion capture system (MCS), the aim of this study was to categorize SHL through a volumetric MCS-based definition and to compare this volume with clinical signs used for SHL diagnosis. METHOD Twenty-three subjects were examined with passive and active measurement of their shoulder range of motion (SROM) and then with an MCS protocol, allowing computation of the shoulder configuration space volume (SCSV). Clinical data of SHL were assessed by the sulcus sign, external rotation with the arm at the side (ER1) >85° in a standing position, external rotation >90° in a lying position, and Beighton score for general joint laxity. Active and passive ER1, EIR2 (sum of external and internal rotation at 90° of abduction), flexion-extension, and abduction were also measured and correlated to SCSV. RESULTS Except for the sulcus sign, SCSV was significantly correlated with all clinical signs used for SHL. Passive examination of the different SROMs was better correlated to SCSV than active examination. In passive examination, the worst SROM was ER1 (R = 0.36; P = .09), whereas EIR2, flexion, and abduction were highly correlated to SCSV (P < .01). CONCLUSION SCSV appears to be an appealing tool for evaluation of SHL regarding its correlation with clinical signs used for SHL diagnosis. The sulcus sign and ER1 >85° in a standing position appear less discriminating and should be replaced by EIR2 measurement for SHL diagnosis.
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Affiliation(s)
- Mickaël Ropars
- Orthopedics Department, Pontchaillou University Hospital, Rennes, France; M2S (Mouvement Sport Santé) Laboratory, University Rennes 2, ENS Bretagne, UEB, Campus de Ker Lann, Bruz, France.
| | - Armel Cretual
- M2S (Mouvement Sport Santé) Laboratory, University Rennes 2, ENS Bretagne, UEB, Campus de Ker Lann, Bruz, France
| | - Hervé Thomazeau
- Orthopedics Department, Pontchaillou University Hospital, Rennes, France
| | - Rajiv Kaila
- Orthopedics Department, Pontchaillou University Hospital, Rennes, France
| | - Isabelle Bonan
- M2S (Mouvement Sport Santé) Laboratory, University Rennes 2, ENS Bretagne, UEB, Campus de Ker Lann, Bruz, France
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King JJ, Wright TW. Physical examination of the shoulder. J Hand Surg Am 2014; 39:2103-12. [PMID: 25257491 DOI: 10.1016/j.jhsa.2014.04.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/03/2014] [Accepted: 04/06/2014] [Indexed: 02/02/2023]
Abstract
This article summarizes the overall assessment of the shoulder joint and seeks to help direct clinicians to diagnose shoulder pathology using standard and specific physical examinations. The history and standard examination can prompt the examiner to focus on specific tests to further evaluate the shoulder and limit the differential diagnoses. An appropriate and directed shoulder physical examination allows the clinician to focus on further diagnostic strategies and treatment options for the patient.
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Affiliation(s)
- Joseph J King
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, FL.
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21
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Tanaka M, Koizumi K, Kakiuchi M, Hayashida K. Evaluation of dislocation position in patients with recurrent anterior shoulder dislocation. J Shoulder Elbow Surg 2012; 21:1588-92. [PMID: 22361716 DOI: 10.1016/j.jse.2011.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 11/09/2011] [Accepted: 11/14/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND The usual mechanism of anterior shoulder dislocation is widely believed to be a combination of glenohumeral joint abduction, extension, and external rotation forces, even though no published reports to date have investigated the arm position of anterior shoulder dislocation in detail. Understanding the exact position of anterior shoulder dislocations is important for the management of anterior shoulder instability. MATERIALS AND METHODS The study included 40 shoulders of 38 patients (32 males, 6 females), aged 28.0 (range, 13-73) years with symptomatic post-traumatic recurrent anterior shoulder instability. While patients were under general anesthesia, but before shoulder-stabilizing surgery, we evaluated the angle of external rotation with 90° elevation in the scapular plane at which the humeral head showed anterior translations over the glenoid rim. RESULTS The center of anterior instability at 90° elevation in the scapular plane was at 25.9° of external rotation. Anterior translations were detected in the range of 3.4° of internal rotation to 55.1° of external rotation, and no shoulders (except one) showed anterior translation at maximal external rotation. CONCLUSIONS Gross anterior translation was seen in the middle range of rotation at approximately 25° of external rotation, and anterior translation decreased close to the end of external and internal rotation. Shoulders with grade III translation showed anterior translation in a wider range of rotation, especially in external rotation. These data will help to further our understanding of the management and the prevention of anterior shoulder dislocations.
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Affiliation(s)
- Makoto Tanaka
- Department of Orthopaedic Surgery, Osaka Police Hospital, Osaka, Japan
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Posterior shoulder instability: current concepts review. Knee Surg Sports Traumatol Arthrosc 2011; 19:1547-53. [PMID: 20953863 DOI: 10.1007/s00167-010-1293-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 09/28/2010] [Indexed: 12/31/2022]
Abstract
PURPOSE Posterior shoulder instability has been difficult to diagnose and even more challenging to manage. However, it is being diagnosed and treated more frequently, particularly after sports injuries. The purpose of this article is to review literature concerning the management of these pathologies. METHODS A literature review was carried out in the main medical databases to evaluate the several studies concerning the open and arthroscopic treatment of posterior shoulder instability. RESULTS Because of better awareness of the pathology, better technical investigations, and a better understanding of shoulder biomechanics, more and more mechanical factors that can cause posterior instability have been described. Structural abnormalities can be divided into bony abnormalities and soft-tissue abnormalities. Each group can also be divided into abnormalities caused by trauma (macro- or microtrauma) or congenital. These abnormalities can be treated with non-anatomic and anatomic stability procedures. During the last decades, the latter have been described more frequently, most of them arthroscopically. CONCLUSION For surgical treatment to be successful, the instability must be attributable to mechanical factors that can be modified by surgery. Because of better knowledge of the pathology, a more specific surgery can be performed. This lesion-specific surgery has improved clinical results compared to non-anatomic stability procedures, particularly when that surgery has been performed arthroscopically.
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Jia X, Yokota A, McCarty EC, Nicholson GP, Weber SC, McMahon PJ, Dunn WR, McFarland EG. Reproducibility and reliability of the Snyder classification of superior labral anterior posterior lesions among shoulder surgeons. Am J Sports Med 2011; 39:986-91. [PMID: 21285446 DOI: 10.1177/0363546510392332] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies of the reliability of classifications for superior labral anterior and posterior (SLAP) lesions suggest that intraobserver/interobserver reliability is poor. PURPOSE The goals were to (1) evaluate intraobserver/interobserver reliability of the Snyder classification of labrum tears among experienced surgeons, (2) determine the effect of simplifying that classification into normal versus abnormal labrums, (3) determine the reliability of subdividing type II SLAP lesions, and (4) evaluate the effect of videotape quality on diagnostic confidence. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS At 2 separate times, 5 experienced shoulder surgeons (all >10 years of practice) evaluated 90 videotapes of shoulder arthroscopy performed for SLAP lesions to identify lesion type, to grade video quality, and to determine degree of confidence in diagnosis. The results were compared for intraobserver reliability (κ analysis) and interobserver reliability (intraclass correlation coefficients) and effect of video quality on diagnostic confidence. Significance was set at P < .05. RESULTS When the choices were normal labrum or the 4 types of SLAP lesions, the intraobserver agreements (mean κ, 0.670) and interobserver agreements (mean correlation, 0.804) were substantial. When the labrums were divided into normal (normal and type I) and abnormal (types II-IV), the intraobserver agreements (mean κ, 0.792) and interobserver agreements (mean correlation, 0.648) were substantial. When the 3 type II SLAP lesion subvariants were evaluated, the intraobserver agreement (mean κ, 0.598) was moderate, and the interobserver agreement (mean correlation, 0.804) was substantial. The confidence of the diagnosis was highly correlated with the perceived video quality (average Pearson correlation, 0.718; P < .01). Repeated measures analysis showed a significant relationship between confidence and quality (parameter estimate, 0.732; standard error, 0.021; P < .01) adjusting for rater and review. CONCLUSION For experienced shoulder surgeons, the Snyder classification is a reliable system for identifying SLAP lesions.
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Affiliation(s)
- Xiaofeng Jia
- Departments of Biomedical Engineering, Physical Medicine and Rehabilitation, The Johns Hopkins University, Baltimore, Maryland, USA
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Affiliation(s)
- Marc Tompkins
- Department of Orthopaedics, University of Virginia, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA 22908, USA
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Jia X, Ji JH, Pannirselvam V, Petersen SA, McFarland EG. Does a positive neer impingement sign reflect rotator cuff contact with the acromion? Clin Orthop Relat Res 2011; 469:813-8. [PMID: 20878281 PMCID: PMC3032859 DOI: 10.1007/s11999-010-1590-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 09/10/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND One possible cause of shoulder pain is rotator cuff contact with the superior glenoid (cuff-glenoid contact) with the arm in flexion, as occurs during a Neer impingement sign. It has been assumed that the pain with a Neer impingement sign on physical examination of the shoulder was secondary to the rotator cuff making contact with the anterior and lateral acromion. QUESTIONS/PURPOSES We determined if the arm position where pain occurs with a Neer impingement sign would correlate with the position where the rotator cuff made contact with the superior glenoid, as determined by arthroscopic evaluation. PATIENTS AND METHODS We prospectively studied 398 consecutive patients with a positive Neer impingement sign during office examination and used a handheld goniometer to measure (in degrees of flexion) the arm position in which impingement pain occurred. During subsequent arthroscopy, the arm was moved into a similar position, and we measured the arm's position in flexion at the point the rotator cuff made contact with the superior glenoid using a handheld goniometer. We compared the degrees of flexion at which pain occurred preoperatively and at which there was cuff-glenoid contact. RESULTS Among the 398 patients, 302 (76%) had arthroscopically documented cuff-glenoid contact, whereas 96 did not. For the 302 patients with a positive Neer sign preoperatively and with arthroscopically documented cuff-glenoid contact, the average preoperative impingement pain position was 120.1°±26.7°, similar to that of the average intraoperative cuff-glenoid contact position of 120.6°±14.7°. CONCLUSIONS Our data suggest pain associated with a positive Neer sign more often relates to contact of the rotator cuff with the superior glenoid than to contact between the rotator cuff and acromion. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Xiaofeng Jia
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Jong Hun Ji
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Vinodhkumar Pannirselvam
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Steve A. Petersen
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Edward G. McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780 USA
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Bahk MS, Karzel RP, Snyder SJ. Arthroscopic posterior stabilization and anterior capsular plication for recurrent posterior glenohumeral instability. Arthroscopy 2010; 26:1172-80. [PMID: 20810077 DOI: 10.1016/j.arthro.2010.06.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 06/06/2010] [Accepted: 06/07/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the outcomes and identify predictors of success for arthroscopic posterior Bankart reconstruction with modern suture anchor repair and anterior capsulolabral plication in a well-defined patient population-recurrent, traumatic, involuntary, unidirectional posterior shoulder instability. METHODS Patients with recurrent, traumatic, involuntary, unidirectional posterior shoulder instability who underwent arthroscopic repair with a minimum of 2 years' follow-up were identified and evaluated retrospectively with outcome measures in the form of objective and subjective scores. Statistical analysis was performed to identify predictors of success with significance set at .05. RESULTS Twenty-nine consecutive patients with a mean age of 26.3 years underwent posterior reconstruction and anterior balancing capsulolabral plication as needed with a mean follow-up of 5.5 years. Outcome scores averaged as follows: American Shoulder and Elbow Surgeons, 90.7; University of California, Los Angeles, 32.6; Simple Shoulder Test, 11.7; and Western Ontario Shoulder Instability, 82.9% of normal. Recurrent instability occurred in 3.4% of patients, 84.6% returned to sports, and 96.6% of patients believed surgery was successful and worthwhile. Patients who were younger (<30 years) or patients with more extensive pathology who required additional surgical procedures or received supplemental anterior plication sutures had less reliable or worse outcomes (P < or = .041). CONCLUSIONS In a traumatic patient population with involuntary, unidirectional posterior shoulder instability, modern suture anchor repair of posterior labral lesions is effective and provides reliable outcomes. Younger patients and patients with worse pathology who required additional procedures had less reliable outcomes. Patients with supplemental anterior plication had more postoperative pain, and this adjunctive procedure may not be necessary for traumatic posterior labral tear surgery. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Michael S Bahk
- Southern California Orthopedic Institute, Simi Valley, California 93063, USA.
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Abstract
Generalized ligamentous hyperlaxity and glenohumeral joint instability are common conditions that exhibit a spectrum of diverse clinical forms and may coexist in the same patient. No single diagnostic test can confirm the presence of these disorders, and a careful clinical assessment is important. Unlike patients with traumatic shoulder instability, patients with hyperlaxity and instability are more likely to experience episodes of recurrent subluxation than they are to have recurrent dislocation. They are more likely to have instability in more than one anatomic plane, and they usually do not have the soft-tissue and osseous lesions associated with traumatic instability. Shoulder symptoms in a patient with hyperlaxity are not always due to instability; other pathological conditions may coexist, with rotator cuff impingement being the most common. Most patients with hyperlaxity have a reduction in instability symptoms after nonoperative treatment, including physical therapy, activity modification, and additional psychological support when necessary. Operative treatment provides reproducibly good results for patients with hyperlaxity who do not respond to a prolonged program of nonoperative measures. Open inferior capsular shift remains the gold standard of operative treatment, although arthroscopic capsular shift and plication procedures are now producing comparable results. Thermal capsulorrhaphy is associated with unacceptably high failure rates and postoperative complications and cannot be recommended as a treatment.
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Affiliation(s)
- Simon M Johnson
- Shoulder Injury Clinic, Royal Infirmary of Edinburgh, Edinburgh EH16 4SU, UK
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Jia X, Petersen SA, Khosravi AH, Almareddi V, Pannirselvam V, McFarland EG. Examination of the shoulder: the past, the present, and the future. J Bone Joint Surg Am 2009; 91 Suppl 6:10-8. [PMID: 19884407 DOI: 10.2106/jbjs.i.00534] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Xiaofeng Jia
- Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA
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