scholarly journals The current anatomical description of the inferior glenohumeral ligament does not correlate with its functional role in positions of external rotation

2008 ◽  
Vol 26 (12) ◽  
pp. 1598-1604 ◽  
Author(s):  
Susan M. Moore ◽  
Jens H. Stehle ◽  
Eric J. Rainis ◽  
Patrick J. McMahon ◽  
Richard E. Debski
Keyword(s):  
Functional Role ◽  
External Rotation ◽  
Glenohumeral Ligament ◽  
Inferior Glenohumeral Ligament

Development of a Finite Element Model of the Inferior Glenohumeral Ligament of the Glenohumeral Joint

2003 ◽  
Author(s):  
William J. Newman ◽  
Richard E. Debski ◽  
Susan M. Moore ◽  
Jeffrey A. Weiss
Keyword(s):  
Finite Element ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Element Model ◽  
Fe Modeling ◽  
Glenohumeral Ligament ◽  
Subject Specific ◽  
Inferior Glenohumeral Ligament ◽  
Glenohumeral Capsule ◽  
Shoulder Stability

The shoulder is one of the most complex and often injured joints in the human body. The inferior glenohumeral ligament (IGHL), composed of the anterior band (AB), posterior band (PB) and the axillary pouch, has been shown to be an important contributor to anterior shoulder stability (Turkel, 1981). Injuries to the IGHL of the glenohumeral capsule are especially difficult to diagnose and treat effectively. The objective of this research was to develop a methodology for subject-specific finite element (FE) modeling of the ligamentous structures of the glenohumeral joint, specifically the IGHL, and to determine how changes in material properties affect predicted strains in the IGHL at 60° of external rotation. Using the techniques developed in this research, an improved understanding of the contribution of the IGHL to shoulder stability can be acquired.

Performing Clinical Exams at Specific Joint Positions May Help Identify Injured Regions of the Glenohumeral Capsule Following Anterior Dislocation

2012 ◽  
Author(s):  
Carrie A. Rainis ◽  
Daniel P. Browe ◽  
Patrick J. McMahon ◽  
Richard E. Debski
Keyword(s):  
Tissue Damage ◽  
External Rotation ◽  
Anterior Dislocation ◽  
Joint Position ◽  
Anterior Instability ◽  
Glenohumeral Ligament ◽  
Before And After ◽  
Inferior Glenohumeral Ligament ◽  
Glenohumeral Capsule ◽  
The Relationship

The anteroinferior glenohumeral capsule (anterior band of the inferior glenohumeral ligament (AB-IGHL), axillary pouch) limits anterior translation, particularly in positions of external rotation. [1, 2] Permanent tissue deformation that occurs as a result of dislocation contributes to anterior instability, but, the extent and effects of this injury are difficult to evaluate as the deformation cannot be seen using diagnostic imaging. Clinical exams are used to identify the appropriate location of tissue damage and current arthroscopic procedures allow for selective tightening of localized capsule regions; however, identifying the specific location for optimal treatment of each patient is challenging. Although the reliability of clinical exams has been shown to change with joint position [3] a standardized procedure has yet to be established. This lack of standardization is particularly problematic since capsule function is highly dependent upon joint position [4–7], and could be responsible for failed repairs attributed to plication of the wrong capsular region [8]. Understanding the relationship between the location of tissue damage and changes in capsule function following anterior dislocation could aid clinicians in diagnosing and treating anterior instability. Therefore, the objective of this work was to compare strain distributions in the anteroinferior capsule before and after anterior dislocation in order to identify joint positions at which clinical exams would be capable of detecting damage (nonrecoverable strain) in specific locations.

Ligamentous Restraints to External Rotation of the Humerus in the Late-Cocking Phase of Throwing

2000 ◽  
Vol 28 (2) ◽  
pp. 200-205 ◽  
Author(s):  
John E. Kuhn ◽  
Michael J. Bey ◽  
Laura J. Huston ◽  
Ralph B. Blasier ◽  
Louis J. Soslowsky
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Coracoacromial Ligament ◽  
Glenohumeral Ligament ◽  
Coracohumeral Ligament ◽  
Potential Source ◽  
Glenohumeral Ligaments ◽  
Inferior Glenohumeral Ligament ◽  
Glenohumeral Capsule

The late-cocking phase of throwing is characterized by extreme external rotation of the abducted arm; repeated stress in this position is a potential source of glenohumeral joint laxity. To determine the ligamentous restraints for external rotation in this position, 20 cadaver shoulders (mean age, 65 16 years) were dissected, leaving the rotator cuff tendons, coracoacromial ligament, glenohumeral capsule and ligaments, and coracohumeral ligament intact. The combined superior and middle glenohumeral ligaments, anterior band of the inferior glenohumeral ligament, and the entire inferior glenohumeral ligament were marked with sutures during arthroscopy. Specimens were mounted in a testing apparatus to simulate the late-cocking position. Forces of 22 N were applied to each of the rotator cuff tendons. An external rotation torque (0.06 N m/sec to a peak of 3.4 N m) was applied to the humerus of each specimen with the capsule intact and again after a single randomly chosen ligament was cut (N 5 in each group). Cutting the entire inferior glenohumeral ligament resulted in the greatest increase in external rotation (10.2° 4.9°). This was not significantly different from sectioning the coracohumeral ligament (8.6° 7.3°). The anterior band of the inferior glenohumeral ligament (2.7° 1.5°) and the superior and middle glenohumeral ligaments (0.7° 0.3°) were significantly less important in limiting external rotation.

Changes in Capsule Function Following Anterior Dislocation Elucidate the Need for Standardized Clinical Exams to Diagnose Shoulder Instability

2011 ◽  
Author(s):  
Carrie A. Voycheck ◽  
Daniel P. Browe ◽  
Patrick J. McMahon ◽  
Richard E. Debski
Keyword(s):  
Tissue Damage ◽  
External Rotation ◽  
Permanent Deformation ◽  
Experimental Models ◽  
Anterior Dislocation ◽  
Tissue Deformation ◽  
Glenohumeral Ligament ◽  
Anterior Translation ◽  
Inferior Glenohumeral Ligament ◽  
Glenohumeral Capsule

The anteroinferior glenohumeral capsule (anterior band of the inferior glenohumeral ligament (AB-IGHL), axillary pouch) limits anterior translation, particularly in positions of external rotation, and as a result is frequently injured during anterior dislocation. [1,2] A common capsular injury is permanent tissue deformation, however, the extent and effects of this injury are difficult to evaluate as the deformation cannot be seen using diagnostic imaging. In addition, clinical exams to diagnose this injury are not reliable [3] and poor patient outcome still exists following repair procedures. [4] Previous experimental models have observed increased joint mobility following permanent tissue deformation. [5] While other models have quantified the permanent deformation using nonrecoverable strain [6], no model has correlated the amount of tissue damage to altered capsule function. Understanding the relationship between the extent of tissue damage and changes in capsule function following anterior dislocation could aid surgeons in diagnosing and treating anterior instability. Therefore, the objectives of this work were to 1) quantify the nonrecoverable strain in the anteroinferior capsule resulting from an anterior dislocation and 2) evaluate capsule function (strain distribution in anteroinferior capsule, anterior translation) during a simulated clinical exam at three joint positions, in the intact and injured joint.

scholarly journals Effects of arthroscopic capsular and inferior glenohumeral ligament release on function and stability for patients with frozen shoulder

2020 ◽  
Author(s):  
Yao Zhang ◽  
Shichao Cao ◽  
Mingsheng Liu ◽  
Wenyong Fei ◽  
Jingcheng Wang
Keyword(s):  
Shoulder Joint ◽  
External Rotation ◽  
Constant Score ◽  
Frozen Shoulder ◽  
Joint Stability ◽  
Postoperative Rehabilitation ◽  
Glenohumeral Ligament ◽  
Vas Score ◽  
Inferior Glenohumeral Ligament ◽  
And Function

Abstract Background The inferior glenohumeral ligament (IGHL) plays an important role in maintaining shoulder joint stability. However, no systematic studies on shoulder stability and function of patients with FS after IGHL release exist. This study assessed the functional and clinical outcomes of IGHL release for FS.Methods Forty-seven patients underwent arthroscopic capsule and IGHL release with the same postoperative rehabilitation procedure. Five functional parameters were measured postoperatively at 4, 8, 12 and 28 weeks: the apprehension test result, American Shoulder and Elbow Surgeons Score (ASES), Constant score, visual analog scale (VAS) score and active range of motion (ROM).Results All patients improved in the aforementioned evaluations. At 28 weeks, the ASES, Constant score and VAS score improved from 31.30±6.41 to 92.43±3.89, 30.15±6.85 to 90.71±4.27 and 6.73±0.72 to 0.60±0.74, respectively (p<0.05). Forward flexion (FF) and abduction (ABD) improved from 73.85±14.94 to 166.70±7.23 and from 69.65±12.74 to 165.03±6.36, respectively (p<0.05). External rotation (ER) and internal rotation (IR) also significantly improved. In total, 95% of the patients were able to perform full elevation, and 97.5% of the patients could place the dorsum of their hands between their shoulder blades. All patients had negative apprehension tests, and no dislocations occurred. No other serious postoperative complications were observed.Conclusions Arthroscopic capsule and IGHL release was effective and could improve the active ROM and relieve pain in patients with FS. This surgical procedure did not cause instability or dislocations in the shoulder joint.

scholarly journals Mapping of the Inferior Glenohumeral Ligament for Suture Pullout Strength: A Biomechanical Analysis

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712096964
Author(s):  
Sumit Raniga ◽  
Joseph Cadman ◽  
Danè Dabirrahmani ◽  
David Bui ◽  
Richard Appleyard ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Biomechanical Study ◽  
Labral Repair ◽  
Pullout Strength ◽  
Recurrent Instability ◽  
Glenohumeral Ligament ◽  
Time Zero ◽  
Capsular Plication ◽  
Inferior Glenohumeral Ligament ◽  
The Impact

Background: Suture pullout during rehabilitation may result in loss of tension in the inferior glenohumeral ligament (IGHL) and contribute to recurrent instability after capsular plication, performed with or without labral repair. To date, the suture pullout strength in the IGHL is not well-documented. This may contribute to recurrent instability. Purpose/Hypothesis: A cadaveric biomechanical study was designed to investigate the suture pullout strength of sutures in the IGHL. We hypothesized that there would be no significant variability of suture pullout strength between specimens and zones. Additionally, we sought to determine the impact of early mobilization on sutures in the IGHL at time zero. We hypothesized that capsular plication sutures would fail under low load. Study Design: Descriptive laboratory study. Methods: Seven fresh-frozen cadaveric shoulders were dissected to isolate the IGHL complex, which was then divided into 18 zones. Sutures in these zones were attached to a linear actuator, and the resistance to suture pullout was recorded. A suture pullout strength map of the IGHL was constructed. These loads were used to calculate the load applied at the hand that would initiate suture pullout in the IGHL. Results: Mean suture pullout strength for all specimens was 61.6 ± 26.1 N. The maximum load found to cause suture pullout through tissue was found to be low, regardless of zone of the IGHL. Calculations suggest that an external rotation force applied to the hand of only 9.6 N may be sufficient to tear capsular sutures at time zero. Conclusion: This study did not provide clear evidence of desirable locations for fixation in the IGHL. However, given the low magnitude of failure loads, the results suggest the timetable for initiation of range-of-motion exercises should be reconsidered to prevent suture pullout through the IGHL. Clinical Relevance: From this biomechanical study, the magnitude of force required to cause suture pullout through the IGHL is met or surpassed by normal postoperative early range-of-motion protocols.

scholarly journals Mini-open Repair of the Floating Anterior Inferior Glenohumeral Ligament: Combined Treatment of Bankart and Humeral Avulsion of the Glenohumeral Ligament Lesions

2018 ◽  
Vol 7 (12) ◽  
pp. e1281-e1287 ◽  
Author(s):  
Zachary S. Aman ◽  
Mitchell I. Kennedy ◽  
Anthony Sanchez ◽  
Joseph J. Krob ◽  
Colin P. Murphy ◽  
...  
Keyword(s):  
Open Repair ◽  
Combined Treatment ◽  
Glenohumeral Ligament ◽  
Inferior Glenohumeral Ligament ◽  
Mini Open

scholarly journals Biomechanical properties of the anterior band of the inferior glenohumeral ligament under stress

2003 ◽  
Vol 11 (2) ◽  
pp. 72-78
Author(s):  
José Atualpa Pinheiro Júnior ◽  
José Alberto Dias Leite ◽  
Francisco Erivan de Abreu Melo ◽  
José de Sá Cavalcante Júnior ◽  
Antônio Cantídio Silva Campos ◽  
...  
Keyword(s):  
Biomechanical Properties ◽  
Force Constants ◽  
Stress Strain ◽  
Hooke’S Law ◽  
Glenohumeral Ligament ◽  
Group I ◽  
Hooke's Law ◽  
Inferior Glenohumeral Ligament ◽  
Group Ii

This paper is aimed at studying the behavior of the band of inferior glenohumeral ligament subjected to uniaxial traction. Twenty ligaments were distributed in two groups: Group I ( ligaments with bony origin and insertion) and Group II ( medial portion of the ligament). Uniaxial traction was applied to all tendons utilizing a traction machine develop in the Department of Physics of UFC. Hooke's Law was used for evaluation of ligament behavior during elastic phase and the Exponential stress-strain Law, for rigidity phase. All ligaments had the same behavior, presenting a phase of elasticity , followed by one of rigidity. After evaluation of the elastic phase , applying Hooke's Law, ligaments constants were 10.507 N/mm ( group I ) and 13.80 N/mm ( group II), suffering a straining of 2.83% and 2.84%,respectively, until the ligament became rigid. During rigidity phase, the constants were 511.56% N/mm (group I) and 156.84% N/mm (group II). It is concluded that the ligament submitted to traction suffers a small elongation until becoming rigid along with an important increase in force constants during rigidity phase.

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