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.

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.

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.

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.

The Effect of Anterior Dislocation on the Mechanical Properties of the Inferior Glenohumeral Ligament

2012 ◽  
Author(s):  
Daniel P. Browe ◽  
Carrie A. Rainis ◽  
Patrick J. McMahon ◽  
Richard E. Debski
Keyword(s):  
Mechanical Properties ◽  
Glenohumeral Joint ◽  
Permanent Deformation ◽  
Recurrent Dislocation ◽  
The Body ◽  
Anterior Dislocation ◽  
Glenohumeral Ligament ◽  
Inferior Glenohumeral Ligament ◽  
Glenohumeral Capsule ◽  
Repair Techniques

The glenohumeral joint is the most frequently dislocated major joint in the body with about 2% of the population dislocating their shoulders between the ages of 18 and 70 [1]. Instability due to permanent deformation of the glenohumeral capsule is commonly associated with dislocation [2]. Current surgical repair techniques for shoulder dislocations typically consist of plication of the glenohumeral capsule, or folding the tissue over on itself, to reduce redundancy in the capsule and restore stability to the shoulder. Up to 25% of patients who undergo surgery for a shoulder dislocation still experience pain, instability, and recurrent dislocation after surgery [3]. It is hypothesized that the mechanical properties of the glenohumeral capsule change in response to dislocation. In addition, the magnitude and location of these changes may have implications for the ideal location and extent of plication. Therefore, the objective of this study was to quantify the mechanical properties of the axillary pouch of the glenohumeral capsule in tension and shear after anterior dislocation.

Collagen Fiber Alignment and Maximum Principal Strain in the Glenohumeral Capsule Predict Location of Failure During Uniaxial Extension

2011 ◽  
Author(s):  
Kelvin Luu ◽  
Carrie A. Voycheck ◽  
Patrick J. McMahon ◽  
Richard E. Debski
Keyword(s):  
Collagen Fiber ◽  
Glenohumeral Joint ◽  
Uniaxial Extension ◽  
Principal Strain ◽  
Fiber Alignment ◽  
Glenohumeral Ligament ◽  
Maximum Principal Strain ◽  
Inferior Glenohumeral Ligament ◽  
Glenohumeral Capsule ◽  
Collagen Fiber Alignment

The glenohumeral joint is frequently dislocated causing injury to the glenohumeral capsule (axillary pouch (AP), anterior band of the inferior glenohumeral ligament (AB-IGHL), posterior band of the inferior glenohumeral ligament (PB-IGHL), posterior (Post), and anterosuperior region (AS)). [1, 2] The capsule is a passive stabilizer to the glenohumeral joint and primarily functions to resist dislocation during extreme ranges of motion. [3] When unloaded, the capsule consists of randomly oriented collagen fibers, which play a pertinent role in its function to resist loading in multiple directions. [4] The location of failure in only the axillary pouch has been shown to correspond with the highest degree of collagen fiber orientation and maximum principle strain just prior to failure. [4, 5] However, several discrepancies were found when comparing the collagen fiber alignment between the AB-IGHL, AP, and PB-IGHL. [3,6,7] Therefore, the objective was to determine the collagen fiber alignment and maximum principal strain in five regions of the capsule during uniaxial extension to failure and to determine if these parameters could predict the location of tissue failure. Since the capsule functions as a continuous sheet, we hypothesized that maximum principal strain and peak collagen fiber alignment would correspond with the location of tissue failure in all regions of the glenohumeral capsule.

Mechanical Properties of the Glenohumeral Capsule Change With Simulated Injury

2010 ◽  
Author(s):  
Carrie A. Voycheck ◽  
Patrick J. McMahon ◽  
Richard E. Debski
Keyword(s):  
Glenohumeral Joint ◽  
Tissue Sample ◽  
Biomechanical Properties ◽  
Recurrent Instability ◽  
Glenohumeral Ligament ◽  
Inferior Glenohumeral Ligament ◽  
Normal Stability ◽  
Glenohumeral Capsule ◽  
Anterior Direction ◽  
Repair Techniques

The glenohumeral joint suffers more dislocations than any other joint, most of which occur in the anterior direction. The anterior band of the inferior glenohumeral ligament (AB-IGHL) is the primary restraint to these dislocations and as a result experiences the highest strains during these events. [1] Injuries to the capsule following dislocation include permanent tissue deformation that increases joint mobility and contributes to recurrent instability. [2] This deformation can be quantified by measuring nonrecoverable strain. [3] Simulated injury of the capsule results in permanently elongated tissue and nonrecoverable strain. Current surgical repair techniques are subjective and may not fully address all capsular tissue pathologies resulting from dislocation. Surgeons typically repair the injured capsule by plicating the stretched-out tissue; however, these techniques are inadequate with 23% of patients needing an additional repair. [4] Quantitative data on the changes in the biomechanical properties of the capsule following dislocation may help to predict the amount of capsular tissue to plicate for restoring normal stability. Therefore, the objectives of this study were to quantify changes in stiffness and material properties of the AB-IGHL tissue sample following simulated injury (creation of nonrecoverable strain).

Evaluation of the relationship of tibiofemoral kinematics before and after total knee replacement in an in vitro model of cranial cruciate deficiency in the dog

2016 ◽  
Vol 29 (06) ◽  
pp. 484-490 ◽  
Author(s):  
Rebecca Howie ◽  
Timothy Foutz ◽  
Curtis Cathcart ◽  
Jeff Burmeister ◽  
Steve Budsberg
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Flexion Extension ◽  
Before And After ◽  
Total Knee ◽  
Tibiofemoral Kinematics ◽  
The Relationship

SummaryObjective: To investigate the relationship between tibiofemoral kinematics before and after total knee replacement (TKR) in vitro.Animals: Eight canine hemipelves.Methods: A modified Oxford Knee Rig was used to place cadaveric limbs through a range of passive motion allowing the kinematics of the stifle to be evaluated. Four measurements were performed: a control stage, followed by a cranial cruciate transection stage, then following TKR with the musculature intact stage, and finally TKR with removal of limb musculature stage. Joint angles and translations of the femur relative to the tibia, including flexion-extension versus adduction-abduction, flexion-extension versus internal-external rotation, as well as flexion-extension versus each translation (cranial-caudal and lateral-medial) were calculated.Results: Significant differences were identified in kinematic data from limbs following TKR implantation as compared to the unaltered stifle. The TKR resulted in significant decreases in external rotation of the stifle during flexion-extension compared to the limb prior to any intervention, as well as increasing the abduction. The TKR significantly increased the caudal translation of the femur relative to the tibia compared to the unaltered limb. When compared with the cranial cruciate ligament-transection stage, TKR significantly decreased the ratio of the external rotation to flexion.Discussion: All three test periods showed significant differences from the unaltered stifle. The TKR did not completely restore the normal kinematics of the stifle.

Injury to the Glenohumeral Capsule During Anterior Dislocation Leads to Higher Joint Contact Forces During Simulated Clinical Exams

2011 ◽  
Author(s):  
Carrie A. Voycheck ◽  
Daniel P. Browe ◽  
Patrick J. McMahon ◽  
Richard E. Debski
Keyword(s):  
Glenohumeral Joint ◽  
External Rotation ◽  
Permanent Deformation ◽  
Supraspinatus Tendon ◽  
Contact Forces ◽  
Anterior Dislocation ◽  
Joint Stability ◽  
Articular Surfaces ◽  
Increased Risk ◽  
Glenohumeral Capsule

Glenohumeral joint stability is maintained by a combination of active and passive soft tissue structures and osteoarticular contact. Anatomical structures that contribute to each of these categories include the rotator cuff muscles, the glenohumeral capsule, and the contact between the articular surfaces of the humeral head and glenoid of the scapula, respectively. Dislocation may result in injury to one or more of these stabilizing components requiring the other structures to account for the deficit. For example, previous research has shown that a torn supraspinatus tendon results in increased bony contact forces during glenohumeral abduction. [1] Another common injury resulting from dislocation is permanent deformation of the glenohumeral capsule as the capsule is the primary static restraint to anterior translation in positions of external rotation. [2] Increased joint translations and rotations usually occur following permanent deformation [3] indicating a loss in joint stability provided by the capsule. These changes in joint kinematics following dislocation imply that differences in the contact forces between the humerus and scapula may exist as well. Irregular contact between two articular surfaces can lead to abnormal wear and an increased risk of osteoarthritis when left untreated. Therefore, the objective of this work was to assess the affect of anterior dislocation on glenohumeral joint stability by determining the in situ force in the glenohumeral capsule and the bony contact forces between the humerus and scapula during a simulated clinical exam at three joint positions in the intact and injured joint.

scholarly journals Direction of Capsular Strain Implies Surgical Repair Following Recurrent Anterior Shoulder Dislocation

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0011
Author(s):  
Tetsuya Takenaga ◽  
Masahito Yoshida ◽  
Calvin Chan ◽  
Volker Musahl ◽  
Albert Lin ◽  
...  
Keyword(s):  
Glenohumeral Joint ◽  
External Rotation ◽  
Reference State ◽  
Circular Statistics ◽  
Recoverable Strain ◽  
Glenohumeral Ligament ◽  
The Maximum Principle ◽  
Capsular Plication ◽  
Glenohumeral Capsule ◽  
Williams Test

Objectives: Capsular plication is often performed in addition to arthroscopic Bankart repair. However, little is known regarding the direction of capsular injury making the direction of plication fairly arbitrary. This study aimed to determine the optimal direction for capsular plication within four sub-regions of the inferior glenohumeral capsule following multiple dislocations. Methods: Seven fresh-frozen cadaveric shoulders (age range 48-66 yrs) were dissected free of all soft tissue except the glenohumeral capsule. A grid of strain markers was affixed to the anterior and posterior band (A/PB) of the inferior glenohumeral ligament (IGHL), and the axillary pouch. The position of the markers while the capsule was inflated with minimal pressure served as the reference state. The humerus and scapula were then mounted in a 6 degree-of-freedom robotic testing system. At 60 degrees of abduction and 60 degrees of external rotation of the glenohumeral joint, an anterior load was applied to reach an anterior translation of one half the maximum AP width of the glenoid plus 10 mm. This definition of dislocation resulted in non-recoverable strain and a reproducible Bankart lesion. Following 1, 2, 3, 4, 5 and 10 dislocations, the positions of the strain markers were again recorded with the capsule inflated. The difference in these positions compared to the reference state defined the non-recoverable strain. The strain map was split into four sub-regions, the anterior band of IGHL (AB), anterior axillary pouch (AA), posterior axillary pouch (PA), and the posterior band of IGHL (PB) (Fig. 1). The angle of deviation between each of the maximum principle strain vectors and the AB-IGHL or PB-IGHL for the anterior and posterior regions of the capsule were determined using ImageJ. Circular statistics were employed to calculate mean direction of each sub-region and a Watson-Williams test was performed to compare mean direction among each dislocation with significance set at p < 0.05. The mean direction of all strain vectors in each sub-region was categorized as parallel or perpendicular to the AB-IGHL or PB-IGHL serving as the clinical reference. Direction ranging from 0 to 45 or 135 to 180 degrees was categorized as parallel. Direction ranging between 45 and 135 degrees was categorized as perpendicular. Results: The direction of 81.8% of the AB sub-regions was categorized as parallel and 18.2% categorized as perpendicular to the AB-IGHL. Direction of 61.3% of the AA sub-region was categorized as parallel (Table 1) and 38.7% categorized as perpendicular to AB-IGHL. The direction of 33.3% of the PA sub-region was categorized as parallel and 66.7% categorized as perpendicular to the PB-IGHL. The direction of 21.4% of PB sub-region was categorized as parallel and 78.6% categorized as perpendicular to PB-IGHL. A Watson-Williams test demonstrated that the direction of 81.3% of the sub-regions were not significantly different (p > 0.05) among dislocations for each specimen (Table 1). Conclusion: The non-recoverable strain in most of the AB and AP sub-regions were categorized as parallel to the AB-IGHL while for the PA and PB sub-regions mostly perpendicular to the PB-IGHL. These findings imply that it may be more optimal to plicate the anteroinferior capsule parallel to the AB-IGHL while posteroinferior capsular plication, which is often not classically considered for plication in the setting of anterior instability, may also be necessary and best performed perpendicular to the PB-IGHL. [Figure: see text][Table: see text]

A Method for Predicting Collagen Fiber Alignment in the Glenohumeral Capsule During Clinically Relevant Deformations

2012 ◽  
Author(s):  
Carrie A. Rainis ◽  
Rouzbeh Amini ◽  
Richard E. Debski
Keyword(s):  
Collagen Fiber ◽  
Soft Tissues ◽  
Three Dimensional ◽  
Constitutive Models ◽  
Complex Loading ◽  
Anterior Dislocation ◽  
Fiber Alignment ◽  
Glenohumeral Ligament ◽  
Glenohumeral Capsule ◽  
Collagen Fiber Alignment

Injury to the anteroinferior (anterior band of the inferior glenohumeral ligament (AB-IGHL) and axillary pouch) glenohumeral capsule is a common result of anterior dislocation [1]. Validated finite element models of the capsule can be used to address research questions regarding diagnostic and repair techniques targeted to this region of the capsule. However, these models require adequate constitutive models to describe capsule behavior. Structural models have improved predictions of capsule behavior compared to phenomenological models [2] but current experimental techniques used to measure fiber distributions in biologic soft tissues require that the sample be planar and cannot be performed on three-dimensional structures. Although recent work has demonstrated that the fiber kinematics in the capsule do not precisely follow the global tissue deformation [3], the affine assumption is presently the best approximation to provide initial insight into changes in collagen fiber alignment under moderate deformations. The collagen fibers in localized areas of planar samples from the anteroinferior capsule align with the direction of loading [4,5]; however, their behavior may be quite different during the complex loading conditions experienced by the intact capsule. Therefore, the objective of this work was to computationally project planar fiber distribution information to the three-dimensional glenohumeral capsule and use the affine assumption to quantify the change in fiber alignment of the anteroinferior glenohumeral capsule from an inflated reference state to three clinically relevant joint positions.

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