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

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.

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

Advances in Bioengineering ◽

10.1115/imece2003-43137 ◽

2003 ◽

Cited By ~ 1

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.

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Effects of Simulated Injury on Tissue Deformation and Mechanical Properties of the Anteroinferior Glenohumeral Capsule

ASME 2008 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2008-193013 ◽

2008 ◽

Cited By ~ 1

Author(s):

Carrie A. Voycheck ◽

Andrew J. Brown ◽

Patrick J. McMahon ◽

Richard E. Debski

Keyword(s):

Mechanical Properties ◽

Glenohumeral Joint ◽

Permanent Deformation ◽

Tensile Elongation ◽

The Body ◽

Joint Stability ◽

Glenohumeral Ligament ◽

Inferior Glenohumeral Ligament ◽

Patients Experience ◽

Repair Techniques

The glenohumeral joint is the most dislocated major joint in the body with most dislocations occurring anteriorly. [1] The anterior band of the inferior glenohumeral ligament (AB-IGHL) is the primary passive restraint to dislocation and experiences the highest strains during these events. [2,3] It has been found that injuries to the capsule following dislocation include permanent deformation, which increases joint mobility and contributes to recurrent instability. [4] Many current surgical repair techniques focus on plicating redundant tissue following injury. However, these techniques are inadequate as 12–25% of patients experience pain and instability afterwards and thus may not fully address all capsular tissue pathologies resulting from dislocation. [5] Therefore, the objective of this study was to determine the effect of permanent deformation on the mechanical properties of the AB-IGHL during a tensile elongation. Improved understanding of the capsular tissue pathologies resulting from dislocation may lead to new repair techniques that better restore joint stability and improve patient outcome by placating the capsule in specific locations.

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

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80142 ◽

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.

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Arthroscopic release of subscapularis tendon combined with inferior glenohumeral ligament for resistant frozen shoulder: A retrospective study

Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology ◽

10.1016/j.asmart.2017.05.262 ◽

2017 ◽

Vol 9 ◽

pp. 112

Author(s):

Hui Qiang ◽

Min Feng

Keyword(s):

Retrospective Study ◽

Frozen Shoulder ◽

Subscapularis Tendon ◽

Glenohumeral Ligament ◽

Arthroscopic Release ◽

Inferior Glenohumeral Ligament

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Shoulder Joint Position Sense in Injured and Noninjured Judo Athletes

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.18.2.29 ◽

2013 ◽

Vol 18 (2) ◽

pp. 29-33 ◽

Cited By ~ 1

Author(s):

Carly May Green ◽

Paul Comfort ◽

Lee Herrington

Keyword(s):

Outcome Measures ◽

Shoulder Joint ◽

External Rotation ◽

Position Sense ◽

Joint Position Sense ◽

Average Error ◽

Joint Position ◽

Joint Stability ◽

Shoulder Injury ◽

Judo Athletes

Context:A reduction in joint position sense (JPS) is sometimes a consequence of shoulder injury that may adversely affect the ability to maintain dynamic joint stability.Objective:To compare shoulder JPS between previously injured and noninjured judokas.Design:Cohort study.Participants:Twenty-nine noninjured subjects (10.93 ± 3.45 years) and eleven injured subjects (15.09 ± 3.39 years).Main Outcome Measures:JPS was tested at 45° and 80°of shoulder external rotation at 90° of abduction.Results:No signifcant difference in JPS was found between previously injured and noninjured judokas at either joint position.Conclusion:Despite evidence that JPS acuity decreases following shoulder injury, this study did not demonstrate a difference in average error between previously injured and noninjured judokas. Uncontrolled confounding factors, such as age and time since injury, may have affected the results. Sport-specifc shoulder joint loading patterns may also be an important factor that affects JPS.

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

The American Journal of Sports Medicine ◽

10.1177/03635465000280021001 ◽

2000 ◽

Vol 28 (2) ◽

pp. 200-205 ◽

Cited By ~ 52

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.

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Continuous Cervical Epidural Analgesia for Rehabilitation after Shoulder Surgery: A Retrospective Evaluation

January 2018 - Pain Physician ◽

10.36076/ppj.2009/12/189 ◽

2009 ◽

Vol 1;12 (1;1) ◽

pp. 189-194

Author(s):

Samer N. Narouze

Keyword(s):

Epidural Analgesia ◽

Range Of Motion ◽

Epidural Catheter ◽

Shoulder Joint ◽

External Rotation ◽

Frozen Shoulder ◽

Shoulder Surgery ◽

Forward Flexion ◽

Pain Scores ◽

The Mean

Background: Patients with frozen shoulder who fail conservative therapy need surgical treatment and aggressive post-operative rehabilitation. Objective: To evaluate the effect of continuous cervical epidural analgesia on pain scores and range of motion of the shoulder joint in patients undergoing surgery for treatment of refractory frozen shoulder. Methods: Twenty-one patients with refractory frozen shoulder who had failed conservative treatment and undergone surgical procedure (manipulation under anesthesia or capsular release) were identified and the data were collected retrospectively. These patients had cervical tunneled epidural catheter (TEC) placement for continuous infusion of a mixture of lowdose narcotic and local anesthetics at the time of surgery and were discharged home with the catheter in place. They were then involved in an active physical therapy program to increase the range of motion of the affected shoulder joint. The patients (N = 21) were followed for a median of 4.7 weeks. They were assessed for range of motion, function, visual analog pain scores (VAS), and opiate use before the surgery and after tunneled epidural catheter removal. Results: Statistically significant changes from the time of placement to the time of removal of the tunneled epidural catheter (TEC) were observed for VAS pain score and range of motion of the shoulder in forward flexion, external rotation, and internal rotation. The mean rate of change among the patients for pain score, forward flexion, external rotation, and internal rotation was also computed. The mean change per week in each of these 4 measurements significantly differed from zero. 33 percent of the patients returned to work within one week. Conclusion: Our data show that the continuous infusion of epidural opioids and local anesthetics through a tunneled cervical epidural catheter during the rehabilitation phase after shoulder surgery for adhesive capsulitis may be a safe and effective tool for post-operative pain control and to facilitate rehabilitation. Key words: Cervical epidural, epidural analgesia, shoulder surgery

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

Journal of Orthopaedic Research® ◽

10.1002/jor.20685 ◽

2008 ◽

Vol 26 (12) ◽

pp. 1598-1604 ◽

Cited By ~ 25

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

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

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53831 ◽

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.

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