scholarly journals Anatomy and Biomechanics of the Unstable Shoulder

2017 ◽  
Vol 11 (1) ◽  
pp. 919-933 ◽  
Author(s):  
Ricardo Cuéllar ◽  
Miguel Angel Ruiz-Ibán ◽  
Adrián Cuéllar
Keyword(s):  
Surgical Technique ◽  
Shoulder Instability ◽  
Shoulder Joint ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Therapeutic Implications ◽  
Bony Anatomy ◽  
Evidence Grade ◽  
And Function ◽  
Published Research

Purpose:To review the anatomy of the shoulder joint and of the physiology of glenohumeral stability is essential to manage correctly shoulder instability.Methods:It was reviewed a large number of recently published research studies related to the shoulder instability that received a higher Level of Evidence grade.Results:It is reviewed the bony anatomy, the anatomy and function of the ligaments that act on this joint, the physiology and physiopathology of glenohumeral instability and the therapeutic implications of the injured structures.Conclusion:This knowledge allows the surgeon to evaluate the possible causes of instability, to assess which are the structures that must be reconstructed and to decide which surgical technique must be performed.

Diagnosis of shoulder instability in dogs and cats: a retrospective study

1998 ◽  
Vol 34 (1) ◽  
pp. 42-54 ◽  
Author(s):  
JF Bardet
Keyword(s):  
Shoulder Instability ◽  
Shoulder Joint ◽  
Glenohumeral Joint ◽  
Degenerative Joint Disease ◽  
The Body ◽  
Joint Disease ◽  
Glenohumeral Instability ◽  
The Past ◽  
Arthroscopic Findings ◽  
Stability Results

The glenohumeral joint is a remarkable articulation providing the greatest range of motion of any joint in the body. Glenohumeral stability results from several mechanisms, including those that do not require expenditure of energy by muscle ("passive mechanisms") and those that do ("active mechanisms"). Glenohumeral instability has been recognized in 47 shoulders of 45 dogs and one cat. Cases are presented because of chronic foreleg lameness. Shoulder joint pain is obviated by the orthopedic examination. Only 57% of the involved shoulders presented with degenerative joint disease. Signs of instability are recognized under anesthesia using a craniocaudal or mediolateral drawer sign or both. This report describes the radiographic and arthroscopic findings of shoulder instability. Arthroscopy of the shoulder joint allows identification of all intra-articular pathologies. Shoulder instability, not fully recognized in the past, appears to be the most common cause of shoulder lameness in the dog.

scholarly journals Indication for Computed Tomography Scan in Shoulder Instability: Sensitivity and Specificity of Standard Radiographs to Predict Bone Defects After Traumatic Anterior Glenohumeral Instability

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773366 ◽  
Author(s):  
Audrey Delage Royle ◽  
Frédéric Balg ◽  
Martin J. Bouliane ◽  
Fanny Canet-Silvestri ◽  
Laurianne Garant-Saine ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Loss ◽  
Ct Scan ◽  
Shoulder Instability ◽  
Treatment Algorithm ◽  
Bone Defects ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Predictive Values ◽  
Sensitivity Specificity

Background: Quantifying glenohumeral bone loss is key in preoperative surgical planning for a successful Bankart repair. Hypothesis: Simple radiographs can accurately measure bone defects in cases of recurrent shoulder instability. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A true anteroposterior (AP) view, alone and in combination with an axillary view, was used to evaluate the diagnostic properties of radiographs compared with computed tomography (CT) scan, the current gold standard, to predict significant bone defects in 70 patients. Sensitivity, specificity, and positive and negative predictive values were evaluated and compared. Results: Detection of glenoid bone loss on plain film radiographs, with and without axillary view, had a sensitivity of 86% for both views and a specificity of 73% and 64% with and without the axillary view, respectively. For detection of humeral bone loss, the sensitivity was 8% and 17% and the specificity was 98% and 91% with and without the axillary view, respectively. Regular radiographs would have missed 1 instance of significant bone loss on the glenoid side and 20 on the humeral side. Interobserver reliabilities were moderate for glenoid detection (κ = 0.473-0.503) and poor for the humeral side (κ = 0.278-0.336). Conclusion: Regular radiographs showed suboptimal sensitivity, specificity, and reliability. Therefore, CT scan should be considered in the treatment algorithm for accurate quantification of bone loss to prevent high rates of recurrent instability.

scholarly journals Rotator interval closure: inconsistent techniques and its association with anterior instability. A literature review

2019 ◽  
Author(s):  
Shahin Nizarali Karovalia ◽  
David J. Collett ◽  
Desmond Bokor
Keyword(s):  
Surgical Technique ◽  
Shoulder Instability ◽  
Glenohumeral Joint ◽  
Clinical Effects ◽  
Rotator Interval ◽  
Anterior Instability ◽  
New Classification ◽  
Glenohumeral Instability ◽  
Shoulder Stabilization ◽  
Anterior Glenohumeral Instability

The Rotator interval (RI) is an anatomic space in the anterosuperior part of the glenohumeral joint. An incompetent or lax RI has been implicated in various conditions of shoulder instability and therefore RI has been frequently touted as an area that is important in preserving stability of the shoulder. Biomechanical studies have shown that repair of RI ligamentous and capsular structures decreases glenohumeral joint laxity in various directions. Clinical studies have reported successful outcomes after repair or plication of these structures in patients undergoing shoulder stabilization procedures. Although varieties of methods have been described for its closure, the optimal surgical technique is unclear with various inconsistencies in incorporation of the closure tissue. This in particular makes the analysis of the RI closure very difficult. The purposes of this study is to review the structures of the RI and their contribution to shoulder instability, to discuss the biomechanical and clinical effects of plication of RI structures in particular to anterior glenohumeral instability, to delineate the differences between an arthroscopic and open RI closure. Additionally, we have proposed a new classification system describing various techniques used during RI closure.

Beach Chair Versus Lateral Decubitus Position: Differences in Suture Anchor Position and Number During Arthroscopic Anterior Shoulder Stabilization

2021 ◽  
pp. 036354652110137
Author(s):  
Jacqueline E. Baron ◽  
Kyle R. Duchman ◽  
Carolyn M. Hettrich ◽  
Natalie A. Glass ◽  
Shannon F. Ortiz ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Suture Anchor ◽  
Patient Positioning ◽  
Labral Tear ◽  
Anterior Shoulder Instability ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Lateral Decubitus ◽  
Beach Chair

Background: Arthroscopic shoulder capsulolabral repair using glenoid-based suture anchor fixation provides consistently favorable outcomes for patients with anterior glenohumeral instability. To optimize outcomes, inferior anchor position, especially at the 6-o’clock position, has been emphasized. Proponents of both the beach-chair (BC) and lateral decubitus (LD) positions advocate that this anchor location can be consistently achieved in both positions. Hypothesis: Patient positioning would be associated with the surgeon-reported labral tear length, total number of anchors used, number of anchors in the inferior glenoid, and placement of an anchor at the 6-o’clock position. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study was a cross-sectional analysis of a prospective multicenter cohort of patients undergoing primary arthroscopic anterior capsulolabral repair. Patient positioning in the BC versus LD position was determined by the operating surgeon and was not randomized. At the time of operative intervention, surgeon-reported labral tear length, total anchor number, anchor number in the inferior glenoid, and anchor placement at the 6-o’clock position were evaluated between BC and LD cohorts. Descriptive statistics and between-group differences (continuous: t test [normal distributions], Wilcoxon rank sum test [nonnormal distributions], and chi-square test [categorical]) were assessed. Results: In total, 714 patients underwent arthroscopic anterior capsulolabral repair (BC vs LD, 406 [56.9%] vs 308 [43.1%]). The surgeon-reported labral tear length was greater for patients having surgery in the LD position (BC vs LD [mean ± SD], 123.5°± 49° vs 132.3°± 44°; P = .012). The LD position was associated with more anchors placed in the inferior glenoid and more frequent placement of anchors at the 6-o’clock (BC vs LD, 22.4% vs 51.6%; P < .001). The LD position was more frequently associated with utilization of ≥4 total anchors (BC vs LD, 33.5% vs 46.1%; P < .001). Conclusion: Surgeons utilizing the LD position for arthroscopic capsulolabral repair in patients with anterior shoulder instability more frequently placed anchors in the inferior glenoid and at the 6-o’clock position. Additionally, surgeon-reported labral tear length was longer when utilizing the LD position. These results suggest that patient positioning may influence the total number of anchors used, the number of anchors used in the inferior glenoid, and the frequency of anchor placement at the 6 o’clock position during arthroscopic capsulolabral repair for anterior shoulder instability. How these findings affect clinical outcomes warrants further study. Registration: NCT02075775 (ClinicalTrials.gov identifier)

scholarly journals Recurrent anteroinferior glenohumeral instability resulting from a proximal humerus osteochondroma

2017 ◽  
Vol 3 (1) ◽  
pp. 18
Author(s):  
Marlis T. Sabo ◽  
Stephen J. French
Keyword(s):  
Range Of Motion ◽  
Shoulder Instability ◽  
Shoulder Joint ◽  
Proximal Humerus ◽  
Young Male ◽  
Clinical Event ◽  
Glenohumeral Instability ◽  
Rapid Improvement ◽  
Shoulder Range Of Motion ◽  
Shoulder Range

Shoulder instability is a common clinical event, with most causes due to capsulolabral pathology within the shoulder joint. We present a case of a young male with chronic recurrent anteroinferior instability due to impingement of a proximal humerus osteochondroma on the glenoid during shoulder range of motion. Excision of the osteochondroma and repair of the anteroinferior capsule to the humeral neck successfully treated the instability and enabled a rapid improvement in patient function.

Location of the Glenoid Defect in Shoulders With Recurrent Posterior Glenohumeral Instability

2019 ◽  
Vol 47 (13) ◽  
pp. 3051-3056 ◽  
Author(s):  
Travis J. Dekker ◽  
Liam A. Peebles ◽  
Brandon T. Goldenberg ◽  
Peter J. Millett ◽  
James P. Bradley ◽  
...  
Keyword(s):  
Bone Loss ◽  
Bone Defect ◽  
Shoulder Instability ◽  
Bone Defects ◽  
Posterior Shoulder Instability ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Glenoid Defect ◽  
Posterior Shoulder ◽  
The Mean

Background: Posterior glenoid bone deficiency is an increasingly recognized entity in the setting of recurrent posterior shoulder instability; however, little is known about the subject. Due to the paucity of literature on posterior bone loss, historical comparisons with anterior bone loss may not be fully accurate. Purpose: To systematically describe the morphology of posterior bone defects in the setting of recurrent posterior shoulder instability based on several quantitative parameters, including the mean location, orientation, and extent of bone loss on a clockface model, as well as the angle of the defect relative to the long axis of the glenoid. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Three-dimensional reconstructed computed tomography scans of serially collected patients with a history of recurrent posterior shoulder instability were evaluated by 3 separate reviewers. The posterior glenoid bone defect was characterized using the following measures: (1) the mean lesion location and orientation based on a clockface model with 6 o’clock denoted as inferior and 9 o’clock as directly posterior for all patients; (2) the total extent of the posterior bone defect based on the clockface; and (3) the average angle of the bone loss relative to the long axis of the glenoid. Results: A total of 70 male patients and 1 female patient with a mean age of 29.3 years (range, 24.4-35.1 years) were included in the analysis. The mean clockface location of the posterior glenoid defect originated at 6:44 (range, 4:16-8:12) and extended to a mean of 9:28 (range, 7:02-10:38). The mean extent of the posterior glenoid defect was 2:43 (range, 1:08-4:50), which corresponds to a mean total bone loss arc of 81.5° (range, 34.2°-144.9°), nearly 1 quadrant of the glenoid. Posterior bone loss occurred in a posteroinferior direction at a mean angle of 30.7° (range, 8.0°-80.0°) relative to the long axis of the glenoid. Conclusion: Posterior bone defects in the setting of posterior shoulder instability most commonly occur in the posteroinferior quadrant of the glenoid and extend on average from 6:44 to 9:28 (81.5° total degrees of arc) on a clockface model. Posterior bone loss occurs at a mean of 30° off the long axis of the glenoid in a posteroinferior direction, which is historically different from anterior bone loss, which occurs parallel to the long axis of the glenoid. This study serves to highlight the location and orientation of bone loss that one can expect in a patient with recurrent posterior shoulder instability, although additional work is needed to assess why this develops.

scholarly journals Management of Humeral and Glenoid Bone Loss in Recurrent Glenohumeral Instability

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Randy Mascarenhas ◽  
Jamie Rusen ◽  
Bryan M. Saltzman ◽  
Jeff Leiter ◽  
Jaskarndip Chahal ◽  
...  
Keyword(s):  
Bone Loss ◽  
Physical Examination ◽  
Shoulder Instability ◽  
Humeral Head ◽  
Shoulder Joint ◽  
Radiological Imaging ◽  
Glenohumeral Instability ◽  
Coracoid Transfer ◽  
Recurrent Shoulder Instability ◽  
Transfer Procedures

Recurrent shoulder instability and resultant glenoid and humeral head bone loss are not infrequently encountered in the population today, specifically in young, athletic patients. This review on the management of bone loss in recurrent glenohumeral instability discusses the relevant shoulder anatomy that provides stability to the shoulder joint, relevant history and physical examination findings pertinent to recurrent shoulder instability, and the proper radiological imaging choices in its workup. Operative treatments that can be used to treat both glenoid and humeral head bone loss are outlined. These include coracoid transfer procedures and allograft/autograft reconstruction at the glenoid, as well as humeral head disimpaction/humeroplasty, remplissage, humeral osseous allograft reconstruction, rotational osteotomy, partial humeral head arthroplasty, and hemiarthroplasty on the humeral side. Clinical outcomes studies reporting general results of these techniques are highlighted.

scholarly journals The traditional experience strategy (TES) and combined ultrasonography examination (CUE) for the treatment of lateral compression type 1 pelvic fractures: a historical control study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hai Huang ◽  
Bin-Fei Zhang ◽  
Ping Liu ◽  
Hong-Li Deng ◽  
Peng-Fei Wang ◽  
...  
Keyword(s):  
Pelvic Fractures ◽  
Definitive Treatment ◽  
Lateral Compression ◽  
Level Of Evidence ◽  
Conservative Group ◽  
Medical Records System ◽  
The Stability ◽  
And Function ◽  
Compression Type

Abstract Background It is difficult to judge the stability of lateral compression type-1 (LC-1) pelvic fracture, as it is often based on static images of the pelvis. Compared with the traditional experience strategy, ultrasonography examination may be able to distinguish operative and conservative patients before definitive treatment. However, in previous studies, we have not compared the outcomes between traditional experience strategy (TES group) and combined ultrasonography examination (CUE group). Thus, the aim of the study is comparing the differences between TES and CUE strategy, to identify the value of ultrasonography examination. Methods Medical records system for patients with LC-1 pelvic fractures who were treated with TES and CUE strategy were included. Patients’ baseline characteristics, treatment strategy, and function were recorded at follow-up. Functional outcomes were evaluated using the Majeed grading system. Results In total, 77 patients with LC-1 pelvic fractures were included in the study. There were 42 and 35 patients in TES and CUE group, respectively. Compared to TES group (69 %), there were less proportion patients chosen the operative treatment in CUE group (43 %, P = 0.021). The volume of intraoperative blood loss in CUE operative group was more than TES operative group (P = 0.037). There were more patients with complete sacral fracture in CUE operative group than TES operative group (P = 0.002). The Majeed scores in CUE conservative group was higher than TES conservative group (P = 0.008). The overall Majeed scores in CUE group was higher than that in TES group (P = 0.039). Conclusions The ultrasonography examination could relatively accurately identify the unstable LC-1 pelvis than the traditional experience strategy, the operative rate could be reduced and the overall function of LC-1 patients could be improved under the ultrasonography examination. Level of evidence Level III.

Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications

2020 ◽  
Vol 41 (1) ◽  
pp. 59-71 ◽  
Author(s):  
Torsten Schlosshauer ◽  
Marcus Kiehlmann ◽  
Diana Jung ◽  
Robert Sader ◽  
Ulrich M Rieger
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Surgical Technique ◽  
Significant Risk ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Wound Healing Problems ◽  
Bariatric Patients

Abstract Background Post-bariatric patients present a surgical challenge within abdominoplasty because of residual obesity and major comorbidities. In this study, we analyzed complications following abdominoplasty in post-bariatric patients and evaluated potential risk factors associated with these complications. Objectives The authors sought to determine the complications and risk factors following abdominoplasty in post-bariatric patients. Methods A retrospective study of patients who underwent abdominoplasty was performed from January 2009 to December 2018 at our institution. Variables analyzed were sex, age, body mass index (BMI), smoking, surgical technique, operative time, resection weight, drain output, and complications. Results A total of 406 patients were included in this study (320 female and 86 male) with a mean age of 44.4 years and a BMI of 30.6 kg/m2. Abdominoplasty techniques consisted of traditional (64.3%), fleur-de-lis technique (27.3%), and panniculectomy without umbilical displacement (8.4%). Overall complications recorded were 41.9%, the majority of these being wound-healing problems (32%). Minor and major complications were found in 29.1% and 12.8% of patients, respectively. A BMI value of ≥30 kg/m2 was associated with an increased risk for wound-healing problems (P = 0.001). The frequency of total complications was significantly related to age (P = 0.007), BMI (P = 0.004), and resection weight (P = 0.001). Abdominoplasty technique tended to influence total complications. Conclusions This study demonstrates in a fairly large sample of post-bariatric patients (n = 406) that abdominoplasty alone can be performed safely, with an acceptable complication rate. Age, BMI, and resection weight are shown to be significant risk factors for total complications. The role of surgical technique needs to be evaluated further. Level of Evidence: 4

scholarly journals Combined Hip Abductor and External Rotator Strengthening and Hip Internal Rotator Stretching Improves Pain and Function in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial With Crossover Design

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712198972
Author(s):  
Anis Jellad ◽  
Amine Kalai ◽  
Mohamed Guedria ◽  
Mahbouba Jguirim ◽  
Sana Elmhamdi ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Group Standard ◽  
Hip Muscle ◽  
And Function

Background: Active rehabilitation has an important role in the management of patellofemoral pain syndrome (PFPS). Although some studies have shown the benefit of hip-muscle strengthening, the effect of combining hip-muscle stretching with strengthening has not yet been defined. Purpose: To evaluate the effect of combined strengthening of the hip external rotators and abductors and stretching of the hip internal rotators on pain and function in patients with PFPS. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 109 patients with PFPS (75 female and 34 male; mean age, 31.6 ± 10.8 years) were first randomly assigned to protocol A (n = 67) of the A-B arm (AB group; standard rehabilitation) or protocol B (n = 42) of the B-A arm (BA group; standard rehabilitation with strengthening of the hip external rotators and abductors and stretching of the hip internal rotators). Each protocol consisted of 3 sessions a week for 4 weeks. After a washout period, corresponding to a symptom-free period, rehabilitation programs were crossed over. A visual analog scale (VAS) evaluating perceived pain, the Functional Index Questionnaire (FIQ), and the Kujala score were administered at baseline, the end of each rehabilitation protocol, and 12 weeks after the completion of the second protocol for each group. Results: Until the final follow-up, VAS, FIQ, and Kujala scores were significantly improved in both the A-B and B-A arms ( P < .05 for all). Compared with protocol A, protocol B provided significant improvement in terms of pain and function in both the BA (VAS and Kujala; P < .001) and AB (VAS and Kujala; P < .001) groups. Conclusion: Combined strengthening of the hip abductors and external rotators with stretching of the hip internal rotators provided better outcomes, which were maintained for at least 12 weeks, in terms of pain and function in patients with PFPS.

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