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.

scholarly journals A Rare Complication of Tuberculous Meningitis Pediatric Anterior Glenohumeral Instability

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Kerem Bilsel ◽  
Mehmet Erdil ◽  
Mehmet Elmadag ◽  
Hasan H. Ceylan ◽  
Derya Celik ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Tuberculous Meningitis ◽  
Shoulder Instability ◽  
Rare Complication ◽  
Central Nervous System Infection ◽  
Arthroscopic Stabilization ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Rehabilitation Protocols ◽  
Anterior Glenohumeral Instability

Dislocation and instability of the shoulder joint are rare occurrences in childhood. Traumatic, infectious, congenital, and neuromuscular causes of pediatric recurrent shoulder dislocations are reported before. Central nervous system infection in infancy may be a reason for shoulder instability during childhood. This situation, which causes a disability for children, can be treated successfully with arthroscopic stabilization of the shoulder and postoperative effective rehabilitation protocols. Tuberculous meningitis may be a reason for neuromuscular shoulder instability. We describe a 12-year-old child with a recurrent anterior instability of the shoulder, which developed after tuberculous meningitis at 18 months of age. We applied arthroscopic treatment and stabilized the joint.

scholarly journals Prospective Evaluation of Glenoid Bone Loss After First-time and Recurrent Anterior Glenohumeral Instability Events

2019 ◽  
Vol 47 (5) ◽  
pp. 1082-1089 ◽  
Author(s):  
Jonathan F. Dickens ◽  
Sean E. Slaven ◽  
Kenneth L. Cameron ◽  
Adam M. Pickett ◽  
Matthew Posner ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Recurrent Instability ◽  
History Of ◽  
Anterior Glenohumeral Instability ◽  
First Time

Background: Determining the amount of glenoid bone loss in patients after anterior glenohumeral instability events is critical to guiding appropriate treatment. One of the challenges in treating the shoulder instability of young athletes is the absence of clear data showing the effect of each event. Purpose: To prospectively determine the amount of bone loss associated with a single instability event in the setting of first-time and recurrent instability. Study Design: Cohort study; Level of evidence, 2. Methods: The authors conducted a prospective cohort study of 714 athletes surveilled for 4 years. Baseline assessment included a subjective history of shoulder instability. Bilateral noncontrast shoulder magnetic resonance imaging (MRI) was obtained for all participants with and without a history of previous shoulder instability. The cohort was prospectively followed during the study period, and those who sustained an anterior glenohumeral instability event were identified. Postinjury MRI with contrast was obtained and compared with the screening MRI. Glenoid width was measured for each patient’s pre- and postinjury MRI. The projected total glenoid bone loss was calculated and compared for patients with a history of shoulder instability. Results: Of the 714 athletes (1428 shoulders) who were prospectively followed during the 4-year period, 22 athletes (23 shoulders) sustained a first-time anterior instability event (5 dislocations, 18 subluxations), and 6 athletes (6 shoulders) with a history of instability sustained a recurrent anterior instability event (1 dislocation, 5 subluxations). On average, there was statistically significant glenoid bone loss (1.84 ± 1.47 mm) after a single instability event ( P < .001), equivalent to 6.8% (95% CI, 4.46%-9.04%; range, 0.71%-17.6%) of the glenoid width. After a first-time instability event, 12 shoulders (52%) demonstrated glenoid bone loss ≥5% and 4 shoulders, ≥13.5%; no shoulders had ≥20% glenoid bone loss. Preexisting glenoid bone loss among patients with a history of instability was 10.2% (95% CI, 1.96%-18.35%; range, 0.6%-21.0%). This bone loss increased to 22.8% (95% CI, 20.53%-25.15%; range, 21.2%-26.0%) after additional instability ( P = .0117). All 6 shoulders with recurrent instability had ≥20% glenoid bone loss. Conclusion: Glenoid bone loss of 6.8% was observed after a first-time anterior instability event. In the setting of recurrent instability, the total calculated glenoid bone loss was 22.8%, with a high prevalence of bony Bankart lesions (5 of 6). The findings of this study support early stabilization of young active patients after a first-time anterior glenohumeral instability event.

scholarly journals Prospective Evaluation of Glenoid Bone Loss After First-Time and Recurrent Anterior Glenohumeral Instability Events

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0009 ◽  
Author(s):  
Jonathan F. Dickens ◽  
Sean E. Slaven ◽  
Kenneth L. Cameron ◽  
Adam M. Pickett ◽  
Matthew A. Posner ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Post Injury ◽  
Recurrent Instability ◽  
History Of ◽  
Anterior Glenohumeral Instability ◽  
First Time

Objectives: Determining the amount of glenoid bone loss in patients following anterior glenohumeral instability events is critical to guiding appropriate treatment. One of the challenges in managing shoulder instability in young athletes is the absence of clear data showing the impact of each event. The purpose of this study was to prospectively determine the amount of bone loss associated with a single instability event, in the setting of both first-time and recurrent instability. Methods: We conducted a prospective cohort study of 714 athletes followed for four years. Baseline assessment included a subjective history of shoulder instability. Bilateral shoulder MRIs were obtained in all participants with and without a history of previous shoulder instability. The cohort was prospectively followed during the study period and those who sustained an anterior glenohumeral instability event were identified. A post-injury MRI was obtained and compared to the screening MRI. Glenoid width was measured for each patient’s pre- and post-injury MRI. The projected total glenoid bone loss was calculated and compared for patients with a prior history of shoulder instability. Results: Of the 714 athletes that were prospectively followed during the four-year period, 23 shoulders in 22 subjects sustained a first-time anterior instability event (5 dislocations, 18 subluxations), and six subjects with a previous history of instability sustained a recurrent anterior instability event (1 dislocation, 5 subluxations). On average, there was statistically significant glenoid bone loss (1.84 ± 1.47 mm) following a single instability event (p<0.001), equivalent to 6.8% (95% CI: 4.46%, 9.04%, range 0.71%-17.6%) of the glenoid width. Twelve shoulders (52%) demonstrated glenoid bone loss ≥ 5%, 4 shoulders demonstrated glenoid bone loss ≥13.5% and no shoulders had ≥20% glenoid bone loss after a first-time instability event. Pre-existing glenoid bone loss in subjects with a history of instability was 10.2% (95% CI: 1.96%, 18.35%, range 0.6% - 21.0%). This bone loss increased to 22.8% (95% CI: 20.53%, 25.15%, range 21.2% to 26.0%) following an additional instability event (P=0.0117). All six shoulders with recurrent instability had >20% glenoid bone loss. Conclusion: Glenoid bone loss of 6.8% was observed after a first-time anterior instability event. In the setting of recurrent instability, the total calculated glenoid bone loss was 22.8% with a high prevalence of bony Bankart lesions (5/6). The findings of this study support early stabilization of young, active subjects following a first-time anterior glenohumeral instability event. [Figure: see text][Table: see text]

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 The Interrater Reliability of the Load and Shift Test for Anterior Shoulder Instability: A Technical Report

2010 ◽  
Author(s):  
Morey Kolber ◽  
Melissa Carrao
Keyword(s):  
Shoulder Instability ◽  
Repeated Measures ◽  
Interrater Reliability ◽  
Glenohumeral Joint ◽  
Anterior Shoulder Instability ◽  
Clinical Test ◽  
Anterior Instability ◽  
Functional Impairments ◽  
Special Equipment ◽  
Anterior Translation

Background: Shoulder disorders affect up to 67% of the adult population at some point in their lifetime. The shoulder complex ranks third, trailing low back and neck pain, in musculoskeletal disorders for which individuals seek physical rehabilitation. The assessment of shoulder stability is an integral component of the patient examination, as it may assist the clinician in making a diagnosis, measuring improvement or deterioration, and determining functional impairments. Reliable tests and measurements are therefore essential to both the clinician and researcher desiring to objectively monitor disease progression, outcomes, and mobility impairments. Many of the currently used clinical tests for anterior instability are documented based on a dichotomous outcome, thus do not provide a means of quantifying or ranking the degree of anterior translation associated with the instability. The load and shift test has been described in textbooks and research investigations as a method to quantify (rank) anterior shoulder instability and/or translation at the glenohumeral joint. This test is attractive clinically, as it requires no special equipment or space, thus may be utilized in multiple settings and without cost; however, few studies have investigated the interrater reliability of this test. Purpose: The purpose of this investigation was to determine the interrater reliability of the seated load and shift test using a 4-level grading criteria. Method: Two investigators performed the load and shift test on the non-dominant shoulder of 29 asymptomatic female participants in a repeated measures intrasession design. Each investigator was blinded to the results and the order of testing was counterbalanced to minimize potential bias. Results: Results indicated good interrater reliability with an Intraclass Correlation Coefficient (2, 1) (95% CI) = 0.80 (0.61, 0.90). Conclusion: The load and shift test appears to be a reliable clinical test for detecting and quantifying anterior translation of the glenohumeral joint when using the grading criteria outlined in this investigation. Shoulder translation when excessive is associated with shoulder instability, thus this test may prove valuable as a measurement of anterior instability. Recommendations: Future investigations are needed to determine the reliability and validity of this test among a symptomatic population and including a male cohort.

scholarly journals Bristow-Latarjet Technique: Still a Very Successful Surgery for Anterior Glenohumeral Instability - A Forty Year One Clinic Experience

2015 ◽  
Vol 3 (2) ◽  
pp. 310-314 ◽  
Author(s):  
Vilson Ruci ◽  
Artid Duni ◽  
Alfred Cake ◽  
Dorina Ruci ◽  
Julian Ruci
Keyword(s):  
Functional Outcomes ◽  
Glenohumeral Joint ◽  
Latarjet Procedure ◽  
Glenohumeral Instability ◽  
Clinic Experience ◽  
Operative Result ◽  
The Mean ◽  
Clinical Records ◽  
Anterior Glenohumeral Instability

AIM: To evaluate the functional outcomes of the Bristow-Latarjet procedure in patients with recurrent anterior glenohumeral instability.PATIENTS AND METHODS: Personal clinical records of 42 patients with 45 operated shoulders were reviewed retrospectively. Patient age at time of first dislocation, injury mechanism, and number of recurring dislocations before surgery were recorded. The overall function and stability of the shoulder was evaluated.RESULTS: Thirty five (78%) of the scapulohumeral humeral instabilities were caused by trauma. The mean number of recurring dislocations was 9 (95% confidence interval [CI], 0–18); one patient had had 17 recurrences. Mean follow-up 46 months (95% CI, 16-88). No dislocation happened postoperatively. Four patients have fibrous union (9%). Only two had clinical sign of pain and discomfort. One of them was reoperated for screw removal with very good post-operative result. The overall functional outcome was good, with a mean Rowe score of 88 points (95% CI, 78–100). Scores of 27 (64%) of the patients were excellent, 9 (22%) were good, 4 (9.5%) were fair, and 2 (4.5%) were poor.CONCLUSION: The Bristow-Latarjet procedure is a very good surgical treatment for recurrent anterior-inferior instability of the glenohumeral joint. It must not be used for multidirectional instability or psychogenic habitual dislocations.

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