Posterior Labral Injury and Glenohumeral Instability in Overhead Athletes

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Andrew J. Sheean ◽  
W. Benjamin Kibler ◽  
John Conway ◽  
James P. Bradley
Keyword(s):  
Glenohumeral Instability ◽  
Overhead Athletes ◽  
Labral Injury

scholarly journals Return to Preinjury Levels of Participation After Superior Labral Repair in Overhead Athletes: A Systematic Review

2015 ◽  
Vol 50 (7) ◽  
pp. 767-777 ◽  
Author(s):  
Aaron Sciascia ◽  
Natalie Myers ◽  
W. Ben Kibler ◽  
Timothy L. Uhl
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Shoulder Surgery ◽  
Labral Repair ◽  
Odds Ratios ◽  
Rates Of Return ◽  
Overhead Athletes ◽  
Full Participation ◽  
Overhead Throwing ◽  
Labral Injury

Context Athletes often preoperatively weigh the risks and benefits of electing to undergo an orthopaedic procedure to repair damaged tissue. A common concern for athletes is being able to return to their maximum levels of competition after shoulder surgery, whereas clinicians struggle with the ability to provide a consistent prognosis of successful return to participation after surgery. The variation in study details and rates of return in the existing literature have not supplied clinicians with enough evidence to give overhead athletes adequate information regarding successful return to participation when deciding to undergo shoulder surgery. Objective To investigate the odds of overhead athletes returning to preinjury levels of participation after arthroscopic superior labral repair. Data Sources The CINAHL, MEDLINE, and SPORTDiscus databases from 1972 to 2013. Study Selection The criteria for article selection were (1) The study was written in English. (2) The study reported surgical repair of an isolated superior labral injury or a superior labral injury with soft tissue debridement. (3) The study involved overhead athletes equal to or less than 40 years of age. (4) The study assessed return to the preinjury level of participation. Data Extraction We critically reviewed articles for quality and bias and calculated and compared odds ratios for return to full participation for dichotomous populations or surgical procedures. Data Synthesis Of 215 identified articles, 11 were retained: 5 articles about isolated superior labral repair and 6 articles about labral repair with soft tissue debridement. The quality range was 11 to 17 (42% to 70%) of a possible 24 points. Odds ratios could be generated for 8 of 11 studies. Nonbaseball, nonoverhead, and nonthrowing athletes had a 2.3 to 5.8 times greater chance of full return to participation than overhead/throwing athletes after isolated superior labral repair. Similarly, nonoverhead athletes had 1.5 to 3.5 times greater odds for full return than overhead athletes after labral repair with soft tissue debridement. In 1 study, researchers compared surgical procedures and found that overhead athletes who underwent isolated superior labral repair were 28 times more likely to return to full participation than those who underwent concurrent labral repair and soft tissue debridement (P < .05). Conclusions The rate of return to participation after shoulder surgery within the literature is inconsistent. Odds of returning to preinjury levels of participation after arthroscopic superior labral repair with or without soft tissue debridement are consistently lower in overhead/throwing athletes than in nonoverhead/nonthrowing athletes. The variable rates of return within each group could be due to multiple confounding variables not consistently accounted for in the articles.

Internal Impingement of the Shoulder

2008 ◽  
Vol 37 (5) ◽  
pp. 1024-1037 ◽  
Author(s):  
Benton E. Heyworth ◽  
Riley J. Williams
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Capsular Contracture ◽  
Rotator Cuff Tears ◽  
Scapular Dyskinesis ◽  
Glenohumeral Instability ◽  
Overhead Athletes ◽  
Internal Impingement ◽  
Results Of Treatment ◽  
Orthopaedic Literature

Internal impingement of the shoulder is a pathologic condition characterized by excessive or repetitive contact of the greater tuberosity of the humeral head with the posterosuperior aspect of the glenoid when the arm is abducted and externally rotated. This arm positioning leads to rotator cuff and glenoid labrum impingement by the bony structures of the glenohumeral joint. Although some degree of contact between these structures occurs under normal conditions, to date most of the orthopaedic literature has focused on internal impingement as a disease state that affects overhead athletes and is characterized by the development of articular-sided rotator cuff tears and posterosuperior labral lesions. The precise cause of these impingement lesions remains unclear. However, it is believed that varying degrees of glenohumeral instability, posterior capsular contracture, and scapular dyskinesis may play a role in the development of symptomatic internal impingement. The purpose of this article is to review the pathomechanics, clinical complaints, physical examination findings, and imaging findings that are associated with internal impingement. The results of treatment will be reviewed, and a diagnostic and therapeutic algorithm for the management of internal impingement is presented.

scholarly journals Arthroscopic Treatment of Multidirectional Glenohumeral Instability in Young Overhead Athletes

2009 ◽  
Vol 3 (1) ◽  
pp. 107-114 ◽  
Author(s):  
C. Voigt ◽  
A.P. Schulz ◽  
H. Lill
Keyword(s):  
High Performance ◽  
Glenohumeral Joint ◽  
Constant Score ◽  
Case Series ◽  
Return To Sports ◽  
Glenohumeral Instability ◽  
Overhead Athletes ◽  
Prospective Case Series ◽  
Rare Diagnosis

Purpose: This prospective case series evaluates the outcome, and the return to sports of young overhead athletes with a persistent, symptomatic multidirectional instability (MDI) with hyperlaxity type Gerber B5 treated with an arthroscopic anteroposteroinferior capsular plication and rotator interval closure. Methods: 9 young overhead athletes (10 shoulders) with the rare diagnosis of MDI (Gerber B5) and an indication for operative treatment, after a failed physiotherapy program were physically examined 3, 6 and 12 months postoperatively by a physical examination, and got a final phone interview after median 39 months. Results: At the final follow-up all patients were satisfied; Rowe Score showed 7 “excellent” and “good” results; Constant Score was “excellent” and “good” in 6, and “fair” in 1 patient. 7/9 returned to their previous sports, 3/9 at a reduced level. Conclusion: Symptomatic MDI requires an individual indication for surgical treatment after a primary conservative treatment. The described arthroscopic technique stabilizes glenohumeral joint. A return to overhead sports is possible but often at a reduced level; returning to high-performance sports cannot be recommended because of the high risk of reinstability.

Conservative Management of Shoulder Impingement Syndrome in the Athletic Population

1999 ◽  
Vol 8 (3) ◽  
pp. 230-253 ◽  
Author(s):  
Joseph B. Myers
Keyword(s):  
Rehabilitation Program ◽  
Impingement Syndrome ◽  
Subacromial Bursa ◽  
Glenohumeral Instability ◽  
Shoulder Impingement ◽  
Overhead Athletes ◽  
Athletic Population ◽  
Common Complaint ◽  
Complex Anatomy ◽  
Cause Of Pain

Shoulder pain is a common complaint among overhead athletes. Oftentimes, the cause of pain is impingement of the supraspinatus, bicipital tendon, and subacromial bursa between the greater tuberosity and the acromial arch. The mechanisms of impingement syndrome include anatomical abnormalities, muscle weakness and fatigue of the glenohumeral and scapular stabilizers, posterior capsular tightness, and glenohumeral instability. In order to effectively manage impingement syndrome nonoperatively, the therapist must understand the complex anatomy and biomechanics of the shoulder joint, as well as how to thoroughly evaluate the athlete. The results of the evaluation can then be used to design and implement a rehabilitation program that addresses the cause of impingement specific to the athlete. The purpose of this article is to provide readers with a thorough overview of what causes impingement and how to effectively evaluate and conservatively manage it in an athletic population.

Anterior Glenohumeral Instability

1983 ◽  
Vol 2 (2) ◽  
pp. 319-338 ◽  
Author(s):  
Frederick A. Matsen ◽  
Joseph D. Zuckerman
Keyword(s):  
Glenohumeral Instability ◽  
Anterior Glenohumeral Instability

THE IMPACT OF LUMBOPELVIC CONTROL ON OVERHEAD PERFORMANCE AND SHOULDER INJURY IN OVERHEAD ATHLETES: A SYSTEMATIC REVIEW

2019 ◽  
Vol 14 (4) ◽  
pp. 500-513 ◽  
Author(s):  
Thane Cope ◽  
Sarah Wechter ◽  
Michaella Stucky ◽  
Corey Thomas ◽  
Mark Wilhelm
Keyword(s):  
Systematic Review ◽  
Shoulder Injury ◽  
Overhead Athletes ◽  
The Impact

scholarly journals Factors related to large bone defects of bipolar lesions and a high number of instability episodes with anterior glenohumeral instability

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Noboru Matsumura ◽  
Kazuya Kaneda ◽  
Satoshi Oki ◽  
Hiroo Kimura ◽  
Taku Suzuki ◽  
...  
Keyword(s):  
Humeral Head ◽  
Glenohumeral Joint ◽  
Three Dimensional ◽  
Clinical Results ◽  
Bone Defects ◽  
Symptom Duration ◽  
Glenohumeral Instability ◽  
Explanatory Variables ◽  
Large Bone ◽  
Large Bone Defects

Abstract Background Significant bone defects are associated with poor clinical results after surgical stabilization in cases of glenohumeral instability. Although multiple factors are thought to adversely affect enlargement of bipolar bone loss and increased shoulder instability, these factors have not been sufficiently evaluated. The purpose of this study was to identify the factors related to greater bone defects and a higher number of instability episodes in patients with glenohumeral instability. Methods A total of 120 consecutive patients with symptomatic unilateral instability of the glenohumeral joint were retrospectively reviewed. Three-dimensional surface-rendered/registered models of bilateral glenoids and proximal humeri from computed tomography data were matched by software, and the volumes of bone defects identified in the glenoid and humeral head were assessed. After relationships between objective variables and explanatory variables were evaluated using bivariate analyses, factors related to large bone defects in the glenoid and humeral head and a high number of total instability episodes and self-irreducible dislocations greater than the respective 75th percentiles were evaluated using logistic regression analyses with significant variables on bivariate analyses. Results Larger humeral head defects (P < .001) and a higher number of total instability episodes (P = .032) were found to be factors related to large glenoid defects. On the other hand, male sex (P = .014), larger glenoid defects (P = .015), and larger number of self-irreducible dislocations (P = .027) were related to large humeral head bone defects. An increased number of total instability episodes was related to longer symptom duration (P = .001) and larger glenoid defects (P = .002), and an increased number of self-irreducible dislocations was related to larger humeral head defects (P = .007). Conclusions Whereas this study showed that bipolar lesions affect the amount of bone defects reciprocally, factors related to greater bone defects differed between the glenoid and the humeral head. Glenoid defects were related to the number of total instability episodes, whereas humeral head defects were related to the number of self-irreducible dislocations.

Recurrence and Revision Rates With Arthroscopic Bankart Repair Compared With the Latarjet Procedure in Competitive Rugby Players With Glenohumeral Instability and a Glenoid Bone Loss <20%

2021 ◽  
Vol 49 (4) ◽  
pp. 866-872
Author(s):  
Luciano A. Rossi ◽  
Ignacio Tanoira ◽  
Tomás Gorodischer ◽  
Ignacio Pasqualini ◽  
Maximiliano Ranalletta
Keyword(s):  
Bone Loss ◽  
Functional Outcomes ◽  
Return To Sport ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Latarjet Procedure ◽  
Glenohumeral Instability ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Rugby Players

Background: There is a lack of evidence in the literature comparing outcomes between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Purpose: To compare return to sport, functional outcomes, and complications between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2010 and February 2018, 130 competitive rugby players with anterior shoulder instability were operated on in our institution. The first 80 patients were operated on with the arthroscopic Bankart procedure and the other 50 with the open Latarjet procedure. Return to sport, range of motion (ROM), the Rowe score, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences, reoperations, and complications were also evaluated. Results: In the total population, the mean follow-up was 40 months (range, 24-90 months) and the mean age was 24.2 years (range, 16-33 years). Ninety-two percent of patients were able to return to rugby, 88% at their preinjury level of play. Eighty-nine percent of patients in the Bankart group and 87% in the Latarjet group returned to compete at the same level ( P = .788). No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe and ASOSS scores showed statistical improvement after operation ( P < .01). No significant difference in functional scores was found between the groups The Rowe score in the Bankart group increased from a preoperative mean (± SD) of 41 ± 13 points to 89.7 points postoperatively, and in the Latarjet group, from a preoperative mean of 42.5 ± 14 points to 88.4 points postoperatively ( P = .95). The ASOSS score in the Bankart group increased from a preoperative mean of 53.3 ± 3 points to 93.3 ± 6 points postoperatively, and in the Latarjet group, from a preoperative mean of 53.1 ± 3 points to 93.7 ± 4 points postoperatively ( P = .95). There were 18 recurrences (14%). The rate of recurrence was 20% in the Bankart group and 4% in the Latarjet group ( P = .01). There were 15 reoperations (12%). The rate of reoperation was 16% in the Bankart group and 4% in the Latarjet group ( P = .03). There were 6 complications (5%). The rate of complications was 4% in the Bankart group and 6% in the Latarjet group ( P = .55). The proportion of postoperative osteoarthritis was 10% in the Bankart group (8/80 patients) and 12% (6/50 patients) in the Latarjet group ( P = .55). Conclusion: In competitive rugby players with glenohumeral instability and a glenoid bone loss <20%, both the arthroscopic Bankart repair and the Latarjet procedure produced excellent functional outcomes, with most athletes returning to sport at the same level they had before the injury. However, the Bankart procedure was associated with a significantly higher rate of recurrence (20% vs 4%) and reoperation (16% vs 4%) than the Latarjet procedure.

MR IMAGING OF GLENOHUMERAL INSTABILITY

1997 ◽  
Vol 5 (4) ◽  
pp. 787-809
Author(s):  
Mahvash Rafii ◽  
Hossein Firooznia ◽  
Cornelia Golimbu
Keyword(s):  
Mr Imaging ◽  
Glenohumeral Instability
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