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Glenohumeral joint instability

Huw Lloyd Morgan Williams, Jonathan Peter Evans, Nicholas Duncan Furness, Christopher David Smith
BACKGROUND: The surgical treatment of recurrent shoulder instability has evolved in recent years to include a variety of soft tissue and bone block procedures, undertaken with either an open or arthroscopic approach. Although the utilization of such techniques has rapidly expanded, the associated risk of complications remains poorly defined. This information is vital for clinical decision making and patient counseling. PURPOSE: To quantify the complication rate associated with all types of surgery for anterior glenohumeral joint dislocation...
December 10, 2018: American Journal of Sports Medicine
Patrick Williamson, Amin Mohamadi, Arun J Ramappa, Joseph P DeAngelis, Ara Nazarian
BACKGROUND: Numerous biomechanical studies have addressed normal shoulder function and the factors that affect it. While these investigations include a mix of in-vivo clinical reports, ex-vivo cadaveric studies, and computer-based simulations, each has its own strengths and limitations. A robust methodology is essential in cadaveric work but does not always come easily. Precise quantitative measurements are difficult in in-vivo studies, and simulation studies require validation steps...
November 14, 2018: Journal of Biomechanics
Przemysław Lubiatowski, Piotr Ogrodowicz, Marcin Wojtaszek, Leszek Romanowski
HYPOTHESIS AND BACKGROUND: Proprioception is an important element of shoulder dynamic stability. It has been shown to be affected in cases of capsular or labral injuries of the glenohumeral joint. Therefore, this study was conducted to investigate bilateral shoulder proprioception by active reproduction of joint position both in patients with post-traumatic recurrent unilateral shoulder instability and in normal healthy volunteers. METHODS: We compared 41 patients, comprising 11 female and 30 male patients with an average age of 25...
November 28, 2018: Journal of Shoulder and Elbow Surgery
Redouane Kadi, Annemieke Milants, Maryam Shahabpour
The shoulder joint is functionally and structurally complex and is composed of bone, hyaline cartilage, labrum, ligaments, capsule, tendons and muscles. It links the trunk to the upper limb and plays an important biomechanical role in daily activities. Indications for imaging of the shoulder have considerably increased in the last few years. The article focuses mainly on Magnetic Resonance Imaging (MRI) as well as MR and CT arthrography, diagnostic procedures of choice for assessment of internal derangement of the shoulder...
December 16, 2017: Journal of the Belgian Society of Radiology
Haley Glazebrook, Blair Miller, Ivan Wong
Background: Anterior shoulder instability is the most common sequela of shoulder dislocation and can result in repeated dislocations or subluxation of the glenohumeral joint. Anterior shoulder instability can be treated conservatively or surgically with several procedures. Purpose: To date, arthroscopic Bankart is the most common surgical procedure for the treatment of anterior shoulder instability. No previous studies have compared all anterior shoulder surgical procedures...
November 2018: Orthopaedic Journal of Sports Medicine
Tingting Liu, Jianpeng Ma, Hetao Cao, Dongmei Hou, Lin Xu
BACKGROUND: Physical examinations may reveal the instability of a glenohumeral joint but cannot diagnose the bony Bankart lesions. Soft tissue Bankart lesion cannot be visualized on traditional radiogram. Magnetic resonance images have high cost and availability issues. The purpose of the study was to access the diagnostic performance of the Computed Tomography (CT) in the assessment of patients with shoulder instability and to diagnose the Bankart and bony Bankart lesions. METHODS: A total of 145 patients with shoulder instability were included in the study...
November 23, 2018: BMC Medical Imaging
Jeffrey D Trojan, Steven F DeFroda, Mary K Mulcahey
Shoulder instability is a common condition encountered by sports medicine and shoulder surgeons. Management can be challenging, both with regards to the underlying pathology and the high expectations associated with the very active patient population that this condition typically affects. High-performance athletes who are used to performing at activity levels which typically challenge the normal physiologic limits of the glenohumeral joint may be particularly difficult to treat. As physicians increasingly evaluate patient reported outcomes (PROs), a growing body of literature has emerged related to patient expectations for a variety of orthopaedic conditions, including shoulder instability...
November 14, 2018: Physician and Sportsmedicine
Meghan E Vidt, Anthony C Santago, Anthony P Marsh, Eric J Hegedus, Christopher J Tuohy, Gary G Poehling, Michael T Freehill, Michael E Miller, Katherine R Saul
BACKGROUND: Rotator cuff tears in older individuals may result in decreased muscle forces and changes to force distribution across the glenohumeral joint. Reduced muscle forces may impact functional task performance, altering glenohumeral joint contact forces, potentially contributing to instability or joint damage risk. Our objective was to evaluate the influence of rotator cuff muscle force distribution on glenohumeral joint contact force during functional pull and axilla wash tasks using individualized computational models...
December 2018: Clinical Biomechanics
Peter S Vezeridis, Chad R Ishmael, Kristofer J Jones, Frank A Petrigliano
Dislocation arthropathy describes the development of progressive degenerative changes of the glenohumeral joint in the setting of instability. Although the specific etiology remains unclear, the trauma of a single dislocation, repetitive injury associated with recurrent dislocations, changes in shoulder biomechanics, and complications associated with instability surgery have all been implicated in its development. Pain and restricted range of motion are the most common patient complaints. Conservative management, consisting of pain control, activity modification, and physical therapy, is the first-line treatment after the development of arthropathy...
October 1, 2018: Journal of the American Academy of Orthopaedic Surgeons
Mark J Lemos
It has been reported and verified that anterior glenoid bone loss can lead to increased instability of the glenohumeral joint. Many authors have tried to quantify glenoid bone loss in recurrent instability of the glenohumeral joint. Techniques have included radiographic, magnetic resonance imaging, computed tomography (CT), 3-dimensional CT, and arthroscopic visualization. A 3-dimensional CT scan using the perfect circle technique, the Pico technique, has become a technique of choice for many authors. However, some have applied this technique using only the uninvolved shoulder...
September 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Akira M Murakami, Andrew J Kompel, Lars Engebretsen, Xinning Li, Bruce B Forster, Michel D Crema, Daichi Hayashi, Mohamed Jarraya, Frank W Roemer, Ali Guermazi
BACKGROUND: To use Magnetic Resonance Imaging (MRI) to characterize the severity, location, prevalence, and demographics of shoulder injuries in athletes at the Rio de Janeiro 2016 Summer Olympic Games. METHODS: This was a retrospective analysis of all routine shoulder MRIs obtained from the Olympic Village Polyclinic during the Rio 2016 Summer Olympics. Imaging was performed on 1.5 T and 3 T MRI, and interpretation was centrally performed by a board-certified musculoskeletal radiologist...
August 17, 2018: BMC Musculoskeletal Disorders
A Castagna, E Cesari, A Gigante, B Di Matteo, R Garofalo, G Porcellini
Background: Recurrent shoulder dislocations occur much more frequently in adolescents than in the older population but a clear explanation of this incidence does not exist. The aim of the present study was to define the age-related distribution of the elastic fibers (EFs) in the shoulder capsule's extracellular matrix as a factor influencing shoulder instability. Materials and Methods: Biopsy specimens were obtained from the shoulder capsule of patients divided preoperatively into three groups: Group 1 consisted of 10 male patients undergoing surgery for unidirectional traumatic anterior instability (TUBS); Group 2 consisted of 10 male patients undergoing surgery for multidirectional instability (MDI); Group 3 represents the control, including 10 patients with no history of instability...
2018: BioMed Research International
Alexandra Penelas, Andreas Gutbrod, Karolin Kühn, Antonio Pozzi
OBJECTIVE: To test the feasibility and safety of an arthroscopic imbrication of the medial glenohumeral ligament (MGHL) and the subscapularis tendon with knotless anchors in dogs. STUDY DESIGN: Cadaveric study. SAMPLE POPULATION: Ten limbs. METHODS: Cranial and caudal arms of the MGHL were imbricated with a 2.9- or a 2.4-mm knotless anchor. A horizontal mattress suture secured with a 3.5-mm knotless anchor was used to imbricate the subscapularis tendon...
August 2018: Veterinary Surgery: VS
Christopher Nacca, Joseph A Gil, Steven F DeFroda, Rohit Badida, Brett D Owens
Background: Posterior glenoid bone deficiency can occur with recurrent glenohumeral instability. Glenoid reconstruction with a distal tibial allograft (DTA) has been reported to successfully restore contact pressures that occur during posterior glenohumeral translation. However, there are concerns regarding the risk of allograft resorption, availability, and costs. Extracapsular reconstruction using a scapular spinal autograft (SSA) has been reported as an alternative technique secondary to its anatomic location relative to the posterior shoulder and preferable autograft properties...
July 2018: Orthopaedic Journal of Sports Medicine
Jeffrey R Dugas, Matthew W Crozier
Because of the lack of bony restraints and minimal articular contact, the glenohumeral joint can attain significant range of motion; however, this results in the propensity for instability. The most generic form of instability, traumatic anterior instability, reliably produces a series of pathoanatomic findings. While reliable, these findings contribute to the complexities of caring for patients after an initial instability event. Numerous studies have examined this issue and determined that careful consideration of patient factors can guide successful treatment, whether it be surgical or nonsurgical, after initial instability...
September 2018: Sports Medicine and Arthroscopy Review
Walter Ansanello Netto, Gisele Garcia Zanca, Michele Forgiarini Saccol, Salomão Chade Assan Zatiti, Stela Márcia Mattiello
OBJECTIVE: To investigate possible alterations on scapular muscle strength in subjects with traumatic anterior glenohumeral instability. DESIGN: Cross-sectional study. SETTING: Laboratory setting. PARTICIPANTS: Fifty-two subjects of both sexes: 26 healthy and 26 with traumatic anterior glenohumeral instability. MAIN OUTCOME MEASURES: Subjects performed maximal isometric and concentric isokinetic contractions of shoulder protraction and retraction in scapular and sagittal planes, at slow (12...
September 2018: Physical Therapy in Sport
Kyle R Duchman, Carolyn M Hettrich, Natalie A Glass, Robert W Westermann, Brian R Wolf, Keith Baumgarten, Julie Bishop, Jonathan Bravman, Robert Brophy, James Carpenter, Grant Jones, John Kuhn, C Benjamin Ma, Robert Marx, Eric McCarty, Bruce Miller, Matthew Smith, McCarty Eric, Bruce Miller, Matthew Smith, Rick Wright, Alan Zhang
BACKGROUND: Intra-articular glenohumeral joint changes frequently occur after shoulder instability events. PURPOSE: (1) To compare demographic characteristics, baseline patient-reported outcomes, and intraoperative findings for patients undergoing primary or revision shoulder stabilization surgery and (2) to determine the incidence of glenohumeral bone and cartilage lesions in this population while identifying factors independently associated with these lesions...
August 2018: American Journal of Sports Medicine
Daisuke Momma, Akimoto Nimura, Satoru Muro, Hitomi Fujishiro, Takashi Miyamoto, Tadanao Funakoshi, Tomoyuki Mochizuki, Norimasa Iwasaki, Keiichi Akita
BACKGROUND: Although conventional Bankart repair has been the accepted procedure for traumatic anterior glenohumeral instability, the humeral avulsion of the glenohumeral ligament or an elongation of the capsule remains challenging to decide the appropriate treatment. The anatomical knowledge regarding the whole capsule of glenohumeral joint is necessary to accurately treat for the capsular disorders. The aims of the current study were to investigate the anatomical features of capsular attachment and thickness in a whole capsule of glenohumeral joint...
June 7, 2018: Journal of Experimental Orthopaedics
Stephanie W Mayer, Andrew P Kraszewski, Anne Skelton, Andreas Kontaxis, Russell Warren
BACKGROUND: Surgical treatment for shoulder instability generally involves labral repair with a capsular plication or imbrication. Good results are reported in both open and arthroscopic procedures, but there is no consensus on the amount or location of capsular plication that is needed to achieve stability and anatomic anterior, posterior, and inferior translation of the joint. QUESTIONS/PURPOSES: (1) What are the separate and combined effects of increasing plication magnitude and sequential additive plications in the anterior, posterior, and inferior locations of the joint capsule on glenohumeral joint translation in the anterior, posterior, and inferior directions? (2) What plication location and magnitude restores anterior, posterior, and inferior translation to a baseline level? METHODS: Fourteen cadaveric shoulders were dissected down to the glenohumeral capsule and underwent instrumented biomechanical testing...
July 2018: Clinical Orthopaedics and related Research
Robert Z Tashjian, Brook I Martin, Cassandra A Ricketts, Heath B Henninger, Erin K Granger, Peter N Chalmers
BACKGROUND: Instability is the most common complication after reverse total shoulder arthroplasty (rTSA). In the native glenohumeral joint, in addition to full dislocations, more subtle forms of instability exist. However, the incidence of more subtle forms of instability, the factors associated with instability, and the effect of instability on validated outcome scores after rTSA remain poorly understood. QUESTIONS/PURPOSES: (1) After rTSA, what is the risk of instability, including more subtle forms of subjective instability? (2) What are the factors associated with instability? (3) Are more subtle forms of instability associated with lower American Shoulder and Elbow Surgeons (ASES) functional outcome scores than those patients without instability? METHODS: A total of 168 rTSAs were performed during the study period...
August 2018: Clinical Orthopaedics and related Research
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