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Does surgery for instability of the shoulder truly stabilize the glenohumeral joint?: A prospective comparative cohort study.

Lädermann A, Denard PJ, Tirefort J, Kolo FC, Chagué S, Cunningham G, Charbonnier C - Medicine (Baltimore) (2016)

Bottom Line: Despite the fact that surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation.Differences were significant for flexion and abduction movements (P < 0.001).Postoperatively, no patients demonstrated apprehension and all functional scores were improved.

View Article: PubMed Central - PubMed

Affiliation: aDivision of Orthopaedics and Trauma Surgery, Clinique La Colline bFaculty of Medicine, University of Geneva cDivision of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland dSouthern Oregon Orthopedics, Medford eDepartment of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR fRive Droite Radiology Center gArtanim Foundation, Medical Research Department, Geneva, Switzerland.

ABSTRACT
Despite the fact that surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation. The purpose of this prospective clinical study was to analyze the effect of surgical stabilization on glenohumeral translation.Glenohumeral translation was assessed in 11 patients preoperatively and 1 year postoperatively following surgical stabilization for anterior shoulder instability. Translation was measured using optical motion capture and computed tomography.Preoperatively, anterior translation of the affected shoulder was bigger in comparison to the normal contralateral side. Differences were significant for flexion and abduction movements (P < 0.001). Postoperatively, no patients demonstrated apprehension and all functional scores were improved. Despite absence of apprehension, postoperative anterior translation for the surgically stabilized shoulders was not significantly different from the preoperative values.While surgical treatment for anterior instability limits the chance of dislocation, it does not seem to restore glenohumeral translation during functional range of motion. Such persistent microinstability may explain residual pain, apprehension, inability to return to activity and even emergence of dislocation arthropathy that is seen in some patients. Further research is necessary to better understand the causes, effects, and treatment of residual microinstability following surgical stabilization of the shoulder.

No MeSH data available.


Related in: MedlinePlus

Examples of computed postures on a right shoulder showing the markers setup (small colored spheres) and a virtual skeleton used to better visualize the motion as a whole: (A) maximum flexion, (B) maximum abduction in the scapular plane, (C) maximum external rotation with elbow at side, (D), (E), and (F) show a zoom in the shoulder for each posture (A), (B), and (C), respectively.
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Figure 2: Examples of computed postures on a right shoulder showing the markers setup (small colored spheres) and a virtual skeleton used to better visualize the motion as a whole: (A) maximum flexion, (B) maximum abduction in the scapular plane, (C) maximum external rotation with elbow at side, (D), (E), and (F) show a zoom in the shoulder for each posture (A), (B), and (C), respectively.

Mentions: Shoulder kinematics was computed from the recorded markers’ trajectories using a validated biomechanical model which accounted for skin motion artifact.[11,20] The model was based on a patient-specific kinematic chain using the shoulder 3D models reconstructed from the CT data and a global optimization algorithm with loose constraints on joint translations (accuracy: translational error < 3 mm, rotational error < 4°). Figure 2 shows examples of computed postures.


Does surgery for instability of the shoulder truly stabilize the glenohumeral joint?: A prospective comparative cohort study.

Lädermann A, Denard PJ, Tirefort J, Kolo FC, Chagué S, Cunningham G, Charbonnier C - Medicine (Baltimore) (2016)

Examples of computed postures on a right shoulder showing the markers setup (small colored spheres) and a virtual skeleton used to better visualize the motion as a whole: (A) maximum flexion, (B) maximum abduction in the scapular plane, (C) maximum external rotation with elbow at side, (D), (E), and (F) show a zoom in the shoulder for each posture (A), (B), and (C), respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979797&req=5

Figure 2: Examples of computed postures on a right shoulder showing the markers setup (small colored spheres) and a virtual skeleton used to better visualize the motion as a whole: (A) maximum flexion, (B) maximum abduction in the scapular plane, (C) maximum external rotation with elbow at side, (D), (E), and (F) show a zoom in the shoulder for each posture (A), (B), and (C), respectively.
Mentions: Shoulder kinematics was computed from the recorded markers’ trajectories using a validated biomechanical model which accounted for skin motion artifact.[11,20] The model was based on a patient-specific kinematic chain using the shoulder 3D models reconstructed from the CT data and a global optimization algorithm with loose constraints on joint translations (accuracy: translational error < 3 mm, rotational error < 4°). Figure 2 shows examples of computed postures.

Bottom Line: Despite the fact that surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation.Differences were significant for flexion and abduction movements (P < 0.001).Postoperatively, no patients demonstrated apprehension and all functional scores were improved.

View Article: PubMed Central - PubMed

Affiliation: aDivision of Orthopaedics and Trauma Surgery, Clinique La Colline bFaculty of Medicine, University of Geneva cDivision of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland dSouthern Oregon Orthopedics, Medford eDepartment of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR fRive Droite Radiology Center gArtanim Foundation, Medical Research Department, Geneva, Switzerland.

ABSTRACT
Despite the fact that surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation. The purpose of this prospective clinical study was to analyze the effect of surgical stabilization on glenohumeral translation.Glenohumeral translation was assessed in 11 patients preoperatively and 1 year postoperatively following surgical stabilization for anterior shoulder instability. Translation was measured using optical motion capture and computed tomography.Preoperatively, anterior translation of the affected shoulder was bigger in comparison to the normal contralateral side. Differences were significant for flexion and abduction movements (P < 0.001). Postoperatively, no patients demonstrated apprehension and all functional scores were improved. Despite absence of apprehension, postoperative anterior translation for the surgically stabilized shoulders was not significantly different from the preoperative values.While surgical treatment for anterior instability limits the chance of dislocation, it does not seem to restore glenohumeral translation during functional range of motion. Such persistent microinstability may explain residual pain, apprehension, inability to return to activity and even emergence of dislocation arthropathy that is seen in some patients. Further research is necessary to better understand the causes, effects, and treatment of residual microinstability following surgical stabilization of the shoulder.

No MeSH data available.


Related in: MedlinePlus