Limits...
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

(A) Definition of the glenoid coordinate system used in this study. (B) Schematic representation of glenohumeral subluxation (C = center of the humeral head, R = radius of the width or height of the glenoid surface, T = translation of the humeral head center). Left: the ratio is 40%, there is no instability. Right: the ratio is >50%, instability is noted. Image reproduced from Lädermann et al[24] with permission.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4979797&req=5

Figure 3: (A) Definition of the glenoid coordinate system used in this study. (B) Schematic representation of glenohumeral subluxation (C = center of the humeral head, R = radius of the width or height of the glenoid surface, T = translation of the humeral head center). Left: the ratio is 40%, there is no instability. Right: the ratio is >50%, instability is noted. Image reproduced from Lädermann et al[24] with permission.

Mentions: Glenohumeral translation, defined as anterior–posterior and superior–inferior motion of the humeral head center relative to the glenoid coordinate system,[24] was assessed at maximal ROM during all tested movements. The coordinate system was determined by an anterior–posterior x-axis and a superior–inferior y-axis with an origin placed at the intersection of the anteroposterior and superoinferior aspects of the glenoid rim (Fig. 3A). Subluxation was defined as the ratio between the translation of the humeral head center and the radius of width (anteroposterior subluxation) or height (superoinferior subluxation) of the glenoid surface (Fig. 3B). Instability was defined as subluxation bigger than 50%.[25]


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)

(A) Definition of the glenoid coordinate system used in this study. (B) Schematic representation of glenohumeral subluxation (C = center of the humeral head, R = radius of the width or height of the glenoid surface, T = translation of the humeral head center). Left: the ratio is 40%, there is no instability. Right: the ratio is >50%, instability is noted. Image reproduced from Lädermann et al[24] with permission.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: (A) Definition of the glenoid coordinate system used in this study. (B) Schematic representation of glenohumeral subluxation (C = center of the humeral head, R = radius of the width or height of the glenoid surface, T = translation of the humeral head center). Left: the ratio is 40%, there is no instability. Right: the ratio is >50%, instability is noted. Image reproduced from Lädermann et al[24] with permission.
Mentions: Glenohumeral translation, defined as anterior–posterior and superior–inferior motion of the humeral head center relative to the glenoid coordinate system,[24] was assessed at maximal ROM during all tested movements. The coordinate system was determined by an anterior–posterior x-axis and a superior–inferior y-axis with an origin placed at the intersection of the anteroposterior and superoinferior aspects of the glenoid rim (Fig. 3A). Subluxation was defined as the ratio between the translation of the humeral head center and the radius of width (anteroposterior subluxation) or height (superoinferior subluxation) of the glenoid surface (Fig. 3B). Instability was defined as subluxation bigger than 50%.[25]

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