BACKROUND AND PURPOSE:Shoulder apprehension is defined as anxiety and resistance in patients with a history of anterior glenohumeral instability. It remains unclear whether shoulder apprehension is the result of true recurrent instability or a memorized subjective sensation. We tested whether visual presentation of apprehension videos modifies functional brain networks associated with motor resistance and anxiety. MATERIALS AND METHODS:This prospective study includes 15 consecutive right-handed male patients with shoulder apprehension (9 with right shoulder apprehension, 6 with left shoulder apprehension; 27.5 Ϯ 6.4 years) and 10 healthy male right-handed age-matched control participants (29.0 Ϯ 4.7 years). Multimodal MR imaging included 1) functional connectivity tensorial independent component analysis, 2) taskrelated general linear model analysis during visual stimulation of movies showing typical apprehension movements vs control videos, 3) voxelbased morphometry analysis of GM, and 4) tract-based spatial statistics analysis of WM. RESULTS:Patients with shoulder apprehension had significant (P Ͻ .05 corrected) increase in task-correlated functional connectivity, notably in the bilateral primary sensory-motor area and dorsolateral prefrontal cortex and, to a lesser degree, the bilateral dorsomedial prefrontal cortex, anterior insula, and dorsal anterior cingulate cortex (ϩ148% right, ϩ144% left). Anticorrelated functional connectivity decreased in the higher-level visual and parietal areas (Ϫ185%). There were no potentially confounding structural changes in GM or WM. CONCLUSIONS:Shoulder apprehension induces specific reorganization in apprehension-related functional connectivity of the primary sensory-motor areas (motor resistance), dorsolateral prefrontal cortex (cognitive control of motor behavior), and the dorsal anterior cingulate cortex/dorsomedial prefrontal cortex and anterior insula (anxiety and emotional regulation).ABBREVIATIONS: dACC ϭ dorsal anterior cingulate cortex; dlPFC ϭ dorsolateral prefrontal cortex; dmPFC ϭ dorsomedial prefrontal cortex; GLM ϭ general linear model; IC ϭ independent component; TBSS ϭ tract-based spatial statistics; TICA ϭ tensorial independent component analysis; VBM ϭ voxel-based morphometry S houlder apprehension is defined as anxiety and resistance in patients with a history of anterior glenohumeral instability. The apprehension sign is a physical finding in which placement of the humerus in the position of abduction to 90°and maximal external rotation produces anxiety and resistance in patients with a history of anterior glenohumeral instability.
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