Evaluation of the anterior shoulder instability using ultrasound shear wave elastography

Abstract

Anterior shoulder instability is the most common form of shoulder instability and is seen in 1.7 to 2% of the general population. [1][2][3] Traumatic shoulder instability or dislocation is often seen as an avulsion of the anterior inferior labrum and the lesion is called Bankart lesion. [4] Static factors such as the glenoid labrum, capsuloligamentous structures, bone formations forming the joint, dynamic factors such as the muscles forming the shoulder girdle, negative intra-articular pressure, and joint adhesion-cohesion forces stabilize the glenohumeral joint. [5] As the soft tissues play an active role in shoulder stabilization, the deterioration of the balance in these soft tissues plays an important role in the formation of traumatic or atraumatic dislocations.Objectives: This study aims to evaluate the soft tissue stiffness which has a prominent role in shoulder instability using ultrasound (US) shear wave elastography (SWE) and to compare the results with healthy shoulders.Patients and methods: Between December 2018 and January 2020, a total of 33 male patients (mean age: 26±4.3 years; range, 18 to 35 years) who underwent arthroscopic repair for traumatic isolated anterior glenohumeral instability were included in this prospective study. The shoulder girdle was evaluated with US SWE in patients with traumatic anterior instability. Deltoid (D), supraspinatus (SS), infraspinatus (IS), subscapularis (SSC), and long head of biceps (LHB) tendons forming the shoulder girdle and anterior labrum (L) were evaluated with SWE. The elasticity and velocity of the tissues were quantitatively measured. The operated shoulders of 33 patients due to isolated traumatic anterior instability were named Group 1, while the healthy shoulders of these patients were named Group 2. Thirty volunteers with healthy shoulders were considered as the control group (Group 3, n=30).Results: All three groups were compared in terms of SS, D, LHB, and SSC tendon velocity and elasticity; however, no statistically significant difference was observed among the groups (p<0.05). The anterior labrum of these three groups did not significantly differ in terms of SWE measurements (p<0.05). Conclusion:The stiffness of shoulder girdle muscle tendons and labrum measured with US SWE does not constitute a risk factor for traumatic anterior shoulder instability.

Stabilizing Mechanisms in Patients Treated Using Hill-Sachs Remplissage With Bankart Repair in Abduction–External Rotation Position

“…SWE has been widely applied in glenohumeral capsules and glenoid labral measurements with good accuracy and reliability. 4,6,18,49 Ultrasonic propagation is closely related to collagen and tensile strength of the tissue. 40 Studies have demonstrated that the passive tension in glenohumeral capsules is highly correlated with the elastic characteristics measured using SWE.…”

Patellar Tendon Elasticity and Temperature Following after a 448 Kilohertz Radiofrequency Intervention on Active Healthy Subjects: An Open Controlled Clinical Trial

“…Sarikaya PZ et al carried out a study on anterior shoulder instability after a labral tear where the structures of the shoulder were studied using elastography. It was observed that the rigidity of the structures was not considered a risk factor in anterior instability caused by trauma [ 33 ]. Wu CH et al studied the stiffness of the shoulder ligaments at different degrees of shoulder mobility in people suffering from adhesive capsulitis [ 34 ].…”