Multidirectional Instability of the Shoulder: A Systematic Review

Longo, Umile Giuseppe; Rizzello, Giacomo; Loppini, Mattia; Locher, Joel; Buchmann, Stefan; Maffulli, Nicola; Denaro, Vincenzo

doi:10.1016/j.arthro.2015.06.006

Cited by 127 publications

(93 citation statements)

References 53 publications

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“…Among the 14 patients described by the Authors as "posterior instability", 2 experienced a recurrence. However, their 4% recurrence rate is lower than the one reported in the literature 5 . The thin and exuberant capsular tissue usually located in this kind of patients can be due to a muscle imbalance: when the dynamic restraints are not working, the capsule remains the first stabiliser against the translating forces, and it can result in fatigue failure 22 .…”

Section: Discussioncontrasting

confidence: 50%

Arthroscopic treatment of the atraumatic shoulder instability: a case series with two-year follow-up evaluation

Gervasi

Sebastiani

Cautero

et al. 2016

MLTJ

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SummaryBackground: The purpose of this work is to evaluate the results of arthroscopic capsulolabroplasty in patients affected by atraumatic shoulder instability (ASI). Methods: A retrospective review was performed of 10 patients (7 women and 3 men) who underwent arthroscopic treatment of symptomatic ASI. Mean age at evaluation was 27.9 (19-35) years and the mean follow-up was 23.3 (12-37) months. We evaluated recurrence rate, range of movement, apprehension and relocation tests, hyperlaxity, and sport activity. The ASES score, the Rowe score, the Simple Shoulder Test (SST) and Visual Analogue Scale (VAS) were also used as outcomes measure. Results: None of the patients experienced episodes of dislocation or subluxation after surgery. The apprehension and relocation tests produced positive results in 2 patients. Six out of 10 patients reported apprehension with the arm in specific positions. The ASES mean score was 93.4 (55-100); the Rowe mean score was 85.5 (70-100); the SST mean score was 9.1 (5.8-10). On average, external rotation is reduced by 10° in adduction, and by 8° in abduction in 6 out of 10 patients; internal rotation is reduced on average by 6.6° in abduction with the arm abducted, and was overall limited in 6 out of 10 patients. Conclusions

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Section: Discussioncontrasting

confidence: 50%

Arthroscopic treatment of the atraumatic shoulder instability: a case series with two-year follow-up evaluation

Gervasi

Sebastiani

Cautero

et al. 2016

MLTJ

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“…Certainly, the initial therapeutic approach has to be conservative, consisting of reinforcement of the scapular stabilizers, cuff, and deltoid, and proprioceptive exercises 4 . Unfortunately, physiotherapy alone may lead to unsatisfactory results and, according to a recent meta-analysis 5 , about 20% of the patients require surgical treatment. The most common surgical procedures to treat multidirectional instability are capsuloligamentous techniques, which include open inferior capsular shift, arthroscopic plication and thermal capsulorraphy 6 .…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic treatment of the atraumatic shoulder instability: a case series with two-year follow-up evaluation

Gervasi

Sebastiani

Cautero

et al. 2019

Muscle Ligaments and Tendons J

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Background: The purpose of this work is to evaluate the results of arthroscopic capsulolabroplasty in patients affected by atraumatic shoulder instability (ASI). Methods: A retrospective review was performed of 10 patients (7 women and 3 men) who underwent arthroscopic treatment of symptomatic ASI. Mean age at evaluation was 27.9 (19-35) years and the mean follow-up was 23.3 (12-37) months. We evaluated recurrence rate, range of movement, apprehension and relocation tests, hyperlaxity, and sport activity. The ASES score, the Rowe score, the Simple Shoulder Test (SST) and Visual Analogue Scale (VAS) were also used as outcomes measure. Results: None of the patients experienced episodes of dislocation or subluxation after surgery. The apprehension and relocation tests produced positive results in 2 patients. Six out of 10 patients reported apprehension with the arm in specific positions. The ASES mean score was 93.4 (55-100); the Rowe mean score was 85.5 (70-100); the SST mean score was 9. 1 (5.8-10). On average, external rotation is reduced by 10° in adduction, and by 8° in abduction in 6 out of 10 patients; internal rotation is reduced on average by 6.6° in abduction with the arm abducted, and was overall limited in 6 out of 10 patients. Conclusions: Arthroscopic capsulolabroplasty ensures excellent results in patients showing atraumatic shoulder instability in terms of recurrence. Still, an underlying insecurity persists and the risk of residual stiffness is tangible. Level of evidence: V.

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“…Research in the setting of shoulder instability is growing, even though several aspects remain unsolved problems. 10,[12][13][14][15][16][17][18][19] Unfortunately, despite great advances in surgical techniques, the quality of the published studies is low, given the difficulty of testing promising recently developed techniques in well-designed trials. The current pace of advances in methods forces us to take stockdto ask where we are going and what we should research next.…”

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confidence: 99%

Editorial Commentary: Unsolved Problems in Shoulder Instability—The Dilemma of Bone Loss!

Longo

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Bone loss in the setting of shoulder instability is an unsolved problem. Procedures restoring bone stock on the glenoid side vary from minimally invasive arthroscopic techniques of arthroscopic bone block procedures to traditional transposition of the coracoid or bone transplant. These techniques are evolving, and several tips and tricks have been optimized to improve outcomes and to reduce the risk of complications, even though the most terrible complication of transposition of the coracoid remains osteoarthritis in the young adult. The major innovation in the past few years has been the use of remplissage. The aim of our surgical procedures is to restore the anatomy as much as possible. Therefore, gentle handling of bone defects on both the humeral and glenoid sides by means of an arthroscopic bone block and combined remplissage seems to be the future of our surgical procedures.

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Multidirectional Instability of the Shoulder: A Systematic Review

Cited by 127 publications

References 53 publications

Arthroscopic treatment of the atraumatic shoulder instability: a case series with two-year follow-up evaluation

Arthroscopic treatment of the atraumatic shoulder instability: a case series with two-year follow-up evaluation

Arthroscopic treatment of the atraumatic shoulder instability: a case series with two-year follow-up evaluation

Editorial Commentary: Unsolved Problems in Shoulder Instability—The Dilemma of Bone Loss!

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