Recurrent Posterior Shoulder Instability

Millett, Peter J.; Clavert, Philippe; Hatch, George F. Rick; Warner, Jon J.P.

doi:10.5435/00124635-200608000-00004

Cited by 147 publications

(98 citation statements)

References 35 publications

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“…The vertical shear stress may result in an upward translation of the humeral head, which may exacerbate the development of an impingement of subacromial structures against the overlying acromion, particularly in the presence of narrowed humeroacromial space or osteophytes beneath the acromioclavicular joint. The posterior shear stress may also be detrimental, leading to the development of posterior instability, capsulolabral pathology, and tendinitis (supraspinatus, infraspinatus, teres minor) [7,[28][29][30][31][32]. The repetitive microtrauma associated with these substantial forces may also precipitate joint degenerative changes [33][34].…”

Section: Shoulder and Elbow Joint Forcesmentioning

confidence: 99%

Comparison of peak shoulder and elbow mechanical loads during weight-relief lifts and sitting pivot transfers among manual wheelchair users with spinal cord injury

Gagnon

Nadeau²,

Noreau³

et al. 2008

JRRD

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Abstract-This study compared shoulder and elbow joint forces and moments between weight-relief lifts (WRLs) and sitting pivot transfers (SPTs) among manual wheelchair users with spinal cord injury (SCI) (N = 13) during biomechanical laboratory assessment. Minimum and maximum values were reported for each triaxial component of the joint force at the dominant shoulder and elbow during SPTs (leading and trailing roles) and WRLs. Peak shoulder flexor and adductor moments, along with elbow flexor and extensor moments, observed during the same period were also analyzed. The SPTs predominantly exposed (p < 0.001) the shoulder joints to substantial posteriorly directed forces (leading = -2.6 N/kg; trailing = -3.1 N/kg) compared with WRLs (-2.2 N/kg), whereas superiorly directed forces (2.9 N/kg) were principally sustained (p < 0.001) during WRLs compared with SPTs (leading = 1.5 N/kg; trailing = 1.5 N/kg). High superiorly directed forces (3.6 to 3.9 N/kg) were observed at the elbow, which were comparable (p = 0.33) between the two tasks. The peak shoulder flexor (leading = 1.36 N·m/kg; trailing = 1.45 N·m/kg) and adductor moments (leading only = -0.46 N·m/kg), along with the peak elbow flexor moments (leading = 0.24 N·m/kg; trailing = 0.15 N·m/kg), were significantly more elevated (p < 0.021) during SPTs than during WRLs. Peak shoulder adductor (-0.46 vs -0.24 N·m/kg) and elbow flexor moments were also more elevated (p = 0.03) at the leading upper limb compared with the trailing one. The peak elbow extensor moments did not differ (p = 0.167) between the two tasks (-0.17 to -0.25 N·m/kg). SPTs exposed the shoulder and elbow joints to greater mechanical loads than WRLs among individuals with SCI.

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Section: Shoulder and Elbow Joint Forcesmentioning

confidence: 99%

Comparison of peak shoulder and elbow mechanical loads during weight-relief lifts and sitting pivot transfers among manual wheelchair users with spinal cord injury

Gagnon

Nadeau²,

Noreau³

et al. 2008

JRRD

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“…However, these exams are subjective and depend on examiner skill and experience. [12][13][14] In addition, the function of the capsule 9,15,16 and the reliability of physical exams for instability 17 change with joint position. Even though standardized procedures have yet to be established, physical exams are used as a tool for surgical planning.…”

mentioning

confidence: 99%

Capsule function following anterior dislocation: Implications for diagnosis of shoulder instability

Rainis

Browe

McMahon

et al. 2013

Journal Orthopaedic Research

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During shoulder dislocation, the glenohumeral capsule undergoes non-recoverable strain, leading to joint instability. Clinicians use physical exams to diagnose injury and direct repair procedures; however, they are subjective and do not provide quantitative information. Our objectives were to: (1) determine the relationship between capsule function following anterior dislocation and non-recoverable strain; and (2) identify joint positions at which physical exams can be used to detect non-recoverable strain in specific capsule regions. Physical exams were simulated at three joint positions including external rotation (ER) using robotic technology before and after anterior dislocation. The resulting joint kinematics, strain distribution in the capsule, and non-recoverable strain were determined. Following dislocation, anterior translation increased by as much as 48% (08 ER: p ¼ 0.03; 308 ER: p ¼ 0.03; 608 ER: p < 0.01). Capsule sub-regions with less non-recoverable strain required more ER to detect differences in the strain ratios between the intact and injured joint. Strain ratio changes on the humeral side of the posterior axillary pouch (0.31 AE 0.32) were significant at all joint positions (08 ER: p ¼ 0.03; 308 ER: p ¼ 0.048; 608 ER: p ¼ 0.04), whereas strain ratio differences on the humeral side of the anterior axillary pouch (0.18 AE 0.21) were significant only at 608 of ER (p ¼ 0.03). Therefore, standardizing physical exams for joint position could help surgeons identify specific locations of non-recoverable strain that may have been ignored. ß

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“…Eğer ağrı ve instabilite etkilenen omuzun günlük hayatı engelliyor veya hastanın omzundan beklentisini karşı-lamasına engel oluyorsa cerrahi uygulanmalıdır. [13] CERRAHİ TEDAVİ Yıllar boyunca posterior instabilitenin tedavisinde 'Reverse Bankart' ve 'Putti-Platt' gibi yumuşak doku ameliyatları, kas transferleri ve kapsülorafi, kemik blokları ve glenoid osteotomileri gibi çok çeşitli ameliyatlar önerilmiştir. 1984'te Hawkins ve arkadaşları, tekrarlayan posterior omuz instabilitesi için uygulanan çeşitli posterior stabilizasyon prosedürleri ile %50 başarısızlık oranı bildirmişlerdir.…”

Section: Konservati̇f Tedavi̇unclassified

Posterior omuz instabilitesi

Demi̇rtaş¹

2013

TOTBID

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Atravmatik veya tekrarlayan mikrotravmalara bağlı olarak kazanılmış tekrarlayan posterior subluksasyonlar travmatik posterior çıkıklara göre çok daha sıktır. Bu instabilite şekilleri dikkatlice değerlendirilerek; tek yöne, iki yöne veya çok yöne olarak sınıflandırılmalı ve çıkığın yönü ile semptomatik subluksasyonlar ayrılma-lıdır. [2] Posterior instabilite ile sonuçlanan tekrarlayan aşırı kullanım ve mikrotravma hasarı; baş üstü sporlarda ve ağırlık kaldırma gibi posterior kapsüle tekrarlayan travmalar sonucu ortaya çıkmaktadır. Tekrarlayan posterior subluksasyon tanısı konulan bir grup hastada semptomların başlangıcı hiçbir aktivite veya travmaya bağlanamaz. Bu gibi hastaların çoğunda genel ligamentöz laksite vardır. Glenohumeral instabilite cerrahisinde başarılı olabilmek için, instabilitenin cerrahi ile P osterior omuz çıkıkları ve omuzun tekrarlayan posterior instabilitesi tüm omuz çıkıkları içinde sadece %2-4 oranında görülmektedir. Anterior omuz instabilitesiyle kıyaslanınca oldukça nadirdir. Hastalar tekrarlayan posterior subluksasyon ve akut dislokasyon şikâyetleri ile başvurabilirler. Bununla beraber tekrarlayan posterior subluksasyon en sık görü-len posterior instabilite şeklidir. Tanıda hastanın instabilite anamnezi, fizik muayene sırasında şikâyetlerin oluşturulması ve görüntüleme yöntemleri önem kazanmaktadır. Posterior çıkık, omuzun ön kısmına direkt darbe veya omuzun fleksiyon pozisyonunda ekstremite üzerine düşme sonucu da olabilirken, epileptik atak, elektrik şoku ve intoksikasyon gibi bilinç kaybına neden olan durumlarda da olabilir. [1]

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Recurrent Posterior Shoulder Instability

Cited by 147 publications

References 35 publications

Comparison of peak shoulder and elbow mechanical loads during weight-relief lifts and sitting pivot transfers among manual wheelchair users with spinal cord injury

Comparison of peak shoulder and elbow mechanical loads during weight-relief lifts and sitting pivot transfers among manual wheelchair users with spinal cord injury

Capsule function following anterior dislocation: Implications for diagnosis of shoulder instability

Posterior omuz instabilitesi

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