Glenohumeral Joint Capsule Research Articles

The Effect Of Concomitant Glenohumeral Joint Capsule Release During Rotator Cuff Repair - A Comparative Study Of 195 Patients

Objectives:Background: There is debate as to whether to operate or defer surgery on patients with concomitant rotator cuff tear and shoulder stiffness. The purpose of this study was, therefore, to compare the outcomes in those patients who had both their rotator cuff tear and shoulder stiffness treated with patients who had a rotator cuff repair but no stiffness.Methods:Methods: 1232 primary arthroscopic rotator cuff repairs were performed during the study period, including 44 patients who received a concomitant glenohumeral joint capsule release for ipsilateral shoulder stiffness, forming the stiffness group. A chronologically matched group of four rotator cuff repair-only patients before and after each stiffness patient were chosen from the consecutive list of rotator cuff repairs. Twenty-five patients from the stiffness group and 170 patients from the non-stiffness group met the inclusion criteria, leaving a total cohort of 195 patients. Patients completed modified L’Insalata Questionnaires for patient-ranked pain and function scores pre-operatively, intra-operatively, and at one week, six weeks, 12 weeks, six months and two-years post-operatively, while examiners recorded range of motion, strength, and presence of impingement signs.Results:Results: Patients from both groups had significantly improved clinical outcomes at the two-year follow-up as compared to pre-operative values. Stiffness patients had 0/25 (0%) re-tears at two years, significantly less (p = 0.009) than the non-stiffness patients (34/170 [20%]). Range of motion was similar between groups at two-years for forward flexion, abduction and external rotation, while the non-stiffness group had a superior range of internal rotation (p < 0.02).Conclusion:Discussion: The good outcomes of rotator cuff repair with glenohumeral joint capsule release suggest that there is no advantage in delaying surgical repair of a rotator cuff tear to allow for stiffness to resolve. In contradistinction, the data presented in this paper suggests that shoulder stiffness with glenohumeral joint capsule release, confers an advantage in terms of repair integrity.

The effect of concomitant glenohumeral joint capsule release during rotator cuff repair – A comparative study of 195 patients

Background: There is debate as to whether to operate or defer surgery on patients with concomitant rotator cuff tear and shoulder stiffness. The purpose of this study was, therefore, to compare the outcomes in those patients who had both their rotator cuff tear and shoulder stiffness treated with patients who had a rotator cuff repair but no stiffness.

Neuroanatomical distribution of mechanoreceptors in the human cadaveric shoulder capsule and labrum.

The distribution, location, and spatial arrangement of mechanoreceptors are important for neural signal conciseness and accuracy in proprioceptive information required to maintain functional joint stability. The glenohumeral joint capsule and labrum are mechanoreceptor-containing tissues for which the distribution of mechanoreceptors has not been determined despite the importance of these tissues in stabilizing the shoulder. More recently, it has been shown that damage to articular mechanoreceptors can result in proprioceptive deficits that may lead to recurrent instability. Awareness of mechanoreceptor distribution in the glenohumeral joint capsule and labrum may allow preservation of the mechanoreceptors during surgical treatment for shoulder instability, and in turn retain the joint's proprioceptive integrity. For this reason, we sought to develop a neuroanatomical map of the mechanoreceptors within the capsule and labrum. We postulated that the mechanoreceptors in these tissues are distributed in a unique pattern, with mechanoreceptor-scarce regions that may be more appropriate for surgical dissection. We determined the neuroanatomical distribution of mechanoreceptors and their associated fascicles in the capsule and labrum from eight human cadaver shoulder pairs using our improved gold chloride staining technique and light microscopy. A distribution pattern was consistently observed in the capsule and labrum from which we derived a neuroanatomical map. Both tissues demonstrated mechanoreceptor-dense and -scarce regions that may be considered during surgical treatment for instability. Capsular fascicles were located in the subsynovial layer, whereas labral fascicles were concentrated in the peri-core zone. The capsular fascicles presented as a lattice network and with a plexiform appearance. Fascicles within the labrum resembled a cable structure with the fascicles running in parallel. Our findings contribute to the neuroanatomical knowledge of the two glenohumeral joint stabilizers, namely, capsule and labrum, primarily involved in the onset of shoulder instability and recurrent instability. Neuroanatomical knowledge of articular mechanoreceptors is important for (i) developing a topographical map that reflects correspondence between the joint and surrounding musculature, (ii) understanding proprioceptive deficits that are only partially restored post surgical and post rehabilitative treatment, and (iii) gaining further knowledge about articular mechanoreceptors.

AB0944 Us Investigation of Gleno-Humeral Joint by Anterior Access

BackgroundUS scan was shown to be effective and useful for investigation of gleno-humeral joint (GHJ) synovitis by posterior and axilar (inferior) access (1,2). Synovial fluid in the subacromial bursa and...

Biomechanical properties of the glenohumeral joint capsule in hemiplegic shoulder pain

BackgroundAlthough many hemiplegic shoulder patients have been suffering from limited range of motion, it is not fully established whether the pathologic biomechanics are same in hemiplegic shoulder pain and adhesive capsulitis. Therefore we aimed to investigate biomechanical properties of glenohumeral joint capsules of hemiplegic shoulder pain with limited range of motions. MethodsParticipants were 14 patients with hemiplegic shoulder pain, 10 controls, and 42 adhesive capsulitis patients matched with the hemiplegic shoulder pain group for sex, age, and range of motion. Demographic data, clinical variables, and sonographic findings were comparable between hemiplegic shoulder pain and adhesive capsulitis groups. We compared capsular capacity, maximal pressure, and capsular stiffness of glenohumeral joint capsule among the 3 groups. FindingsHemiplegic shoulder pain and adhesive capsulitis groups had smaller capsular capacity and higher maximal pressure than controls. The capsular stiffness of hemiplegic shoulder pain group was higher than that of controls (P=0.001) but lower than that of adhesive capsulitis group (P<0.001). InterpretationThe stiffness of glenohumeral joint capsules in hemiplegic shoulder pain and adhesive capsulitis patients was substantially higher than that in controls, suggesting that hemiplegic shoulder pain patients had stiffer capsules as adhesive capsulitis patients did although the severities were different. This finding implicates that hemiplegic shoulder pain may share common pathologic properties of tighter capsules with adhesive capsulitis. However, there may be additional mechanisms contributing to range of motion limitation in hemiplegic shoulder pain because capsular stiffness in those patients was not as severe as that in adhesive capsulitis patients with similar range of motion limitation.

Is This Shoulder Really Frozen? Sonographic Measurement of Glenohumeral Joint Capsule Thickness May Aid in the Diagnosis of Adhesive Capsulitis: A Case Series

Is This Shoulder Really Frozen? Sonographic Measurement of Glenohumeral Joint Capsule Thickness May Aid in the Diagnosis of Adhesive Capsulitis: A Case Series

Power Doppler Ultrasonography in the Early Diagnosis of Primary/Idiopathic Adhesive Capsulitis: An Exploratory Study

ObjectiveThe purpose of this exploratory study was to determine if increased vascularity in the rotator interval area of the glenohumeral joint capsule could be visualized with power Doppler ultrasonography (PDUS) in patients with a clinical diagnosis of early-stage adhesive capsulitis. MethodsDemographic and clinical characteristics from a consecutive series of 41 patients diagnosed with early-stage adhesive capsulitis were recorded and examination with PDUS was undertaken. Images were reviewed by 3 musculoskeletal radiologists, and consensus was determined on the presence of increased signal in the rotator interval area. ResultsConsensus was achieved on the presence of increased signal in 12 (29%) of the 41 cases. Participants with an increased PDUS signal did not demonstrate a characteristic set of identifying features, suggesting that those with increased vascularity may not constitute a distinct subgroup. ConclusionThis study found that some patients diagnosed with early-stage adhesive capsulitis demonstrated increased vascularity in the rotator interval area when examined with PDUS. These findings suggest that PDUS may have the potential to assist in the identification of increased vascularization in early stages of this disorder. Further research in the use of PDUS in diagnosing early-stage adhesive capsulitis is warranted.

Changes in Biomechanical Properties of Glenohumeral Joint Capsules With Adhesive Capsulitis by Repeated Capsule-Preserving Hydraulic Distensions With Saline Solution and Corticosteroid

To investigate whether capsule-preserving hydraulic distension with saline solution and corticosteroid for adhesive capsulitis induces biomechanical alterations in glenohumeral joint capsules along with clinical improvements. A case series. University outpatient clinic of physical medicine and rehabilitation. Eighteen patients with unilateral adhesive capsulitis. INTERVENTION AND MAIN OUTCOME MEASUREMENTS: Three hydraulic distensions with saline solution and corticosteroid were performed with 1-month intervals. To avoid rupturing capsules, all distensions were monitored by using real-time pressure-volume curves. Stiffness, maximal volume capacity, and pressure at the maximal volume capacity of the capsule were measured at each intervention. Clinical parameters, such as pain and range of motion, were recorded before, 3 days after, and 1 month after each distension. Stiffness decreased (47.6 ± 27.1 mm Hg/mL to 31.7 ± 18.4 mm Hg/mL to 24.2 ± 14.0 mm Hg/mL, mean SD) and maximal volume capacity increased (18.8 ± 7.3 mL to 20.5 ± 7.5 mL to 24.2 ± 7.0 mL, mean SD) significantly (P = .001 for both) at each repeated hydraulic distension. Pressure at the maximal volume capacity tended to decrease, but the decrements were not statistically significant (P = .662). The clinical parameters were significantly improved throughout and 1 month after the 3 repeat procedures (P < .05 for all). Capsule-preserving hydraulic distension changed the biomechanical properties of the glenohumeral joint capsule, lessening the stiffness and enlarging the volume capacity. These alterations were accompanied by improved range of motion and relief of pain. Repeated capsule-preserving hydraulic distension with saline solution and corticosteroid would be useful to treat adhesive capsulitis and to evaluate the treatment results.

Topographical Anatomy of the Equine M. Cutaneus Trunci in Relation to the Position of the Saddle and Girth

The aim was to investigate the topographical anatomy of m. cutaneus trunci with reference to the position of the saddle and girth and its possible role in persistent sensitivity to girth pressure. The methodology involved dissections of 12 horse cadavers to describe the topography, attachments, morphological features, and thickness of the cutaneous muscles. M. cutaneus trunci was more variable in size and shape, especially the extent and curvature of its dorsal border, than the descriptions in anatomical texts indicate. In all horses, it extended far enough dorsally to lie directly underneath the weight-bearing panels of the saddle. The muscle was substantial in size, weighing 2.6-4.3 kg and having a 1.5- to 2.7-cm thickness in the girth region. Craniodorsally, it was adherent to the underlying fascia in the scapular region. Cranioventrally, m. cutaneus trunci had a distinct fascial attachment with the tendons of m. latissimus dorsi and m. teres major on the teres major tuberosity and the glenohumeral joint capsule. From this fascial attachment, the muscle fibers radiated caudally and were intimately connected to the skin by a diffuse fibrous network. Tactile stimulation of the skin overlying the cutaneous muscle is associated with a reflex muscular contraction that twitches the overlying skin (panniculus reflex). Failure to habituate to pressure of the tack in areas overlying the m. cutaneus trunci may result in continuous stimulation of the panniculus reflex, which could play a role in persistent sensitivity to girth pressure in some horses.

Treatment of reverse Hill-Sachs lesion by autograft reconstruction

Reverse Hill-Sachs lesion is a defect caused by the anterior compression fracture of the humeral head in posterior shoulder dislocation. We present a 34-year-old male patient with pain and limited joint mobility in the right shoulder due to a fall following electric shock 2 days prior to admission. Radiography and CT of the shoulder revealed posterior dislocation of the shoulder with a reverse Hill-Sachs lesion. The patient underwent open reduction of the humeral head, elevation of the depressed osteochondral surface, reconstruction using autograft, and repair of the posterior surface of the glenohumeral joint capsule 5 days following trauma. At the 5th year follow-up, the patient had a perfect outcome when evaluated using the Constant score.

Das spinoglenoidale Ligament – eine anatomische Studie

In over-head motion athletes a dysfunction of the suprascapular nerve has been described. In the literature a relation between the spinoglenoid ligament and the dysfunction of the suprascapular nerve is mentioned. An appreciable variability of this ligament is described. The purpose of the present study was the anatomic documentation of the spinoglenoid ligament and its relation to the suprascapular nerve. In 36 shoulder specimen the suprascapular nerve, the spinoglenoid and bony parameter of the scapula were documented. The statistic evaluation was performed with SPSS12.0. In all but one specimen a spinoglenoid ligament was present. In 20 cases (56 %) the infraspinatus muscle inserted at the spinoglenoid ligament. In five cases (14 %) the spinoglenoid ligament reached the glenohumeral joint capsule. In two cases the suprascapular nerve was completely fixed with the ligament, in four cases the perineural soft tissue had a close connection to the ligament. In four cases a branch of the nerve passed through the ligament. All together in 28 % of the specimen there were mechanical conflicts. In one case a ganglion compressed the nerve. Our anatomic study showed in a significant number of cases a possible entrapment of different origins. These findings have implications both for diagnostics and treatment.

Reported mechanisms of shoulder injury during the baseball throw

Background: Shoulder complex injuries are common among overhand throwing athletes. These injuries often manifest as a result of habitual sport performance and often lead to time loss injuries. The mechanisms of these injuries are often non-traumatic and theories on how shoulder injuries manifest differ.Objectives: To describe the proposed mechanisms of commonly reported shoulder injuries as they relate to the phases of the throwing motion.Major findings: Shoulder injuries commonly involve rotator cuff muscles and tendons, scapulothoracic muscles, glenohumeral joint labrum, proximal humeral epiphysis, glenohumeral joint capsule, biceps muscle and tendon, and subacromial bursa. The injuries found in these tissues and their purported mechanisms of injury during the throw vary.Conclusions: The late cocking and deceleration phases have been implicated with the largest number of associated pathologies. Multiple injuries were theorized to occur at more than one phase of the throwing motion. Consensus has not been achieved on the provocative events leading to shoulder injury during the throwing motion.

Scapular muscle imbalance: implications for shoulder pain and pathology

Background: The scapula is important for normal shoulder function. The correct length, strength, and sequence of recruitment of the scapulothoracic muscles are important in controlling the movement of the scapula which must maintain an optimal position in relation to the elevating humerus. Changes in the action of scapulothoracic muscles may potentially affect alignment and forces and may contribute to glenohumeral joint pathology.Objective: The purpose of this paper is to review the literature that associates abnormal scapulothoracic muscle function with shoulder joint pain and pathology.Major findings: Shoulder impingement syndrome, superior labrum anterior to posterior (SLAP) lesions and multidirectional instability have all been associated with dysfunctional movement patterns of the scapula. It is not clear if the observed changes in scapular movements and muscular control are the result of or are the cause of these various pathologies at the shoulder joint. Alterations in the force production of the scapulothoracic musculature including all parts of the trapezius and serratus anterior muscles have been reported. Tightness in the pectoralis minor and/or in the posterior glenohumeral joint capsule may also affect movement due to a general anterior tilting of the scapula which impairs its ability to attain a normally upwardly rotated position.Conclusions: The results of the investigations reviewed imply that appropriate assessment of the length, strength, and activation of all parts of the upper trapezius, serratus anterior, and pectoralis minor are important in the rehabilitation of patients with glenohumeral joint pathology.

ACR Appropriateness Criteria® on Acute Shoulder Pain

The shoulder joint is a complex array of muscles, tendons, and capsuloligamentous structures that has the greatest freedom of motion of any joint in the body. Acute (<2 weeks) shoulder pain can be attributable to structures related to the glenohumeral articulation and joint capsule, rotator cuff, acromioclavicular joint, and scapula. The foundation for investigation of acute shoulder pain is radiography. Magnetic resonance imaging is the procedure of choice for the evaluation of occult fractures and the shoulder soft tissues. Ultrasound, with appropriate local expertise, is an excellent evaluation of the rotator cuff, long head of the biceps tendon, and interventional procedures. Fluoroscopy is an excellent modality to guide interventional procedures. Computed tomography is an excellent modality for characterizing complex shoulder fractures. Computed tomographic arthrography or fluoroscopic arthrography may be alternatives in patients for whom MR arthrography is contraindicated. A multimodal approach may be required to accurately assess shoulder pathology. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Unusual variation of the rotator interval: insertional abnormality of the pectoralis minor tendon and absence of the coracohumeral ligament

To evaluate the anomalous insertion of the pectoralis minor tendon with absence of the coracohumeral ligament on MR arthrography and to demonstrate the associated findings seen with this anatomical variation. We retrospectively reviewed the 335 MR arthrograms of the shoulder joint (mean age 37.8 years) performed from March 2000 to February 2008. Images were evaluated with attention to anomalous insertion of the pectoralis minor tendon and the coracohumeral ligament. Anomalous insertion of the pectoralis minor tendon was demonstrated in 5 out of 335 shoulders (1.5%). The pectoralis minor tendons crossed over the coracoid process and attached directly to a glenohumeral joint capsule, and the coracohumeral ligament was absent in these 5 patients. In these patients, injected contrast material was noted to extend over the coracoid process along the course of the pectoralis minor tendon. Among 5 patients, 3 patients (60%) were diagnosed with SLAP (superior labrum anterior to posterior) lesions. Anomalous insertion of the pectoralis minor tendon to the glenohumeral joint capsule and associated absence of the coracohumeral ligament is well demonstrated on MR arthrography. It is an unusual variant of the pectoralis minor muscle insertion, and may be a possible contributing factor in the development of a SLAP lesion.

The Evaluation of Glenohumeral Joint Capsule and Bursae by 3DCT

The Evaluation of Glenohumeral Joint Capsule and Bursae by 3DCT

Rotator cuff repair fluid extravasation characteristics are influenced by repair technique

This study evaluates rotator cuff repair fluid extravasation characteristics for different rotator cuff repair techniques. Eight fresh-frozen cadaveric shoulders were dissected free of soft tissues, with the glenohumeral joint capsule and rotator cuff muscles being left intact. A custom fluid infusion device was used to deliver fluid at constant pressure into the glenohumeral joint. The shoulders were tested in conditions of (1) intact rotator cuff, (2) supraspinatus tear, (3) repaired supraspinatus tear with a single-row technique, and (4) repaired supraspinatus tear with a double-row suture bridge technique. The volume per minute of saline solution extravasation for single-row repair and double-row suture bridge repair was 48.53 mL/min and 11.73 mL/min, respectively, at 2 psi; 73.3 _ 24.1 mL/min and 24.5 _ 19.7 mL/min, respectively, at 3 psi; and 95.2 _ 22.6 mL/min and 39.2 _ 23.8 mL/min, respectively, at 4 psi. There was a statistically significant greater fluid extravasation for the single-row repair compared with the double-row suture bridge repair at all 3 pressures tested (P < .05). Single-row rotator cuff repair exposes the healing zone to greater extravasation of fluid compared with double-row suture bridge repair. Therefore, double-row repair potentially enhances rotator cuff healing. Controlled laboratory study.

The stiff shoulder: how, why, and when to treat

Purpose of review Primary frozen shoulder is a common condition affecting many North Americans. Controversies exist with both nonoperative and operative management. In this review, we comment on several recent studies that have advanced our understanding of the various treatment modalities for frozen shoulder. Recent findings Several recent studies have improved our understanding of the natural history and pathology of frozen shoulder. Frozen shoulder has been found to include an inflammatory response with fibroblastic proliferation. New findings in the past year have demonstrated a geographic variation in contractile proteins with a preponderance in the anterior glenohumeral joint capsule. Fibroplasia, conversely, appears to globally involve the joint capsule. Although the use of oral steroids still remains controversial, good data suggest that short-term benefits exist. The role of arthrographic distension still remains unclear, whereas the role of operative release is being better understood. Summary Frozen shoulder remains a frequent and poorly understood disorder. Recent studies have improved our understanding of the pathology of frozen shoulder, its management and the outcomes.

Real‐time pressure monitoring of intraarticular hydraulic distension for painful stiff shoulders

Intraarticular hydraulic distension (IHD) has been utilized to treat painful stiff shoulders by distending and then rupturing the joint capsules. However, no attempts have been made to optimize the capsule distension, which might give a better clinical outcome. To set up a prerequisite technique for a maximal distension without rupturing the capsule, real-time pressure monitoring of IHD procedures was performed in 16 patients, which revealed triphasic pressure-volume profiles in 10 patients and biphasic in 6 patients. The IHD procedures were terminated without rupturing the capsule by observing the real-time pressure-volume curves (N = 10) or by pain (N = 3). The pressure profiles of the 13 patients who had the infusion stopped without rupture demonstrated stress-relaxation curves of the capsules. The biphasic group showed a steeper slope of the second phase of linearly increasing pressure (p = 0.017) and higher pressure (p = 0.005) with slightly larger volume (p = 0.095) at the termination of fluid infusion than did the triphasic group. The stiffness of the glenohumeral joint capsule had a close correlation with the limitation in range of motion. Real-time pressure monitoring would be helpful to develop a novel IHD technique that could distend the glenohumeral joint as much as possible without rupturing it. The biomechanical parameters derived from the pressure-volume profiles would also be useful to characterize the properties of the joints of painful stiff shoulder patients.

The Rotator Interval: Anatomy, Pathology, and Strategies for Treatment

Over the past two decades, it has become accepted that the rotator interval is a distinct anatomic entity that plays an important role in affecting the proper function of the glenohumeral joint. The rotator interval is an anatomic region in the anterosuperior aspect of the glenohumeral joint that represents a complex interaction of the fibers of the coracohumeral ligament, the superior glenohumeral ligament, the glenohumeral joint capsule, and the supraspinatus and subscapularis tendons. As basic science and clinical studies continue to elucidate the precise role of the rotator interval, understanding of and therapeutic interventions for rotator interval pathology also continue to evolve. Lesions of the rotator interval may result in glenohumeral joint contractures, shoulder instability, or in lesions to the long head of the biceps tendon. Long-term clinical trials may clarify the results of current surgical interventions and further enhance understanding of the rotator interval.