Traumatic Anterior Glenohumeral Instability Research Articles

An Evaluation of the Apprehension, Relocation, and Surprise Tests for Anterior Shoulder Instability

Background Although there are many studies describing tests for shoulder instability, there are few assessing the validity of these tests in diagnosing anterior shoulder instability. Purpose To assess the validity of the apprehension, relocation, and surprise tests as predictors of anterior shoulder instability. Study Design Retrospective review of prospectively collected data. Methods Forty-six patients with a clear diagnosis of one of the following shoulder disorders were evaluated by four independent, blinded examiners: traumatic anterior instability (18), rotator cuff tendinosis (17), posterior instability (2), glenohumeral osteoarthritis (4), or multidirectional instability (5). Interobserver reliability was also determined. Results In subjects who had a feeling of apprehension on all three tests, the mean positive and negative predictive values were 93.6% and 71.9%, respectively. The surprise test was the single most accurate test (sensitivity = 63.89%; specificity = 98.91%). An improvement in the feeling of apprehension or painwith the relocation test added little to the value of the tests. Interobserver reliability was determined to be 0.83. Conclusions and Clinical Relevance The results of this study suggest that a positive instability exam on all three tests is highly specific and predictive of traumatic anterior glenohumeral instability.

Bankart repair in traumatic anterior shoulder instability: Open versus arthroscopic technique

Purpose: The purpose of this study was to compare the results of open and arthroscopic Bankart repair using suture anchors in traumatic anterior glenohumeral instability. Variables measured were recurrence rate, range of motion, and return to preinjury activity. Type of Study: Case control study. Methods: Eighty-nine shoulders in 88 patients with traumatic unilateral anterior shoulder instability were evaluated using Rowe and University of California Los Angeles scores, recurrence, return to activity, and range of motion by an independent examiner at an average of 39 months after either an arthroscopic or open Bankart repair using suture anchors. The arthroscopic technique included a minimum of 3 anchors in most patients and a routine incorporation of capsular plication and proximal shift. Of the 89 shoulders, 30 shoulders (30 patients) underwent open Bankart repair and 59 shoulders (58 patients) underwent arthroscopic Bankart repair. Results: Twenty-six shoulders (86.6%) in the open repair group showed excellent or good results, and 54 (91.5%) shoulders in the arthroscopic repair group showed excellent or good results. The arthroscopic group revealed slightly higher scores in the Rowe (P = .041) and UCLA scores (P = .026). Two patients (6.7%) in the open repair group and 2 (3.4%) in the arthroscopic repair group had experienced at least 1 episode of redislocation after the surgery. One patient (3.3%) in the open repair group and 4 (6.8%) in the arthroscopic repair group demonstrated mild apprehension. The overall residual instability was 10% in the open repair group and 10.2% in the arthroscopic repair group. There were no significant differences in the loss of external rotation and return to prior activity between the 2 groups (P > .05). Residual instability occurred more frequently in patients with fewer anchors. Conclusions: Arthroscopic suture anchor capsulorraphy showed similar results to the open Bankart procedure.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 7 (September), 2002: pp 755–763

Recent advances in arthroscopic repair of traumatic anterior glenohumeral instability.

Traumatic anterior instability is the most common type of glenohumeral instability. Although surgical treatment with an open technique has produced excellent results, there has been a trend toward arthroscopic treatment. As understanding of instability advances along with improvements in surgical techniques and instrumentation, arthroscopic results are fast approaching those seen with open procedures. Studies done at the authors' institution showed a 97% satisfactory outcome at short-term followup with 93% stable shoulders in a patient population with high physical demands. Others recently reported similar results. As more surgeons become familiar with the techniques, it is thought that arthroscopic Bankart reconstructions will be the preferred method in the future.

Three-dimensional Computed Tomographic Evaluation of Glenoid Morphology in Traumatic Anterior Glenohumeral Instability

Three-dimensional Computed Tomographic Evaluation of Glenoid Morphology in Traumatic Anterior Glenohumeral Instability

Traumatic Anterior Glenohumeral Instability: The Role of Arthroscopy.

The static and dynamic stabilizers of the glenohumeral joint act together to ensure joint stability throughout the wide range of normal shoulder motion. These structures are functionally altered after a traumatic anterior shoulder dislocation, often resulting in recurrent instability. The arthroscope has enhanced the surgeon's ability to examine and repair the unstable glenohumeral joint. The rate of recurrence of instability after arthroscopic stabilization has historically been unacceptably high compared with that after open stabilization techniques. The authors offer a treatment algorithm and suggest guidelines for the use of arthroscopic techniques in the treatment of the unstable shoulder.

Anterior and anterior-inferior shoulder instability: Treatment by glenoid labrum reconstruction and a modified capsular shift procedure

An anterior glenoid labrum reconstruction in conjunction with a modified anterior-inferior capsular shift is described and was performed in 64 patients (69 shoulders) with traumatic anterior or anterior-inferior glenohumeral instability. Sixty-three operations were performed for recurrent dislocation and six for recurrent subluxation. The patients in this study were extremely active in sports, with the majority of Tegner ratings exceeding 7.0. Fifty-six patients with 61 operated shoulders were available for clinical follow-up at an average of 36 months (range 28 to 78 months). With rating scales from the American Shoulder and Elbow Surgeons, pain improved from an average of 3.1 to an average of 4.4, stability improved from 1.1 to 4.5, and function improved from 2.5 to 3.8. Postoperative average ranges of motion were 180° of forward elevation, 72° of external rotation with the arm at the side, 92° of external rotation with the arm at 90° of abduction, and 90° of internal rotation with the arm at 90° of abduction. Ninety-five percent of the patients were satisfied with the procedure. Five patients suffered a recurrent dislocation, four from significant trauma. One additional patient experienced an episode of subluxation early in the recovery period. According to the criteria of Rowe, 90% had excellent or good results.

Arthroscopic transglenoid Bankart suture repair

Optimal clinical results after arthroscopic Bankart suture repair are mostly dependent on proper patient selection and attention to technical details at the time of surgery. Patients with unidirectional traumatic anterior glenohumeral instability without signs of generalized ligamentous laxity and an arthroscopically proven Bankart lesion are best indicated for this procedure. Results are best in the noncollision athlete population (98% excellent), there being an increased recurrence rate in the collision athlete (16% recurrence). Attention to details during arthroscopic suturing should result in a significant capsular shift of the inferior glenohumeral ligament complex as well as a labral reconstruction up onto the anterior inferior glenoid rim. Failure to accomplish these goals will yield inferior results.

An approach to the repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability.

Between 1976 and 1985, we repaired avulsion of the glenohumeral ligaments in sixty-three shoulders (sixty-one patients) that had traumatic anterior glenohumeral instability. We describe the indications for operation, the operative technique, and the findings at the time of operation. We located thirty-seven patients (thirty-nine shoulders) for clinical follow-up (average, 5.49 years). One patient had recurrent anterior dislocation four years postoperatively, but no patient needed reoperation. The average range of motion was 171 degrees of forward elevation and 84 degrees of external rotation in abduction. According to the criteria of Rowe et al., 97 per cent of the results were good or excellent.