An Analysis of the Rotator Interval in Patients With Anterior, Posterior, and Multidirectional Shoulder Instability

Provencher, Matthew T.; Dewing, Christopher B.; Bell, S. Josh; McCormick, Frank; Solomon, Daniel J.; Rooney, Timothy B.; Stanley, Mark

doi:10.1016/j.arthro.2008.03.005

Cited by 55 publications

(17 citation statements)

References 40 publications

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“…24 However, recent studies have shown no significant difference in the overall size of the rotator interval between patients with shoulder instability and controls. 63 Posterior or inferior instability did not improve after arthroscopic rotator interval closure, whereas anterior stability did. 52 …”

Section: Anatomy: Components Of Posterior Shoulder Stabilitymentioning

confidence: 91%

Evaluation and Management of Posterior Shoulder Instability

Tannenbaum

Sekiya

2011

Sports Health

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Context:Posterior shoulder instability is a commonly misdiagnosed disorder in many competitive athletes.Type of Study:Clinical review.Evidence Acquisition:Relevant studies on posterior shoulder instability from 1950 to 2010 in PubMed and Cochrane databases were reviewed.Results:A total of 107 studies were reviewed.Conclusion:Patients who have undergone at least 6 months of physical therapy and still experience instability symptoms should be considered for surgical stabilization directed at their underlying pathology.

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Section: Anatomy: Components Of Posterior Shoulder Stabilitymentioning

confidence: 91%

Evaluation and Management of Posterior Shoulder Instability

Tannenbaum

Sekiya

2011

Sports Health

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“…6) and to correlate these measurements with the results of clinical assessments. [35][36][37][38] Kim and coworkers found significant differences in RI dimensions between patients with chronic anterior instability and controls with stable shoulders. 37 Lee and coworkers reported significantly higher values for RI width in patients with multidirectional shoulder instability compared with controls.…”

Section: Rotator Interval Laxitymentioning

confidence: 99%

“…The role of RI in shoulder instability is subject to an ongoing debate. 1,35 Although RI laxity may contribute to instability and pain, 1,3,5 it is unlikely to represent the only underlying pathology in most cases. Arthroscopic or open surgical closure of the RI, either alone or in combination with other stabilizing techniques, has been suggested as a means to treat different forms of shoulder instability, but the biomechanical effect of these procedures is doubted nowadays.…”

Section: Rotator Interval Laxitymentioning

confidence: 99%

“…Arthroscopic or open surgical closure of the RI, either alone or in combination with other stabilizing techniques, has been suggested as a means to treat different forms of shoulder instability, but the biomechanical effect of these procedures is doubted nowadays. 1,4,21,35 The diagnosis of glenohumeral instability is mainly based on clinical history and physical examination. 6,36 Several studies have made attempts to quantify the dimensions of the RI on MR arthrograms of the shoulder (►Fig.…”

Section: Rotator Interval Laxitymentioning

confidence: 99%

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Rotator Interval

Woertler

2015

Semin Musculoskelet Radiol

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The general dilemma of the shoulder as a ball-and-socket joint is to provide high mobility and, at the same time, maintain sufficient stability. This is reflected in the controversial pathoanatomical role of the rotator interval (RI), both as a dynamic stabilizer and also a structural weak spot, serving as a capsular reserve space and an outlet for the long head of biceps tendon (LHBT). 1,2 In experimental studies, a section of the RI leads to an increased anterior inferior and posterior translation of the humeral head, whereas surgical closure of the rotator interval limits external rotation, elevation, and extension. 3-5 Thus, although not generally agreed, the rotator interval structures are thought to contribute to joint stability, and consequently pathologic changes of these structures might affect glenohumeral stability and mobility. 1 Imaging of the RI is mostly based on MR techniques. Normal anatomy and MR imaging findings in pathologic conditions involving the RI have been addressed by various review-type articles but only relatively few scientific studies. Therefore, in certain aspects, current practice is not fully based on reproducible results but also on personal experience.This article further extends the list of review articles on the RI. With a focus on MR imaging and MR arthrography it discusses anatomical features, technical aspects, as well as pathology of the RI capsule, the LHBT, and the pulley system. AnatomyThe rotator cuff has two tendinous gaps that are exclusively covered by capsular tissue: one anteriorly between the subscapularis (SSC) tendon and the supraspinatus (SSP) tendon, termed the anterior rotator interval, and one posteriorly between the supraspinatus tendon and the infraspinatus tendon, termed the posterior rotator interval. However, the term rotator interval usually refers to the anterior RI, and thus, to make things more simple, this convention is also assumed for this article.The RI is a triangular shaped space bordered by the anterior free edge of the SSP tendon superiorly, the superior free edge of the SSC tendon inferiorly, and the coracoid process medially. The intertubercular sulcus and transverse ligament represent the lateral apex of this triangle, the coracoid process its base (►Fig. 1). The RI contains the intra-articular portion of the LHBT. It is covered by a fibrous capsule that represents an extension of the anterior joint capsule termed the rotator interval capsule. The RI capsule is reinforced by two ligaments: the coracohumeral ligament (CHL) on its bursal side and the superior glenohumeral ligament (SGHL) on its articular side (►Fig. 1). As the RI capsule forms the roof of the RI, its floor is formed by the articular cartilage surface of the humeral head. [6][7][8][9] If viewed on sagittal sections (►Fig. 1c), the RI shows a quadrilateral configuration with the superior border of the SSC tendon inferiorly, the anterior border of the SSP tendon superiorly, the RI capsule anteriorly, and the humeral head posteriorly. 8 On midsagittal sections, the LHBT is l...

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“…Although labral abnormalities, and increased glenohumeral volume are often seen, these findings are nonspecific and may not reflect actual instability. Rotator interval augmentation or herniation has been pointed out as a key finding in multirectional instability [17], while other studies did not find any difference between different types of instability and control groups [35, 36]. …”

Section: Introductionmentioning

confidence: 99%

Multidirectional Instability: Natural History and Evaluation

Navlet¹,

Asenjo-Gismero²

2017

TOORTHJ

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Background:Multidirectional instability (MDI) represents a great challenge to the orthopedic surgeon. When treating these patients we must be aware that instability refers to a symptomatic situation, thus multidirectional instability is defined as symptomatic involuntary instability in two or more directions, and should be clearly differentiated from asymptomatic hyperlaxity.It may be associated with hyperlaxity, either congenital or acquired following repetitive stress, but also may be present without hyperlaxity, which is rare.Methods:We searched in the online data bases and reviewed the relevant published literature available.Results:Many differences can be seen in the current literature when identifying these patients, unclear definitions and criteria to be included in this patient group are common.Conclusion:Understanding the complex shoulder biomechanics as well as being aware of the typical clinical features and the key examination signs, which we review in this article, is of paramount importance in order to identify and classify these patients, allowing the best treatment option to be offered to each patient.

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An Analysis of the Rotator Interval in Patients With Anterior, Posterior, and Multidirectional Shoulder Instability

Cited by 55 publications

References 40 publications

Evaluation and Management of Posterior Shoulder Instability

Evaluation and Management of Posterior Shoulder Instability

Rotator Interval

Multidirectional Instability: Natural History and Evaluation

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