Non-operative treatment of multidirectional shoulder instability

Kiss, János; Damrel, Dorcas; Mackie, A.; Neumann, Lars; Wallace, W. Angus

doi:10.1007/s002640000202

Cited by 80 publications

(103 citation statements)

References 16 publications

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“…In case of failure, surgical treatment, such as shoulder arthroscopy, is recommended [6]. Arthroscopic techniques have been used to treat the problems successfully for many years.…”

Section: Introductionmentioning

confidence: 99%

Effect of arthroscopic techniques on joint volume in shoulder instability: Bankart repair versus capsular shift

Lubiatowski

Długosz

Ślęzak

et al. 2016

International Orthopaedics (SICOT)

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Purpose The evaluation of glenohumeral joint volume in both unstable (with/without laxity) and stable shoulders (subacromial impingement) and volume reduction potential of arthroscopic techniques: (labral anchor repair vs. capsular shift). Methods Material was based on 133 patients: anterior shoulder instability without laxity (group I, n = 49), with laxity (group II, n = 22) and subacromial impingement (control group, n = 62) operated in 2010-2011. Group I received arthroscopic Bankart repair, group; II -arthroscopic anterior capsular plication, control group -subacromial decompression. Joint volume was measured by fluid aspiration into the syringe via arthroscope, before and after procedure. Then volume reduction potential was calculated. Results The following average values of initial joint volume were recorded: group I -26.8 ml group II -43.7 ml and the control group -25.6 ml with significant differences: impingement vs. instability + laxity (p < 0.00001), impingement vs. instability without laxity (p = 0.0001). There was no significant difference between groups I and II. Joint volume was significantly reduced after labral repair (by average of 37 %, 13.8 ml, p < 0.0001). Capsular shift led to an even greater and more significant volume decrease (61 %, 26.7 ml, p < 0.001). Joint volume in the control group was reduced only by 11 %, 3.8 ml (p = 0.046).Conclusions Patients with unstable shoulders have enlarged joint volume as compared to patients with subacromial impingement. Arthroscopic techniques lead to a significant joint volume reduction, with the most powerful effect for capsular shift. Level of Evidence -Level 2.

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“…In case of failure, surgical treatment, such as shoulder arthroscopy, is recommended [6]. Arthroscopic techniques have been used to treat the problems successfully for many years.…”

Section: Introductionmentioning

confidence: 99%

Effect of arthroscopic techniques on joint volume in shoulder instability: Bankart repair versus capsular shift

Lubiatowski

Długosz

Ślęzak

et al. 2016

International Orthopaedics (SICOT)

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“…The measurement was performed at the Biomechanical Laboratory of the Department of Applied Mechanics at the Budapest University of Technology and Economics, and Szolnok Hospital of Hungarian Railways. The detailed ultrasound-based shoulder kinematic and electromyographic measurement method is described by the same authors previously 8,9 .…”

Section: Methods Of Biomechanic Measurementmentioning

confidence: 99%

Intermediate biomechanical analysis of the effect of physiotherapy only compared to capsular shift and physiotherapy in multidirectional shoulder instability

Nyiri¹,

Illyés²,

Kiss³

et al. 2010

Biomech Hung

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Purpose: The aim of study is to compare the kinematic parameters and activity pattern of muscles around the glenohumeral joint in multidirectional instability (MDI) treated by only physiotherapy and by capsular shift and physiotherapy, before and after treatment. Materilal and method:The study was carried out on 32 patients with MDI treated with only physiotherapy (29 patients after 2 years, and 21 patients after 4 years), 19 patients with MDI treated by capsular shift and physiotherapy (19 patients after 2 and 4 years), and 50 healthy subjects as control group. The investigated kinematic parameters were the range of the humeral elevation (HE) in the scapular plane, the scapulothoracal and glenohumeral angle, the scapulothoracal (ST) and glenohumeral (GH) rhytms, and relative displacement between the rotation centers of the humerus and the scapula. The muscle activity was modeled by the on-off pattern of muscles around the shoulder.Results: Before treatment the increased relative displacement between the rotation centers of the scapula and the humerus and different ST and GH rhythms were observed in MDI patients. The physiotherapy strengthened the rotator cuff, biceps brachii, triceps brachii, deltoid muscle, but ST and GH rhytms remained monolinear. Capsular shift and physiotherapy resulted bilinear ST and GH rhytms and normal relative displacement between the rotation center of scapula and humerus was restored. After surgery and physiotherapy the activity pattern of muscles around the shoulder was almost normal. Conclusion:The signifi cant alterations in kinematic parameters in MDI patients cannot be restored by physiotherapy only. After the capsular shift and postoperative physiotherapy the bilinear ST and GH rhytm (angulation at 60 degree), the normal relative displacement between the rotation centers of scapula and humerus and the normal muscular activity pattern can be restored.

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“…Several studies showed variable results with success rates between 30 and 80% (41)(42)(43). Surgical treatment should be considered after failure of conservative treatment or in the presence of bony abnormalities.…”

Section: J Ointsmentioning

confidence: 99%

Generalized joint laxity and multidirectional instability of the shoulder

Saccomanno¹,

Fodale²,

Capasso³

et al. 2013

Joints

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Generalized joint laxity and shoulder instability are common conditions that exhibit a wide spectrum of different clinical forms and may coexist in the same patient. Generalized joint laxity can be congenital or acquired. It is fundamental to distinguish laxity from instability. Laxity is a physiological condition that may predispose to the development of shoulder instability. A high prevalence of generalized joint laxity has been identified in patients with multidirectional instability of the shoulder. Multidirectional instability is defined as symptomatic instability in two or more directions. The diagnosis and treatment of this condition are still challenging because of complexities in its classification and etiology. These complexities are compounded when multidirectional instability and laxity exist in the same patient. With an improved understanding of the clinical symptoms and physical examination findings, a successful strategy for conservative and/or surgical treatments can be developed. Conservative treatment is the first-line option. If it fails, different surgical options are available. Historically, open capsular shift has been considered the gold standard in the surgical management of these patients. Nowadays, advanced arthroscopic techniques offer several advantages over traditional open approaches and have shown similar outcomes. The correct approach to the management of failed stabilization procedures has not been yet defined.

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Non-operative treatment of multidirectional shoulder instability

Cited by 80 publications

References 16 publications

Effect of arthroscopic techniques on joint volume in shoulder instability: Bankart repair versus capsular shift

Effect of arthroscopic techniques on joint volume in shoulder instability: Bankart repair versus capsular shift

Intermediate biomechanical analysis of the effect of physiotherapy only compared to capsular shift and physiotherapy in multidirectional shoulder instability

Generalized joint laxity and multidirectional instability of the shoulder

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