Position of Immobilization After Dislocation of the Shoulder. A Cadaveric Study*

Itoi, Eiji; Hatakeyama, Yuji; Urayama, Masakazu; Pradhan, Rabindra Lal; Kido, Tadato; Satô, Kôzô

doi:10.2106/00004623-199903000-00011

Cited by 105 publications

(57 citation statements)

References 18 publications

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“…Itoi et al [11] first raised the possibility of improving non-operative treatment after shoulder dislocation by placing the arm in external rotation. However, there have been many criticisms about conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic repair for combined Bankart and superior labral anterior posterior lesions: a comparative study between primary and recurrent anterior dislocation in the shoulder

Kim

Yoon

2011

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to compare clinical outcomes between a primary dislocation group (group P) and a recurrent dislocation group (group R) with combined lesion of Bankart and type II SLAP lesions (type V SLAP lesion) and to evaluate incidence of type V SLAP lesion. In addition, the authors evaluated clinical outcomes of these patients by dividing two groups according to the sequence for Bankart and SLAP lesion suture. Methods From May 2000 to May 2005, 310 patients who gave informed consent, underwent the diagnostic arthroscopy and magnetic resonance arthrography (MRA). One hundred and ten patients met the following criteria: (1) post-traumatic primary or recurrent anterior shoulder instability, (2) a normal contralateral shoulder, (3) a type V SLAP lesion, and (4) minimum follow-up of two years. Group P included 42 patients, and group R, 68 patients. Among all patients, 58 patients who had Bankart lesions sutured first were included in group B, and 52 who had their SLAP lesions sutured beforehand, group S. Visual analogue scale, range of motion, Rowe and Constant score were used to compare results between group P and group R, also group B and group S. Results The incidence rates of type V SLAP lesion were 42.8% in group P and 32.0% in group R. The overall treatment results in our study were good. Even if the difference between the two groups was statistically insignificant, group P showed greater recovery of range of motion than group R in external rotation. No significant difference was found between the two different operative methods according to suture sequence. ConclusionThe incidence rates of type V SLAP lesion were 42.8% in the primary dislocation group and 32.0% in the recurrent dislocation group. The overall treatment results in our study were good. Although there was no statistical significance in surgical time between the two groups, when both SLAP and Bankart lesions are present, the Bankart lesion must be sutured first to reduce surgical time.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic repair for combined Bankart and superior labral anterior posterior lesions: a comparative study between primary and recurrent anterior dislocation in the shoulder

Kim

Yoon

2011

International Orthopaedics (SICOT)

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“…These results do not apply to those patients actively participating in sports, or to those patients with multidirectional or posterior instability, other labral lesions, a rotator cuff tear, or a larger bony Bankart lesion involving greater than 30% of the glenoid. Additionally, considering that the capsulolabral complex appears to be within the safe boundaries of stress with the arm in adduction and up to 30° of external rotation, 37 immediate postoperative ROM in this range is safe. 46 Based on this evidence and our significant clinical experience rehabilitating patients following this surgery, we recommend a variable period between 0 up to 4 weeks of absolute immobilization following an arthroscopic anterior capsulolabral repair, in which sutures or suture anchors are utilized.…”

Section: Guiding Principlementioning

confidence: 99%

“…68,81,86 A standard anterior capsulolabral repair, addressing attenuation of the anterior inferior capsule, is most directly stressed by external rotation, particularly above 90° of abduction. 68,86 In a cadaveric model, Itoi et al 37 demonstrated that with the arm by the side, external rotation to 30° could safely be applied to the shoulder without separating a simulated Bankart lesion.…”

mentioning

confidence: 99%

The American Society of Shoulder and Elbow Therapists' Consensus Rehabilitation Guideline for Arthroscopic Anterior Capsulolabral Repair of the Shoulder

Gaunt¹,

Shaffer²,

Sauers³

et al. 2010

Journal of Orthopaedic & Sports Physical Therapy

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Synopsis This manuscript describes the consensus rehabilitation guideline developed by the American Society of Shoulder and Elbow Therapists. The purpose of this guideline is to facilitate clinical decision making during the rehabilitation of patients following arthroscopic anterior capsulolabral repair of the shoulder. This guideline is centered on the principle of the gradual application of stress to the healing capsulolabral repair through appropriate integration of range of motion, strengthening, and shoulder girdle stabilization exercises during rehabilitation and daily activities. Components of this guideline include a 0- to 4-week period of absolute immobilization, a staged recovery of full range of motion over a 3-month period, a strengthening progression beginning at postoperative week 6, and a functional progression for return to athletic or demanding work activities between postoperative months 4 and 6. This document represents the first consensus rehabilitation guideline developed by a multidisciplinary society of international rehabilitation professionals specifically for the postoperative care of patients following arthroscopic anterior capsulolabral repair of the shoulder. J Orthop Sports Phys Ther 2010;40(3):155–168. doi:10.2519/jospt.2010.3186

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“…Itoi et al 5,6 stated that the tightened anterior soft tissue structure with the arm in external rotation could hold a separated labrum back in the glenoid rim in primary anterior shoulder dislocations. In our study, the humeral head also moved in an anterior direction with an increase of external rotation angle.…”

Section: [ ( F I G _ 4 ) T D $ F I G ]mentioning

confidence: 99%

“…[1][2][3][4] Recently, there have been reports that placing an arm in an externally rotated position for three to six weeks instead of an internally rotated position could reduce the dislocation recurrence rate. [5][6][7] However, some authors have described the advantages of early surgery. 1,[8][9][10] At the center of this controversy is the question of whether after primary shoulder dislocation, translation of the humerus relative to the glenoid can meaningfully be changed in the shoulder with primary dislocation compared with the normal side, during dynamic active movement.…”

Section: Introductionmentioning

confidence: 99%

Comparison of dynamics in 3D glenohumeral position between primary dislocated shoulders and contralateral healthy shoulders

Kim

Lee

Banks

et al. 2017

Journal of Orthopaedics

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A B S T R A C TBackgrounds: After shoulder dislocation, kinematic changes in shoulder, including translation of the humeral head, ensue. There have been many attempts to measure these changes using motion measurement techniques, but in vivo three-dimensional (3D) glenohumeral changes have not been appreciated until now. The purpose of this study was to measure and analyze changes in glenohumeral translation in patients with shoulder dislocation and compare these changes with healthy shoulder. Methods: We included 20 subjects who had suffered shoulder dislocation for first time, and 3D models of their humerus and scapula were obtained using computed tomography and fluoroscopic images during scapular plane abduction and external rotation of shoulder with elbow flexed at 90and arm abducted at 90. We measured the superior/inferior (SI) and anterior/posterior (AP) translations for both shoulders. Results: No statistically significant difference between healthy and dislocated shoulders was detected in SI translation for scapular plane abduction with increasing elevation angles. In AP translation, the humeral head was located 2.29 mm more anteriorly in the dislocated shoulder than in the healthy shoulder. However, no statistically significant difference was seen. For internal to external rotation, the angle of the rotated arm had an effect on AP translation. However, no statistically significant difference was detected. In the apprehension test, there was no significant difference in the mean value of AP translation. Conclusion: Compared with the contralateral healthy shoulder, changes in glenohumeral translation during in vivo movement after shoulder dislocation were found to be non-significant.

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Position of Immobilization After Dislocation of the Shoulder. A Cadaveric Study*

Cited by 105 publications

References 18 publications

Arthroscopic repair for combined Bankart and superior labral anterior posterior lesions: a comparative study between primary and recurrent anterior dislocation in the shoulder

Arthroscopic repair for combined Bankart and superior labral anterior posterior lesions: a comparative study between primary and recurrent anterior dislocation in the shoulder

The American Society of Shoulder and Elbow Therapists' Consensus Rehabilitation Guideline for Arthroscopic Anterior Capsulolabral Repair of the Shoulder

Comparison of dynamics in 3D glenohumeral position between primary dislocated shoulders and contralateral healthy shoulders

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