Stress radiography for clinical evaluation of anterior shoulder instability

Park, Jin‐Young; Kim, Young Bok; Oh, Kyung-Soo; Lim, Hwa-Kyung; Kim, Joo-Yong

doi:10.1016/j.jse.2016.04.002

Cited by 6 publications

(10 citation statements)

References 24 publications

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“…Previous studies of AHHT in the healthy shoulder showed a wide range of translation distance: 7.5 to 11.3 mm of translation with a 67- to 134-N anterior force at 0° of abduction with neutral rotation according to Sauers et al 30 ; 1.3 mm of translation with a 150-N distraction force at 90° of abduction with neutral rotation according to Park et al 25 ; and 2 to 3 mm of translation with a 100-N distraction force at 90° of abduction with 60° of external rotation according to Borsa et al 4 These inconsistent results may reflect either the difference of distraction methods among previous studies or the difficulty of suppressing muscle contraction; the examinations were conducted in conscious patients, and contraction of rotator cuff muscles may restrict humeral head translation. 29 Previous studies on anterior shoulder instability have reported an AHHT of 3.4 mm with a 150-N distraction force at 90° of abduction with neutral rotation (Park et al) and an AHHT of 4.9 mm with a 90-N distraction force at 0° of abduction with internal rotation (Krarup et al 12 ); AHHT in the current study was 5.29 mm at 0°, 8.90 mm at 45° and 9.46 mm at 90°.…”

Section: Discussionmentioning

confidence: 96%

“…Stress radiography, motion capture, navigation systems, and ultrasonography have been used in earlier reports to dynamically evaluate the joint. 4 , 13 , 16 , 25 , 33 In particular, ultrasonography enables the assessment of patients repeatedly and dynamically, without any invasion or radiation exposure. Even ultrasonography-based quantitative analysis has been used for evaluating the translation of humeral head with a high reproducibility in a cadaveric study.…”

mentioning

confidence: 99%

“… 33 Previous studies using stress radiograph or ultrasound showed that patients with anterior shoulder instability had larger translation than a healthy shoulder when the humeral head was pushed anteriorly. 12 , 25 However, the difference in the translation between the positions of the shoulder or the factors affecting the translation remains unknown. Especially in the clinical setting, knowledge of the effect of an increasing number of dislocations or bone loss on the increase in pathological translation of the humeral head would be helpful for making treatment decisions.…”

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confidence: 99%

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Ultrasound Assessment of Anterior Humeral Head Translation in Patients With Anterior Shoulder Instability: Correlation With Demographic, Radiographic, and Clinical Data

Inoue

Takenaga

Tsuchiya

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Ultrasonography can be used to quantitatively assess anterior humeral head translation (AHHT) at different degrees of shoulder abduction. Risk factors for recurrent shoulder instability have been identified. Hypothesis: It was hypothesized that the number of dislocations or glenoid or humeral bone loss would be associated with more AHHT as measured using ultrasound. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 39 patients who underwent surgery for anterior shoulder instability were prospectively studied. Ultrasound assessment of AHHT was performed immediately after general anesthesia was induced. The upper arm was placed at 0°, 45°, and 90° of abduction, and a 40-N anterior force was applied to the proximal third of the arm. The distance from the posterior edge of the glenoid to that of the humeral head was measured at each abduction angle using ultrasound with and without a 40-N anterior force, and the AHHT was calculated. The differences in translation at each shoulder angle were compared. Additionally, the authors investigated the association between AHHT and demographic, radiographic, and clinical data. Results: Compared with the AHHT at 0° of abduction (5.29 mm), translation was significantly larger at 45° of abduction (8.90 mm; P < .01) and 90° of abduction (9.46 mm; P < .01). The mean translation was significantly larger in female patients than in male patients at all degrees of abduction ( P ≤ .036 for all). There was no correlation between AHHT at any abduction angle and number of dislocations, clinical data, or radiographic data (including bone loss). Conclusion: Ultrasound assessment of AHHT showed larger amounts of laxity at 45° and 90° than at 0° of abduction. Anterior glenohumeral laxity was greater in female than male patients. Glenoid or humeral bone loss did not correlate with AHHT, thereby clarifying that bone loss has no direct effect on measurements of capsular laxity in neutral rotation.

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Section: Discussionmentioning

confidence: 96%

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Ultrasound Assessment of Anterior Humeral Head Translation in Patients With Anterior Shoulder Instability: Correlation With Demographic, Radiographic, and Clinical Data

Inoue

Takenaga

Tsuchiya

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…With one hand, the evaluator had stabilized the scapula by applying force on the coracoid process. The other hand was grasped the humeral and drew it out anteriorly [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the diagnostic performance of the simple method of computed tomography in the assessment of patients with shoulder instability: a prospective cohort study

Liu

Cao

et al. 2018

BMC Med Imaging

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BackgroundPhysical examinations may reveal the instability of a glenohumeral joint but cannot diagnose the bony Bankart lesions. Soft tissue Bankart lesion cannot be visualized on traditional radiogram. Magnetic resonance images have high cost and availability issues. The purpose of the study was to access the diagnostic performance of the Computed Tomography (CT) in the assessment of patients with shoulder instability and to diagnose the Bankart and bony Bankart lesions.MethodsA total of 145 patients with shoulder instability were included in the study. Patients were subjected to clinical examination tests, traditional radiography, and CT. Two orthopedic surgeons, two engineers (trained in musculoskeletal imaging), and two physiotherapists have analyzed the radiological images, CT scans, and the clinical examination tests respectively. The Chi-square test or one-way ANOVA/ Dunnett Multiple comparisons test was performed at 99% of confidence level.ResultsSensitivity (0.972 ± 0.18 vs. 1, p = 0.11) and accuracy (0.942 ± 0.17 vs. 1, p < 0.0001, q = 3.88) for the clinical examination tests combining the traditional radiological images were same to CT. However, the clinical examination tests combining the traditional radiological images had more inconclusive results (5 vs. 1), false-positive results (6 vs. 5), and false negative results (4 vs. 1) than CT. The area that detects the Bankart and bony Bankart lesions at least one time for CT was higher than that of the clinical examination tests combining the traditional radiological images.ConclusionCT should be considered for evaluation in patients with shoulder instability and suspected Bankart and bony Bankart lesions.Trial registrationResearchregistry3990 dated 15 December 2014 (www.researchregistry.com).

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“…Anterior shoulder instability is common in young athletes, particularly in those participating in collision sports. 2 , 19 Patients with anterior shoulder instability have been known to have excessive anterior translation of the humeral head, 20 which could provoke pain and anxiety related to dislocation and/or recurrent dislocation. A surgical procedure is often needed to enable these patients to continue sports activity.…”

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confidence: 99%

Ultrasonographic Assessment of Glenohumeral Joint Stability Immediately After Arthroscopic Bankart-Bristow Procedure

Inoue

Takenaga

Tsuchiya

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The changes in glenohumeral joint stability after surgery in a clinical setting are yet unknown. Purpose/Hypothesis: This study aimed to compare the anterior humeral head translation between pre- and postsurgical conditions using ultrasonography. It was hypothesized that ultrasonographic assessment would reveal decreased anterior translation. Study Design: Case series; Level of evidence, 4. Methods: A total of 27 patients (24 male, 3 female; mean age, 24.1 ± 9.7 years) with anterior shoulder instability were studied prospectively. All the patients underwent the arthroscopic Bankart-Bristow procedure under general anesthesia, and ultrasonographic evaluation was performed before and immediately after surgery. The forearm was fixed with an arm positioner in the beach-chair position, and the ultrasonographic transducer was located at the posterior part of the shoulder to visualize the humeral head and glenoid rim at the level of interval between the infraspinatus tendon and teres minor tendon. The upper arm was drawn anteriorly with a 40-N force at 0°, 45°, and 90° of shoulder abduction with neutral rotation. The distance from the posterior edge of the glenoid to that of the humeral head was measured using ultrasonography with and without anterior force. Anterior translation was defined by subtracting the distance with anterior force from the distance without anterior force. Results: The humeral head position was translated posteriorly immediately after surgery in all patients. Anterior translation decreased significantly after surgery at 45° (7.7 ± 4.3 vs 5.8 ± 2.0 mm; P = .031) and 90° (8.9 ± 3.4 vs 6.1 ± 2.2 mm; P < .001) of abduction, whereas there was no difference between pre- and postsurgical translation at 0° of abduction (4.9 ± 2.3 vs 4.0 ± 2.1 mm, P = .089). Conclusion: Ultrasonographic assessment immediately after a Bankart-Bristow procedure showed the humeral head was translated posteriorly relative to the glenoid at 0°, 45°, and 90° of abduction. The surgery also decreased anterior translation in response to an anteriorly directed force at 45° and 90° of abduction.

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Stress radiography for clinical evaluation of anterior shoulder instability

Cited by 6 publications

References 24 publications

Ultrasound Assessment of Anterior Humeral Head Translation in Patients With Anterior Shoulder Instability: Correlation With Demographic, Radiographic, and Clinical Data

Ultrasound Assessment of Anterior Humeral Head Translation in Patients With Anterior Shoulder Instability: Correlation With Demographic, Radiographic, and Clinical Data

Evaluation of the diagnostic performance of the simple method of computed tomography in the assessment of patients with shoulder instability: a prospective cohort study

Ultrasonographic Assessment of Glenohumeral Joint Stability Immediately After Arthroscopic Bankart-Bristow Procedure

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