Original ArticlesTranslation of the glenohumeral joint in patients with multidirectional and posterior instability: Awake examination versus examination under anesthesia*
Section snippets
Materials and methods
Forty-three patients with a history of multidirectional instability and 28 patients with a history of posterior instability were examined clinically and while they were under general anesthesia in preparation for shoulder stabilization surgery. In the MDI group, 13 men and 30 women (mean age, 28 years; range, 12 to 59 years) were included in the study. In the posterior instability group, 24 men and 4 women (mean age, 23.5 years; range, 4 to 45 years) were included in the study. For patients to
Results
Patients' documented translation grades before surgery and during the examination under anesthesia are listed in Table I.Empty Cell Direction of translation Empty Cell Anterior Posterior Inferior Grade* 1 2 3 1 2 3 1 2 3 MDI (n = 43 patients) Affected shoulder Preoperative examination 10 25 8 6 20 17 9 23 11 EUA 5 18 20 4 22 17 7 22 14 Unaffected shoulder Preoperative examination 20 22 1 16 20 7 22 19 2 EUA 11 17 15 10 25 8 16 22 5 Posterior instability (n = 28 patients) Affected shoulder Preoperative examination 19 7 2 1 14 13 15 11 2 EUA 15 9 4 2 13 13 16 8 4
Discussion
To our knowledge, this study represents the first attempt at comparing side-to-side differences in shoulder translation in patients with MDI and in patients with posterior instability while awake or under anesthesia. This work may assist in establishing guidelines to determine the degree of shoulder instability, the value of awake (clinical) examination, the value of EUA, and the comparison of results obtained at each examination. This study is a continuation of the premise behind our recent
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Cited by (18)
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2011, Journal of Shoulder and Elbow SurgeryCitation Excerpt :It could be argued that every form of shoulder instability could have excessive translations in multiple planes. Biomechanical research and clinical studies suggest that the capsule of the glenohumeral joint behaves as a circle and that injuries are unlikely to produce damage in only one part of the capsule.26,41,45,46,48 These points argue for the elimination of the concept of multidirectional instability and argue for the concept of a primary direction of the instability.
Multidirectional Instability: Evaluation and Treatment Options
2008, Clinics in Sports MedicineCitation Excerpt :On coronal images, often a huge inferior pouch is observed. Although examination in the office may be compromised by pain and guarding, examination under anesthesia (EUA) may afford a more reliable means of assessment.39,41–43 Cofield and colleagues42 found 100% sensitivity, 93% specificity, 93% positive predictive value, and 7% false positive rates for diagnosing the unstable shoulder under anesthesia.
Arthroscopic Posterior/Multidirectional Instability
2008, Operative Techniques in OrthopaedicsCitation Excerpt :Examination under anesthesia has been shown to be as much as 100% sensitive and 93% specific in determining direction of shoulder instability.28 Yoldas and coworkers29 demonstrated side-to-side shoulder examination differences in patients undergoing arthroscopic surgery for either posterior or multidirectional instability. Affected shoulders in patients with MDI had greater anterior translation as compared with their unaffected side, whereas there was no side-to-side difference among the patients with posterior instability.
Exploration of glenohumeral instability under anesthesia: The shoulder jerk test
2005, Arthroscopy - Journal of Arthroscopic and Related SurgeryPosterior Shoulder Instability
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Reprint requests: Richard J. Hawkins, MD, FRCS(C), Steadman Hawkins Sports Medicine Foundation, 181 West Meadow Dr, Suite 1000, Vail, CO 81657.