Elsevier

Journal of Shoulder and Elbow Surgery

Volume 10, Issue 5, September–October 2001, Pages 416-420
Journal of Shoulder and Elbow Surgery

Original Articles
Translation of the glenohumeral joint in patients with multidirectional and posterior instability: Awake examination versus examination under anesthesia*

https://doi.org/10.1067/mse.2001.116650Get rights and content

Abstract

The purpose of this study was to assist in establishing guidelines to determine the degree of shoulder instability, the value of awake clinical examination, and the value of examination under anesthesia (EUA). Forty-three patients with clinical diagnosis of multidirectional shoulder instability (MDI) and 28 patients with posterior instability underwent bilateral shoulder translation testing, both awake and while under anesthesia. Two surgeons using guidelines and translation grades developed by the American Shoulder and Elbow Surgeons examined each patient and assigned a single grade for the anterior, posterior, and inferior directions. A comparison of translational grade was performed with the use of Pearson χ2 and McNemar symmetry to determine association. The patients with MDI showed increased translation in the anterior, inferior, and posterior directions when the affected limb was compared with the noninvolved side in both preoperative examination and EUA. Furthermore, the patients with MDI showed increased anterior translation on the affected side during EUA compared with the clinical examination. Patients with posterior instability demonstrated increased anterior translation for both affected and noninvolved limbs during EUA. However, the posterior translation obtained before surgery did not change during EUA for both the affected and noninvolved limbs, and there was no side-to-side difference in posterior translation. (J Shoulder Elbow Surg 2001;10:416-20.)

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.

. Patients' documented translation

Empty CellDirection of translation
Empty CellAnteriorPosteriorInferior
Grade*123123123
MDI (n = 43 patients)
 Affected shoulder
  Preoperative examination102586201792311
  EUA518204221772214
 Unaffected shoulder
  Preoperative examination202211620722192
  EUA1117151025816225
Posterior instability (n = 28 patients)
 Affected shoulder
  Preoperative examination19721141315112
  EUA1594213131684
 

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

References (16)

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Cited by (18)

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    2011, Journal of Shoulder and Elbow Surgery
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    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 Medicine
    Citation 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 Orthopaedics
    Citation 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 Surgery
  • Posterior Shoulder Instability

    2003, Arthroscopy - Journal of Arthroscopic and Related Surgery
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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.

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