Mapping Glenohumeral Laxity: Effect of Capsule Tension and Abduction in Cadaveric Shoulders

Details

• Personal Author:
  Hillstrom HJ ; Kontaxis A ; Kraszewski AP ; Mayer SW ; Sheikhzadeh A ; Warren RP
• Description:
  Background: Shoulder capsular plication aims to restore the passive stabilization of the glenohumeral capsule; however, high reported recurrence rates warrant concern. Improving our understanding of the clinical laxity assessment across 2 dimensions, capsular integrity and shoulder position, can help toward the standardization of clinical tools. Our objectives were to test and describe glenohumeral laxity across 5 capsular tension levels and 4 humeral position levels and describe tension-position interplay. Methods: We tested 14 dissected cadavers for glenohumeral laxity in 5 directions: anterior, posterior, and inferior translation, and internal and external axial rotation. Laxity was recorded across capsule tension (baseline, stretched, 5 mm, 10 mm, and 15 mm of plication) and position (0 degrees, 20 degrees, 40 degrees, 60 degrees of scapular abduction). Repeated-measures analysis of variance with post hoc contrasts tested the effect of tension, position, and composite tension × position on laxity. Results: Capsule tension, position, and composite interplay had a statistically significant, although unequal, effect on laxity in each direction. Laxity was consistently overconstrained in 15-mm plication and was overall greatest in 20 degrees and lowest in 60 degrees. Restoration occurred most in 10 mm, but this depended on the position. The composite effect was significant for external and internal rotation and inferior laxity, but laxity at the middle range (20 degrees or 40 degrees) was different than at the end range (0 degrees or 60 degrees) for all directions. Conclusions: On average, laxity was restored to baseline tension after 10-mm plication, but this determination varied depending on shoulder position. Middle-range laxity behaved differently than end-range laxity across plication tensions. This information is useful in understanding the unstable shoulder as well as for standardizing clinical laxity assessment. [Description provided by NIOSH]
• Subjects:
  Anatomy Biomechanical Phenomena Men Musculoskeletal System Occupational Health Safety
• Keywords:
  Articulation Author Keywords: Multidirectional Instability Biomechanics Body Mechanics Body Regions Clinical Laxity Test Clinical Techniques Clinical Tests Differential Engagement Glenohumeral Capsule Humans Motion Studies Physiological Function Physiopathology Plication Restoration Rotational Laxity Skeletal Movement Surgery Tension Translational Laxity Upper Extremities

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• ISSN:
  1058-2746
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Colorado ; New York ; OSHA Region 2 ; OSHA Region 8
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  27
• Issue:
  4
• NIOSHTIC Number:
  nn:20052322
• Citation:
  J Shoulder Elbow Surg 2018 Apr; 27(4):624-634
• Contact Point Address:
  Andrew P. Kraszewski, Department of Rehabilitation, Hospital for Special Surgery, New York, NY, USA
• Email:
  kraszewskia@hss.edu
• Federal Fiscal Year:
  2018
• Performing Organization:
  Mount Sinai School of Medicine
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of Shoulder and Elbow Surgery
• End Date:
  20270630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:a9134b4b6015fa4097fa215ca12e883f50668be46a8c2db9a7a59daad315772c77c53f8e84bf7126384aa6526d9a214771307ac2d39d579a9ce56df5722a1d8d
• Download URL:
  https://stacks.cdc.gov/view/cdc/211866/cdc_211866_DS1.pdf
• File Type:
  [PDF - 1.92 MB ]