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Recent Developments in the Clinical Treatment of Shoulder Joint Instability

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 12160

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Special Issue Editor

Dr. Philipp Moroder

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Guest Editor

Head of the Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité University Hospital Berlin, Berlin, Germany
Interests: shoulder stabilization surgery; shoulder arthroplasty; rotator cuff repair; shoulder fracture treatment; conservative treatment of shoulder pathologies

Special Issue Information

Dear Colleagues,

Joint instability is one of the most common shoulder problems we have to deal with in clinical practice. Over the last few decades, treatment options have experienced a shift from open solutions to less-invasive arthroscopic techniques. In order to facilitate this transition, modifications of traditional techniques have been developed by shoulder surgeons and new instruments and implants were introduced by different companies. However, the treatment outcome of shoulder instability patients has not only been improved by surgical innovations but also by advances made in the field of pre-interventional assessement, including recognition of glenoid and humeral bone loss as well as consideration of patient-specific structural and behavioural risk factors. These changes have led to a more patient-specific treatment approach with a case-by-case evaluation of the underlying pathology and the according treatment tailored to the needs of each individual patient. As innovation continues at a high pace and most studies focus on short-term results, long-term effects of different therapeutic approaches must not be neglected as most patients receiving these new treatments are expected to live on for several decades. Therefore, in this Special Issue, we would like to offer both insight into recent technical innovations and new diagnostic developments and a long-term perspective of the clinical treatment of shoulder joint instability.

Dr. Philipp Moroder
Guest Editor

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Keywords

anterior shoulder instability
posterior shoulder instability
functional shoulder instability
glenoid defects
humeral defects
bankart repair
latarjet
free bone grafting
instability
arthropathy

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Published Papers (5 papers)

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Research

16 pages, 6014 KiB

Open AccessArticle

Associated Pathologies following Luxatio Erecta Humeri: A Retrospective Analysis of 38 Cases

by Roman C. Ostermann, Julian Joestl, Marcus Hofbauer, Christian Fialka, Jakob E. Schanda, Maximilian Gruber, Harald Binder and Thomas M. Tiefenboeck

J. Clin. Med. 2022, 11(2), 453; https://doi.org/10.3390/jcm11020453 - 17 Jan 2022

Cited by 3 | Viewed by 2652

Abstract

Inferior shoulder dislocation in fixed abduction, also known as luxatio erecta humeri (LEH), is a rare injury with little data available. Therefore, the primary aim of this study was to evaluate and present our case series of this type of injury with special emphasis on associated pathologies; the secondary aim was to present diagnostic recommendations to detect for potential associated pathologies typically seen with this injury. A total of 38 patients (13 females, average age 72.8 years and 25 males, average age 41.4 years), who have been treated for inferior shoulder dislocation between 1992 and 2020, were included in this study. Associated pathologies after LEH were found in 81% of the cases. Twenty-one of these patients presented with secondary bony pathologies. Six patients revealed rotator cuff injuries diagnosed by magnetic resonance imaging (MRI). Seven patients exhibited pathological findings at the capsule-ligament complex. Eight patients presented with neurological findings. All neurologic symptoms except one axillary nerve palsy and a radialis paresis dissolved during the follow-up period. Five patients received surgical treatment of the affected shoulder. Inferior shoulder dislocation is a rare condition presenting with a high number of associated injuries. According to the findings of the present study, we want to raised awareness of the high rate of potential secondary shoulder pathologies associated with LEH. Beside a thorough clinical examination and immediate standard radiographs in two planes, we recommend to perform computed tomography scanning and an MRI of the shoulder as soon as possible. In the case of neurologic deficiencies, a determination of nerve conduction should be performed. Full article

(This article belongs to the Special Issue Recent Developments in the Clinical Treatment of Shoulder Joint Instability)

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9 pages, 28223 KiB

Open AccessArticle

Biceps Brachii Alterations Following the Latarjet Procedure: A Prospective Multicenter Study

by Lucca Lacheta, Marco-Christopher Rupp, Andrea Achtnich, Sepp Braun, Mark Tauber, Andreas B. Imhoff, Peter Habermeyer and Frank Martetschläger

J. Clin. Med. 2021, 10(23), 5487; https://doi.org/10.3390/jcm10235487 - 23 Nov 2021

Cited by 3 | Viewed by 1836

Abstract

Purpose: To prospectively investigate the postoperative forearm supination and elbow flexion strength of both upper extremities and popeye deformity in patients who underwent a mini-open Latarjet procedure for anterior shoulder instability. Methods: Patients who underwent a mini-open Latarjet procedure at two specialized shoulder centers were prospectively evaluated preoperatively (T0) and at least 6 months (T1) after surgery. Subjects were tested for elbow flexion and forearm supination strength of both upper extremities using an isometric dynamometer and customized torque dynamometer. Clinical outcome was assessed by the Constant Score (CS), American Shoulder and Elbow Score (ASES) and Simple Shoulder test (SST). Popeye deformity was defined as a distalization of the greatest circumference of the biceps muscle belly towards the lateral epicondyle of the elbow. Results: A total of 20 patients with a mean age of 27 ± 6 years were included in the study. At a mean follow-up of 10 ± 3 months, the elbow flexion strength was restored to the preoperative state (p = 0.240). Forearm supination strength significantly decreased at final follow-up, to 88 % in the surgical arm (p = 0.015) vs. 90 % in the non-surgical arm (p = 0.023). There was no statistical difference when comparing both arms concerning elbow flexion strength (p = 0.510) and forearm supination strength (p = 0.495). No significant popeye deformity was observed in both arms (p = 0.111 vs. p = 0.508). Clinical outcome scores improved significantly from 73 ± 18 to 82 ± 13 (p = 0.014) for CS and 76 ± 22 to 89 ± 12 (p = 0.008) for ASES score preoperatively to final follow-up. No difference in the SST was documented (p = 0.10). Conclusion: The Latarjet procedure showed to preserve elbow flexion strength and provided comparable forearm supination strength compared to the uninjured arm with reliable clinical outcome in this study population. However, a decrease of forearm supination strength in both arms was persistent at a mean of 10 months postoperatively. No popeye deformity was noted in the postoperative examinations. Level of evidence: Case series, Level III. Full article

(This article belongs to the Special Issue Recent Developments in the Clinical Treatment of Shoulder Joint Instability)

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16 pages, 2799 KiB

Open AccessArticle

Differences in Patients’ and Surgeons’ Expectations before Shoulder Stabilization Surgery

by Katrin Karpinski, Fabian Plachel, Christian Gerhardt, Tim Saier, Mark Tauber, Alexander Auffarth, Doruk Akgün and Philipp Moroder

J. Clin. Med. 2021, 10(20), 4661; https://doi.org/10.3390/jcm10204661 - 11 Oct 2021

Cited by 3 | Viewed by 2030

Abstract

Purpose: The primary goal of shoulder stabilization procedures is to re-establish stability and many surgeons measure the success after shoulder stabilization surgery only by the absence of re-dislocation. However, patients might also suffer from pain, loss of range of motion and strength as well as anxiety and stigmatization and therefore have other expectations from a stabilization surgery than just a stable shoulder. Purpose of this study was to analyze if surgeons know what their patients typically expect from a shoulder stabilization surgery. Furthermore, the aim was to analyze the influence of various factors on patients’ expectations. Materials and Methods: 204 patients with a diagnosis of shoulder instability scheduled for surgical treatment were included in this prospective multicentric study. Preoperatively, objective and subjective scores were obtained and patients were asked about their postoperative expectations. Additionally, 25 surgeons were interviewed with regard to what they think their patients expect from the surgery using standardized questions. Results: With regard to postoperative expectations surveyed by the Hospital for Special Surgery questionnaire (HSS), the most important goal to achieve for the patients was ‘stopping the shoulder from dislocation’, followed by ‘to improve the ability to exercise or participate in sports’ and ‘being the shoulder to be back the way it was before the issue started’. The ranking of factors for patients was ‘stability’ as the most important to achieve, followed by ‘movement’, ‘strength’, ‘pain’ and ‘cosmetics’. For surgeons, the order was ‘stability’ (p = 0.004 **), ‘movement’ (p = 0.225), ‘pain’ (p = 0.509), ‘strength’ (p = 0.007 **) and ‘cosmetics’ (p = 0.181). There was a significant difference between patients and surgeons with regard to gaining stability at the cost of movement (p = 0.001 **). Conclusion: Patients and surgeons expectations regarding outcome after surgical shoulder stabilization procedures are quite similar with limited topics of disagreement. Generally, surgeons tend to overrate the importance of stability at the costs of other factors. Full article

(This article belongs to the Special Issue Recent Developments in the Clinical Treatment of Shoulder Joint Instability)

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10 pages, 2589 KiB

Open AccessArticle

The Anatomy of Glenoid Concavity—Bony and Osteochondral Assessment of a Stability-Related Parameter

by Jens Wermers, Michael J. Raschke, Marcel Wilken, Arne Riegel and J. Christoph Katthagen

J. Clin. Med. 2021, 10(19), 4316; https://doi.org/10.3390/jcm10194316 - 22 Sep 2021

Cited by 8 | Viewed by 2293

Abstract

Glenoid concavity is a crucial factor for glenohumeral stability. However, the distribution of this stability-related parameter has not been focused on in anatomical studies. In this retrospective study, computed tomography (CT) data and tactile measurements of n = 27 human cadaveric glenoids were analyzed with respect to concavity. For this purpose, the bony and osteochondral shoulder stability ratio (BSSR/OSSR) were determined based on the radius and depth of the glenoid shape in eight directions. Various statistical tests were performed for the comparison of directional concavity and analysis of the relationship between superoinferior and anteroposterior concavity. The results proved that glenoid concavity is the least distinctive in anterior, posterior, and anterosuperior direction but increases significantly toward the superior, anteroinferior, and posteroinferior glenoid. The OSSR showed significantly higher concavity than the BSSR for most of the directions considered. Moreover, the anteroposterior concavity is linearly correlated with superoinferior concavity. The nonuniform distribution of concavity indicates directions with higher stability provided by the anatomy. The linear relationship between anteroposterior and superoinferior concavity may motivate future research using magnetic resonance imaging (MRI) data to optimize clinical decision-making toward more personalized treatment of glenoid bone loss. Full article

(This article belongs to the Special Issue Recent Developments in the Clinical Treatment of Shoulder Joint Instability)

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10 pages, 7526 KiB

Open AccessArticle

Promising Mid-Term Outcomes after Humeral Head Preserving Surgery of Posterior Fracture Dislocations of the Proximal Humerus

by Lukas F. Heilmann, J. Christoph Katthagen, Michael J. Raschke, Benedikt Schliemann, Helmut Lill, Hassan El Bajjati, Gunnar Jensen and Rony-Orijit Dey Hazra

J. Clin. Med. 2021, 10(17), 3841; https://doi.org/10.3390/jcm10173841 - 27 Aug 2021

Cited by 3 | Viewed by 2273

Abstract

Background: The aim of this study was to evaluate the clinical outcome after humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus. Methods: Patients with a posterior fracture dislocation of the proximal humerus that were operatively treated in two level-1 trauma centers within a timeframe of 8 years were identified. With a minimum follow-up of 2 years, patients with humeral head preserving surgical treatment were invited for examination. Results: 19/24 fractures (79.2%; mean age 43 years) were examined with a mean follow-up of 4.1 ± 2.1 years. Of these, 12 fractures were categorized as posteriorly dislocated impression type fractures, and 7 fractures as posteriorly dislocated surgical neck fractures. Most impression type fractures were treated by open reduction, allo- or autograft impaction and screw fixation (n = 11), while most surgical neck fractures were treated with locked plating (n = 6). Patients with impression type fractures showed significantly better ASES scores (p = 0.041), Simple Shoulder Test scores (p = 0.003), Rowe scores (p = 0.013) and WOSI scores (p = 0.023), when compared to posteriorly dislocated surgical neck fractures. Range of motion was good to excellent for both groups with no significant difference. Conclusions: This mid-term follow-up study reports good to very good clinical results for humeral head preserving treatment. Full article

(This article belongs to the Special Issue Recent Developments in the Clinical Treatment of Shoulder Joint Instability)

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