Glenohumeral translation during active external rotation with the shoulder abducted in cases with glenohumeral instability: a 4-dimensional computed tomography analysis

Noboru Matsumura; Satoshi Oki; Naoto Fukasawa; Morio Matsumoto; Masaya Nakamura; Takeo Nagura; Yoshitake Yamada; Masahiro Jinzaki

doi:10.1016/j.jse.2019.03.008

Glenohumeral translation during active external rotation with the shoulder abducted in cases with glenohumeral instability: a 4-dimensional computed tomography analysis

J Shoulder Elbow Surg. 2019 Oct;28(10):1903-1910. doi: 10.1016/j.jse.2019.03.008. Epub 2019 Jun 14.

Authors

Noboru Matsumura¹, Satoshi Oki², Naoto Fukasawa¹, Morio Matsumoto¹, Masaya Nakamura¹, Takeo Nagura¹, Yoshitake Yamada³, Masahiro Jinzaki³

Affiliations

¹ Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
² Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan. Electronic address: [email protected].
³ Department of Radiology, School of Medicine, Keio University, Tokyo, Japan.

PMID: 31204064
DOI: 10.1016/j.jse.2019.03.008

Abstract

Background: Although glenohumeral instability is common, the mechanism of instability remains unclear. The purpose of this study was to quantitatively evaluate humeral head translation during active external rotation with abduction in patients with glenohumeral instability by use of 4-dimensional computed tomography scans.

Methods: Ten patients with unilateral glenohumeral instability with a positive fulcrum test were prospectively included in this study. Sequential computed tomography of bilateral shoulders during active external rotation at 90° of shoulder abduction was performed for 6 seconds at 5 frames per second. The 3-dimensional positions of the humeral head center in the anteroposterior, superoinferior, and mediolateral directions were calculated at 0°, 20°, 40°, 60°, and maximum shoulder abduction-external rotation from the starting position. Translation of the humeral head center from the starting position was evaluated using Dunnett multiple-comparison tests, and the differences between the affected and intact shoulders were assessed using Wilcoxon signed rank tests.

Results: The humeral head center translated posteriorly, inferiorly, and medially during glenohumeral external rotation with the shoulder in the abducted position on the intact side. However, the affected humeral head showed significantly less posterior translation (P = .028), greater inferior translation (P = .047), and less medial translation (P = .037) than the contralateral side.

Conclusions: This study indicated that dysfunction of the anterior band of the inferior glenohumeral ligament causes decreased posterior, increased inferior, and decreased medial translation of the humeral head during active shoulder abduction-external rotation.

Keywords: Glenohumeral instability; anterior dislocation; glenohumeral dislocation; glenohumeral translation; humeral head translation; inferior glenohumeral ligament; shoulder dislocation.

MeSH terms

Adult
Biomechanical Phenomena
Four-Dimensional Computed Tomography
Humans
Humeral Head / diagnostic imaging
Humeral Head / physiopathology*
Joint Instability / diagnostic imaging*
Joint Instability / etiology
Joint Instability / physiopathology*
Ligaments, Articular / diagnostic imaging
Ligaments, Articular / physiopathology
Male
Prospective Studies
Range of Motion, Articular
Rotation
Shoulder Joint / diagnostic imaging*
Shoulder Joint / physiopathology*
Young Adult