DOI QR코드

DOI QR Code

Evaluation of Inferior Capsular Laxity in Patients with Atraumatic Multidirectional Shoulder Instability with Magnetic Resonance Arthrography

  • Kyoung-Jin Park (Goodsam Orthopaedic Clinic) ;
  • Ho-Seung Jeong (Department of Orthopaedic Surgery, Chungbuk National University Hospital) ;
  • Ji-Kang Park (Department of Orthopaedic Surgery, Chungbuk National University Hospital) ;
  • Jung-Kwon Cha (Department of Orthopaedic Surgery, Chungbuk National University Hospital) ;
  • Sang-Woo Kang (Department of Orthopaedic Surgery, Chungbuk National University Hospital)
  • 투고 : 2018.08.09
  • 심사 : 2019.02.13
  • 발행 : 2019.06.01

초록

Objective: To compare inferior capsular redundancy by using magnetic resonance arthrography (MRA) images in patients with multidirectional instability (MDI) of the shoulder and control subjects without instability and thereby develop a screening method to identify the presence of shoulder MDI. Materials and Methods: The MRA images of patients with MDI of the shoulder (n = 65, 57 men, 8 women; mean age, 24.5 years; age range, 18-42 years) treated over an eight-year period were retrospectively reviewed; a control group (n = 65, 57 men, 8 women; mean age, 27.4 years; age range, 18-45 years) without instability was also selected. The inferior capsular redundancy was measured using a new method we named the glenocapsular (GC) ratio method. MRA images of both groups were randomly mixed together, and two orthopedic surgeon reviewers measured the cross-sectional areas (CSAs) and sagittal capsule-head ratios on oblique sagittal images, as well as the axial capsule-head ratios on axial images and GC ratios on oblique coronal images. Results: The CSAs and GC ratios were significantly higher in patients than in controls (both, p < 0.001); however, the sagittal capsule-head ratios and axial capsule-head ratios were not significantly different (p = 0.317, p = 0.053, respectively). In addition, GC ratios determined the presence of MDI more sensitively and specifically than did CSAs. A GC ratio of > 1.42 was found to be most suggestive of MDI of the shoulder, owing to its high sensitivity (92.3%) and specificity (89.2%). Conclusion: GC ratio can be easily measured and used to accurately screen for MDI of the shoulder.

키워드

과제정보

I extend my appreciation to all colleagues that aided me during this study.

참고문헌

  1. Neer CS 2nd, Foster CR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg Am 1980;62:897-908 https://doi.org/10.2106/00004623-198062060-00004
  2. Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop Relat Res 2002;(400):65-76
  3. Choi CH, Ogilvie-Harris DJ. Inferior capsular shift operation for multidirectional instability of the shoulder in players of contact sports. Br J Sports Med 2002;36:290-294 https://doi.org/10.1136/bjsm.36.4.290
  4. Misamore GW, Sallay PI, Didelot W. A longitudinal study of patients with multidirectional instability of the shoulder with seven- to ten-year follow-up. J Shoulder Elbow Surg 2005;14:466-470 https://doi.org/10.1016/j.jse.2004.11.006
  5. Pollock RG, Owens JM, Flatow EL, Bigliani LU. Operative results of the inferior capsular shift procedure for multidirectional instability of the shoulder. J Bone Joint Surg Am 2000;82-A:919-928 https://doi.org/10.2106/00004623-200007000-00003
  6. McIntyre LF, Caspari RB, Savoie FH 3rd. The arthroscopic treatment of multidirectional shoulder instability: two-year results of a multiple suture technique. Arthroscopy 1997;13:418-425 https://doi.org/10.1016/S0749-8063(97)90118-3
  7. Johnson SM, Robinson CM. Shoulder instability in patients with joint hyperlaxity. J Bone Joint Surg Am 2010;92:1545-1557 https://doi.org/10.2106/JBJS.H.00078
  8. Levine WN, Prickett WD, Prymka M, Yamaguchi K. Treatment of the athlete with multidirectional shoulder instability. Orthop Clin North Am 2001;32:475-484 https://doi.org/10.1016/S0030-5898(05)70216-9
  9. Barden JM, Balyk R, Raso VJ, Moreau M, Bagnall K. Atypical shoulder muscle activation in multidirectional instability. Clin Neurophysiol 2005;116:1846-1857 https://doi.org/10.1016/j.clinph.2005.04.019
  10. Hsu YC, Pan RY, Shih YY, Lee MS, Huang GS. Superior-capsular elongation and its significance in atraumatic posteroinferior multidirectional shoulder instability in magnetic resonance arthrography. Acta Radiol 2010;51:302-308 https://doi.org/10.3109/02841850903524421
  11. Lee HJ, Kim NR, Moon SG, Ko SM, Park JY. Multidirectional instability of the shoulder: rotator interval dimension and capsular laxity evaluation using MR arthrography. Skeletal Radiol 2013;42:231-238 https://doi.org/10.1007/s00256-012-1441-2
  12. Kim KC, Rhee KJ, Shin HD, Kim YM. Estimating the dimensions of the rotator interval with use of magnetic resonance arthrography. J Bone Joint Surg Am 2007;89:2450-2455 https://doi.org/10.2106/00004623-200711000-00016
  13. Lim CO, Park KJ, Cho BK, Kim YM, Chun KA. A new screening method for multidirectional shoulder instability on magnetic resonance arthrography: labro-capsular distance. Skeletal Radiol 2016;45:921-927 https://doi.org/10.1007/s00256-016-2364-0
  14. Dewing CB, McCormick F, Bell SJ, Solomon DJ, Stanley M, Rooney TB, et al. An analysis of capsular area in patients with anterior, posterior, and multidirectional shoulder instability. Am J Sports Med 2008;36:515-522 https://doi.org/10.1177/0363546507311603
  15. Helmig P, Sojbjerg JO, Kjaersgaard-Andersen P, Nielsen S, Ovesen J. Distal humeral migration as a component of multidirectional shoulder instability. An anatomical study in autopsy specimens. Clin Orthop Relat Res 1990;(252):139-143
  16. Kim SH, Kim HK, Sun JI, Park JS, Oh I. Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder. Am J Sports Med 2004;32:594-607 https://doi.org/10.1177/0363546503262170
  17. Shafer BL, Mihata T, McGarry MH, Tibone JE, Lee TQ. Effects of capsular plication and rotator interval closure in simulated multidirectional shoulder instability. J Bone Joint Surg Am 2008;90:136-144 https://doi.org/10.2106/JBJS.F.00841
  18. Lubowitz J, Bartolozzi A, Rubinstein D, Ciccotti M, Schweitzer M, Nazarian L, et al. How much does inferior capsular shift reduce shoulder volume? Clin Orthop Relat Res 1996;(328):86-90
  19. Luke TA, Rovner AD, Karas SG, Hawkins RJ, Plancher KD. Volumetric change in the shoulder capsule after open inferior capsular shift versus arthroscopic thermal capsular shrinkage: a cadaveric model. J Shoulder Elbow Surg 2004;13:146-149 https://doi.org/10.1016/j.jse.2003.11.008
  20. Resnik CS, Fronek J, Frey C, Gershuni D, Resnick D. Intra-articular pressure determination during glenohumeral joint arthrography. Preliminary investigation. Invest Radiol 1984;19:45-50 https://doi.org/10.1097/00004424-198401000-00010