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Статті в журналах з теми "Instabilité rotatoire"

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Автор: Grafiati

Опубліковано: 7 вересня 2024

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1

Chamseddine, A., H. Zein, B. Obeid, F. Khodari, and A. Saleh. "Instabilité postéro-latérale rotatoire du coude secondaire à une entorse." Chirurgie de la Main 30, no. 1 (February 2011): 52–55. http://dx.doi.org/10.1016/j.main.2011.01.014.

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2

Cavaignac, Étienne, Karine Wytrykowski, Reina Nicolas, Marie Faruch, Jérôme Murgier, and Philippe Chiron. "Corrélation entre lésion du ligament antérolatéral du genou et instabilité rotatoire : étude échographique in vivo." Revue de Chirurgie Orthopédique et Traumatologique 102, no. 8 (December 2016): S274. http://dx.doi.org/10.1016/j.rcot.2016.10.010.

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3

Gottlieb, Uri, and Shmuel Springer. "The Relationship Between Fear Avoidance Beliefs, Muscle Strength, and Short-Term Disability After Surgical Repair of Shoulder Instability." Journal of Sport Rehabilitation 30, no. 7 (September 1, 2021): 973–80. http://dx.doi.org/10.1123/jsr.2020-0035.

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Context: Arthroscopic surgical repair of the shoulder is recommended when conservative treatment for shoulder instability (SI) fails. However, many patients undergoing this procedure do not return to same level of activity. Psychological factors and muscle strength have been shown to be associated with postoperative outcomes in other musculoskeletal conditions. Objective: To investigate the association between fear avoidance, muscle strength, and short-term function in patients after surgical SI repair. Methods: Twenty-five male patients who underwent shoulder surgery following at least one event of SI were included in this study. Evaluations of fear avoidance related to physical activity and disability were performed at baseline (during the first encounter with the physical therapist) and 7 to 8 weeks postsurgery. Fear avoidance beliefs were assessed using the Fear Avoidance Beliefs Questionnaire. Disability was assessed using the Disabilities of Arm, Shoulder, and Hand questionnaire and the Western Ontario SI index. The follow-up evaluation (weeks 7–8) included measurement of maximal isometric strength of the internal and external rotators. Nonparametric Kendall tau was used to determine the correlations between baseline fear avoidance, muscle strength, and disability at follow-up. Results: Disabilities of Arm, Shoulder, and Hand questionnaire at follow-up was significantly correlated with baseline Disabilities of Arm, Shoulder, and Hand questionnaire (τ = .520, P < .001), baseline fear avoidance (τ = .399, P = .008), and both internal rotator (τ = −.400, P = .005) and external rotator strength (τ = −.353, P = .014). Western Ontario SI index at follow-up was moderately correlated with baseline Western Ontario SI index (τ = .387, P = .007), internal rotator (τ = −.427, P = .003), and external rotator (τ = −.307, P = .032), but not with baseline Fear Avoidance Beliefs Questionnaire (τ = .22, P = .145). Conclusions: The results indicate a possible association between fear avoidance beliefs and short-term disability. Further studies are warranted to better explore and understand these relationships.

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4

Irrgang, James J., Susan L. Whitney, and Christopher D. Harner. "Nonoperative Treatment of Rotator Cuff Injuries in Throwing Athletes." Journal of Sport Rehabilitation 1, no. 3 (August 1992): 197–222. http://dx.doi.org/10.1123/jsr.1.3.197.

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Shoulder pain in throwing athletes is reviewed. The anatomy and function of the rotator cuff and the biomechanics of the throwing mechanism are described. Physical examination for rotator cuff injuries, treatment considerations, and a protocol are presented. Failure to recognize glenohumeral instability may limit the success of nonoperative management of rotator cuff injuries in throwing athletes. This article provides a comprehensive review of some of the underlying causes of rotator cuff pathology in throwing athletes. Rotator cuff injuries in throwing athletes are closely associated with glenohumeral instability. The role of glenohumeral instability in the pathogenesis of rotator cuff injuries is described.

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5

Sonar, Satish B., Hemant Parekh, and Rajendra Baitule. "POSTEROLATERAL ROTATORY, INSTABILITY, ELBOW." Journal of Evidence Based Medicine and Healthcare 2, no. 33 (August 17, 2015): 4981–88. http://dx.doi.org/10.18410/jebmh/2015/695.

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6

Haslam, P. G., and D. R. Bickerstaff. "Postero-lateral rotatory instability." Current Orthopaedics 21, no. 6 (December 2007): 451–56. http://dx.doi.org/10.1016/j.cuor.2007.07.008.

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7

Patiño, Juan Martín, Alejandro Rullan Corna, Alejandro Michelini, Ignacio Abdon, and Alejandro José Ramos Vertiz. "Elbow Posterolateral Rotatory Instability due to Cubitus Varus and Overuse." Case Reports in Orthopedics 2018 (August 5, 2018): 1–5. http://dx.doi.org/10.1155/2018/1491540.

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A malunion as a complication of distal humerus fractures has been frequently linked with aesthetic problems but less frequently with posterolateral rotatory instability. We report 2 cases of childhood posttraumatic cubitus varus with subsequent posterolateral rotatory instability and their treatment with a minimum of 2 years of follow-up. The etiology of the so-called posterolateral rotatory instability of the elbow is mostly traumatic, but iatrogenic causes have also been described such as the treatment of tennis elbow and less frequently and chronically due to overuse and overload because of distal humerus malunion.

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8

Lee, Joo Yeon, Yon-Sik Yoo, and Kilhwan Shon. "Teres minor denervation and pathologies resulting in shoulder joint instability and rotator cuff tears: A retrospective cross-sectional MRI study." Medicine 103, no. 8 (February 23, 2024): e37232. http://dx.doi.org/10.1097/md.0000000000037232.

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Teres minor denervation (TMD) has gained increasing attention in recent years, particularly with the advent of magnetic resonance imaging (MRI). The potential association between TMD and shoulder instability or rotator cuff tear remains a subject of interest in the orthopedic community. In this retrospective and cross-sectional study, authors aim to investigate the potential association between TMD and shoulder instability or rotator cuff tears. Authors retrospectively analyzed MRI findings from 105 patients with TMD, focusing on rotator cuff pathologies, posterior labrocapsular complex (PLCC) tears, and posteroinferior glenohumeral joint capsule alterations. Authors assessed the association between TMD and rotator cuff and PLCC tears. For the multivariate analysis, partial proportional odds models were constructed for subscapularis (SSC) and SSP tears. Rotator cuff tears were present in 82.9% of subjects, with subscapularis (SSC) tears being the most frequent (77.1%). A significant association was observed between TMD and rotator cuff pathology (P = .002). PLCC tears were found in 82.3% of patients, and humeral position relative to the osseous glenoid was noted in 60% of patients with TMD. A significant association was identified between TMD and shoulder instability or labral/capsular abnormalities (P < .001). More than half of the cases exhibited a long tethering appearance toward the axillary neurovascular bundle on T1-weighted sagittal images. Our findings suggest that TMD is significantly associated with rotator cuff tears and shoulder instability. This study highlights the importance of identifying and treating PLCC tears in patients with TMD to address shoulder instability. Further research is needed to elucidate the role of TMD in the pathogenesis of shoulder instability and rotator cuff pathology.

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9

Tsenkov, Tsvetan, and Alexander Gerchev. "CONCOMITANCE OF ROTATOR CUFF DISEASE IN SYMPTOMATIC ANTERIOR SHOULDER INSTABILITY." Journal of IMAB - Annual Proceeding (Scientific Papers) 28, no. 3 (August 24, 2022): 4517–20. http://dx.doi.org/10.5272/jimab.2022283.4517.

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Purpose: To evaluate the concomitance of rotator cuff disease in patients with symptomatic anterior shoulder instability and its impact on the severity of lesions. Materials and Methods: Retrospective data were collected from 326 patients from a single institution for a 16-year period. The demographic characteristics of the patients were selected randomly. The leading diagnosis was shoulder instability. Excluded from the study were patients with posterior (n=24) or mixed instability (n=5). Primary diagnosis was confirmed with clinical findings and MRI imaging studies. All patients from the group underwent arthroscopic surgery. A throughout analysis was performed of the collected materials. Results: 297 patients with primary anterior instability underwent arthroscopic stabilization in the clinic. 25% (n=75) presented with different grade rotator cuff lesions, of which only 33% (n=25) were discovered on MRI preoperatively. In these patients, rotator cuff tenoplasty was performed. In 27% (n=79) of the patients, an evident subacromial space narrowing without rotator cuff lesions was found during arthroscopy. In these cases, a subacromial decompression was performed, and in some of the cases - acromioplasty. In 52% (n=154) of patients who underwent an arthroscopic stabilization for anterior shoulder instability, additional treatment was necessary. Conclusions: The complex analysis of shoulder pathology can shield the surgeon from diagnostic misses and unsatisfactory results. Coexisting rotator cuff disease may have a role in symptomatic anterior shoulder instability as it is often neglected in clinical evaluations due to the main diagnosis of instability.

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10

SLOCUM, DONALD B., and ROBERT L. LARSON. "ROTATORY INSTABILITY OF THE KNEE." Journal of Bone and Joint Surgery-American Volume 84, no. 5 (May 2002): 868. http://dx.doi.org/10.2106/00004623-200205000-00026.

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11

Swain, Randall A., and Franklin D. Wilson. "Diagnosing Posterolateral Rotatory Knee Instability." Physician and Sportsmedicine 21, no. 4 (April 1993): 95–102. http://dx.doi.org/10.1080/00913847.1993.11710366.

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12

Matsumoto, H., and B. B. Seedhom. "Rotation of the Tibia in the Normal and Ligament-Deficient Knee. A study Using Biplanar Photography." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 207, no. 3 (September 1993): 175–84. http://dx.doi.org/10.1243/pime_proc_1993_207_290_02.

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The difference between physiological tibial rotation and rotatory instability of the knee, particularly the ‘pivot shift’ phenomenon, was investigated by analysing knee movements under both rotatory and valgus torques using 29 fresh cadaveric knees. The knee movements were measured in three dimensions using biplanar photography, when all ligaments were intact, and then after the ligaments were sequentially sectioned. The axis of the physiological tibial rotation was shown to be located about the centre of the tibial plateaux, while that of the pivot shift is located about the medial collateral ligament (MCL). When the anterior cruciate ligament (ACL) was sectioned, little or no significant change in physiological tibial rotation was observed under rotary torques, while a significant rotatory instability, including the ‘pivot shift’ phenomenon, was observed under a valgus torque. It was thus concluded that the rotatory instability is not simply an increase in the magnitude of the physiological rotation of the tibia, but is an abnormal tibial rotation which occurs with a different mechanism.

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13

Malavolta, Eduardo Angeli, Mauro Emilio Conforto Gracitelli, Jorge Henrique Assunção, Gustavo de Mello Ribeiro Pinto, Arthur Zorzi Freire da Silveira, and Arnaldo Amado Ferreira Neto. "Shoulder disorders in an outpatient clinic: an epidemiological study." Acta Ortopédica Brasileira 25, no. 3 (June 2017): 78–80. http://dx.doi.org/10.1590/1413-785220172503170849.

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ABSTRACT OBJECTIVE: To describe shoulder disorders in patients evaluated by two shoulder and elbow surgeons. METHODS: This cross-sectional study analyzed patients evaluated by two authors, excluding acute fractures and dislocations and patients with symptoms not involving the shoulder. Age and sex distribution was determined for the different diagnoses. RESULTS: We evaluated 1001 patients. Mean age was 51.43±15.15 years and 51.0% were female. Disorders of the rotator cuff occurred in 64.3% (41.2% tendinopathy, 11.0% partial tears and 12.2% full-thickness tears). Adhesive capsulitis occurred in 13.5% of cases and glenohumeral instability in 8.1%. Rotator cuff disorders were more common in women, with a peak between 50 and 59 years for tendinopathy and partial tears and between 60 and 69 years for full-thickness tears. Glenohumeral instability was more frequent in men, with a peak between 30 and 39 years. CONCLUSION: The most frequent diagnosis was rotator cuff tendinopathy, followed by adhesive capsulitis, full-thickness rotator cuff tears, partial rotator cuff tears and glenohumeral instability. Rotator cuff lesions were more common in women, with a peak between 60 and 69 years for full-thickness tears. Level of Evidence IV, Case Series.

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14

Sheean, Andrew J., Jayson Lian, Sean J. Meredith, Robert Tisherman, Andrew D. Lynch, Volker Musahl, and Bryson P. Lesniak. "Lateral Extra-Articular Tenodesis Does Not Affect Rotatory Knee Instability in Anatomic ACL Reconstruction." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0029. http://dx.doi.org/10.1177/2325967119s00295.

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Objectives: Single-bundle, anatomic anterior cruciate ligament reconstruction (ACLR) may not fully restore rotatory knee stability, and the addition of a lateral extra-articular tenodesis (LET) has been proposed as means for reducing residual rotatory knee instability. However, the magnitude of the in vivo, time zero effects of these procedures on rotatory knee instability remain poorly defined. The pivot shift test is used to assess for rotatory knee instability; however, it is a subjective grading system with limited generalizability and ability to predict clinical outcomes. Consequently, a quantified pivot shift (QPS) test software application, PIVOT iPad, has been developed and validated to measure the magnitude of rotatory knee laxity. The objective of this study was use intraoperative QPS (iQPS) to assess for differences in residual rotatory knee instability after ACLR versus ACLR augmented with lateral extra-articular tenodesis (ACLR + LET.) Methods: During examination under anesthesia (EUA), QPS was performed on both the operative and non-operative knees prior to ACLR (Figure 1A) Three, yellow ¾ inch markers were attached to skin overlying bony landmarks: lateral epicondyle, Gerdy’s tubercle and 3 cm posterior to Gerdy’s tubercle. The PIVOT software application was used to measure lateral compartment translation (Figure 1B) ACLR were randomly augmented with a LET if the lateral compartment translation measured during QPS was greater than or equal to double the amount of lateral compartment translation measured for the unaffected knee. iQPS measurements were subsequently performed after either ACLR or ACLR + LET with sterile markers (Figure 1C) iQPS data were recorded and compared to both the preoperative QPS measurements of the affected and unaffected knees. Based upon normative QPS data established from a database of >150 previously performed ACLR at our institution, it was determined that 8 patients in each group would be required to achieve 80% power with an effect size of 1.2 mm and an alpha level of 0.05. Post-procedure iQPS data were compared to preoperative QPS measurements with paired samples t-tests. Results: iQPS measurements were performed in 20 ACLR (10 ACLR and 10 ACLR + LET). The mean age in the cohort was 17.3 years old (range: 17-24 years old.). Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee instability when compared to preoperative QPS measurements (pre-ACLR: 4.7 ± 1.9 v. post-ACLR: 1.3 ± 0.70, P < 0.001; pre-ACLR +LET: 3.6 ± 1.8 v. post-ACLR + LET: 0.9 ± 0.5, P < 0.001.) When comparing isolated ACLR to ACLR + LET, no significant differences were observed in the magnitude of change in iQPS between the pre and post-intervention states (ACLR: - 3.5 ± 1.6 mm v. ACLR + LET: -1.5 ± 3.1 mm, P = N.S.) Furthermore, there were no significant differences in lateral compartment translation between the operative knees and non-operative knees (ACLR: -0.1 ± 0.9 mm v. ACLR + LET: -0.5 ± 1.0 mm, P = N.S.), suggesting that neither ACLR nor ACLR + LET led to over-constrained kinematics. Conclusion: In this randomized control study, both ACLR and ACLR + LET resulted in significant decreases in rotatory knee instability. However, there were no significant differences in time-zero, rotatory knee instability detected between isolated ACLR versus ACLR combined with LET in patients. The utility of combining a LET with ACLR remains unclear, and future research is necessary to refine the indications for LET in patients with high-grade rotatory knee instability.

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15

Mehta, Janak A., and Gregory I. Bain. "Posterolateral Rotatory Instability of the Elbow." Journal of the American Academy of Orthopaedic Surgeons 12, no. 6 (November 2004): 405–15. http://dx.doi.org/10.5435/00124635-200411000-00005.

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16

Norwood, Lyle A. "Treatment of Acute Anterolateral Rotatory Instability." Orthopedic Clinics of North America 16, no. 1 (January 1985): 127–34. http://dx.doi.org/10.1016/s0030-5898(20)30472-7.

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17

Andrews, James R., Richard A. Sanders, and Benoit Morin. "Surgical treatment of anterolateral rotatory instability." American Journal of Sports Medicine 13, no. 2 (March 1985): 112–19. http://dx.doi.org/10.1177/036354658501300206.

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18

Coughlin, L., J. Oliver, and G. Berretta. "Knee bracing and anterolateral rotatory instability." American Journal of Sports Medicine 15, no. 2 (March 1987): 161–63. http://dx.doi.org/10.1177/036354658701500211.

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19

Charalambous, C. P., and J. K. Stanley. "Posterolateral rotatory instability of the elbow." Journal of Bone and Joint Surgery. British volume 90-B, no. 3 (March 2008): 272–79. http://dx.doi.org/10.1302/0301-620x.90b3.19868.

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20

Anakwenze, Oke A., Vamsi K. Kancherla, Jaicharan Iyengar, Christopher S. Ahmad, and William N. Levine. "Posterolateral Rotatory Instability of the Elbow." American Journal of Sports Medicine 42, no. 2 (July 11, 2013): 485–91. http://dx.doi.org/10.1177/0363546513494579.

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21

Gantsoudes, George D., and Bradford O. Parsons. "Posterolateral rotatory instability of the elbow." Current Opinion in Orthopaedics 18, no. 4 (July 2007): 395–98. http://dx.doi.org/10.1097/bco.0b013e328186440e.

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22

Smith, Julious P., Felix H. Savoie, and Larry D. Field. "Posterolateral Rotatory Instability of the Elbow." Clinics in Sports Medicine 20, no. 1 (January 2001): 47–58. http://dx.doi.org/10.1016/s0278-5919(05)70246-5.

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23

Fedorka, Catherine J., and Luke S. Oh. "Posterolateral rotatory instability of the elbow." Current Reviews in Musculoskeletal Medicine 9, no. 2 (May 18, 2016): 240–46. http://dx.doi.org/10.1007/s12178-016-9345-8.

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24

Guenther, Daniel, Chad Griffith, Bryson Lesniak, Nicola Lopomo, Alberto Grassi, Stefano Zaffagnini, Freddie H. Fu, and Volker Musahl. "Anterolateral rotatory instability of the knee." Knee Surgery, Sports Traumatology, Arthroscopy 23, no. 10 (May 5, 2015): 2909–17. http://dx.doi.org/10.1007/s00167-015-3616-6.

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25

Conway, John E., and Steven B. Singleton. "Posterolateral Rotatory Instability of the Elbow." Sports Medicine and Arthroscopy Review 11, no. 1 (March 2003): 71–78. http://dx.doi.org/10.1097/00132585-200311010-00010.

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26

OʼDriscoll, S. W., D. F. Bell, and B. F. Morrey. "Posterolateral rotatory instability of the elbow." Journal of Bone & Joint Surgery 73, no. 3 (March 1991): 440–46. http://dx.doi.org/10.2106/00004623-199173030-00015.

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27

Amarasooriya, Melanie. "Posterolateral rotatory instability of the elbow." Sri Lankan Journal of Orthopaedic Surgery 8, no. 1 (November 1, 2022): 15–21. http://dx.doi.org/10.4038/tsljos.v8i1.4.

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Posterolateral rotatory instability (PLRI) of the elbow is the most common chronic instability pattern identified. It is the resultant ulno-humeral instability secondary to compromised lateral ligament complex. The characteristic injury is the avulsion of the lateral ulnar collateral ligament (LUCL) from its humeral attachment. Acute PLRI can present following simple or complex elbow dislocations. Chronic PLRI mostly follows trauma but also can be the result of iatrogenic injury.

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28

Tashiro, Yasutaka, Ken Okazaki, Hiromasa Miura, Shuichi Matsuda, Takefumi Yasunaga, Makoto Hashizume, Yoshitaka Nakanishi, and Yukihide Iwamoto. "Quantitative Assessment of Rotatory Instability after Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 37, no. 5 (March 4, 2009): 909–16. http://dx.doi.org/10.1177/0363546508330134.

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Background Anterior cruciate ligament reconstruction successfully reduces anterior knee instability, but its effect on rotatory stability is not fully understood. In addition, a definitive method for the quantitative evaluation of rotatory instability remains to be established. Hypothesis Measurement of anterolateral tibial translation by open magnetic resonance imaging could positively correlate with the clinical grading of the pivot-shift test and would clarify residual rotatory abnormalities not shown by conventional methods for measurement of anterior stability. Study Design Controlled laboratory study. Methods An anterior cruciate ligament—reconstructed group (n = 21) and an anterior cruciate ligament—deficient group (n = 20) were examined using a Slocum anterolateral rotatory instability test in open magnetic resonance imaging. Anterior tibial translation was measured at the medial and lateral compartments by evaluating sagittal images. Clinical knee stability was evaluated before the above measurement using the pivot-shift test, KT-2000 arthrometer, and stress radiography. A cutoff value for anterolateral tibial translation relating to pivot-shift was determined using a receiver operating characteristic curve. Results Side-to-side differences of anterolateral tibial translation correlated with clinical grade of the pivot-shift test and stress radiography but not with KT-2000 arthrometry in both groups. The cutoff value was established as 3.0 mm. Although the mean anterolateral translation showed no difference, 9 reconstructed knees revealed greater than 3 mm of anterolateral tibial translation, whereas only 3 uninjured knees did. Conclusion Measurement using an open magnetic resonance imaging successfully quantified the remaining rotatory instability in anterior cruciate ligament—reconstructed knees. Clinical Relevance This method is a useful means for quantifying anterior cruciate ligament function to stabilize tibial rotation.

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29

Smartt, Anne A., Ryan R. Wilbur, Bryant M. Song, Aaron J. Krych, Kelechi Okoroha, Jonathan D. Barlow, and Christopher L. Camp. "Natural History of First-Time Anterior Shoulder Dislocation in Patients Older Than 50 Years: A Study of 179 Patients With a Mean Follow-up of 11 Years." Orthopaedic Journal of Sports Medicine 10, no. 11 (November 1, 2022): 232596712211293. http://dx.doi.org/10.1177/23259671221129301.

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Background: There is a dearth of knowledge on anterior shoulder instability in older patients. Purpose/Hypothesis: The purposes of this study were to describe the incidence and epidemiology, injury characteristics, and treatment and outcomes in patients ≥50 years old with first-time anterior shoulder instability. We also describe the historical trends in diagnosis and treatment. It was hypothesized that the rates of obtaining a magnetic resonance imaging (MRI) scan and surgical intervention have increased over the past 20 years. Study Design: Descriptive epidemiology study. Methods: An established geographic database was used to identify 179 patients older than 50 years who experienced new onset anterior shoulder instability between 1994 and 2016. Medical records were reviewed to obtain patient characteristics, imaging characteristics, and surgical treatment and outcomes, including recurrent instability. Comparative analysis was performed to identify differences between age groups. Mean follow-up time was 11 years. Results: The incidence of first-time anterior shoulder dislocation in our study population was 28.8 per 100,000 person-years, which is higher than previously reported. Full-thickness rotator cuff tears were found in 62% of the 66 patients who underwent MRI scans. Of all patients, 26% progressed to surgery at a mean time of 1.6 years after injury; 57% of all surgical procedures involved a rotator cuff repair, and 17% included anterior labral repair. All patients who underwent a labral repair also underwent concomitant rotator cuff repair. The rate of recurrent instability for the cohort was 15% at a median of 176 days after the initial instability event. There were no instances of recurrent instability after operative intervention. At an average of 7.5 years after the initial instability event, 14% of patients developed radiographic progression of glenohumeral arthritis. The rate of surgical intervention within 1 year of initial dislocation increased from 5.1% in 1994 to 1999 to 52% in 2015 to 2016. Conclusion: The incidence of first-time anterior shoulder instability in patients aged ≥50 years was 28.8 per 100,000 person-years. Full-thickness rotator cuff tears (62%) were the most common condition associated with anterior shoulder instability, followed by Hill-Sachs lesions (56%). The rate of recurrent instability for the entire cohort was 15%, with no instances of recurrent instability after operative intervention.

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30

Marco, Santos Moros, José Luis Ávila Lafuente, Miguel Angel Ruiz Ibán, and Jorge Diaz Heredia. "Controversies In The Surgical Management Of Shoulder Instability: Associated Soft Tissue Procedures." Open Orthopaedics Journal 11, no. 1 (August 31, 2017): 989–1000. http://dx.doi.org/10.2174/1874325001711010989.

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Background:The glenohumeral joint is a ball-and-socket joint that is inherently unstable and thus, susceptible to dislocation. The traditional and most common anatomic finding is the Bankart lesion (anterior-inferior capsule labral complex avulsion), but there is a wide variety of anatomic alterations that can cause shoulder instability or may be present as a concomitant injury or in combination, including bone loss (glenoid or humeral head), complex capsule-labral tears, rotator cuff tears, Kim´s lesions (injuries to the posterior-inferior labrum) and rotator interval pathology.Methods:A review of articles related to shoulder anatomy and soft tissue procedures that are performed during shoulder instability arthroscopic management was conducted by querying the Pubmed database and conclusions and controversies regarding this injury were exposed.Results:Due to the complex anatomy of the shoulder and the large range of movement of this joint, a wide variety of anatomic injuries and conditions can lead to shoulder instability, specially present in young population. Recognizing and treating all of them including Bankart repair, capsule-labral plicatures, SLAP repair, circumferential approach to pan-labral lesions, rotator interval closure, rotator cuff injuries and HAGL lesion repair is crucial to achieve the goal of a stable, full range of movement and not painful joint.Conclusion:Physicians must be familiarized with all the lesions involved in shoulder instability, and should be able to recognize and subsequently treat them to achieve the goal of a stable non-painful shoulder. Unrecognized or not treated lesions may result in recurrence of instability episodes and pain while overuse of some of the techniques previously described can lead to stiffness, thus the importance of an accurate diagnosis and treatment when facing a shoulder instability.

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31

Oh, Jeong-Hwan, and Jin-Young Park. "Rotator Interval Lesion: Instability & Stiffness." Journal of the Korean Shoulder and Elbow Society 8, no. 1 (June 1, 2005): 5–8. http://dx.doi.org/10.5397/cise.2005.8.1.005.

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32

Field, Larry D., and Felix H. Savoie. "Anterosuperior instability and the rotator interval." Operative Techniques in Sports Medicine 5, no. 4 (October 1997): 257–63. http://dx.doi.org/10.1016/s1060-1872(97)80010-x.

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33

Porcellini, Giuseppe, Francesco Caranzano, Fabrizio Campi, Andrea Pellegrini, and Paolo Paladini. "Glenohumeral Instability and Rotator Cuff Tear." Sports Medicine and Arthroscopy Review 19, no. 4 (December 2011): 395–400. http://dx.doi.org/10.1097/jsa.0b013e31820d583b.

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34

Gomberawalla, M. Mustafa, and Jon K. Sekiya. "Rotator Cuff Tear and Glenohumeral Instability." Clinical Orthopaedics and Related Research® 472, no. 8 (September 17, 2013): 2448–56. http://dx.doi.org/10.1007/s11999-013-3290-2.

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35

Unger, R. Zackary, Jeremy M. Burnham, Lee Gammon, Chaitu S. Malempati, Cale A. Jacobs, and Eric C. Makhni. "The Responsiveness of Patient- Reported Outcome Tools in Shoulder Surgery Is Dependent on the Underlying Pathological Condition." American Journal of Sports Medicine 47, no. 1 (January 11, 2018): 241–47. http://dx.doi.org/10.1177/0363546517749213.

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Background: Given the high number of available patient-reported outcome (PRO) tools for patients undergoing shoulder surgery, comparative information is necessary to determine the most relevant forms to incorporate into clinical practice. Purpose: To determine the utilization and responsiveness of common PRO tools in studies involving patients undergoing arthroscopic rotator cuff repair or operative management of glenohumeral instability. Study Design: Systematic review. Methods: A systematic review of rotator cuff and instability studies from multiple databases was performed according to PRISMA guidelines. Means and SDs of each PRO tool utilized, study sample sizes, and follow-up durations were collected. The responsiveness of each PRO tool compared with other PRO tools was determined by calculating the effect size and relative efficiency (RE). Results: After a full-text review of 238 rotator cuff articles and 110 instability articles, 81 studies and 29 studies met the criteria for final inclusion, respectively. In the rotator cuff studies, 25 different PRO tools were utilized. The most commonly utilized PRO tools were the Constant (50 studies), visual analog scale (VAS) for pain (44 studies), American Shoulder and Elbow Surgeons (ASES; 39 studies), University of California, Los Angeles (UCLA; 20 studies), and Disabilities of the Arm, Shoulder and Hand (DASH; 13 studies) scores. The ASES score was found to be more responsive than all scores including the Constant (RE, 1.94), VAS for pain (RE, 1.54), UCLA (RE, 1.46), and DASH (RE, 1.35) scores. In the instability studies, 16 different PRO tools were utilized. The most commonly used PRO tools were the ASES (13 studies), Rowe (10 studies), Western Ontario Shoulder Instability Index (WOSI; 8 studies), VAS for pain (7 studies), UCLA (7 studies), and Constant (6 studies) scores. The Rowe score was much more responsive than both the ASES (RE, 22.84) and the Constant (RE, 33.17) scores; however, the ASES score remained more responsive than the Constant (RE, 1.93), VAS for pain (RE, 1.75), and WOSI (RE, 0.97) scores. Conclusion: Despite being frequently used in the research community, the Constant score may be less clinically useful as it was less responsive. Additionally, it is a greater burden on the provider because it requires objective strength and range of motion data to be gathered by the clinician. In contrast, the ASES score was highly responsive after rotator cuff repair and requires only subjective patient input. Furthermore, separate PRO scoring methods appear to be necessary for patients undergoing rotator cuff repair and surgery for instability as the instability-specific Rowe score was much more responsive than the ASES score.

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Okazaki, Ken, Hiromasa Miura, Shuich Matsuda, Takefumi Yasunaga, Hideaki Nakashima, Kozo Konishi, Yukihide Iwamoto, and Makoto Hashizume. "Assessment of Anterolateral Rotatory Instability in the Anterior Cruciate Ligament—Deficient Knee Using an Open Magnetic Resonance Imaging System." American Journal of Sports Medicine 35, no. 7 (July 2007): 1091–97. http://dx.doi.org/10.1177/0363546507299530.

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Background In the clinical evaluation of the anterior cruciate ligament—deficient knee, anterolateral rotatory instability is assessed by manual tests such as the pivot-shift test, which is subjective and not quantitative. Hypothesis The anterolateral rotatory instability in an anterior cruciate ligament—deficient knee can be quantified by our newly developed method using open magnetic resonance imaging. Study Design Controlled laboratory study. Methods Eighteen subjects with anterior cruciate ligament—deficient knees and 18 with normal knees were recruited. We administered the Slocum anterolateral rotatory instability test in the open magnetic resonance imaging scanner and scanned the sagittal view of the knee. The anterior displacements of the tibia at the medial and lateral compartments were measured. Furthermore, we examined 14 anterior cruciate ligament—deficient knees twice to assess intraobserver and interobserver reproducibility and evaluated the difference and interclass correlation coefficient of 2 measures. Results In the anterior cruciate ligament—deficient knee, displacement was 14.4 ± 5.5 mm at the lateral compartment and 1.6 ± 2.3 mm at the medial compartment; in the normal knee, displacement was 0.7 ± 1.9 mm and —1.1 ± 1.2 mm, respectively. The difference and interclass correlation coefficient between 2 repeated measures at the lateral compartment were 1.0 ± 0.7 mm and .98 for intraobserver reproducibility and 1.1 ± 0.7 mm and .91 for interobserver reproducibility. Conclusion This method is useful to assess the anterolateral rotatory instability of the anterior cruciate ligament—deficient knee. Clinical Relevance This method can be used in the clinical assessment of anterior cruciate ligament stability, such as comparing studies of graft positions or 2-bundle anatomic reconstruction and the conventional 1-bundle technique.

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Hughston, J. C., and K. E. Jacobson. "Chronic posterolateral rotatory instability of the knee." Journal of Bone & Joint Surgery 67, no. 3 (March 1985): 351–59. http://dx.doi.org/10.2106/00004623-198567030-00001.

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38

Streubel, Philipp N., and Mark S. Cohen. "Diagnosis and Treatment of Posterolateral Rotatory Instability." Operative Techniques in Sports Medicine 25, no. 4 (December 2017): 319–26. http://dx.doi.org/10.1053/j.otsm.2017.08.013.

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39

Rhyou, In Hyeok. "Posterolateral Rotatory Instability of the Elbow Joint." Archives of Hand and Microsurgery 23, no. 2 (2018): 69. http://dx.doi.org/10.12790/ahm.2018.23.2.69.

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40

Singleton, Steven B., and John E. Conway. "PLRI: posterolateral rotatory instability of the elbow." Clinics in Sports Medicine 23, no. 4 (October 2004): 629–42. http://dx.doi.org/10.1016/j.csm.2004.06.010.

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41

Dhiman, Joginder S. "Suppression of instability in rotatory hydromagnetic convection." Proceedings Mathematical Sciences 110, no. 3 (August 2000): 335–45. http://dx.doi.org/10.1007/bf02878688.

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Nielsen, Strange, J. Ovesen, O. Rasmussen, and K. Andersen. "Experimental rotatory instability of the knee joint." Journal of Biomechanics 18, no. 7 (January 1985): 540. http://dx.doi.org/10.1016/0021-9290(85)90769-9.

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LOOMER, RICHARD L. "A Test for Knee Posterolateral Rotatory Instability." Clinical Orthopaedics and Related Research &NA;, no. 264 (March 1991): 235???238. http://dx.doi.org/10.1097/00003086-199103000-00028.

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44

McLean, James, Michael P. Kempston, Jeffrey M. Pike, Thomas J. Goetz, and Parham Daneshvar. "Varus Posteromedial Rotatory Instability of the Elbow." Journal of Orthopaedic Trauma 32, no. 12 (December 2018): e469-e474. http://dx.doi.org/10.1097/bot.0000000000001313.

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Cerezal, Alvaro, Ronald Ocampo, Eva Llopis, and Luis Cerezal. "Ankle Instability Update." Seminars in Musculoskeletal Radiology 27, no. 03 (May 25, 2023): 231–44. http://dx.doi.org/10.1055/s-0043-1767767.

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AbstractSprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach.

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Cameron, Kenneth L., David J. Tennent, Rodney X. Sturdivant, Matthew A. Posner, Karen Y. Peck, Scot E. Campbell, Richard B. Westrick, and Brett D. Owens. "Increased Glenoid Retroversion Is Associated With Increased Rotator Cuff Strength in the Shoulder." American Journal of Sports Medicine 47, no. 8 (June 7, 2019): 1893–900. http://dx.doi.org/10.1177/0363546519853591.

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Background: The rotator cuff muscles are critical secondary stabilizers in the shoulder. Increased glenoid retroversion and rotator cuff strength have been associated with the risk of posterior shoulder instability; however, the effect of increased glenoid retroversion on rotator cuff strength remains unclear. Purpose/Hypothesis: The purpose was to examine the association between glenoid version and rotator cuff strength in the shoulder in a young and healthy population with no history of shoulder instability. The hypothesis was that increased glenoid retroversion would be associated with increases in rotator cuff muscle strength. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A prospective cohort study was conducted over a 4-year period within a high-risk population to identify the risk factors for shoulder instability. Analyzed participants included 574 freshmen entering a United States service academy. Baseline data collected upon entry into the study included magnetic resonance imaging measurements of glenoid version. Rotator cuff strength was also assessed at baseline using a handheld dynamometer. Internal and external rotation strength were assessed with the glenohumeral joint positioned in neutral and in 45° of abduction. The current study represents an analysis of the baseline data from this cohort. Results: The mean age, height, and weight of participants was 18.77 ± 0.97 years, 176.81 ± 8.48 cm, and 73.80 ± 12.45 kg, respectively. The mean glenoid version at baseline was 7.79°± 4.85° of retroversion. Univariate linear regression analyses demonstrated that increased glenoid retroversion was associated with increased internal and external rotation strength of the rotator cuff in neutral and 45° of abduction ( P < .001). Similar results were observed in multivariable models controlling for important confounding variables. Conclusion: The results of this study demonstrate that as glenoid retroversion increases, internal and external rotation strength of the rotator cuff also increase in a young and healthy athletic population. These compensatory changes may contribute to increased glenohumeral dynamic stability in the presence of worse static stability with increasing retroversion.

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Hsu, Yi-Chih, Ru-Yu Pan, Yen-Yu I. Shih, Meei-Shyuan Lee, and Guo-Shu Huang. "Superior-capsular elongation and its significance in atraumatic posteroinferior multidirectional shoulder instability in magnetic resonance arthrography." Acta Radiologica 51, no. 3 (April 2010): 302–8. http://dx.doi.org/10.3109/02841850903524421.

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Background: Redundancy of the capsule has been considered to be the main pathologic condition responsible for atraumatic posteroinferior multidirectional shoulder instability; however, there is a paucity of measurements providing quantitative diagnosis. Purpose: To determine the significance of superior-capsular elongation and its relevance to atraumatic posteroinferior multidirectional shoulder instability at magnetic resonance (MR) arthrography. Material and Methods: MR arthrography was performed in 21 patients with atraumatic posteroinferior multidirectional shoulder instability and 21 patients without shoulder instability. One observer made the measurements in duplicate and was blinded to the two groups. The superior-capsular measurements (linear distance and cross-sectional area) under the supraspinatus tendon, and the rotator interval were determined on MR arthrography and evaluated for each of the two groups. Results: For the superior-capsular measurements, the linear distance under the supraspinatus tendon was significantly longer in patients with atraumatic posteroinferior multidirectional shoulder instability than in control subjects ( P<0.001). The cross-sectional area under the supraspinatus tendon, and the rotator interval were significantly increased in patients with atraumatic posteroinferior multidirectional shoulder instability compared to control subjects ( P<0.001 and P=0.01, respectively). Linear distance greater than 1.6 mm under the supraspinatus tendon had a specificity of 95% and a sensitivity of 90% for diagnosing atraumatic posteroinferior multidirectional shoulder instability. Cross-sectional area under the supraspinatus tendon greater than 0.3 cm2, or an area under the rotator interval greater than 1.4 cm2 had a specificity of more than 80% and a sensitivity of 90%. Conclusion: The superior-capsular elongation as well as its diagnostic criteria of measurements by MR arthrography revealed in the present study could serve as references for diagnosing atraumatic posteroinferior shoulder instability and offer insight into the spectrum of imaging findings corresponding to the pathologies encountered at clinical presentation.

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Tokunaga, Susumu, and Yoshihiro Abe. "Novel Suture Anchor Technique with Continuous Locking Stitch for Collateral Ligament Repair." Journal of Hand Surgery (Asian-Pacific Volume) 21, no. 02 (May 3, 2016): 276–79. http://dx.doi.org/10.1142/s2424835516710028.

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Collateral ligaments are difficult to repair due to large amount of fraying in detached ligaments and attenuated stumps that may not provide enough strength after the repair. Although strong locking sutures are used to repair the ligament with proper tension, these damages can cause pull-out failure or relaxation of the repaired ligaments even from undersized load that may extend postoperative splinting or casting time. Furthermore, current suture techniques can repair varus or valgus instability of the elbow and radial or ulnar instability of the fingers, but these techniques do not offer rotatory stability of these areas. We have developed a novel suture anchor technique that has overcome this problem of current suture techniques, and this can be used to correct rotatory instability in the elbow and fingers. We used this procedure in seven cases with injury of collateral ligament in the elbow and eight cases with detached collateral ligaments of finger joint. No patient experienced rerupture or any kind of residual instability. We believe that the proposed method can produce much stronger repair and may shorten the postoperative immobilization period.

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Slavin, Justin, Marcello DiStasio, Paul F. Dellaripa, and Michael Groff. "Odontoid cervical gout causing atlantoaxial instability: case report." Journal of Neurosurgery: Spine 30, no. 4 (April 2019): 541–44. http://dx.doi.org/10.3171/2018.9.spine18122.

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The authors present a case report of a patient discovered to have a rotatory subluxation of the C1–2 joint and a large retroodontoid pannus with an enhancing lesion in the odontoid process eventually proving to be caused by gout. This patient represented a diagnostic conundrum as she had known prior diagnoses of not only gout but also sarcoidosis and possible rheumatoid arthritis, and was in the demographic range where concern for an oncological process cannot fully be ruled out. Because she presented with signs and symptoms of atlantoaxial instability, she required posterior stabilization to reduce the rotatory subluxation and to stabilize the C1–2 instability. However, despite the presence of a large retroodontoid pannus, she had no evidence of spinal cord compression on physical examination or imaging and did not require an anterior procedure to decompress the pannus. To confirm the diagnosis but avoid additional procedures and morbidity, the authors proceeded with the fusion as well as a posterior biopsy to the retroodontoid pannus and confirmed a diagnosis of gout.

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50

Loehr, Joachim F., Peter Helmig, Jens-Ole S??jbjerg, and Alexander Jung. "Shoulder Instability Caused by Rotator Cuff Lesions." Clinical Orthopaedics and Related Research &NA;, no. 304 (July 1994): 84???90. http://dx.doi.org/10.1097/00003086-199407000-00015.

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