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Magnitude and location of glenohumeral capsular injury following multiple shoulder anterior dislocations
ESSKA Academy. Yoshida M. May 11, 2018; 218034
Masahito Yoshida
Masahito Yoshida
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Abstract
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Objectives: Permanent deformation of the glenohumeral capsule can occur during multiple shoulder dislocations resulting in capsular injury. During surgical repair, the glenohumeral capsule is often plicated and shifted to reduce joint laxity, following multiple dislocations. However, quantitative evaluation and regional capsular injury has not been described. The purpose of this study is to evaluate the location and magnitude of the glenohumeral capsular injury following multiple dislocations.

Methods: Seven fresh-frozen cadaveric shoulders were (age range 48-66 yrs) were dissected free of all soft tissue except the glenohumeral capsule. A 7 x 11 grid of strain markers were affixed to the anterior and posterior band of the inferior glenohumeral ligament (IGHL), and the axillary pouch. The humerus and scapula were then mounted within a robotic testing system. An anterior load was applied to the joint and the humerus was allowed to move until the anterior translation reached one half the maximum AP width of the glenoid plus 10 mm. Following dislocation, the positions of the strain markers were recorded again and served as the non-recoverable strain state. Marker capture was performed following 1, 2, 3, 4, 5 and 10 dislocations to determine the magnitude of non-recoverable strain. The non-recoverable strains in the anteroinferior capsule were divided into eight sub-regions: 1) anterior band of IGHL on the glenoid side (ABG), 2) anterior band of IGHL on the humeral side (ABH), 3) anterior axillary pouch on the glenoid side (AAPG), 4) anterior axillary pouch on the humeral side (AAPH), 5) posterior axillar pouch on the glenoid side (PAPG), 6) posterior axillary pouch on the humeral side (PAPH), 7) posterior band of IGHL on the glenoid side (PBG), 8) posterior band of IGHL on the humeral side (PBH). For each specimen, a spearman's rank-order correlation was performed between the peak value of non-recoverable strain and the number of dislocation. Statistical significance was set at p<0.05.

Results: The peak value of non-recoverable strain of the inferior capsule following multiple dislocations statistically increased with the number of dislocations in five specimens. (p<0.05) The non-recoverable strain in the AAPH increased with the number of dislocations compared to the other regions(p<0.05). Significantly higher non-recoverable strain was also identified in the AAPG than the ABH, PAPG and PBG. (p<0.05) The region of the capsule that had the peak value of non-recoverable strain varied according to the number of dislocations.

Conclusions: The magnitude of injury of the glenohumeral capsule increased with the number of dislocations. The most injured regions of the capsule varied following each dislocation. In addition, the humeral region of the anterior axillary pouch of the glenohumeral capsule demonstrated the highest magnitude of capsular injury through all of the dislocations. The amount and location of capsular plication may vary based on each individual and number of dislocations.

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