• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.27 no.1
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• pp.13-20
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• 2021

Background: The serratus anterior and upper trapezius muscles act synergistically to allow for an appropriate scapulothoracic rhythm. However, a decrease in serratus anterior activation causes the upper trapezius to become overactivated, resulting in dysfunction. This study compared serratus anterior and upper trapezius muscle activity according to sling angle and compared serratus anterior strength between healthy adults and patients with shoulder instability. Methods: Twenty participants (10 healthy adults and 10 patients with shoulder instability) were included in this study. The participants had their arms extended at sling angles of 30°, 60°, and 90° in reach forward with shoulder flexion using goniometer. Serratus anterior strength was measured three times while the participants were supine. The outcome measures were surface electromyography amplitude of the upper trapezius and serratus anterior and serratus anterior strength. Results: The Wilcoxon signed-rank test indicated that the upper trapezius was significantly different between healthy group and shoulder instability group at a sling angle of 60°, and both the upper trapezius and serratus anterior exhibited significant differences at 90°. Moreover, a significant difference was noted in the muscle strength of the serratus anterior. Conclusion: Our results provide novel and promising clinical evidence that patients with shoulder instability have decreased serratus anterior activation and upper trapezius overactivation, resulting in muscle imbalance. In addition, there was a significant difference between the healthy group and shoulder instability group in the serratus anterior muscle strength

• Clinics in Shoulder and Elbow
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• v.19 no.3
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• pp.155-162
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• 2016

Background: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes. Methods: We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule. Results: With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence. Conclusions: Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.

• Clinics in Shoulder and Elbow
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• v.7 no.2
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• pp.70-75
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• 2004

Purpose: To evaluate the results of arthroscopic repair of traumatic anterior shoulder instability with glenoid bone defect. Materials and Methods: Nineteen patients who had underwent arthroscopic repair for the shoulder with traumatic anterior instability and glenoid bone defect were retrospectively reviewed. Mean age was 24.6 years(range, 20 to 39) and mean follow-up was 23 months(range, 19 to 55). No glenoid bone defect was greater than 7mm in length and 20% of the glenoid. The results were evaluated according to stability, range of motion and function. Results: All patients obtained excellent-good results according to Rowe scoring system. Two patients(10.5%) had instability. The mean loss of external rotation was 15 degrees (range, 0 to 25). Functionally, 17 patients could participate in preinjured work or sports to the same level with or without mild discomfort. The remained 2 patients who had 25 degree loss of external rotation could not play sports. Conclusion: Though arthroscopic repair is a good treatment for traumatic anterior shoulder instability with small glenoid bone defect, it is possible to cause loss of external rotation

• Clinics in Shoulder and Elbow
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• v.3 no.1
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• pp.10-19
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• 2000

The aims of this retrospective study were to evaluate the results of inferior capsular shift operation which were approached anteriorly or posteriorly according to a main instability direction in contact sports population who had multidirectional shoulder instability. Fifty-three shoulders in 47 athletes who engaged in contact sports underwent an anterior or posterior inferior capsular shift procedure for the correction of multidirectional instability of the shoulder joint. The surgical approach was selected according to the predominant direction of the instability. Follow up was average of 42 months(24∼73 months). After anterior inferior capsular shift, anterior dislocation was recurred in three shoulders, posterior dislocation in one, and inferior dislocation in two shoulders. After posterior inferior capsular shift, one dislocation occurred anteriorly, one inferiorly and one posteriorly. The excessive tightening of capsule or improper diagnosis could be causative factors for the development of dislocation in the opposite direction to the preoperative major instability. Of six patients who could not return to their sports, five had bilateral repairs. Successful repair based on the criteria of the American shoulder and elbow association was achieved in 92% of anterior repairs, and 81 % of posterior repairs.

• Journal of Korean Foot and Ankle Society
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• v.6 no.2
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• pp.251-255
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• 2002

Purpose: Chronic subtalar instability is not common and similar to chronic ankle instability and the incidence and cause chronic subtalar instability are not well known. Recently we have experienced chronic subtalar instability without chronic ankle instability which was treated with modified Brostrom procedures. Materials and Methods: The patient is 46 year old man who has suffered from left ankle sprain for 30 years and recently aggravated more than twice a day. On subtalar stress view, 14 degree angulation of subtalar joint was noted and on anterior drawer view, 8 mm anterior displacement of left ankle was seen. Results: In operation, there was no anterior talofibular ligament abnormility but calcaneofibular ligament loosening was found. Ligament reconstruction was performed using modified Brostrom procedure. At 12 months after operation, the patient complains no pain and no limit of motion and no instability. Conclusion: We experienced chronic subtalar instability without ankle instability treated with modified Brostrom procedures. No instability was found after treatment without complication.

• Clinics in Shoulder and Elbow
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• v.7 no.2
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• pp.76-82
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• 2004

Purpose: In the traumatic anterior shoulder instability, the laxity of joint capsule and ligament is frequently demonstrated. Although a arthroscopic procedure to address anterior instability with joint capsular redundancy have generally provided good results, its recurrence rate is higher than open procedure. By reducing the capsular redundancy, thermal shrinkage is likely to improve the outcome of arthroscopic anterior stabilization. The objective of this study was to evaluate additional thermal capsular shrinkage as a treatment of joint capsular redundancy in anterior shoulder instability. Materials and Methods: From March 1999 to June 2000, 25 shoulders of 23 patients of recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with shrinkage procedure. The mean follow up was 29 months and average age at the time of operation was 26 years. Of these patients, 20 were male and 3 were female who had been experienced the average 8 times of dislocation before operation. Thermal shrinkage alone without Bankart repair was performed in two cases who did not have Bankart lesion. The clinical result was evaluated in according to Modified Rowe Score. Results: The Modified Rowe Score was improved from preoperative 35 points to postoperative 88 points. None of cases showed recurrence of dislocation. But, in two cases, temporary sensory hypesthesia of the axillary nerve was developed and in two cases of postoperative stiffness, arthroscopic capsular release and brisement were performed. Conclusion: Additional capsular shrinkage in arthroscopic technique to address recurrent anterior shoulder instability could treat effectively the capsular redundancy.

• Clinics in Shoulder and Elbow
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• v.26 no.3
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• pp.252-259
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• 2023

Background: The purpose of this study was to identify demographics and risk factors associated with unplanned 30-day readmission and reoperation following open procedures for shoulder instability and examine recent trends in open shoulder instability procedures. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using current procedural terminology (CPT) codes 23455, 23460, and 23462 to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests and chi-square tests were used in univariate analyses to identify demographic, lifestyle, and perioperative variables related to 30-day readmission following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed. Results: In total, 1,942 cases of open surgical procedures for shoulder instability were identified. Within our study sample, 1.27% of patients were readmitted within 30 days of surgery, and 0.85% required reoperation. Multivariate logistic regression modeling confirmed that the following patient variables were associated with a statistically significant increase in the odds of readmission: open anterior bone block/Latarjet-Bristow procedure, being a current smoker, and a long hospital stay (all P<0.05). Multivariate logistic regression modeling confirmed statistically significant increased odds of reoperation with an open anterior bone block or Latarjet-Bristow procedure (P<0.05). Conclusions: Unplanned 30-day readmission and reoperation after open shoulder instability surgery is infrequent. Patients who are current smokers, have an open anterior bone block or Latarjet-Bristow procedure, or a longer than average hospital stay have higher odds of readmission than others. Patients who undergo an open anterior bone block or Latarjet-Bristow procedure have higher odds of reoperation than those who undergo an open soft-tissue procedure. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• v.5 no.1
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• pp.47-54
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• 2002

Purpose : We evaluated clinical result of arthroscopic and open Bankart repair in anterior shoulder instability to identify factors iuluencing operative result and prognosis. Materials & Methods . We reviewed 24 patients of anterior shoulder instability treated with arthroscopic Bankart repair in 16 cases and open Bankart repair in 8 cases. Average age was 26 years old and involved in dominant arm in 15 cases. Patients were suffered instability for 3.1 years before operation and mean follow-up was 2 year 9 months ( 1 you 9 months -4year 10 months). Results : Post operative pain was subsided in 2 weeks in arthroscopic surgery and 3 weeks in open surgery. The final range of motion after arthroscopic repair were flekion in 168" , external rotation in 54" , and internal rotation in 79, and after open repair 168" ,49" , and 78 respectively. In arthroscopic surgery,2 cases (13%) were redislocated, and 4 cases(25%) showed mild instability. In open case,1 case (11%) showed mild instability. According to function- al result by Rowe grading scale, satisfactory results were 12case (76%) in arthroscopic repair and 7 cases (88%) in open cases. Conclusions Both arthroscopic or open Bankart could get good results in the treatment of anterior instability of shoulder. In arthroscopic repair, perioperative morbidity was lower than open repair, but it needs careful rehabilitation program to prevent redislocation and to return to sports activity.

• Clinics in Shoulder and Elbow
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• v.23 no.2
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• pp.62-70
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• 2020

Background: Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods: Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results: The mean glenoid bone defect size was 25.8%±4.2% (range, 20.4%-37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24-86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions: Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

• Journal of the Korean Arthroscopy Society
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• v.17 no.1
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• pp.88-94
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• 2013

Three cases who had medial compartment osteoarthritis of the knee (Kellgrene-Laurence grade 3 and Outerbridge grade 4) and anterior instability of the knee due to rupture of the anterior cruciate ligament in relative young ages underwent staged anterior cruciate ligament reconstruction followed by medial unicondylar arthroplasty in 2 cases and simultaneous anterior cruciate ligament reconstruction and unicondylar arthroplasty. We evaluated clinical results some kinds of preoperative and postoperative International Knee Documentation Committee (IKDC), Lysholm score and last follow-up hospital for special surgery (HSS), knee society score (KSS). We consider that medial unicondylar arthroplasty with staged or simultaneous anterior cruciate ligament reconstruction is very good option of the treatment for the anterior instability and pain from advanced arthritis.