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Dynamic examination techniques in shoulder instability
Abstracts $43
J. Shoulder Elbow Surg. Volume 5, Number 2, Part 2
10
DYNAMIC EXAMINATION TECHNIQUES IN SHOULDER INSTABILITY. N. Wuelker, MD, D. Kohn, MD, & F. Mertens, MD, Orthopaedic Department, Hannover Medical School, Hannover, Germany The goal of this study was to assess the predictive value of various techniques to measure glenohumeral joint laxity. We prospectively examined 25 patients with recurrent shoulder dislocation prior to surgical stabilization. On the basis of pre- and intraoperative findings, a prefiminary working diagnosis was established. This was anterior dislocation in 14 patients, posterior dislocation in four and unclassified dislocation in seven shoulders. Glenohumeral joint laxity was subsequently assessed by clinical examination, fluoroscopy and ultrasonography in all patients, and in a control group of 25 individuals without shoulder disease. Normal laxity was defined as humeral head displacement not exceeding the standard deviation of the mean in the control group Ultrasonography was poody reproducible and concurred with clinical examination in only four and with fluoroscopy in seven patients. Clinical examination and fluoroscopy were sufficiently reproducible and had identical results in 19 patients. Laxity was present at clinical examination / fluoroscopy in 23 / 18 shoulders. The preliminary working diagnosis was confirmed in 10 ! 6 patients and revealed previously unknown laxity in 13 / 11 shoulders. Glenohumeral joint laxity should be evaluated preoperatively by clinical examination in all patients.and by fluoroscopic examination, if additional information or documentation are needed. The results of dynamic examination must be reflected in the technique of operative stabilization.
112
AUTOMATED DATA ACQUISITION FOR OUTCOME RESEARCH IN TOTAL SHOULDER ARTHROPLASTY. RJ Friedman, MD, FRCS(C), G Gartsman, MD, RL Dooley, phD. Medical University of South Carolina, Charleston, SC, 29425, USA. There is a great need to standardize the methods for recording and reporting the outcome of total shoulder arthroplasty so that results from various institutions can be compared. In addition, a new method o f handling imaging information combined with the clinical information is needed. The purpose of this study is to develop a comprehensive system for documenting and analyzing the clinical and mentgenographic results of total shoulder arthroplasty. The personal computer-based system links patient demographic and outcome data with digital storage, retrieval, and analysis of the roentgenograms. The system consists of a roentgenograpNc scanner for converting the original roentgenogram to digital data, an optical mark reader for patient data input, an arcNving system with optical storage, and a large screen monitor for preoperative planning and postoperative evaluation. The clinical information is collected on machine-readaNe data acquisition forms, and includes all preoperative and postoperative evaluations and treatment data. The roentgenograms are digitized using a high resolution charged-coupled device camera. The images may be manipulated electronically to correct for magnification and exposure. Postoperative measurements are preprogramrued. An intelligent database system linking patient demographic and outcome data with the roentgenographic data employs uniform criteria and terminology, allowing for the study and statistical analysis o f comparable cases. Automatic medical record preparation can also be integrated into the program and generated for the clinician. The system allows for rapid data acquisition, storage and retrieval, and provides a sophisticated database for research and outcome evaluations of Iota] shoulder arthropiasty. Clinicians and researchers can use the database for both preoperative planning and postoperative evaluation. Research teams can compare their data with punished results using the same standardized terminology, and explore the database to gain insight into the effectiveness of new treatment modalities, leading to more meaningful outcome studies.
111
A STANDARD METHOD FOR STRENGTH MEASUREMENT IN THE CONSTANT SCORE USING A SPRING BALANCE M.J.K. Bankes, J.E. Crossman & R.J.H. Emery Dept. of Orthopaedics, St. Mary's Hospital, Praed Street, London W2 1NY
113
FACTORS INFLUENCING THE ACROMIO-tIUMERAL INTERVAL IN ROTATOR CUFF TEARS. L. Nov6-josserand M.D. & C. L6vigne M.D. & E. Noel M.D. & G. Walch M.D. Clinique St Charles. LYON . FRANCE The narrowing of the Acroruio Humeral Interval (AHI) has been considered to be a sensitive indicator for full-thickness cuff tears.The purpose of this study is to analyse the factors iiffluencing the AHI. METHODS 264 shoulders were operated on between 1984 and 1994 for full tl~ickness tear of the rotator cuff. All patients had X-ray with A.P view of the shoulder in neutral rotation. The AHI was defined as the shortest distance measured between the inferior cortex (dense line) of the aeromion and the humerus. An arhro-CT was performed in 96 patients to analyse the muscular degeneration of the muscle: RESUI~T~ There was a moderate significant relationship (p
Whilst gaining wide acceptancefor initial assessment and follow-up of all types of shoulder pathology, the Constant score has been criticised for its failure to standardise the method used to measurethe strength of lateral elevalion,for which some 25 points out of a lotal of 100 are available.An unsecured spring balance was originally described for use in the score but the test position, the timing of the measurement, and the number of repefifions requiredwere not specified. Lack of fixation at both ends of the spring balance makes accurate measurement difficult. A method using the Isobexisometric dynamometerand a standard test position and lever arm has been shown to produceconsistent readingsin normal shoulders. Two experimentswere performed to compare the following methods in normal and pathological shoulders: (i) the Isobex(it) Constanl's unsecured spring balance (iii) a new method in which the spring balance is fixed at one end, and the reading taken after 5 seconds of maximum effort.The test position consisted of the subject standing, with the arm in g0~of lateral elevationin the scapular plane, the elbow extended,and the forearm pronated,with the device attachedto the wdst. Experiment 1. Compadson of the Isobex and the fixed spring balance in healthy volunteers (n=50) showed there to be a mean difference of only one or two points between the methods,although the differencewas highly significant (p < 0.001). Experiment2. Comparison b~tween all three methods on pathological shoulders (n=20) showed there to be no significant difference (p < 0.70) between the Isobex and fixed spring balance. The unsecured spring balance gave readings 1.5 points higher than either the fixed spnng balance or the Isobex(p < 0~05). A technique has been developedto take advantageof the availabilityand low cost of the spring balance. With a standard test position and the spring balancefixed at one end, the reading is taken after 5 seconds of maximum effort and the highestof three successive readings is used. Patients who are unable to achieve the test position of 900 shoulder abduction ate assigned a strength score of zero. In conclusion it is proposed that the strength component of the Constant score should be measured using either this clearly defined spring balancemethod or an Isobex. In this way some of the inconsistencies in the reporting of the score may be overcome.
J. Shoulder Elbow Surg. Volume 5, Number 2, Part 2
10
DYNAMIC EXAMINATION TECHNIQUES IN SHOULDER INSTABILITY. N. Wuelker, MD, D. Kohn, MD, & F. Mertens, MD, Orthopaedic Department, Hannover Medical School, Hannover, Germany The goal of this study was to assess the predictive value of various techniques to measure glenohumeral joint laxity. We prospectively examined 25 patients with recurrent shoulder dislocation prior to surgical stabilization. On the basis of pre- and intraoperative findings, a prefiminary working diagnosis was established. This was anterior dislocation in 14 patients, posterior dislocation in four and unclassified dislocation in seven shoulders. Glenohumeral joint laxity was subsequently assessed by clinical examination, fluoroscopy and ultrasonography in all patients, and in a control group of 25 individuals without shoulder disease. Normal laxity was defined as humeral head displacement not exceeding the standard deviation of the mean in the control group Ultrasonography was poody reproducible and concurred with clinical examination in only four and with fluoroscopy in seven patients. Clinical examination and fluoroscopy were sufficiently reproducible and had identical results in 19 patients. Laxity was present at clinical examination / fluoroscopy in 23 / 18 shoulders. The preliminary working diagnosis was confirmed in 10 ! 6 patients and revealed previously unknown laxity in 13 / 11 shoulders. Glenohumeral joint laxity should be evaluated preoperatively by clinical examination in all patients.and by fluoroscopic examination, if additional information or documentation are needed. The results of dynamic examination must be reflected in the technique of operative stabilization.
112
AUTOMATED DATA ACQUISITION FOR OUTCOME RESEARCH IN TOTAL SHOULDER ARTHROPLASTY. RJ Friedman, MD, FRCS(C), G Gartsman, MD, RL Dooley, phD. Medical University of South Carolina, Charleston, SC, 29425, USA. There is a great need to standardize the methods for recording and reporting the outcome of total shoulder arthroplasty so that results from various institutions can be compared. In addition, a new method o f handling imaging information combined with the clinical information is needed. The purpose of this study is to develop a comprehensive system for documenting and analyzing the clinical and mentgenographic results of total shoulder arthroplasty. The personal computer-based system links patient demographic and outcome data with digital storage, retrieval, and analysis of the roentgenograms. The system consists of a roentgenograpNc scanner for converting the original roentgenogram to digital data, an optical mark reader for patient data input, an arcNving system with optical storage, and a large screen monitor for preoperative planning and postoperative evaluation. The clinical information is collected on machine-readaNe data acquisition forms, and includes all preoperative and postoperative evaluations and treatment data. The roentgenograms are digitized using a high resolution charged-coupled device camera. The images may be manipulated electronically to correct for magnification and exposure. Postoperative measurements are preprogramrued. An intelligent database system linking patient demographic and outcome data with the roentgenographic data employs uniform criteria and terminology, allowing for the study and statistical analysis o f comparable cases. Automatic medical record preparation can also be integrated into the program and generated for the clinician. The system allows for rapid data acquisition, storage and retrieval, and provides a sophisticated database for research and outcome evaluations of Iota] shoulder arthropiasty. Clinicians and researchers can use the database for both preoperative planning and postoperative evaluation. Research teams can compare their data with punished results using the same standardized terminology, and explore the database to gain insight into the effectiveness of new treatment modalities, leading to more meaningful outcome studies.
111
A STANDARD METHOD FOR STRENGTH MEASUREMENT IN THE CONSTANT SCORE USING A SPRING BALANCE M.J.K. Bankes, J.E. Crossman & R.J.H. Emery Dept. of Orthopaedics, St. Mary's Hospital, Praed Street, London W2 1NY
113
FACTORS INFLUENCING THE ACROMIO-tIUMERAL INTERVAL IN ROTATOR CUFF TEARS. L. Nov6-josserand M.D. & C. L6vigne M.D. & E. Noel M.D. & G. Walch M.D. Clinique St Charles. LYON . FRANCE The narrowing of the Acroruio Humeral Interval (AHI) has been considered to be a sensitive indicator for full-thickness cuff tears.The purpose of this study is to analyse the factors iiffluencing the AHI. METHODS 264 shoulders were operated on between 1984 and 1994 for full tl~ickness tear of the rotator cuff. All patients had X-ray with A.P view of the shoulder in neutral rotation. The AHI was defined as the shortest distance measured between the inferior cortex (dense line) of the aeromion and the humerus. An arhro-CT was performed in 96 patients to analyse the muscular degeneration of the muscle: RESUI~T~ There was a moderate significant relationship (p
Whilst gaining wide acceptancefor initial assessment and follow-up of all types of shoulder pathology, the Constant score has been criticised for its failure to standardise the method used to measurethe strength of lateral elevalion,for which some 25 points out of a lotal of 100 are available.An unsecured spring balance was originally described for use in the score but the test position, the timing of the measurement, and the number of repefifions requiredwere not specified. Lack of fixation at both ends of the spring balance makes accurate measurement difficult. A method using the Isobexisometric dynamometerand a standard test position and lever arm has been shown to produceconsistent readingsin normal shoulders. Two experimentswere performed to compare the following methods in normal and pathological shoulders: (i) the Isobex(it) Constanl's unsecured spring balance (iii) a new method in which the spring balance is fixed at one end, and the reading taken after 5 seconds of maximum effort.The test position consisted of the subject standing, with the arm in g0~of lateral elevationin the scapular plane, the elbow extended,and the forearm pronated,with the device attachedto the wdst. Experiment 1. Compadson of the Isobex and the fixed spring balance in healthy volunteers (n=50) showed there to be a mean difference of only one or two points between the methods,although the differencewas highly significant (p < 0.001). Experiment2. Comparison b~tween all three methods on pathological shoulders (n=20) showed there to be no significant difference (p < 0.70) between the Isobex and fixed spring balance. The unsecured spring balance gave readings 1.5 points higher than either the fixed spnng balance or the Isobex(p < 0~05). A technique has been developedto take advantageof the availabilityand low cost of the spring balance. With a standard test position and the spring balancefixed at one end, the reading is taken after 5 seconds of maximum effort and the highestof three successive readings is used. Patients who are unable to achieve the test position of 900 shoulder abduction ate assigned a strength score of zero. In conclusion it is proposed that the strength component of the Constant score should be measured using either this clearly defined spring balancemethod or an Isobex. In this way some of the inconsistencies in the reporting of the score may be overcome.