The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing pa...The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends onthe procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.展开更多
复发性肩关节前脱位的手术治疗是运动损伤医学领域中的一个难题,其主要原因在于无法较好地恢复肩关节动力性及骨性约束。目前国内外大多采用关节镜手术治疗,术后总体效果满意,但具体术式的选择仍存在较大争议。临床中需根据关节盂及肱...复发性肩关节前脱位的手术治疗是运动损伤医学领域中的一个难题,其主要原因在于无法较好地恢复肩关节动力性及骨性约束。目前国内外大多采用关节镜手术治疗,术后总体效果满意,但具体术式的选择仍存在较大争议。临床中需根据关节盂及肱骨头骨性缺损的有无及大小,选择不同方案治疗。笔者建议:无关节盂骨性缺损或关节盂骨性缺损<20%,选用Bankart术;关节盂骨性缺损<20%伴Hill–Sachs骨性缺损<40%,选用Bankart术联合Remplissage术或ASA术;关节盂骨性缺损20%~25%,选用“Sling”术;关节盂骨性缺损25%~40%,选用Bristow-Latarjet术;关节盂或Hill–Sachs骨性缺损>40%或Bristow-Latarjet术修复失败,选用骨移植术。此外,若存在盂肱韧带肱骨撕脱(humeral avulsion of glenohumeral ligaments,HAGL)损伤,则选用HAGL损伤修复术。除考虑骨性缺损这一重要因素外,还需结合患者年龄、运动水平及术者技术来综合选择最佳术式。展开更多
Shoulder immobilization can induce adhesion of the joint, capsular contracture or lead to the condition of frozen shoulder. However, little is known about the histological effects of immobilization on the shoulder joi...Shoulder immobilization can induce adhesion of the joint, capsular contracture or lead to the condition of frozen shoulder. However, little is known about the histological effects of immobilization on the shoulder joint. This study aimed to explore the effect of immobility on the subscapular bursa （SSB） and the joint capsular content, including the distribution of typesⅠ and Ⅲcollagen, within an immobilized rat shoulder. Methods Forty-six Sprague-Dawley rats were randomly divided into one control group （n=6） and four immobilization groups （n=10 in each group）, in which the left shoulders were immobilized with plaster for 1,2, 3 and 4 weeks. At the end of each time point, 2 rats from each group were euthanized and shoulders prepared for serial histological observations of the glenohumeral joints, as well as picrosirius red and immunohistochemical observation of type Ⅲcollagen. Histological sections of the remaining rat shoulders were used for the immunohistochemical detection of the capsular content of types Ⅰand Ⅲcollagen. Results The hyperplastic synovium of the anterior capsule obstructed the communication between the SSB and the glenohumeral joint cavity at 2 and 3 weeks. The adhesion of the SSB appeared at 3 and 4 weeks. The quantitative and qualitative results showed that the capsular contents of types Ⅰand Ⅲcollagen progressively increased at 2, 3 and 4 weeks, and that type Ⅲcollagen was distributed extensively within the joint capsule at 2 and 3 weeks. Conclusion Immobilization of the rat shoulder induced synovial hyperplasia of the joint capsule, adhesion of the SSB and an increase of the capsular content of types Ⅰ and Ⅲcollagen.展开更多
Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the t...Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the trapezius muscle between their dominant arm and non-dominant arm, to clarify the correlation between the muscle thickness and muscular strength during internal and external rotation in the shoulder joints used to throw a handball. We measured the thickness of the middle and lower trapezius muscles at an abduction angle of 90° descending by the ultrasonic LOGIQ e and measured internal and external rotational muscular strength of the glenohumeral joint by BIODEX. The players showed significantly greater thickness of the lower trapezius muscle during constriction in the dominant arm than that in the non-dominant arm. Furthermore, a positive correlation was observed between muscle thickness of the lower trapezius muscle and the muscular strength during internal rotation of the glenohumeral joint. It is highly probable that the height of the constricting ability in the lower trapezius muscle in the dominant arm is related to the prevention of throwing injuries.展开更多
文摘The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends onthe procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.
文摘复发性肩关节前脱位的手术治疗是运动损伤医学领域中的一个难题,其主要原因在于无法较好地恢复肩关节动力性及骨性约束。目前国内外大多采用关节镜手术治疗,术后总体效果满意,但具体术式的选择仍存在较大争议。临床中需根据关节盂及肱骨头骨性缺损的有无及大小,选择不同方案治疗。笔者建议:无关节盂骨性缺损或关节盂骨性缺损<20%,选用Bankart术;关节盂骨性缺损<20%伴Hill–Sachs骨性缺损<40%,选用Bankart术联合Remplissage术或ASA术;关节盂骨性缺损20%~25%,选用“Sling”术;关节盂骨性缺损25%~40%,选用Bristow-Latarjet术;关节盂或Hill–Sachs骨性缺损>40%或Bristow-Latarjet术修复失败,选用骨移植术。此外,若存在盂肱韧带肱骨撕脱(humeral avulsion of glenohumeral ligaments,HAGL)损伤,则选用HAGL损伤修复术。除考虑骨性缺损这一重要因素外,还需结合患者年龄、运动水平及术者技术来综合选择最佳术式。
文摘Shoulder immobilization can induce adhesion of the joint, capsular contracture or lead to the condition of frozen shoulder. However, little is known about the histological effects of immobilization on the shoulder joint. This study aimed to explore the effect of immobility on the subscapular bursa （SSB） and the joint capsular content, including the distribution of typesⅠ and Ⅲcollagen, within an immobilized rat shoulder. Methods Forty-six Sprague-Dawley rats were randomly divided into one control group （n=6） and four immobilization groups （n=10 in each group）, in which the left shoulders were immobilized with plaster for 1,2, 3 and 4 weeks. At the end of each time point, 2 rats from each group were euthanized and shoulders prepared for serial histological observations of the glenohumeral joints, as well as picrosirius red and immunohistochemical observation of type Ⅲcollagen. Histological sections of the remaining rat shoulders were used for the immunohistochemical detection of the capsular content of types Ⅰand Ⅲcollagen. Results The hyperplastic synovium of the anterior capsule obstructed the communication between the SSB and the glenohumeral joint cavity at 2 and 3 weeks. The adhesion of the SSB appeared at 3 and 4 weeks. The quantitative and qualitative results showed that the capsular contents of types Ⅰand Ⅲcollagen progressively increased at 2, 3 and 4 weeks, and that type Ⅲcollagen was distributed extensively within the joint capsule at 2 and 3 weeks. Conclusion Immobilization of the rat shoulder induced synovial hyperplasia of the joint capsule, adhesion of the SSB and an increase of the capsular content of types Ⅰ and Ⅲcollagen.
文摘Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the trapezius muscle between their dominant arm and non-dominant arm, to clarify the correlation between the muscle thickness and muscular strength during internal and external rotation in the shoulder joints used to throw a handball. We measured the thickness of the middle and lower trapezius muscles at an abduction angle of 90° descending by the ultrasonic LOGIQ e and measured internal and external rotational muscular strength of the glenohumeral joint by BIODEX. The players showed significantly greater thickness of the lower trapezius muscle during constriction in the dominant arm than that in the non-dominant arm. Furthermore, a positive correlation was observed between muscle thickness of the lower trapezius muscle and the muscular strength during internal rotation of the glenohumeral joint. It is highly probable that the height of the constricting ability in the lower trapezius muscle in the dominant arm is related to the prevention of throwing injuries.
