Int J Sports Med 2006; 27(8): 648-652
DOI: 10.1055/s-2005-865815
Orthopedics & Biomechanics

© Georg Thieme Verlag KG Stuttgart · New York

Joint Position Awareness and Sports Activity After Capsulolabral Reconstruction in the Overhead Athlete

R. Fremerey1 , U. Bosch2 , P. Lobenhoffer3 , B. Wippermann1
  • 1Trauma Department, Klinikum Hildesheim GmbH, Hildesheim, Germany
  • 2International Neuroscience Institute, Zentrum für Orthopädische Chirurgie, Hannover, Germany
  • 3Unfallchirurgische Klinik, Henriettenstiftung, Hannover, Germany
Further Information

Publication History

Accepted after revision: June 4, 2005

Publication Date:
30 August 2005 (online)

Abstract

A total of 24 overhead athletes with posttraumatic, chronic anterior shoulder instability underwent surgery. Twenty-two patients were examined after an average follow-up of 2.8 ± 0.7 years. On average, a Constant-Score and Constant-Murley-Score of 93.7 ± 5.3 points and an ASES-Score of 95.0 ± 5.1 points were achieved. The redislocation rate was 9 %. The study demonstrated, that despite the good clinical results, only 12 out of 22 (55 %) of patients were able to return to their previous sports activity level. This relevant problem is in agreement with other similar studies [[4]], so it was further addressed by determination of joint position awareness (JPA) and electromyographic muscle activity. Postoperatively, a persisting deficit of JPA, as well as an altered EMG pattern, was found with a significant reduction in activity of the deltoideus muscle on the operated side. The analysis of the data of each patient showed that there was a significant relation between the restitution of JPA and ability to return to the previous sports activity level. In contrast, the relation between EMG pattern and full recovery to completely unrestricted shoulder function was not significant. The anterior capsulolabral reconstruction enables a reliable restoration of shoulder stability and a low rate of complications. The problem that a relatively high percentage of overhead athletes can not return to their previous performance level is based on an impaired joint position awareness.

References

  • 1 Aydin T, Yildiz Y, Yanmis C, Kalyon T. Shoulder proprioception: a comparison between the shoulder joint in healthy and surgically repaired shoulders.  Arch Orthop Trauma Surg. 2001;  121 422-425
  • 2 Barret D S. Proprioception and function after anterior cruciate reconstruction.  J Bone Joint Surg. 1991;  73 B 833-838
  • 3 Bartl C, Lichtenberg S, Habermeyer P. Arthroskopische Verfahren in der Behandlung der Schulterluxation.  Zbl Chir. 2002;  127 180-186
  • 4 Bigliani L U, Kurzweil P R, Schwartzbach C C, Wolfe I N, Flatow E L. Inferior capsular shift procedure for anterior-inferior shoulder instability in athletes.  Am J Sports Med. 1994;  22 578-584
  • 5 Constant C R, Murley A H. A clinical method of functional assessment of the shoulder.  Clin Orthop. 1987;  214 160-164
  • 6 Fabbriciani C, Milano G, Demontis A, Fadda S, Ziranu F, Mulas P D. Arthroscopic versus open treatment of Bankart lesion of the shoulder: a prospective randomized study.  Arthroscopy. 2004;  20 456-462
  • 7 Gill T J, Zarins B. Open repairs for the treatment of anterior shoulder instability.  Am J Sports Med. 2003;  31 142-153
  • 8 Gohlke F, Müller T, Sökeland T. Distribution and morphology of mechanoreceptors in the rotator cuff.  J Shoulder Elbow Surg. 1996;  5 (Suppl) 72
  • 9 Goodwin G, McCloskey D I, Matthews P BC. The contribution of muscle afferents to kineasthesia shown by vibration induced illusions of movement and by the effects of paralyzing joint afferents.  Brain. 1972;  95 705-748
  • 10 Habermeyer P, Magoosch P, Lichtenberg S. Shoulder instability. Classification and treatment.  Orthopäde. 2004;  33 847-874
  • 11 Hovelius L, Augustini B G, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study.  J Bone Joint Surg. 1996;  78 A 1677-1684
  • 12 Jobe F W, Giangarra C E, Kvitne R S, Glousman R E. Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports.  Am J Sports Med. 1991;  19 428-434
  • 13 Jolles B M, Pelet S, Farron A. Traumatic recurrent anterior dislocation of the shoulder: two to four-year follow-up of an anatomic open procedure.  J Shoulder Elbow Surg. 2004;  13 30-34
  • 14 Lundberg A, Malmgren K, Schomburg E D. Role of joint afferents in motor control exemplified by effects on reflex pathways from Ib afferents.  J Physiol. 1978;  284 327-343
  • 15 Magnusson L, Kartus J, Ejerhed L, Hultenheim I, Sernert N, Karlsson J. Revisiting the open Bankart experience: a four- to nine-year follow-up.  Am J Sports Med. 2002;  30 778-782
  • 16 Nebelung W, Jaeger A, Wiedemann E. Rationales of arthroscopic shoulder stabilization.  Arch Orthop Trauma Surg. 2002;  122 472-487
  • 17 O'Brian S J, Neves M C, Arnoczky S P. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder.  Am J Sports Med. 1990;  18 449-456
  • 18 Pötzl W, Thorwesten L, Götze C, Garmann S, Steinbeck J. Proprioception of the shoulder joint after surgical repair for instability.  Am J Sports Med. 2004;  32 425-430
  • 19 Richards R R, An K N, Bigliani L U. A standardized method for the assessment of shoulder function.  J Shoulder Elbow Surg. 1994;  6 347-352
  • 20 Sperber A, Hamberg P, Karlsson J, Sward L, Wredmark T. Comparison of an arthroscopic and an open procedure for posttraumatic instability of the shoulder. A prospective, randomized multicenter study.  J Shoulder Elbow Surg. 2001;  10 105-108

R. W. Fremerey

Trauma Department
Klinikum Hildesheim GmbH

Weinberg 1

31141 Hildesheim

Germany

Phone: + 49(0)5121894556

Fax: + 49 (0) 51 21 89 45 97

Email: ReinhardFremerey@t-online.de