Rebalancing theory of shoulder stability mechanism for the diseases related to the shoulder instability and dysfunction of motion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIN Baoyong , LI Yan ^△ , MA Lin ,  ZHOU Binghua ,  TANG Kanglai

Department of Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 445000, P. R. China;

Corresponding?author：

ZHOU Binghua, Email: yijian510868@hotmail.com; TANG Kanglai, Email: tangkanglai@hotmail.com

Keywords：

Shoulder instability; rebalancing theory; dynamic stability; passive stability

DOI：

10.7507/1002-1892.202110075

Video：

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Objective To introduce a new theory of shoulder stability mechanism, rebalancing theory, and clinical application of this new theory for the shoulder instability and dysfunction of motion. Methods Through extensive review of the literature related to shoulder instability and dysfunction of the motion in recent years, combined with our clinical practice experience, the internal relation between passive stability mechanism and dynamic stability mechanism were summarized. Results Rebalancing theory of shoulder stability mechanism is addressed, namely, when the shoulder stability mechanism is destructive, the stability of the shoulder can be restored by the rebalance between dynamic stability mechanism and passive stability mechanism. When dynamic stability is out of balance, dynamic stability can be restored by rebalancing the different parts of dynamic stability mechanism or to strengthen the passive stability mechanism. When passive stability mechanism is out of balance, passive stability can be restored by rebalancing the soft tissue and bone of the shoulder. Conclusion Rebalancing theory of shoulder stability mechanism could make a understanding the occurrence, development, and prognosis of shoulder instability and dysfunction from a comprehensive and dynamic view and guide the treatment effectively.

Citation： JIN Baoyong, LI Yan, MA Lin, ZHOU Binghua, TANG Kanglai. Rebalancing theory of shoulder stability mechanism for the diseases related to the shoulder instability and dysfunction of motion. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(3): 380-385. doi: 10.7507/1002-1892.202110075 Copy

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3.	鄭小龍, 李焱, 穆米多, 等. 麻醉下手法松解聯合關節鏡下關節囊松解和肩峰下滑囊清理治療原發性凍結肩的中期療效. 中國修復重建外科雜志, 2020, 34(6): 737-743.
4.	馬林, 靳寶雍. 關節鏡下肩關節囊松解合并肩峰下間隙恢復治療創傷性肩關節功能障礙與凍結肩的中期療效比較. 中華創傷骨科雜志, 2021, 23(11): 924-930.
5.	李懷勝, 馬林, 李焱, 等. 自體闊筋膜重建上關節囊治療不可修復巨大肩袖撕裂的近期療效. 中國修復重建外科雜志, 2021, 35(11): 1427-1433.
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1. 王惠芳, 王予彬, 崔芳, 等. 動力與靜力性穩定結構對肩關節穩定作用的生物力學研究//中國康復醫學會運動療法分會第十一屆全國康復學術大會學術會議論文摘要匯編. [出版者不詳], 2011: 285.
2. 李焱, 馬林, 楊明宇, 等. 關節鏡下垂直褥式縫合關節囊治療肩關節復發性前脫位合并關節松弛癥的早期臨床療效. 中國修復重建外科雜志, 2020, 34(11): 1392-1398.
3. 鄭小龍, 李焱, 穆米多, 等. 麻醉下手法松解聯合關節鏡下關節囊松解和肩峰下滑囊清理治療原發性凍結肩的中期療效. 中國修復重建外科雜志, 2020, 34(6): 737-743.
4. 馬林, 靳寶雍. 關節鏡下肩關節囊松解合并肩峰下間隙恢復治療創傷性肩關節功能障礙與凍結肩的中期療效比較. 中華創傷骨科雜志, 2021, 23(11): 924-930.
5. 李懷勝, 馬林, 李焱, 等. 自體闊筋膜重建上關節囊治療不可修復巨大肩袖撕裂的近期療效. 中國修復重建外科雜志, 2021, 35(11): 1427-1433.
6. von Eisenhart-Rothe R, Mayr HO, Hinterwimmer S, et al. Simultaneous 3D assessment of glenohumeral shape, humeral head centering, and scapular positioning in atraumatic shoulder instability: a magnetic resonance-based in vivo analysis. Am J Sports Med, 2010, 38(2): 375-382.
7. Ogston JB, Ludewig PM. Differences in 3-dimensional shoulder kinematics between persons with multidirectional instability and asymptomatic controls. Am J Sports Med, 2007, 35(8): 1361-1370.
8. Mayer SW, Kraszewski AP, Skelton A, et al. What are the effects of capsular plication on translational laxity of the glenohumeral joint: a study in cadaveric shoulders. Clin Orthop Relat Res, 2018, 476(7): 1526-1536.
9. Friedman LGM, Lafosse L, Garrigues GE. Global perspectives on management of shoulder instability: Decision making and treatment. Orthop Clin North Am, 2020, 51(2): 241-258.
10. Ruiz Ibán MA, Díaz Heredia J, García Navlet M, et al. Multidirectional shoulder instability: Treatment. Open Orthop J, 2017, 11: 812-825.
11. Warby SA, Watson L, Ford JJ, et al. Multidirectional instability of the glenohumeral joint: Etiology, classification, assessment, and management. J Hand Ther, 2017, 30(2): 175-181.
12. Neer CS, Foster CR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder: a preliminary report. 1980. J Bone Joint Surg (Am), 2001, 83(10): 1586. doi: 10.2106/00004623-200110000-00021.
13. Inui H, Sugamoto K, Miyamoto T, et al. Three-dimensional relationship of the glenohumeral joint in the elevated position in shoulders with multidirectional instability. J Shoulder Elbow Surg, 2002, 11(5): 510-515.
14. Lubiatowski P, Ogrodowicz P, Wojtaszek M, et al. Measurement of active shoulder proprioception: dedicated system and device. Eur J Orthop Surg Traumatol, 2013, 23(2): 177-183.
15. Hurley ET, Matache BA, Wong I, et al. Anterior shoulder instability Part Ⅱ -Latarjet, Remplissage, and glenoid bone-grafting—An international consensus statement. Arthroscopy, 2021. doi: 10.1016/j.arthro.2021.07.023.
16. Cruz CA, Sy J, Miles R, et al. Surgical treatment of anterior shoulder instability with glenoid bone loss with the Latarjet procedure in active-duty military service members. J Shoulder Elbow Surg, 2021. doi: 10.1016/j.jse.2021.08.015.
17. Park KJ, Jeong HS, Park JK, et al. Evaluation of inferior capsular laxity in patients with atraumatic multidirectional shoulder instability with magnetic resonance arthrography. Korean J Radiol, 2019, 20(6): 931-938.
18. Kim SH, Noh KC, Park JS, et al. Loss of chondrolabral containment of the glenohumeral joint in atraumatic posteroinferior multidirectional instability. J Bone Joint Surg (Am), 2005, 87(1): 92-98.
19. Kikuchi K, Itoi E, Yamamoto N, et al. Scapular inclination and glenohumeral joint stability: a cadaveric study. J Orthop Sci, 2008, 13(1): 72-77.
20. Schaeffeler C, Waldt S, Bauer JS, et al. MR arthrography including abduction and external rotation images in the assessment of atraumatic multidirectional instability of the shoulder. Eur Radiol, 2014, 24(6): 1376-1385.
21. Lee HJ, Kim NR, Moon SG, et al. Multidirectional instability of the shoulder: rotator interval dimension and capsular laxity evaluation using MR arthrography. Skeletal Radiol, 2013, 42(2): 231-238.
22. Jost B, Koch PP, Gerber C. Anatomy and functional aspects of the rotator interval. J Shoulder Elbow Surg, 2000, 9(4): 336-341.
23. Navlet MG, Asenjo-Gismero CV. Multidirectional instability: Natural history and evaluation. Open Orthop J, 2017, 11: 861-874.
24. Best MJ, Tanaka MJ. Multidirectional instability of the shoulder: treatment options and considerations. Sports Med Arthrosc Rev, 2018, 26(3): 113-119.
25. Coyner KJ, Arciero RA. Shoulder instability: anterior, posterior, multidirectional, arthroscopic versus open, bone block procedures. Sports Med Arthrosc Rev, 2018, 26(4): 168-170.
26. Watson L, Warby S, Balster S, et al. The treatment of multidirectional instability of the shoulder with a rehabilitation program: Part 1. Shoulder Elbow, 2016, 8(4): 271-278.
27. Spanhove V, De Wandele I, Kj?r BH, et al. The effect of five isometric exercises on glenohumeral translations in healthy subjects and patients with the hypermobility type of the ehlers-danlos syndrome (heds) or hypermobility spectrum disorder (hsd) with multidirectional shoulder instability: an observational study. Physiotherapy, 2020, 107: 11-18.
28. Watson L, Balster S, Lenssen R, et al. The effects of a conservative rehabilitation program for multidirectional instability of the shoulder. J Shoulder Elbow Surg, 2018, 27(1): 104-111.
29. Warby SA, Pizzari T, Ford JJ, et al. Exercise-based management versus surgery for multidirectional instability of the glenohumeral joint: a systematic review. Br J Sports Med, 2016, 50(18): 1115-1123.
30. Misamore GW, Sallay PI, Didelot W. A longitudinal study of patients with multidirectional instability of the shoulder with seven- to ten-year follow-up. J Shoulder Elbow Surg, 2005, 14(5): 466-470.
31. Garibaldi R, Altomare D, Sconza C, et al. Conservative management vs. surgical repair in degenerative rotator cuff tears: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci, 2021, 25(2): 609-619.
32. Levy O. Deltoid re-education program for massive rotator cuff tears. Operative Techniques in Orthopaedics, 2018, 28(4): 179-190.
33. Agout C, Berhouet J, Spiry C, et al. Functional outcomes after non-operative treatment of irreparable massive rotator cuff tears: Prospective multicenter study in 68 patients. Orthop Traumatol Surg Res, 2018, 104(8S): S189-S192.
34. Kim C, Lee YJ, Kim SJ, et al. Subscapularis re-tears associated with preoperative advanced fatty infiltration and greater subscapularis involvement, leading to inferior functional outcomes and decreased acromiohumeral distance. Knee Surg Sports Traumatol Arthrosc, 2021, 29(8): 2624-2630.
35. Hsu CH, Chiu CH, Weng CJ, et al. Arthroscopic superior capsule reconstruction using autologous fascia lata and biceps tendon augmentation. Arthrosc Tech, 2021, 10(6): e1411-e1415.
36. Luo Z, Lin J, Sun Y, et al. Outcome comparison of latissimus dorsi transfer and pectoralis major transfer for irreparable subscapularis tendon tear: A systematic review. Am J Sports Med, 2021. doi: 10.1177/03635465211018216.
37. Ibrahim M, Narbona P, Denard PJ, et al. A reproducible technique for creation of the subscapularis split during dynamic anterior stabilization for shoulder instability. Arthrosc Tech, 2020, 9(9): e1433-e1438.
38. Longo UG, Rizzello G, Loppini M, et al. Multidirectional instability of the shoulder: A systematic review. Arthroscopy, 2015, 31(12): 2431-2443.
39. Burkhart SS, Pranckun JJ, Hartzler RU. Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery. Arthroscopy, 2020, 36(2): 373-380.
40. Stirling PHC, Crighton EA, Butterworth G, et al. Glenoid track measurement using magnetic resonance imaging arthrography is predictive of recurrent instability following arthroscopic shoulder stabilisation. Eur J Orthop Surg Traumatol, 2021. https://doi.org/10.1007/s00590-021-03100-2.
41. Lim CO, Park KJ, Cho BK, et al. A new screening method for multidirectional shoulder instability on magnetic resonance arthrography: labro-capsular distance. Skeletal Radiol, 2016, 45(7): 921-927.
42. Miller MD, Larsen KM, Luke T, et al. Anterior capsular shift volume reduction: an in vitro comparison of 3 techniques. J Shoulder Elbow Surg, 2003, 12(4): 350-354.
43. Armstrong MD, Smith B, Coady C, et al. Arthroscopic anterior and posterior glenoid bone augmentation with capsular plication for Ehlers-Danlos syndrome with multidirectional instability. Arthrosc Tech, 2018, 7(5): e541-e545.
44. Flanigan DC, Forsythe T, Orwin J, et al. Volume analysis of arthroscopic capsular shift. Arthroscopy, 2006, 22(5): 528-533.
45. Chen D, Goldberg J, Herald J, et al. Effects of surgical management on multidirectional instability of the shoulder: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2016, 24(2): 630-639.
46. Myers JB, Lephart SM. Sensorimotor deficits contributing to glenohumeral instability. Clin Orthop Relat Res, 2002, (400): 98-104.
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48. Itoi E, Arce G, Bain GI, et al. Shoulder stiffness: current concepts and concerns. Arthroscopy, 2016, 32(7): 1402-1414.
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Rebalancing theory of shoulder stability mechanism for the diseases related to the shoulder instability and dysfunction of motion

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