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Glenohumeral Joint Instability: Basic Science and Potential Treatment Options

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360° Around Shoulder Instability

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Abstract

The glenohumeral joint facilitates the large range of upper limb motion that is essential for undertaking most activities of daily living. The shallow concavity of the bony glenoid and fibrocartilaginous labrum, together with the humeral head, comprises an inherently unstable joint that is dependent on the integrity and morphology of the articular surfaces, as well as the simultaneous activity of the rotator cuff for glenohumeral joint compression and stability. The scapulothoracic joint provides an additional stabilization by increasing upper limb range of motion and providing a moving “seat” for the humeral head, while the bony glenoid concavity, joint capsule and ligaments generate passive support to the glenohumeral joint, particularly in the mid-range and end range of joint motion. Disease or trauma to any of these bony or soft-tissue stabilizers may result in glenohumeral instability.

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References

  1. Warner JJ, et al. Articular contact patterns of the normal glenohumeral joint. J Shoulder Elbow Surg. 1998;7(4):381–8.

    Article  CAS  PubMed  Google Scholar 

  2. Zumstein V, et al. The glenohumeral joint—a mismatching system? A morphological analysis of the cartilaginous and osseous curvature of the humeral head and the glenoid cavity. J Orthop Surg Res. 2014;9:34.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Doyle AJ, Burks RT. Comparison of humeral head retroversion with the humeral axis/biceps groove relationship: a study in live subjects and cadavers. J Shoulder Elbow Surg. 1998;7(5):453–7.

    Article  CAS  PubMed  Google Scholar 

  4. Zumstein V, Kraljevic M, Muller-Gerbl M. Glenohumeral relationships: subchondral mineralization patterns, thickness of cartilage, and radii of curvature. J Orthop Res. 2013;31(11):1704–7.

    Article  CAS  PubMed  Google Scholar 

  5. Ernstbrunner L, et al. Biomechanical analysis of the effect of congruence, depth and radius on the stability ratio of a simplistic ‘ball-and-socket’ joint model. Bone Joint Res. 2016;5(10):453–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Moroder P, et al. Anterior shoulder instability is associated with an underlying deficiency of the bony glenoid concavity. Arthroscopy. 2015;31(7):1223–31.

    Article  PubMed  Google Scholar 

  7. Wu W, et al. Subject-specific musculoskeletal modeling in the evaluation of shoulder muscle and joint function. J Biomech. 2016;49(15):3626–34.

    Article  PubMed  Google Scholar 

  8. Ackland DC, Pandy MG. Lines of action and stabilizing potential of the shoulder musculature. J Anat. 2009;215:184–97.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lucas DB. Biomechanics of the shoulder joint. Arch Surg. 1973;107(3):425–32.

    Article  CAS  PubMed  Google Scholar 

  10. Wattanaprakornkul D, et al. The rotator cuff muscles have a direction specific recruitment pattern during shoulder flexion and extension exercises. J Sci Med Sport. 2011;14(5):376–82.

    Article  PubMed  Google Scholar 

  11. Griffith JF, et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. AJR Am J Roentgenol. 2008;190(5):1247–54.

    Article  PubMed  Google Scholar 

  12. Yamamoto N, et al. Does the “bumper” created during Bankart repair contribute to shoulder stability? J Shoulder Elbow Surg. 2013;22(6):828–34.

    Article  PubMed  Google Scholar 

  13. Karduna AR, et al. Kinematics of the glenohumeral joint: influences of muscle forces, ligamentous constraints, and articular geometry. J Orthop Res. 1996;14(6):986–93.

    Article  CAS  PubMed  Google Scholar 

  14. Lephart SM, et al. Proprioception of the shoulder joint in healthy, unstable, and surgically repaired shoulders. J Shoulder Elbow Surg. 1994;3(6):371–80.

    Article  CAS  PubMed  Google Scholar 

  15. Lugo R, Kung P, Ma CB. Shoulder biomechanics. Eur J Radiol. 2008;68(1):16–24.

    Article  PubMed  Google Scholar 

  16. Warner JJ, McMahon PJ. The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Joint Surg Am. 1995;77(3):366–72.

    Article  CAS  PubMed  Google Scholar 

  17. Abboud JA, Soslowsky LJ. Interplay of the static and dynamic restraints in glenohumeral instability. Clin Orthop Relat Res. 2002;400:48–57.

    Article  Google Scholar 

  18. Pagnani MJ, et al. Role of the long head of the biceps brachii in glenohumeral stability: a biomechanical study in cadavera. J Shoulder Elbow Surg. 1996;5(4):255–62.

    Article  CAS  PubMed  Google Scholar 

  19. Halder AM, Itoi E, An KN. Anatomy and biomechanics of the shoulder. Orthop Clin North Am. 2000;31(2):159–76.

    Article  CAS  PubMed  Google Scholar 

  20. Gottschalk MB, et al. Posterior shoulder instability: does glenoid retroversion predict recurrence and contralateral instability? Arthroscopy. 2015;31(3):488–93.

    Article  PubMed  Google Scholar 

  21. Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop Relat Res. 2002;400:65–76.

    Article  Google Scholar 

  22. Merolla G, et al. Multidirectional instability of the shoulder: biomechanics, clinical presentation, and treatment strategies. Eur J Orthop Surg Traumatol. 2015;25(6):975–85.

    Article  PubMed  Google Scholar 

  23. Dodson CC, Cordasco FA. Anterior glenohumeral joint dislocations. Orthop Clin North Am. 2008;39(4):507–18, vii

    Article  PubMed  Google Scholar 

  24. Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16(7):677–94.

    Article  CAS  PubMed  Google Scholar 

  25. Zimmermann SM, et al. Long-term restoration of anterior shoulder stability: a retrospective analysis of arthroscopic bankart repair versus open latarjet procedure. J Bone Joint Surg Am. 2016;98(23):1954–61.

    Article  PubMed  Google Scholar 

  26. Allain J, Goutallier D, Glorion C. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am. 1998;80(6):841–52.

    Article  CAS  PubMed  Google Scholar 

  27. Ernstbrunner L, Gerber C. Editorial commentary: computed tomography-based analysis of the arthroscopic latarjet procedure suggests graft positioning is more variable than expected. Arthroscopy. 2018;34(7):2041–4.

    Article  PubMed  Google Scholar 

  28. Ernstbrunner L, et al. Arthroscopic versus open iliac crest bone grafting in recurrent anterior shoulder instability with glenoid bone loss: a computed tomography-based quantitative assessment. Arthroscopy. 2018;34(2):352–9.

    Article  PubMed  Google Scholar 

  29. Hovelius L, Saeboe M. Neer Award 2008: arthropathy after primary anterior shoulder dislocation—223 shoulders prospectively followed up for twenty-five years. J Shoulder Elbow Surg. 2009;18(3):339–47.

    Article  PubMed  Google Scholar 

  30. Ladermann A, et al. Risk factors for dislocation arthropathy after Latarjet procedure: a long-term study. Int Orthop. 2013;37(6):1093–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ghodadra N, et al. Normalization of glenohumeral articular contact pressures after Latarjet or iliac crest bone-grafting. J Bone Joint Surg Am. 2010;92(6):1478–89.

    Article  PubMed  Google Scholar 

  32. Montgomery WH Jr, et al. Anteroinferior bone-grafting can restore stability in osseous glenoid defects. J Bone Joint Surg Am. 2005;87(9):1972–7.

    Article  PubMed  Google Scholar 

  33. Bushnell BD, et al. Bony instability of the shoulder. Arthroscopy. 2008;24(9):1061–73.

    Article  PubMed  Google Scholar 

  34. Shaha JS, et al. Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med. 2015;43(7):1719–25.

    Article  PubMed  Google Scholar 

  35. Butt U, et al. Complications associated with open coracoid transfer procedures for shoulder instability. J Shoulder Elbow Surg. 2012;21(8):1110–9.

    Article  PubMed  Google Scholar 

  36. Di Giacomo G, et al. Does the presence of glenoid bone loss influence coracoid bone graft osteolysis after the Latarjet procedure? A computed tomography scan study in 2 groups of patients with and without glenoid bone loss. J Shoulder Elbow Surg. 2014;23(4):514–8.

    Article  PubMed  Google Scholar 

  37. Moroder P, et al. The Arthroscopic Bankart-Plus Procedure for treatment of anterior shoulder instability with small to intermediate glenoid defects. Arthrosc Tech. 2018;7(4):e379–84.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Yamamoto N, et al. Stabilizing mechanism in bone-grafting of a large glenoid defect. J Bone Joint Surg Am. 2010;92(11):2059–66.

    Article  PubMed  Google Scholar 

  39. Kim JY, et al. Morphological characteristics of the repaired labrum according to glenoid location and its clinical relevance after arthroscopic bankart repair: postoperative evaluation with computed tomography arthrography. Am J Sports Med. 2014;42(6):1304–14.

    Article  PubMed  Google Scholar 

  40. Kon E, et al. Platelet-rich plasma (PRP) to treat sports injuries: evidence to support its use. Knee Surg Sports Traumatol Arthrosc. 2011;19(4):516–27.

    Article  PubMed  Google Scholar 

  41. Dragoo JL, et al. Comparison of the acute inflammatory response of two commercial platelet-rich plasma systems in healthy rabbit tendons. Am J Sports Med. 2012;40:1274–81.

    Article  PubMed  Google Scholar 

  42. Marcazzan S, et al. Efficacy of platelet concentrates in bone healing: a systematic review on animal studies—part B: large-size animal models. Platelets. 2018;29(4):338–46.

    Article  CAS  PubMed  Google Scholar 

  43. Guzel Y, et al. The biomechanical and histological effects of platelet-rich plasma on fracture healing. Knee Surg Sports Traumatol Arthrosc. 2015;23:1378–83.

    Article  PubMed  Google Scholar 

  44. Roffi A, et al. Does PRP enhance bone integration with grafts, graft substitutes, or implants? A systematic review. BMC Musculoskelet Disord. 2013;14:330.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Le ADK, et al. Current clinical recommendations for use of platelet-rich plasma. Curr Rev Musculoskelet Med. 2018;11(4):624–34.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Holtby R, et al. Impact of platelet-rich plasma on arthroscopic repair of small- to medium-sized rotator cuff tears: a randomized controlled trial. Orthop J Sports Med. 2016;4:232596711666559.

    Article  Google Scholar 

  47. Cai Y, et al. Efficacy of platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis. J Shoulder Elbow Surg. 2015;24:1852–9.

    Article  PubMed  Google Scholar 

  48. Gianakos AL, et al. Clinical application of concentrated bone marrow aspirate in orthopaedics: a systematic review. World J Orthop. 2017;8(6):491–506.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Pak J, et al. Current use of autologous adipose tissue-derived stromal vascular fraction cells for orthopedic applications. J Biomed Sci. 2017;24(1):9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland

    Lukas Ernstbrunner

  2. Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia

    David Ackland

  3. IRCCS Istituto Ortopedico Galeazzi, Milano, Italy

    Laura de Girolamo

Authors
  1. Lukas Ernstbrunner
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  2. David Ackland
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  3. Laura de Girolamo
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Corresponding author

Correspondence to Lukas Ernstbrunner .

Editor information

Editors and Affiliations

  1. Shoulder and Upper Limb Department, St. Luke's Hospital, Bielsko-Biała, Poland

    Roman Brzóska

  2. Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy

    Giuseppe Milano

  3. Istituto Ortopedico Gaetano Pini, Prima Clinica Ortopedica, Milan, Italy

    Pietro S. Randelli

  4. Department of Traumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Ladislav Kovačič

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Ernstbrunner, L., Ackland, D., de Girolamo, L. (2020). Glenohumeral Joint Instability: Basic Science and Potential Treatment Options. In: Brzóska, R., Milano, G., Randelli, P., Kovačič, L. (eds) 360° Around Shoulder Instability. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61074-9_43

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  • DOI: https://doi.org/10.1007/978-3-662-61074-9_43

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  • Print ISBN: 978-3-662-61073-2

  • Online ISBN: 978-3-662-61074-9

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