Comparison of Open and Arthroscopic Inferior Capsular Shifts for Multidirectional Instability of the Shoulder / 대한정형외과학회잡지

PURPOSE: To compare outcomes of open and arthroscopic inferior capsular shifts in multidirectional instability of the shoulder and to evaluate the factors affecting the outcomes. MATERIALS AND METHODS: We measured outcomes in 81 patients (84 shoulders) receiving open or arthroscopic inferior capsular shifts because of multidirectional instability of the shoulder from February, 1994, to April, 2006. There were 76 males and 8 females. Their mean age was 22 years at the time of surgery. The visual analogue scale (VAS) for pain, shoulder range of motion (ROM), and Rowe scores were evaluated preoperatively and postoperatively. RESULTS: In open surgery, the VAS for pain was 5.3 preoperatively and 2.1 postoperatively. VAS for instability changed from 4.6 to 1.7, and the average postoperative Rowe score was 83.7. Forward flexion was 173.7degrees preoperatively and 166.1degrees postoperatively. External rotation on the side changed from 75.5degrees to 62.7degrees. In arthroscopic surgery, the VAS for pain was 4.6 preoperatively and 1.2 postoperatively. VAS for instability changed from 5.9 to 1.2, and the average postoperative Rowe score was 87.4. Forward flexion was 169.5degrees preoperatively and 171.2degrees postoperatively. External rotation changed from 70.8degrees to 61.4degrees. CONCLUSION: Arthroscopic surgery was more effective in decreasing pain and conserving forward flexion of the shoulder than open surgery. Postoperative instability appeared to be related with generalized or bilateral shoulder joint laxity. Pain during motion after the operation was more significant during a voluntary subluxator. Low clinical scores were related with the operation on the dominant side or postoperative instability.

Medial Anterior-inferior Capsular Shift in Multidirectional Shoulder Instability

Purpose: The purpose of this study was to prove the effectiveness of the open medial (glenoid-based) anteriorinferior capsular shift in patients with multidirectional shoulder instability. Materials and Methods: We reviewed 19 patients treated by medial anterior-inferior capsular shift for multidirectional shoulder instability from March, 1998 to December, 2003. 15 patients of them have experienced recurrent dislocation. 8 patients(42%) showed bilateral laxity and 11 patients(58%) generalized ligamentous laxity, and 2 patients(10.5%) voluntary subluxation. An average follow-up was 24 months (range : 9~32 months). Results: Pain improved in 18 patients of all. There was an average loss of 10 degree of external rotation, but no limitation of activity of daily living. There was no redislocation and subluxation, but two patients had some apprehension in sports activity. With Rowe score, the result was excellent or good in all patients. There were hematoma and local skin problem in 1 patient, but all had healed up. Conclusion: Medial anterior-inferior capsular shift in multidirectional shoulder instability provided satisfactory results in pain relief, patient's satisfactions and stability of glenohumeral joint. Though some of them have anterior gleniod deformities and large Hill-Sachs lesions, we could get good stabilities.

Neer's Inferior Capsular shift for Involuntary Inferior and Multidirectional Instability of the Shoulder / 대한정형외과학회잡지

Multidirectional shoulder instability is often difficult to diagnose and treat and can be cause of significant disability. Nonoperative rehabilitations and life tyle modifications are the primary treatments. Hiwever, the inferior capsular shift procedure, performed either from an anterior or posterior approach, as described by Neer and Foster, is recommended for symptomatic multidirectional instability that is unresponsive to nonoperative therapy. Twenty-seven shoulders in twenty-seven patients with inferior and multidirectional instability were managed with Neer s inferior capsular shift, through anterior or posterior approach depending on the direction in which the shoulder is most unstable. All of the patients were followed up for an average of 3 years (range one to seven years). The postoperative range of motion of the shoulders was well maintained except 1 patient. Three patients had recurrence of symptomatic and disabling multidirectional instability, but twenty-four (89%) of the shoulders continued to function well with no instability, no pain, no recurrence and no remarkable limitation of motion.