The presented study investigated the difference of positioning sense of the shoulder before and after surgery (capsular shift or Arthroscopic Bankart repair) for shoulder instability. For this purpose a sample of patients with recurrent dislocations of the shoulder that underwent surgery and patients with instability before surgery volunteered to participate in a set of experiments. Their results were compared to the results obtained from a matching sample of healthy subjects. All subjects completed all movement’s conditions that included the performance of hand movements towards memorized visual target in A-horizontal plane condition and B-Three dimensional movement condition. The mixed design (3 groups x 3 2D levels x 3 3D levels) with repeated measures allowed the comparison among the groups in terms of final accuracy measures (Absolute and Variable Errors) and variability around mean tangential velocities and end-point paths. The results showed that operative shoulder stabilization improves the ability to accurately position the arm on a target at the end of the movement and in addition the kinematic profile, which is disturbed before stabilization, improves as well. These measures may be used as an objective tool to asses the success of conservative as well as operative treatment for shoulder instability.
Four threaded pins were inserted retrograde and trimmed under the skin. Two antegrade pins were left out of the skin and banded to prevent migration to the axilla. Patients were immobilized in shoulder immobilizer for 6 weeks when pins were removed in outpatient clinic. Control X-ray was taken at 2, 4, 6, 12 weeks. If fracture was noted to be unstable, X-ray was taken every week up to 4 weeks. In case of any deterioration after 12 weeks X-ray was taken to detect signs of AVN. Rehabilitation program commenced after clinical union with passive and assisted active for 4 weeks followed by active mobilization. Follow-up ranged from 10–34 months (mean: 22) and range of motion with X-ray description were documented.
Mean range of motion for all groups was: Elevation – 144 (60–180), External Rotation – 54.6 (−10–80), Internal Rotation – L1 (Throchanter – T8). Statistical analysis for fracture groups showed best results for impacted valgus and greater tuberosity fracture after open reduction and worst results were noted for 4 parts fractures and fracture dislocation. Although the study was not randomized there was no significant difference between the group of closed pinning and open surgery.
Indication for surgery were: 1. Multidirectional instability with less than 3 frank dislocation. 2. Symptomatic subluxators with positive apprehension test after failed non-operative rehabilitation program. 3. High demands first dislocators sportsman with failure of non operative rehabilitation program. The arthroscopy was performed in sitting position with posterior and anterior portals as a day surgery or overnight hospitalization. Anterior portal was used for VAPR probe first and portals were switched if needed. All patients were immobilized in shoulder immobilizer for 6 weeks. Rehabilitation program was planed on individual basis and patients were instructed not to return to full contact sport or activities at least 6 months post operatively. Patients were checked at 2 and 6 weeks before commence rehabilitation and than at 3, 6, 24 months. Mean follow up was 17.6 months (range 6–27 m.).
The second patient, a 16 years female elite judoka, commenced judo matches after 3 months and was asymptomatic with 24 months follow-up time.