Laxity of the normal glenohumeral joint: A quantitative in vivo assessment.
Laxity of the normal glenohumeral joint: A quantitative in vivo assessment.
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DOI：
10.1016/s1058-2746(09)80123-7
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发表时间：
1992-03-01
影响因子：
3
通讯作者：
Matsen, F A 3rd
中科院分区：
文献类型：
--
作者：
Harryman, D T 2nd;Sidles, J A;Matsen, F A 3rd
外科医生了解盂肱关节的正常松弛度至关重要（1）以帮助他们诊断临床不稳定的情况和（2）帮助确定治疗过度僵硬肩部的治疗终点。在临床实践中，这种关节松弛是通过标准手动测试来判断的。我们报告了一个定量研究的临床在体内松弛的正常肩膀的8名男性志愿者。据我们所知，这是第一次在体内量化标准手动临床试验中显示的松弛。使用电磁空间跟踪器确定肱骨和肩胛骨的相对运动。将该装置固定在8名25至45岁的正常男性志愿者的肱骨和肩胛骨上。一名经验丰富的肩关节外科医生进行了盂肱松弛的标准手动临床试验，同时测量了肱骨头相对于关节盂的位移。空间跟踪器数据表明，对于每种不同的测试，盂肱关节和肩胛胸关节的位置对于给定的受试者和受试者之间是可重现的。在关节未处于其活动范围极限的手动松弛试验期间测量了大量盂肱平移：抽屉试验，前7.8 ± 4.0 mm和后7.9 ± 5.6 mm;沟试验，下10.6 ± 3.8 mm;推拉试验，后9.0 ± 6.3 mm。在盂肱韧带处于张力下的支点测试期间，测得最小平移为0.3 ± 2.5 mm。观察到的平移在每例受试者的肩部均可重现。另一方面，受试者之间存在明显的差异。尽管手动松弛测试是肩关节临床评价的标准部分，但我们发现正常盂肱关节显示大量平移，这表明临床手动松弛测试的平移本身并不足以指示手术稳定。
It is critical that surgeons comprehend the normal laxity of the glenohumeral joint (1) to assist them in diagnosing conditions of clinical instability and (2) to help define a therapeutic end point for the management of shoulders with excessive stiffness. In clinical practice this joint laxity is judged by standard manual tests. We report a quantitative study of the clinical in vivo laxity of the normal shoulders of eight male volunteers. To our knowledge this is the first time that the laxity revealed on standard manual clinical tests has been quantified in vivo. The relative motions of the humerus and scapula were determined with an electromagnetic spatial tracker. This device was pinned percutaneously to the humerus and scapula of each of eight normal male volunteers of ages 25 to 45 years. An experienced shoulder surgeon carried out standard manual clinical tests of glenohumeral laxity while the resulting displacements of the humeral head relative to the glenoid were measured. Spatial tracker data indicated that for each of the different tests, the positions of the glenohumeral and scapulothoracic joints were reproducible for a given subject and among subjects. Substantial glenohumeral translations were measured during those manual laxity tests in which the joint was not at the limit of its range of motion: the drawer test, 7.8 ± 4.0 mm anterior and 7.9 ± 5.6 mm posterior; the sulcus test, 10.6 ± 3.8 mm inferior; and the push-pull test, 9.0 ± 6.3 mm posterior. A minimal translation of 0.3 ± 2.5 mm was measured during the fulcrum test in which the glenohumeral ligaments were under tension. The observed translations were reproducible in each subject's shoulder. On the other hand, there was marked variability among subjects. Even though manual laxity tests are a standard part of the clinical evaluation of the shoulder, our finding that normal glenohumeral joints show substantial translations indicates that translation on clinical manual laxity testing is not in and of itself a sufficient indication for surgical stabilization.