Winner of the 2006 J.A. Nutter Award

Best Paper Overall Presented at the 2006 CORA Annual Meeting

Patients with Traumatic Anterior Shoulder Instability Have Restricted External Rotation Range of Motion

Matthew D. Di Silvestro, M.D., MSc
Calgary, AB

Ian K.Y. Lo, M.D., FRCSC,
Nicholas Mohtadi, M.D., MSc, FRCSC
Kristie Pletsch BKin
Richard S. Boorman, M.D., MSc, FRCSC

The standard of care in the surgical treatment of recurrent traumatic anterior shoulder dislocations is the Bankart repair. Supplementation with a capsular plication has been suggested to address a perceived laxity. It is unclear if capsular laxity is consistently present. The glenohumeral (GH) ligaments not only define translational laxity, but they also restrict GH range of motion (ROM). GH ROM in this population has never been reported in a consistent or controlled manner. The purpose of this study was to measure the external rotation ROM of shoulders in patients under general anaesthetic.

Bilateral GH joint external rotation ROM of 15 patients was measured under anaesthetic by a blinded observer, using a standardized torque and goniometry. All patients had a Bankart lesion. The mean loss of external rotation in the unstable shoulder with the arm abducted 90° was 14° (SD 9), this was statistically significant (p< 0.01). There was a significant (p < 0.01) average loss of 11° (SD 9) with the arm externally rotated at the side.

These findings indicate that patients with a Bankart lesion are rotationally stiff suggesting that the GH ligaments may be contracted. This may call into question the use of routine capsular tightening.