THE CAPSULAR MECHANISM IN RECURRENT DISLOCATION OF THE SHOULDER

¹ Orthopaedic Department, Henry Ford Hospital, Detroit

Functional lengthening of the capsule and loss of the anterior restraining effect of the capsular mechanism appear to be the primary causes of recurrent dislocation of the shoulder. Separation of the medial attachment of the capsule from the anterior glenoid margin is the most consistent cause of capsular lengthening. Congenital lengthening is probably present more often than is suspected, but interpretation is made difficult by the finding of secondary damage at the glenoid margin. The function of the normal capsule, which allows this usually lax structure to become an effective barrier against anterior projection of the humeral head in external rotation, is referred to as the capsular mechanism.

Repair should aim at re-establishment of the capsular mechanism. If there is no medial capsular separation, a modification of Magnuson's procedure is adequate. If there is separation of the capsule, but capsular tissue remains at the glenoid margin, sutures into the soft tissue only need he used. If there is complete loss of soft. tissue from the anterior glenoid margin, the capsule should be anchored directly to the bone. Reattachment of the glenoidal labrum is not necessary, and the presence or absence of this structure does not alter the operative procedure or the success of the repair. Limitation of shoulder motion to prevent dislocation is usually not necessary.

Bankart must be credited for focusing attention on the medial attachment of the capsule to the glenoid margin, and for gradual recognition of the correct operative procedure for the majority of cases of dislocation of the shoulder.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				C. B. Dewing, F. McCormick, S. J. Bell, D. J. Solomon, M. Stanley, T. B. Rooney, and M. T. Provencher An Analysis of Capsular Area in Patients With Anterior, Posterior, and Multidirectional Shoulder Instability Am. J. Sports Med., March 1, 2008; 36(3): 515 - 522. [Abstract] [Full Text] [PDF]

				G. Porcellini, P. Paladini, F. Campi, and M. Paganelli Long-term Outcome of Acute Versus Chronic Bony Bankart Lesions Managed Arthroscopically Am. J. Sports Med., December 1, 2007; 35(12): 2067 - 2072. [Abstract] [Full Text] [PDF]

				H. Saito, E. Itoi, H. Sugaya, H. Minagawa, N. Yamamoto, and Y. Tuoheti Location of the Glenoid Defect in Shoulders With Recurrent Anterior Dislocation Am. J. Sports Med., June 1, 2005; 33(6): 889 - 893. [Abstract] [Full Text] [PDF]

				P. J. Millett, P. Clavert, and J. J.P. Warner Open Operative Treatment for Anterior Shoulder Instability: When and Why? J. Bone Joint Surg. Am., February 1, 2005; 87(2): 419 - 432. [Abstract] [Full Text] [PDF]

				C. S. Ahmad, M. Q. Freehill, T. A. Blaine, W. N. Levine, and L. U. Bigliani Anteromedial Capsular Redundancy and Labral Deficiency in Shoulder Instability Am. J. Sports Med., March 1, 2003; 31(2): 247 - 252. [Abstract] [Full Text] [PDF]

				W. N. Levine and E. L. Flatow The Pathophysiology of Shoulder Instability Am. J. Sports Med., November 1, 2000; 28(6): 910 - 917. [Abstract] [Full Text] [PDF]

				W. N. Levine, J. S. Arroyo, R. G. Pollock, E. L. Flatow, and L. U. Bigliani Open Revision Stabilization Surgery for Recurrent Anterior Glenohumeral Instability Am. J. Sports Med., March 1, 2000; 28(2): 156 - 160. [Abstract] [Full Text] [PDF]

				K. P. Black, D. J. Schneider, J. R. Yu, and C. R. Jacobs Biomechanics of the Bankart Repair: The Relationship Between Glenohumeral Translation and Labral Fixation Site Am. J. Sports Med., May 1, 1999; 27(3): 339 - 344. [Abstract] [Full Text] [PDF]

				M. T. Selecky, C. T. Vangsness Jr, W.-L. Liao, V. Saadat, and T. P. Hedman The Effects of Laser-Induced Collagen Shortening on the Biomechanical Properties of the Inferior Glenohumeral Ligament Complex Am. J. Sports Med., March 1, 1999; 27(2): 168 - 172. [Abstract] [Full Text] [PDF]

				M. APRELEVA, C. T. HASSELMAN, R. E. DEBSKI, F. H. FU, S. L-Y. WOO, and J. J. P. WARNER A Dynamic Analysis of Glenohumeral Motion after Simulated Capsulolabral Injury. A Cadaver Model J. Bone Joint Surg. Am., April 1, 1998; 80(4): 474 - 80. [Abstract] [Full Text]

				K. P. Black, T.-H. Lim, L. M. McGrady, and W. Raasch In Vitro Evaluation of Shoulder External Rotation After a Bankart Reconstruction Am. J. Sports Med., July 1, 1997; 25(4): 449 - 453. [Abstract] [PDF]

				D. C. Taylor and R. A. Arciero Pathologic Changes Associated with Shoulder Dislocations: Arthroscopic and Physical Examination Findings in First-Time, Traumatic Anterior Dislocations Am. J. Sports Med., June 1, 1997; 25(3): 306 - 311. [Abstract] [PDF]

				K. P. SPEER, R. F. WARREN, M. PAGNANI, and J. J. P. WARNER An Arthroscopic Technique for Anterior Stabilization of the Shoulder with a Bioabsorbable Tack J. Bone Joint Surg. Am., December 1, 1996; 78(12): 1801 - 7. [Abstract] [Full Text]

				M. D. LAZARUS, J. A. SIDLES, D. T. HARRYMAN II, and F. A. MATSEN III Effect of a Chondral-Labral Defect on Glenoid Concavity and Glenohumeral Stability. A Cadaveric Model J. Bone Joint Surg. Am., January 1, 1996; 78(1): 94 - 102. [Abstract] [Full Text]

				K. P. Speer, Xianghua Deng, P. A. Torzilli, D. A. Altchek, and R. F. Warren Strategies for an Anterior Capsular Shift of the Shoulder: A Biomechanical Comparison Am. J. Sports Med., June 1, 1995; 23(3): 264 - 269. [Abstract] [PDF]

				F. A. Cordasco, S. Steinmann, E. L. Flatow, and L. U. Bigliani Arthroscopic treatment of glenoid labral tears Am. J. Sports Med., June 1, 1993; 21(3): 425 - 431. [Abstract] [PDF]

				J. J.P. Warner, X.-H. Deng, R. F. Warren, and P. A. Torzilli Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint Am. J. Sports Med., December 1, 1992; 20(6): 675 - 685. [Abstract] [PDF]

				R. D. Lebar and A. H. Alexander Multidirectional shoulder instability: Clinical results of inferior capsular shift in an active-duty population Am. J. Sports Med., March 1, 1992; 20(2): 193 - 198. [Abstract] [PDF]

				G. C. Terry, D. Hammon, P. France, and L. A. Norwood The stabilizing function of passive shoulder restraints Am. J. Sports Med., January 1, 1991; 19(1): 26 - 34. [Abstract] [PDF]

				P. W. O'Connell, G. W. Nuber, R. A. Mileski, and E. Lautenschlager The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint Am. J. Sports Med., December 1, 1990; 18(6): 579 - 584. [Abstract] [PDF]

				M. Raf, J. Minkoff, J. Bonamo, H. Firooznia, L. Jaffe, C. Golimbu, and O. Sherman Computed tomography (CT) arthrography of shoulder instabilities in athletes Am. J. Sports Med., July 1, 1988; 16(4): 352 - 361. [Abstract] [PDF]

				P. R. Cain, T. A. Mutschler, F. H. Fu, and S.K. Lee Anterior stability of the glenohumeral joint: A dynamic model Am. J. Sports Med., March 1, 1987; 15(2): 144 - 148. [Abstract] [PDF]

				A. F. Depalma and G. F. Flannery Acute anterior dislocation of the shoulder Am. J. Sports Med., January 1, 1973; 1(2): 6 - 15. [PDF]