This Article Full Text Full Text (PDF) Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by BLASIER, R. B. Articles by PALMER, M. L. Search for Related Content PubMed PubMed Citation Articles by BLASIER, R. B. Articles by PALMER, M. L. Social Bookmarking             What's this?

Posterior Glenohumeral Subluxation: Active and Passive Stabilization in a Biomechanical Model*

RALPH B. BLASIER, M.D., LOUIS J. SOSLOWSKY, PH.D., DAVID M. MALICKY, M.S. and MARK L. PALMER, M.S., ANN ARBOR, MICHIGAN

Investigation performed at Orthopaedic Research Laboratories, Department of Surgery and Department of Mechanical Engineering and Applied Mechanics, University of Michigan, Ann Arbor

We examined the role of the glenohumeral and coracohumeral ligaments as well as the forces provided by the rotator cuff muscles, the long head of the biceps, the anterior and middle deltoids, and the pectoralis major in the stabilization of the glenohumeral joint in the posterior direction. Simulated muscle forces were mechanically applied to eight shoulder specimens. The humeroscapular position for testing simulated the 90-degree forward-flexion (humerothoracic) position used clinically for the so-called jerk test, which is the most clinically important position with regard to posterior instability of the shoulder. Experiments were performed with a variety of configurations of ligamentous and capsular cuts, humeral rotation, and levels of muscle force. Stability was investigated by measuring the force required to subluxate the humeral head a specified amount from its reduced position. Of the muscles and ligaments tested, the subscapularis muscle contributed the most to this subluxation force. The coracohumeral ligament was an effective contributor in neutral humeral rotation, and the inferior glenohumeral ligament was an effective contributor in internal humeral rotation. The long head of the biceps was found to reduce the subluxation force in certain positions. CLINICAL RELEVANCE: It is widely agreed that a complex interaction of passive and active stabilizing structures and forces is necessary for clinical stability of the shoulder. The present study identified the contributions of ligaments and muscles to posterior stability of the shoulder in the position of greatest clinical importance—posterior subluxation with the shoulder in forward flexion.

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

This article has been cited by other articles:

				T. S. Mologne, K. Zhao, M. Hongo, A. A. Romeo, K.-N. An, and M. T. Provencher The Addition of Rotator Interval Closure After Arthroscopic Repair of Either Anterior or Posterior Shoulder Instability: Effect on Glenohumeral Translation and Range of Motion Am. J. Sports Med., June 1, 2008; 36(6): 1123 - 1131. [Abstract] [Full Text] [PDF]

				J. P. Bradley, C. L. Baker III, A. J. Kline, D. R. Armfield, and A. Chhabra Arthroscopic Capsulolabral Reconstruction for Posterior Instability of the Shoulder: A Prospective Study of 100 Shoulders Am. J. Sports Med., July 1, 2006; 34(7): 1061 - 1071. [Abstract] [Full Text] [PDF]

				M. T. Provencher, S. J. Bell, K. A. Menzel, and T. S. Mologne Arthroscopic Treatment of Posterior Shoulder Instability: Results in 33 Patients Am. J. Sports Med., October 1, 2005; 33(10): 1463 - 1471. [Abstract] [Full Text] [PDF]

				M. R. Safran, M. H. McGarry, S. Shin, S. Han, and T. Q. Lee Effects of Elbow Flexion and Forearm Rotation on Valgus Laxity of the Elbow J. Bone Joint Surg. Am., September 1, 2005; 87(9): 2065 - 2074. [Abstract] [Full Text] [PDF]

				C. M. Robinson and J. Aderinto Posterior Shoulder Dislocations and Fracture-Dislocations J. Bone Joint Surg. Am., March 1, 2005; 87(3): 639 - 650. [Abstract] [Full Text] [PDF]

				S.-H. Kim, K.-C. Noh, J.-S. Park, B.-D. Ryu, and I. Oh Loss of Chondrolabral Containment of the Glenohumeral Joint in Atraumatic Posteroinferior Multidirectional Instability J. Bone Joint Surg. Am., January 1, 2005; 87(1): 92 - 98. [Abstract] [Full Text] [PDF]

				S.-H. Kim, J.-C. Park, J.-S. Park, and I. Oh Painful Jerk Test: A Predictor of Success in Nonoperative Treatment of Posteroinferior Instability of the Shoulder Am. J. Sports Med., December 1, 2004; 32(8): 1849 - 1855. [Abstract] [Full Text] [PDF]

				M. C. Park and C. S. Ahmad Dynamic Contributions of the Flexor-Pronator Mass to Elbow Valgus Stability J. Bone Joint Surg. Am., October 1, 2004; 86(10): 2268 - 2274. [Abstract] [Full Text] [PDF]

				S.-H. Kim, H.-K. Kim, J.-I. Sun, J.-S. Park, and I. Oh Arthroscopic Capsulolabroplasty for Posteroinferior Multidirectional Instability of the Shoulder Am. J. Sports Med., April 1, 2004; 32(3): 594 - 607. [Abstract] [Full Text] [PDF]

				S.-H. Kim, K.-I. Ha, J.-H. Park, Y.-M. Kim, Y.-S. Lee, J.-Y. Lee, and J.-C. Yoo Arthroscopic Posterior Labral Repair and Capsular Shift for Traumatic Unidirectional Recurrent Posterior Subluxation of the Shoulder J. Bone Joint Surg. Am., August 1, 2003; 85(8): 1479 - 1487. [Abstract] [Full Text] [PDF]

				T. Kido, E. Itoi, S.-B. Lee, P. G. Neale, and K.-N. An Dynamic Stabilizing Function of the Deltoid Muscle in Shoulders with Anterior Instability Am. J. Sports Med., May 1, 2003; 31(3): 399 - 403. [Abstract] [Full Text] [PDF]

				G. A. Tung and D. D. Hou MR Arthrography of the Posterior Labrocapsular Complex: Relationship with Glenohumeral Joint Alignment and Clinical Posterior Instability Am. J. Roentgenol., February 1, 2003; 180(2): 369 - 375. [Abstract] [Full Text] [PDF]

				J. Walton, A. Paxinos, A. Tzannes, M. Callanan, K. Hayes, and G. A. C. Murrell The Unstable Shoulder in the Adolescent Athlete Am. J. Sports Med., September 1, 2002; 30(5): 758 - 767. [Abstract] [Full Text] [PDF]

				A.-T. Hsu, T. Hedman, J. H. Chang, C. Vo, L. Ho, S. Ho, and G.-L. Chang Changes in Abduction and Rotation Range of Motion in Response to Simulated Dorsal and Ventral Translational Mobilization of the Glenohumeral Joint Physical Therapy, June 1, 2002; 82(6): 544 - 556. [Abstract] [Full Text] [PDF]

				C. Hurschler, N. Wulker, H. Windhagen, P. Plumhoff, and N. Hellmers Medially Based Anterior Capsular Shift of the Glenohumeral Joint: Passive Range of Motion and Posterior Capsular Strain Am. J. Sports Med., May 1, 2001; 29(3): 346 - 353. [Abstract] [Full Text] [PDF]

				J. Antoniou, D. T. Duckworth, and D. T. Harryman II Capsulolabral Augmentation for the Management of Posteroinferior Instability of the Shoulder J. Bone Joint Surg. Am., September 1, 2000; 82(9): 1220 - 1220. [Abstract] [Full Text]

				P. J. Nowotarski, C. H. Turen, R. J. Brumback, and J. M. Scarboro Conversion of External Fixation to Intramedullary Nailing for Fractures of the Shaft of the Femur in Multiply Injured Patients J. Bone Joint Surg. Am., June 1, 2000; 82(6): 781 - 781. [Abstract] [Full Text]

				J. E. Kuhn, M. J. Bey, L. J. Huston, R. B. Blasier, and L. J. Soslowsky Ligamentous Restraints to External Rotation of the Humerus in the Late-Cocking Phase of Throwing: A Cadaveric Biomechanical Investigation Am. J. Sports Med., March 1, 2000; 28(2): 200 - 205. [Abstract] [Full Text] [PDF]

				B. FUCHS, B. JOST, and C. GERBER Posterior-Inferior Capsular Shift for the Treatment of Recurrent, Voluntary Posterior Subluxation of the Shoulder J. Bone Joint Surg. Am., January 1, 2000; 82(1): 16 - 25. [Abstract] [Full Text]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 1997 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.