The Journal of Bone and Joint Surgery (American) 83:661-667 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Position of Immobilization After Dislocation of the Glenohumeral Joint
A Study with Use of Magnetic Resonance Imaging
Eiji Itoi, MD,
Ryuji Sashi, MD,
Hiroshi Minagawa, MD,
Togo Shimizu, MD,
Ikuko Wakabayashi, MD and
Kozo Sato, MD
Investigation performed at the Departments of Orthopedic
Surgery and Radiology, Akita University School of Medicine, Akita,
Japan
Eiji Itoi, MD
Ryuji Sashi, MD
Togo Shimizu, MD
Ikuko Wakabayashi, MD
Kozo Sato, MD
Departments of Orthopedic Surgery (E.I., T.S., I.W., and K.S.) and
Radiology (R.S.), Akita University School of Medicine, Hondo 1-1-1,
Akita 010-8543, Japan. E-mail address for E. Itoi: itoi{at}med.akita-u.ac.jp
Hiroshi Minagawa, MD
Department of Orthopedic Surgery, Ugo Municipal Hospital, Ugo-machi,
Ogachi-gun 012-1131, Japan
No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
A commentary is available with the electronic versions of this
article, on our web site (www.jbjs.org) and on our CD-ROM (call
781-449-9780, ext. 140, to order).
Background: Glenohumeral dislocations often
recur, probably because a Bankart lesion does not heal sufficiently during
the period of immobilization. Using magnetic resonance imaging,
we assessed the position of the Bankart lesion, with the arm in
internal and external rotation, in shoulders that had had a dislocation.
Methods: Coaptation of a Bankart lesion was examined
with use of magnetic resonance imaging, with the arm held at the
side of the trunk and positioned first in internal rotation (mean,
29°) and then in external rotation (mean, 35°), in nineteen shoulders.
Six shoulders (six patients) had had an initial anterior dislocation,
and thirteen shoulders (twelve patients) had had recurrent anterior
dislocation. Fast-spin-echo T2-weighted axial images were made when the
dislocation had occurred less than two weeks earlier, and spin-echo
T1-weighted axial images after intra-articular injection of gadolinium-diethylenetriamine
pentaacetic acid were made when the dislocation had occurred more
than two weeks earlier. Separation and displacement of the anteroinferior
portion of the labrum from the glenoid rim were measured on the
axial images, and coaptation of the anterior part of the capsule
to the glenoid neck was assessed by measurement of the detached area,
opening angle, and detached length.
Results: Separation and displacement of the labrum
were both significantly less (p = 0.0047 and p = 0.0017, respectively)
when the arm was in external rotation than when it was in internal
rotation. The detached area and the opening angle of the anteroinferior portion
of the capsule were both significantly smaller (p = 0.0003
and p < 0.0001, respectively), and the detached length
was significantly shorter (p < 0.0001) with the arm in
external rotation.
Conclusion: Immobilization of the arm in external
rotation better approximates the Bankart lesion to the glenoid neck
than does the conventional position of internal rotation.
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