Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice, Nice, France.
J Shoulder Elbow Surg. 2011 Jan;20(1):98-106. doi: 10.1016/j.jse.2010.05.020. Epub 2010 Sep 20.
The etiology of shoulder pain in the overhead athlete is often difficult to determine. This study hypothesized that (1) instability can present in a purely painful form, without any apparent history of instability, but with anatomic lesions indicative of instability, termed unstable painful shoulder (UPS), and that (2) arthroscopic shoulder stabilization is effective.
The study evaluated 20 patients (mean age, 22 ± 8 years) at a mean of 38 months postoperatively (range, 24-69 months). Inclusion criteria were painful shoulder with lesions indicative of instability on imaging or at surgery, minimum 2-year follow-up. Exclusion criteria were recognized instability, other associated pathologies, and previous shoulder surgery.
Patients were young, hyperlax athletes who complained of deep, anterior shoulder pain and denied any instability. Pain was reproduced with the arm in an anterior apprehension position and relieved by a relocation test; however, no actual apprehension was experienced. Patients often had glenohumeral laxity and hyperlaxity. Lesions indicative of instability confirmed that at least 1 unapparent shoulder subluxation occurred. The Rowe, Walch-Duplay, and University of California, Los Angeles scores improved significantly (P < .05); 19 patients (95%) were satisfied, and 15 (75%) returned to their previous level of sports.
The diagnosis of UPS is often missed but is important to consider in the young hyperlax athlete. Soft tissue and/or bony lesions consistent with instability are necessary to confirm the diagnosis. Arthroscopy certainly deserves a significant place in this form of anteroinferior instability because it allows both the assessment of lesions (ie, diagnosis) and a satisfactory functional result and return to sport.
肩部疼痛的病因在过头运动员中往往难以确定。本研究假设：（1）不稳定可能以单纯疼痛的形式出现，没有明显的不稳定病史，但存在提示不稳定的解剖学病变，称为不稳定性疼痛性肩（UPS），并且（2）关节镜下肩部稳定化是有效的。
本研究评估了 20 名患者（平均年龄 22 ± 8 岁），术后平均随访 38 个月（范围 24-69 个月）。纳入标准为影像学或手术提示有不稳定病变的疼痛性肩，随访至少 2 年。排除标准为已确诊的不稳定、其他相关病变和先前的肩部手术。
患者为年轻的过度松弛运动员，主诉深部、前肩部疼痛，否认任何不稳定。手臂在前瞻性焦虑位时出现疼痛，并通过复位试验缓解；然而，实际上并未经历焦虑。患者通常有盂肱关节松弛和过度松弛。不稳定病变提示至少发生了 1 次未察觉的肩半脱位。Rowe、Walch-Duplay 和加利福尼亚大学洛杉矶分校评分显著改善（P<.05）；19 名患者（95%）满意，15 名（75%）恢复到之前的运动水平。
UPS 的诊断常常被忽视，但对于年轻的过度松弛运动员来说是重要的考虑因素。需要存在与不稳定一致的软组织和/或骨病变来确认诊断。关节镜术在这种前下不稳定形式中当然值得占据重要地位，因为它既可以评估病变（即诊断），又可以获得令人满意的功能结果和恢复运动。
