Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2011 Sep;19(9):1570-5. doi: 10.1007/s00167-011-1552-7. Epub 2011 May 24.
Disruption in the balance of shoulder stability can produce a widely varied spectrum of clinical symptoms, ranging from minor shoulder instability to frank shoulder dislocation, followed by recurrent instability. In this study, a series of patients suffering from minor shoulder instability, all with clinical signs of preoperative subacromial impingement associated with instability, were treated. The shoulder instability alone was addressed, with the aim of eliminating the clinical symptoms of subacromial impingement and pain.
In this study, 20 patients with minor shoulder instability, presenting with subacromial impingement symptoms, underwent arthroscopic treatment to address capsule-labral pathology. All patients underwent a preoperative assessment by one independent physiotherapist, using Constant and WOSI scores, as well as the Castagna test, on both the affected and non-affected sides. The Hawkins test and subacromial pain in 90° of abduction and internal rotation were also evaluated. All patients followed the same rehabilitation protocol by a second physiotherapist. All patients were followed up at 6, 12 and 24 months postoperatively by the same independent physiotherapist.
We observed that 20/20 patients had a positive Hawkins sign at >20° of internal rotation preoperatively, while 4/19 had a positive Hawkins sign--all with less pain--at the 24-month follow-up (P < 0.0001). Moreover, 20/20 had a positive Castagna test preoperatively, while 1/20 had a positive Castagna test at the 24-month follow-up. In terms of shoulder scores, at 24 months, the Constant score had improved from a median value of 70 (51-91) preoperatively to a median value of 91 (86-100). The median WOSI score was 48.3 (12.7-78.6) preoperatively and improved to 84.9 (39.5-98.5) at 24 months postoperatively.
Minor shoulder instability is an intra-articular pathology presenting with extra-articular subacromial impingement symptoms. By treating the intra-articular pathology, the extra-articular symptoms can be relieved in the vast majority of patients.
肩部稳定性平衡的破坏可产生广泛的临床表现，从轻微的肩部不稳定到明显的肩关节脱位，随后出现复发性不稳定。在这项研究中，我们治疗了一系列患有轻微肩关节不稳定的患者，所有患者均有术前肩峰下撞击相关的亚临床不稳定的临床体征。仅处理肩关节不稳定，旨在消除肩峰下撞击和疼痛的临床症状。
在这项研究中，20 例有亚临床不稳定症状的轻微肩关节不稳定患者接受了关节镜下治疗，以解决关节囊-盂唇病变。所有患者均由一名独立的物理治疗师进行术前评估，使用 Constant 和 WOSI 评分，以及 Castagna 试验，在患侧和健侧均进行评估。还评估了 Hawkins 试验和外展 90°和内旋时的肩峰下疼痛。所有患者均由第二位物理治疗师遵循相同的康复方案。所有患者均由同一位独立的物理治疗师在术后 6、12 和 24 个月进行随访。
我们观察到，20/20 例患者在术前内旋超过 20°时出现阳性 Hawkins 征，而在 24 个月随访时，4/19 例患者出现阳性 Hawkins 征（所有患者疼痛均减轻）（P < 0.0001）。此外，20/20 例患者在术前出现阳性 Castagna 试验，而在 24 个月随访时，有 1/20 例患者出现阳性 Castagna 试验。就肩部评分而言，在 24 个月时，Constant 评分从术前的中位数 70（51-91）改善至中位数 91（86-100）。术前 WOSI 评分为 48.3（12.7-78.6），术后 24 个月改善至 84.9（39.5-98.5）。
轻微肩关节不稳定是一种关节内病变，表现为关节外肩峰下撞击的症状。通过治疗关节内病变，可以缓解绝大多数患者的关节外症状。
