Harryman D T, Sidles J A, Harris S L, Matsen F A
Seattle, Wash, USA.
J Shoulder Elbow Surg. 1992 Mar;1(2):66-76. doi: 10.1016/S1058-2746(09)80123-7. Epub 2009 Feb 19.
It is critical that surgeons comprehend the normal laxity of the glenohumeral joint (1) to assist them in diagnosing conditions of clinical instability and (2) to help define a therapeutic end point for the management of shoulders with excessive stiffness. In clinical practice this joint laxity is judged by standard manual tests. We report a quantitative study of the clinical in vivo laxity of the normal shoulders of eight male volunteers. To our knowledge this is the first time that the laxity revealed on standard manual clinical tests has been quantified in vivo. The relative motions of the humerus and scapula were determined with an electromagnetic spatial tracker. This device was pinned percutaneously to the humerus and scapula of each of eight normal male volunteers of ages 25 to 45 years. An experienced shoulder surgeon carried out standard manual clinical tests of glenohumeral laxity while the resulting displacements of the humeral head relative to the glenoid were measured. Spatial tracker data indicated that for each of the different tests, the positions of the glenohumeral and scapulothoracic joints were reproducible for a given subject and among subjects. Substantial glenohumeral translations were measured during those manual laxity tests in which the joint was not at the limit of its range of motion: the drawer test, 7.8 ± 4.0 mm anterior and 7.9 ± 5.6 mm posterior; the sulcus test, 10.6 ± 3.8 mm inferior; and the push-pull test, 9.0 ± 6.3 mm posterior. A minimal translation of 0.3 ± 2.5 mm was measured during the fulcrum test in which the glenohumeral ligaments were under tension. The observed translations were reproducible in each subject's shoulder. On the other hand, there was marked variability among subjects. Even though manual laxity tests are a standard part of the clinical evaluation of the shoulder, our finding that normal glenohumeral joints show substantial translations indicates that translation on clinical manual laxity testing is not in and of itself a sufficient indication for surgical stabilization.
外科医生理解盂肱关节的正常松弛度至关重要，这有助于他们诊断临床不稳定状况，并有助于确定治疗过度僵硬肩部的治疗终点。在临床实践中，这种关节松弛度通过标准手法检查来判断。我们报告了一项对八名男性志愿者正常肩部临床体内松弛度的定量研究。据我们所知，这是首次在体内对标准手法临床检查所显示的松弛度进行量化。使用电磁空间跟踪仪确定肱骨和肩胛骨的相对运动。该设备经皮固定在八名年龄在25至45岁的正常男性志愿者的肱骨和肩胛骨上。一位经验丰富的肩部外科医生进行盂肱关节松弛度的标准手法临床检查，同时测量肱骨头相对于关节盂的位移。空间跟踪仪数据表明，对于每种不同的检查，盂肱关节和肩胛胸壁关节的位置在给定受试者以及不同受试者之间都是可重复的。在那些关节未处于其活动范围极限的手法松弛度检查中，测量到了显著的盂肱关节平移：抽屉试验，向前7.8±4.0毫米，向后7.9±5.6毫米；沟试验，向下10.6±3.8毫米；推拉试验，向后9.0±6.3毫米。在支点试验中，当盂肱韧带处于张力下时，测量到最小平移为0.3±2.5毫米。观察到的平移在每个受试者的肩部都是可重复的。另一方面，不同受试者之间存在明显差异。尽管手法松弛度检查是肩部临床评估的标准组成部分，但我们发现正常盂肱关节显示出显著平移这一结果表明，临床手法松弛度检查中的平移本身并不足以作为手术稳定的指征。
