Fabis Jaroslaw, Rzepka Remigiusz, Fabis Anna, Zwierzchowski Jacek, Kubiak Grzegorz, Stanula Arkadiusz, Polguj Michal, Maciej Radek
Department of Arthroscopy Minimally Invasive Surgery and Sport Traumatology, Medical University of Lodz and FMC Medical Centre Lodz, Lodz, Poland.
BMC Musculoskelet Disord. 2016 Mar 12;17:123. doi: 10.1186/s12891-016-0971-5.
Of all the most frequent soft tissue disorders of the shoulder, idiopathic frozen shoulder (IFS) offers the greatest potential for studying proprioception. Studies concerning the presence of proprioception dysfunctions have failed to determine the potential for spontaneous healing of passive shoulder stabilizers (anterior and posterior capsule, middle and inferior gleno-humeral ligaments), its relationship with passive (PJPS) and active (AJPS) shoulder proprioception for internal and external rotation (IR, ER), as well as the isokinetic muscle performance of the internal and external rotators. This study investigates these dependencies in the case of arthroscopic release of IFS.
The study group comprised 23 patients (average aged 54.2) who underwent arthroscopic release due to IFS and 20 healthy volunteers. The average follow-up time was 29.2 months. The Biodex system was used for proprioception measurement in a modified neutral arm position and isokinetic evaluation. The results were analysed using the T-test, Wilcoxon and interclass correlation coefficient. P-values lower than 0.05 were considered significant.
Statistically significant differences were found between involved (I) and uninvolved (U) shoulders only in the cases of PJPS and AJPS, peak torque, time to peak torque and acceleration time for ER (p < 0.05). No statistically significant difference was noted between PJPS IR and PJPS ER or between AJPS IR and AJPS ER (p > 0.05) for the U shoulders.
The anatomical structure of anterior (capsule, middle and anterior band of inferior gleno-humeral ligament) and posterior (capsule and posterior band of inferior gleno-humeral ligament) passive shoulder restraints has no impact on the difference in PJPS values between ER and IR in a modified neutral shoulder position. The potential for spontaneous healing of the anterior and posterior passive shoulder restraints influences PJPS recovery after arthroscopic release of IFS. ER peak torque deficits negatively affect AJPS values. PJPS and AJPS of ER and IR can be measured with a high level of reproducibility using an isokinetic dynamometer with the arm in a modified neutral shoulder position. Differences greater than 15 % for PJPS and >24 % for AJPS for ER and IR can be helpful for future studies as baseline data for identification of particular passive and active shoulder stabilizers at risk.
在所有最常见的肩部软组织疾病中，特发性冻结肩（IFS）为研究本体感觉提供了最大的潜力。关于本体感觉功能障碍存在情况的研究未能确定被动肩部稳定器（前、后关节囊，盂肱中、下韧带）的自发愈合潜力，其与内旋（IR）和外旋（ER）的被动（PJPS）及主动（AJPS）肩部本体感觉的关系，以及内、外旋肌的等速肌肉表现。本研究在IFS关节镜松解的情况下调查这些相关性。
研究组包括23例因IFS接受关节镜松解的患者（平均年龄54.2岁）和20名健康志愿者。平均随访时间为29.2个月。使用Biodex系统在改良中立臂位进行本体感觉测量和等速评估。结果采用T检验、Wilcoxon检验和组内相关系数进行分析。P值低于0.05被认为具有统计学意义。
仅在PJPS和AJPS、峰值扭矩、ER达到峰值扭矩的时间和加速时间方面，患侧（I）和健侧（U）肩部之间存在统计学显著差异（p < 0.05）。对于U侧肩部，PJPS IR和PJPS ER之间或AJPS IR和AJPS ER之间未发现统计学显著差异（p > 0.05）。
前侧（关节囊及盂肱下韧带的中、前束）和后侧（关节囊及盂肱下韧带的后束）被动肩部约束结构对改良中立肩位时ER和IR之间PJPS值的差异无影响。前、后侧被动肩部约束的自发愈合潜力影响IFS关节镜松解后PJPS的恢复。ER峰值扭矩缺陷对AJPS值有负面影响。使用等速测力计在改良中立肩位时，ER和IR的PJPS及AJPS能够以高度可重复性进行测量。ER和IR的PJPS差异大于15%以及AJPS差异大于24%，可为未来研究作为识别特定有风险的被动和主动肩部稳定器的基线数据提供帮助。
