Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
J Shoulder Elbow Surg. 2020 Jan;29(1):68-78. doi: 10.1016/j.jse.2019.05.025. Epub 2019 Aug 1.
Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this prospective study was to provide an in-detail description of the characteristics of FSI.
In the year 2017, a total of 36 consecutive cases of FSI presenting to our outpatient clinic were prospectively collected. Diagnostic investigation included a pathology-specific questionnaire, standardized clinical scores, clinical examination, psychological evaluation, video and dynamic fluoroscopy documentation of the instability mechanism, as well as magnetic resonance imaging (MRI). In a final reviewing process, the material from all collected cases was evaluated and, according to the observed pattern, different subtypes of FSI were determined and compared.
Based on the pathomechanism, positional FSI (78%) was distinguished from nonpositional FSI (22%). Controllable positional FSI was observed in 6% of all cases and noncontrollable positional FSI in 72%, whereas controllable and noncontrollable nonpositional FSI were each detected in 11% of the cases. The different subtypes of FSI showed significant differences in all clinical scores (Western Ontario Shoulder Instability Index: P = .002, Rowe Score: P = .001, Subjective Shoulder Value: P = .001) and regarding functional impairment (shoulder stability: P < .001, daily activities: P = .001, sports activities: P < .001). Seventy-eight percent had posterior, 17% anterior, and 6% multidirectional instability. Although several patients showed constitutional glenoid shape alterations or soft tissue hyperlaxity, only few patients with acquired minor structural defects were observed.
FSI can be classified into 4 subtypes based on pathomechanism and volitional control. Depending on the subtype, patients show different degrees of functional impairment. The majority of patients suffer from unidirectional posterior FSI.
肌肉的病理性激活模式可导致肩关节不稳定。我们提出将这种病理学称为功能性肩关节不稳定（FSI）。本前瞻性研究的目的是详细描述 FSI 的特征。
在 2017 年，我们前瞻性地收集了 36 例连续的 FSI 门诊病例。诊断性检查包括特定于病理学的问卷、标准化的临床评分、临床检查、心理评估、不稳定机制的视频和动态荧光透视记录，以及磁共振成像（MRI）。在最终的回顾过程中，对所有收集到的病例的资料进行评估，并根据观察到的模式确定和比较不同类型的 FSI。
基于发病机制，位置性 FSI（78%）与非位置性 FSI（22%）区分开来。所有病例中观察到可控性位置性 FSI 占 6%，不可控性位置性 FSI 占 72%，而可控性和不可控性非位置性 FSI 分别占 11%。不同类型的 FSI 在所有临床评分（Western Ontario Shoulder Instability Index：P =.002，Rowe 评分：P =.001，主观肩部价值：P =.001）和功能障碍方面（肩部稳定性：P <.001，日常活动：P =.001，运动活动：P <.001）均有显著差异。78%的患者有后向、17%的患者有前向、6%的患者有多向不稳定。尽管一些患者出现了关节盂形态改变或软组织过度松弛的先天结构改变，但仅观察到少数患者有后天的轻微结构缺陷。
根据发病机制和自主控制能力，FSI 可分为 4 个亚型。根据亚型的不同，患者表现出不同程度的功能障碍。大多数患者患有单向的后向 FSI。
