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Does the glenohumeral joint capsule have proprioceptive capability?

  • J. Jerosch
  • W. H. M. Castro
  • H. Halm
  • H. Drescher
Originals

Abstract

We performed a clinical study examining 60 volunteers with stable shoulder joints randomized to two groups. In group 1 we injected 5 ml lidocaine intra-articularly. In group 2 we injected 5 ml saline with 5 ml contrast dye the same way. After the injection we measured the amount of passive anteroposterior translation that occurred during anterior and posterior drawer tests and the amount of inferior subluxation during downward stress. We documented the extent of the passive glenohumeral translation using ultrasound. We had no complications related to the intra-articular injection or to the stability measurement. After the injection neither group had significant pain, and the patients were not apprehensive about the ensuing stability test. In group 1 (lidocaine) anteroposterior translation of 13.2±6.3 mm was seen in the anterior and posterior drawer test, whereas in group 2 (no lidocaine) the anteroposterior translation was only 6.8±3.2 mm. The difference between the two groups was statistically significant (P<0.05). With downward stress during the sulcus test the distance between the acromion and the humeral head increased by 5.6 mm (±3.2) in group 1 and by 2.7 mm (±2.1) in group 2. This difference was also statistically significant (P<0.05).Clinical consequences: Taking our preliminary findings into account, the capsule of the glenohumeral joint seems to have proprioceptive capability. Nerve fibres and mechanoreceptors seem to be localized in the capsule tissue, being part of a physiological feedback mechanism. If our conclusions proprioceptive capability. Nerve fibres and mechanoreceptors seem to be localized in the capsule tissue, being part of a physiological feedback mechanism. If our conclusions turn out to be right, patients with labrum detachment after traumatic shoulder dislocation should undergo surgery as soon as possible to restore their anatomical integrity and retain the neurophysiological feedback mechanism.

Key words

Glenohumeral joint Proprioceptive capability 

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References

  1. 1.
    Baker CL, Uribe JW, Whitman C (1990) Arthroscopic evaluation of acute initial anterior shoulder dislocation. Am J Sports Med 18: 25–28PubMedGoogle Scholar
  2. 2.
    Bankart ASB (1923) Recurrent or habitual dislocation of the shoulder joint. Br Med J 2: 23–29Google Scholar
  3. 3.
    Bankart ASB (1938) Pathology and treatment of recurrent dislocation of shoulder-joint. Br J Surg 26: 23–29Google Scholar
  4. 4.
    Blazina E, Satzman JS (1969) Recurrent anterior subluxation of the shoulder in athletics. J Bone Joint Surg [Am] 51: 1037–1038Google Scholar
  5. 5.
    Boyd IA (1954) The histological structure of the receptors in the knee joint of the cat correlated with their physiological response. J Physiol (Lond) 124: 476–488Google Scholar
  6. 6.
    Brewer BJ, Wubben RC, Carrera GF (1986) Excessive retroversion of the glenoid cavity. A cause of non-traumatic posterior instability of the shoulder. J Bone Joint Surg [Am] 68: 721–731Google Scholar
  7. 7.
    Broca A, Hartmann H (1890) Contribution à l'étude des luxations de l'épaule. Bull Soc Anat Paris 4: 312–336, 416–423Google Scholar
  8. 8.
    Burgess PR, Clarke FJ (1969) Characteristics of the knee joint receptors in the cat. J Physiol (Lond) 203: 317–335Google Scholar
  9. 9.
    Caird FM (1887) The shoulder joint in relation to certain dislocations and fractures. Edinb Med J 32: 708–714Google Scholar
  10. 10.
    Cyprien JM, Vasey HM, Burdet A (1983) Humeral retrotorsion and the glenohumeral relationship in the normal shoulder and in recurrent anterior dislocation. Clin Orthop 175: 8–17PubMedGoogle Scholar
  11. 11.
    Delorme D (1910) Die Hemmungsbänder des Schultergelenks und ihre Bedeutung für die Schulterluxation. Arch Klin Chir 92: 79–101Google Scholar
  12. 12.
    DePalma AF (1983) Surgery of the shoulder, 3rd edn. Lippincott, PhiladelphiaGoogle Scholar
  13. 13.
    Detrisiac DA, Johnson LL (1986) Arthroscopic shoulder anatomy. Slack, New JerseyGoogle Scholar
  14. 14.
    Ecklund G, Skoglund S (1970) On the specificity of the Ruffini like joint receptors. Arch Physiol Scand 49: 184–191Google Scholar
  15. 15.
    Fick R (1904) Handbuch der Anatomie und Mechanik der Gelenke unter Berücksichtigung der bewegenden Muskeln. Fischer, JenaGoogle Scholar
  16. 16.
    Flood V (1829) Discovery of a new ligament of the shoulder joint. Lancet 1: 672–673Google Scholar
  17. 17.
    Flower WH (1861) On pathologic changes produced in the shoulder by traumatic dislocation. Trans Pathol Soc Lond 12: 179–200Google Scholar
  18. 18.
    Freeman MAR, Wyke BD (1964) Articular contribution to limb muscle reflexes. I. An electromyographic study of the ankle joint mechanoreceptors upon reflex activity in the gastroenemius muscle of the cat. J Physiol (Lond) 171: 20–21Google Scholar
  19. 19.
    Freeman MAR, Wyke BD (1967) The innervation of the knee joint: an anatomical and histological study in the cat. J Anat 101: 505–532PubMedGoogle Scholar
  20. 20.
    Habermever P, Wiedemann E, Kreusser T, Brunner U, Kaiser E (1985) Anatomical and electrophysiological evaluation of stabilising mechanism of the long head of the biceps brachii. In: Refior HJ, Piltz W, Jäger M, Hackenbroch MM (eds) Biomechanik der gesunden und kranken Schuler. Thieme, Stuttgart, pp 66–70Google Scholar
  21. 21.
    Harryman DT, Slides JA, Harris SL, Matsen FA (1992) Laxity of the normal glenohumeral joint: a quantitative in vivo assessment. J Shoulder Elbow Surg 1: 66–76Google Scholar
  22. 22.
    Helmig P, Sojbjerg JO, Kjaersgaard-Andersen P, Nielsen S, Ovesen J (1990) Distal humeral migration as a component of multidirectional shoulder instability. Clin Orthop 252: 139–143PubMedGoogle Scholar
  23. 23.
    Hilton J (1863) On the influence of mechanical and physiological rest in the treatment of accidents and surgical diseases, and diagnostic value of pain. A Course of Lectures, Bell and Daldy, LondonGoogle Scholar
  24. 24.
    Hovelius L (1987) Anterior dislocation of the shoulder in teenagers and young adults. J Bone Joint Surg [Am] 69: 393–399Google Scholar
  25. 25.
    Hovelius L, Eriksson K, Fredin H, Hagberg G, Hussenius A, Lind B, Thorling J, Weckström J (1983) Recurrence after initial dislocation of the shoulder. J Bone Joint Surg [Am] 65: 343–348Google Scholar
  26. 26.
    Howell SM, Imobersteg AM, Seger DH, Maroned PJ (1986) Clarification of the role of the supraspinatus muscle in shoulder function. J Bone Joint Surg [Am] 68: 398–404Google Scholar
  27. 27.
    Inman VT, Saunders JC, Abott LC (1944) Observations of the function of the shoulder joint. J Bone Joint Surg [Am] 26: 1Google Scholar
  28. 28.
    Jerosch J (1992) Über die Funktion der passiven Stabilisatoren des glenohumeralen Gelenkes. In: Kohn D, Wirth CJ (eds) Die Schulter-Aktuelle operative Therapie. Thieme. Stuttgart, pp 2–15Google Scholar
  29. 29.
    Jerosch J, Marquardt M (1990) Sonographische Untersuchung zur AP-Translation des Humeruskopfes bei der aktiven Bewegung bei traumatischer anteriorer Schulterinstabilität. Z Orthop 128: 637–641PubMedGoogle Scholar
  30. 30.
    Jerosch J, Marquardt M, Winkelmann W (1990) Der Stellenwert der Sonographie in der Beurteilung von Instabilitäten des glenohumeralen Gelenkes. Z Orthop 128: 41–45PubMedGoogle Scholar
  31. 31.
    Jerosch J, Moersler M, Castro WHM (1990) Über die Funktion der passiven Stabilisatoren des glenohumeralen Gelenkes — Eine biomechanische Untersuchung. Z Orthop 128: 206–212PubMedGoogle Scholar
  32. 32.
    Jerosch J, Clahsen H, Grosse-Hackmann A, Castro WHM (1992) Proprioceptive capability of the glenohumeral joint capsule — an anatomic and clinical study. First World Congress of Sports Trauma, 25–29 May 1992. Palma de MalloreaGoogle Scholar
  33. 33.
    Jobe FW (1985) Unstable shoulders in athletes. Instr Course Lect 34: 228–231PubMedGoogle Scholar
  34. 34.
    Johansson H, Sjölander P, Sojka P (1991) A sensory role for the cruciate ligaments. Clin Orthop 268: 161–178PubMedGoogle Scholar
  35. 35.
    Kumar VP, Balsubramaniam P (1985) The role of atmospheric pressure in stabilizing the shoulder: An experimental study. J Bone Joint Surg [Br] 67: 719–721Google Scholar
  36. 36.
    Levick JR (1983) Joint pressure-volume studies: their importance, design and interpretation. J Rheumatol 10: 353–357PubMedGoogle Scholar
  37. 37.
    Moseley HF, Övergaard B (1962) In anterior capsular mechanism in recurrent anterior dislocation of the shoulder. Morphological and clinical studies with special reference to the glenoid labrum and the glenohumeral ligament. J Bone Joint Surg [Br] 44: 913–927Google Scholar
  38. 38.
    Müller W (1929) Über den negativen Luftdruck im Gelenkraum. Dtsch A Chir 217: 395–401Google Scholar
  39. 39.
    Perry J (1983) Anatomy and biomechanics of the shoulder in throwing, swimning, gymnastics and tennis. Clin Sports Med 2: 247–270PubMedGoogle Scholar
  40. 40.
    Perthes G (1906) Über Operationen bei habitueller Schulterluxation. Dtsch Z Chir 85: 199–227Google Scholar
  41. 41.
    Poppen NK, Walker PS (1978) Forces at the glenohumeral joint. Clin Orthop 135: 165–170PubMedGoogle Scholar
  42. 42.
    Post M (1978) The shoulder — surgical and non-surgical treatment. Lea & Febiger, PhiladelphiaGoogle Scholar
  43. 43.
    Randelli M, Gambrioli PL (1986) Glenohumeral osteometry by computed tomography in normal and unstable shoulders. Clin Orthop 208: 151PubMedGoogle Scholar
  44. 44.
    Rockwood CA, Matsen FA (1990) The shoulder, Saunders, PhiladelphiaGoogle Scholar
  45. 45.
    Rowe CR (1980) Acute and recurrent anterior dislocations of the shoulder. Orthop Clin North Am 11: 253–270PubMedGoogle Scholar
  46. 46.
    Rowe CR, Patel D, Southmayd WW (1978) The Bankart procedure: a long-term and end-result study. J Bone Joint Surg [Am] 60: 1–16Google Scholar
  47. 47.
    Saha AK (1971) Dynamic stability of the glenohumeral joint. Acta Orthop Scand 42: 491–505PubMedGoogle Scholar
  48. 48.
    Saha AK (1973) Mechanics of elevation of glenohumeral joint. Acta Orthop Scand 44: 668PubMedGoogle Scholar
  49. 49.
    Schlemm F (1985) Über die Verstärkungsbänder am Schultergelenk. Arch Anat 45–48Google Scholar
  50. 50.
    Simoneit WT, Cofield RH (1984) Prognosis in anterior shoulder dislocation. Am J Sports Med 12: 19–24PubMedGoogle Scholar
  51. 51.
    Skoglund S (1956) Anatomical and physiological studies of the knee joint innervation in the cat. Acta Physiol Scand 36 Suppl 124: 1–101Google Scholar
  52. 52.
    Townley CO (1950) The capsular mechanism in recurrent dislocation of the shoulder. J Bone Joint Surg [Am] 32-A: 370–380Google Scholar
  53. 53.
    Turkel SJ, Panio MW, Marshall JL, Girgis FG (1981) Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg [Am] 63: 1208–1217Google Scholar
  54. 54.
    Wheeler JH, Ryan JB, Arciero RA, Molinari RN (1989) Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes. Arthroscopy 5: 213–217PubMedGoogle Scholar
  55. 55.
    Wyke BD (1973) Structural and functional characteristics of articular receptor system. Acta Chir Orthop Traumatol Cech 40: 489–497PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • J. Jerosch
    • 1
  • W. H. M. Castro
    • 1
  • H. Halm
    • 1
  • H. Drescher
    • 1
  1. 1.Orthopedic DepartmentWestfälische Wilhelms UniversityMünsterGermany

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