Archives of Orthopaedic and Trauma Surgery

, Volume 131, Issue 8, pp 1077–1084 | Cite as

The laser-pointer assisted angle reproduction test for evaluation of proprioceptive shoulder function in patients with instability

  • Maurice BalkeEmail author
  • D. Liem
  • N. Dedy
  • L. Thorwesten
  • Maryam Balke
  • W. Poetzl
  • B. Marquardt
Arthroscopy and Sports Medicine



Over the last decade, proprioceptive function gained increasing attention in joint disorders such as instability of the shoulder. Common tests for evaluation of proprioception are limited by their complexity and high technical demands. Thus, they are hardly applicable during daily routine. Our hypothesis was that the simplified “laser-pointer assisted angle reproduction test” (LP-ART) presented here allows for clinically feasible assessment of proprioceptive shoulder function.


Active angle reproduction capability as an aspect of sensorimotor function was evaluated with the new method in patients with shoulder instability (n = 24) and healthy controls (n = 24). 15 patients had traumatic, 9 non-traumatic anterior instability (6 bilateral), 17 were treated surgically, 13 non-operatively. Tests were performed in flexion and abduction in different angles (55°, 90°, 125°) in randomized order.


Angle reproduction capability was worst below shoulder level (55°) in all groups. Best results were achieved at shoulder level (90°). Healthy controls showed overall better results than patients with instability. Patients after surgical stabilization had better results in 55° and 90° abduction compared to instability patients before surgery.


The new LP-ART presented here is a technically simple, yet effective instrument for evaluation of the proprioceptive function of the shoulder. In contrast to former test setups it is feasible in daily routine. Compared to healthy controls, patients with unstable shoulder joints show significant proprioceptive disorders that can be quantified by the LP-ART.


Proprioception Instability Shoulder Angle reproduction test Joint position sense 


Conflict of interest

All authors declare no conflict of interest.


  1. 1.
    Allegrucci M, Whitney SL, Lephart SM, Irrgang JJ, Fu FH (1995) Shoulder kinesthesia in healthy unilateral athletes participating in upper extremity sports. J Orthop Sports Phys Ther 21:220–226PubMedGoogle Scholar
  2. 2.
    Altchek DW, Hobbs WR (2001) Evaluation and management of shoulder instability in the elite overhead thrower. Orthop Clin North Am 32:423–430 viiiPubMedCrossRefGoogle Scholar
  3. 3.
    Ando S, Iwata T, Ishikawa H, Dakeishi M, Murata K (2008) Effects of acute alcohol ingestion on neuromotor functions. Neurotoxicology 29:735–739PubMedCrossRefGoogle Scholar
  4. 4.
    Aydin T, Yildiz Y, Yanmis I, Yildiz C, Kalyon TA (2001) Shoulder proprioception: a comparison between the shoulder joint in healthy and surgically repaired shoulders. Arch Orthop Trauma Surg 121:422–425PubMedCrossRefGoogle Scholar
  5. 5.
    Bankart AS, Cantab MC (1993) Recurrent or habitual dislocation of the shoulder-joint. 1923. Clin Orthop Relat Res 3–6Google Scholar
  6. 6.
    Blasier RB, Carpenter JE, Huston LJ (1994) Shoulder proprioception. Effect of joint laxity, joint position, and direction of motion. Orthop Rev 23:45–50PubMedGoogle Scholar
  7. 7.
    Carpenter JE, Blasier RB, Pellizzon GG (1998) The effects of muscle fatigue on shoulder joint position sense. Am J Sports Med 26:262–265PubMedGoogle Scholar
  8. 8.
    Chan KM, Maffulli N, Nobuhara M, Wu JJ (1996) Shoulder instability in athletes. The Asian perspective. Clin Orthop Relat Res 106–112Google Scholar
  9. 9.
    Edmonds G, Kirkley A, Birmingham TB, Fowler PJ (2003) The effect of early arthroscopic stabilization compared to nonsurgical treatment on proprioception after primary traumatic anterior dislocation of the shoulder. Knee Surg Sports Traumatol Arthrosc 11:116–121PubMedGoogle Scholar
  10. 10.
    Good L, Roos H, Gottlieb DJ, Renstrom PA, Beynnon BD (1999) Joint position sense is not changed after acute disruption of the anterior cruciate ligament. Acta Orthop Scand 70:194–198PubMedCrossRefGoogle Scholar
  11. 11.
    Herrington L, Simmonds C, Hatcher J (2005) The effect of a neoprene sleeve on knee joint position sense. Res Sports Med 13:37–46PubMedGoogle Scholar
  12. 12.
    Hogervorst T, Brand RA (1998) Mechanoreceptors in joint function. J Bone Joint Surg Am 80:1365–1378PubMedGoogle Scholar
  13. 13.
    Janwantanakul P, Magarey ME, Jones MA, Dansie BR (2001) Variation in shoulder position sense at mid and extreme range of motion. Arch Phys Med Rehabil 82:840–844PubMedCrossRefGoogle Scholar
  14. 14.
    Jerosch J, Brinkmann T, Schneppenheim M (2003) The angle velocity reproduction test (AVRT) as sensorimotor function of the glenohumeral complex. Arch Orthop Trauma Surg 123:151–157PubMedGoogle Scholar
  15. 15.
    Jerosch J, Prymka M (1996) Proprioception and joint stability. Knee Surg Sports Traumatol Arthrosc 4:171–179PubMedCrossRefGoogle Scholar
  16. 16.
    Jerosch J, Thorwesten L, Steinbeck J, Reer R (1996) Proprioceptive function of the shoulder girdle in healthy volunteers. Knee Surg Sports Traumatol Arthrosc 3:219–225PubMedCrossRefGoogle Scholar
  17. 17.
    Lephart SM, Pincivero DM, Giraldo JL, Fu FH (1997) The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med 25:130–137PubMedCrossRefGoogle Scholar
  18. 18.
    Levine WN, Flatow EL (2000) The pathophysiology of shoulder instability. Am J Sports Med 28:910–917PubMedGoogle Scholar
  19. 19.
    Lonn J, Crenshaw AG, Djupsjobacka M, Pedersen J, Johansson H (2000) Position sense testing: influence of starting position and type of displacement. Arch Phys Med Rehabil 81:592–597PubMedCrossRefGoogle Scholar
  20. 20.
    Myers JB, Ju YY, Hwang JH, McMahon PJ, Rodosky MW, Lephart SM (2004) Reflexive muscle activation alterations in shoulders with anterior glenohumeral instability. Am J Sports Med 32:1013–1021PubMedCrossRefGoogle Scholar
  21. 21.
    Myers JB, Lephart SM (2002) Sensorimotor deficits contributing to glenohumeral instability. Clin Orthop Relat Res 98–104Google Scholar
  22. 22.
    Noda M, Demura S, Yamaji S, Kitabayashi T (2004) Influence of alcohol intake on the parameters evaluating the body center of foot pressure in a static upright posture. Percept Mot Skills 98:873–887PubMedCrossRefGoogle Scholar
  23. 23.
    Perthes G (1906) Über Operationen bei habitueller Schulterluxation. Dtsch Ztschr Chir 85:199–222Google Scholar
  24. 24.
    Potzl W, Thorwesten L, Gotze C, Garmann S, Steinbeck J (2004) Proprioception of the shoulder joint after surgical repair for Instability: a long-term follow-up study. Am J Sports Med 32:425–430PubMedCrossRefGoogle Scholar
  25. 25.
    Redding GM, Wallace B (1990) Effects on prism adaptation of duration and timing of visual feedback during pointing. J Mot Behav 22:209–224PubMedGoogle Scholar
  26. 26.
    Rodeo SA, Suzuki K, Yamauchi M, Bhargava M, Warren RF (1998) Analysis of collagen and elastic fibers in shoulder capsule in patients with shoulder instability. Am J Sports Med 26:634–643PubMedGoogle Scholar
  27. 27.
    Safran MR, Borsa PA, Lephart SM, Fu FH, Warner JJ (2001) Shoulder proprioception in baseball pitchers. J Shoulder Elbow Surg 10:438–444PubMedCrossRefGoogle Scholar
  28. 28.
    Skinner HB, Wyatt MP, Hodgdon JA, Conard DW, Barrack RL (1986) Effect of fatigue on joint position sense of the knee. J Orthop Res 4:112–118PubMedCrossRefGoogle Scholar
  29. 29.
    Turkof E, Jurecka W, Sikos G, Piza-Katzer H (1993) Sensory recovery in myocutaneous, noninnervated free flaps: a morphologic, immunohistochemical, and electron microscopic study. Plast Reconstr Surg 92:238–247PubMedCrossRefGoogle Scholar
  30. 30.
    Voight ML, Hardin JA, Blackburn TA, Tippett S, Canner GC (1996) The effects of muscle fatigue on and the relationship of arm dominance to shoulder proprioception. J Orthop Sports Phys Ther 23:348–352PubMedGoogle Scholar
  31. 31.
    Warner JJ, Lephart S, Fu FH (1996) Role of proprioception in pathoetiology of shoulder instability. Clin Orthop Relat Res 35–39Google Scholar
  32. 32.
    Zuckerman JD, Gallagher MA, Cuomo F, Rokito A (2003) The effect of instability and subsequent anterior shoulder repair on proprioceptive ability. J Shoulder Elbow Surg 12:105–109PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Maurice Balke
    • 1
    Email author
  • D. Liem
    • 2
  • N. Dedy
    • 2
  • L. Thorwesten
    • 3
  • Maryam Balke
    • 4
  • W. Poetzl
    • 5
  • B. Marquardt
    • 6
  1. 1.Department of Trauma and Orthopedic Surgery, University of Witten-HerdeckeCologne-Merheim Medical CenterCologneGermany
  2. 2.Department of Orthopaedic SurgeryUniversity Hospital MuensterMuensterGermany
  3. 3.Department of Sports MedicineUniversity Hospital of MuensterMuensterGermany
  4. 4.Department of Neurology, KnappschaftskrankenhausRuhr-University of BochumBochumGermany
  5. 5.Department of Shoulder and Elbow SurgeryVulpiusklinikBad RappenauGermany
  6. 6.Orthopedic Practice ClinicMuensterGermany

Personalised recommendations