Effect of selective capsulorrhaphy on the passive range of motion of the glenohumeral joint.
BACKGROUND
Capsulorrhaphy of the glenohumeral joint is a common surgical procedure for the treatment of instability caused by increased capsular laxity. The effect of capsulorrhaphy on the range of motion of the shoulder is poorly understood.


METHODS
We simulated localized capsular contractures by selective capsular plications in eight human cadaveric shoulders and studied the effect of such plications on the passive range of glenohumeral abduction, flexion, and external and internal rotation in different degrees of abduction. A 0.5 or 1-N-m torque was applied to the humerus, and the range of glenohumeral motion was measured with electronic goniometers in three planes and compared with those of the intact shoulder.


RESULTS
Anterosuperior capsular plication most markedly affected external rotation of the adducted arm, decreasing it by a mean of 30.1 degrees (p < 0.0001). Anteroinferior plication significantly reduced abduction by a mean of 19.4 degrees (p < 0.0001) and external rotation by a mean of 20.6 degrees (p = 0.0046). Posterosuperior plication mostly limited internal rotation of the adducted arm (mean decrease, 16.1 degrees, p = 0.0045). On the average, total anterior and total posterior plication each limited flexion by approximately 20 degrees (p = 0.005) and abduction by >or=15 degrees (p < 0.005), whereas total anterior plication limited external rotation by >30 degrees (p <or= 0.0002) and total posterior plication limited internal rotation by >20 degrees (p < 0.0001). Total inferior capsular plication restricted abduction (by a mean of 27.7 degrees, p = 0.0001), flexion, and rotation. Total superior plication restricted external rotation and flexion.


CONCLUSIONS
Localized plications of the glenohumeral joint capsule lead to predictable patterns of loss of glenohumeral mobility. If plication is planned, losses of movement can be anticipated. The findings of this study may assist surgeons in identifying the parts of the capsule that are contracted and that may need lengthening.
Gerber
C
C
Department of Orthopaedics, University of Zürich, Balgrist, Switzerland. christian.gerber@balgrist.ch
Werner
C M L
CM
Macy
J C
JC
Jacob
H A C
HA
Nyffeler
R W
RW
D001696:Biomechanical Phenomena; D003286:Contracture / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D006811:Humerus / Q000503:physiopathology* / Q000601:surgery*; D017746:Joint Capsule / Q000503:physiopathology* / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D019637:Orthopedic Procedures; D018579:Patient Selection; D016059:Range of Motion, Articular / Q000502:physiology*; D012307:Risk Factors; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery*