Loss of passive external rotation at 90 degrees abduction is predictive of a medially healed Bankart lesion.
OBJECTIVE
This prospective study correlates passive range of external rotation with arthroscopic findings in patients with anterior instability for the purpose of defining criteria that can be used to detect a medially healed Bankart lesion.


METHODS
External rotation at 90 degrees abduction (ER90) was assessed on examination with the patient under anesthesia in bilateral shoulders of 46 consecutive patients with unidirectional, anterior glenohumeral instability. Arthroscopy was used to identify 22 patients with a detached Bankart lesion (group I) and 24 patients with a medially healed Bankart lesion (group II). Differences in ER90 between symptomatic and asymptomatic shoulders for both groups were compared. The t test and the Wilcoxon rank-sum test measured significance.


RESULTS
In group I, mean ER90 in the symptomatic shoulder was 5 degrees greater than in the asymptomatic shoulder; in group II, mean ER90 in the symptomatic shoulder was 7.4 degrees less than in the asymptomatic shoulder (P < .001). Loss of ER90 was highly sensitive (92%) and specific (95%), with a positive predictive value of 96% for detection of a medially healed Bankart lesion.


CONCLUSIONS
If a loss of 5 degrees or more of ER90 in the affected shoulder is found on examination under anesthesia, one should have a high degree of suspicion for the presence of a medially healed Bankart lesion.


METHODS
Level II, development of diagnostic criteria on basis of consecutive patients.
Deutsch
Allen
A
Department of Orthopaedic Surgery, Baylor College of Medicine, Kelsey-Seybold Clinic, Houston, Texas 77025, USA. adeutschmd@aol.com
Ramsey
Matthew L
ML
Williams
Gerald R
GR
D000293:Adolescent; D000328:Adult; D000758:Anesthesia; D001182:Arthroscopy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012008:Recurrence; D012399:Rotation; D012680:Sensitivity and Specificity; D012783:Shoulder Dislocation / Q000150:complications*; D012785:Shoulder Joint; D014945:Wound Healing