Recovery of shoulder strength and proprioception after open surgery for recurrent anterior instability: a comparison of two surgical techniques.
BACKGROUND
Previous studies have documented a decrease in proprioceptive capacity in the unstable shoulder. The degree to which surgical approach affects recovery of strength and proprioception is unknown.


METHODS
The recovery of strength and proprioception after open surgery for recurrent anterior glenohumeral instability was compared for 2 surgical procedures. A prospective analysis of 55 consecutive patients with posttraumatic unilateral recurrent anterior glenohumeral instability was performed. Thirty patients (group 1) underwent an open inferior capsular shift with detachment of the subscapularis, and 25 (group 2) underwent an anterior capsulolabral reconstruction.


RESULTS
Mean preoperative proprioception and strength values were significantly lower for the affected shoulders in both groups. At 6 months after surgery, there were no significant differences for mean strength and proprioception values between the unaffected and operative sides for group 2 patients. In group 1 patients, however, there were still significant deficits in mean position sense and strength values. Complete restoration of proprioception and strength, however, was evident by 12 months in group 1.


CONCLUSIONS
This study demonstrates that there are significant deficits in both strength and proprioception in patients with posttraumatic, recurrent anterior glenohumeral instability. Although both are completely restored by 1 year after surgery, a subscapularis-splitting approach allows for complete recovery of strength and position sense as early as 6 months postoperatively. Detachment of the subscapularis delays recovery of strength and position sense for up to 12 months after surgery.
Rokito
Andrew S
AS
Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA.
Birdzell
Maureen Gallagher
MG
Cuomo
Frances
F
Di Paola
Matthew J
MJ
Zuckerman
Joseph D
JD
D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D019637:Orthopedic Procedures / Q000379:methods*; D011434:Proprioception / Q000502:physiology*; D011446:Prospective Studies; D020127:Recovery of Function; D012782:Shoulder / Q000294:innervation / Q000502:physiology*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult