title: Neural Correlates of Clinical Scores in Patients with Anterior Shoulder Apprehension.
abstract: BACKGROUND
  Anterior shoulder apprehension is a commonly reported complaint in anterior shoulder instability, which may lead to patient morbidity and impede shoulder function. It is the result of a cognitively complex mechanism, which includes anxiety, salience, fear, and anticipation.
  
  
  OBJECTIVE
  The aim of this prospective case-control study was to correlate five clinically established scores using functional magnetic resonance imaging to assess brain activation patterns in patients with apprehension related to anterior shoulder instability.
  
  
  METHODS
  This study includes 28 consecutive male right-handed patients (mean ± SEM, 26.8 ± 1.2 yr) with positive shoulder apprehension test and 10 healthy matched control participants without apprehension or a history of instability. Task-related and functional connectivity functional magnetic resonance imaging activation patterns occurring during apprehension video cue stimulation were correlated with five clinical tests and scores: Visual Analog Scale (VAS), Rowe score for instability, Simple Shoulder Test, Subjective Shoulder Value (SSV), and Western Ontario Shoulder Instability (WOSI).
  
  
  RESULTS
  Rowe, pain VAS, and WOSI scores correlated with prefrontal cortex, dorsolateral prefrontal cortex, dorsomedial prefrontal cortex, somatosensory area, and parieto-occipital and temporal areas (default mode network). Rowe score additionally correlated with frontal pole, anterior midcingulate cortex, and visual areas. Moreover, SSV correlated with task-related brain activity in the bilateral precentral gyrus, bilateral postcentral gyrus, and bilateral superior parietal lobe.
  
  
  CONCLUSIONS
  Overall, Rowe score provides the strongest link between shoulder apprehension and brain level alterations as it correlates with the highest number of independent components involving areas responsible for both motor and cognitive functions, whereas pain VAS and WOSI occupy an intermediately strong link recruiting less brain networks. Finally, Simple Shoulder Test and SSV have the weakest link at the brain level.
authors.affiliation: 1Division of Orthopedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, SWITZERLAND; 2Department of Imaging and Medical Informatics, University Hospitals of Geneva, Geneva, SWITZERLAND; 3Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, SWITZERLAND; 4Faculty of Medicine, University of Geneva, Geneva, SWITZERLAND; 5Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, SWEDEN; 6Department of Neuroradiology, University Hospital Freiburg, Freiburg, GERMANY; and 7Affidea, Centre de Diagnostique Radiologique de Carouge, Carouge, SWITZERLAND.
authors.forename: Gregory
authors.initials: G
authors.lastname: Cunningham
authors.forename: Davide
authors.initials: D
authors.lastname: Zanchi
authors.forename: Kirsten
authors.initials: K
authors.lastname: Emmert
authors.forename: Rotem
authors.initials: R
authors.lastname: Kopel
authors.forename: Dimitri
authors.initials: D
authors.lastname: Van De Ville
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lädermann
authors.forename: Sven
authors.initials: S
authors.lastname: Haller
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
mesh_terms: D000293:Adolescent; D000328:Adult; D059031:Anticipation, Psychological; D001007:Anxiety; D001921:Brain / Q000503:physiopathology*; D016022:Case-Control Studies; D005239:Fear; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology; D017397:Prefrontal Cortex / Q000503:physiopathology; D011446:Prospective Studies; D012785:Shoulder Joint / Q000503:physiopathology*; D013003:Somatosensory Cortex / Q000503:physiopathology; D055815:Young Adult