title: Brain activity in the right-frontal pole and lateral occipital cortex predicts successful post-operatory outcome after surgery for anterior glenoumeral instability.
abstract: Shoulder apprehension is more complex than a pure mechanical problem of the shoulder, creating a scar at the brain level that prevents the performance of specific movements. Surgery corrects for shoulder instability at the physical level, but a re-dislocation within the first year is rather common. Predicting which patient will be likely to have re-dislocation is therefore crucial. We hypothesized that the assessment of neural activity at baseline and follow-up is the key factor to predict the post-operatory outcome. 13 patients with shoulder apprehension (30.03 ± 7.64 years) underwent clinical and fMRI examination before and one year after surgery for shoulder dislocation contrasting apprehension cue videos and control videos. Data analyses included task-related general linear model (GLM) and correlations imaging results with clinical scores. Clinical examination showed decreased pain and increased shoulder functions for post-op vs. pre-op. Coherently, GLM results show decreased activation of the left pre-motor cortex for post-surgery vs. pre-surgery. Right-frontal pole and right-occipital cortex activity predicts good recovery of shoulder function measured by STT. Our findings demonstrate that beside physical changes, changes at the brain level also occur one year after surgery. In particular, decreased activity in pre-motor and orbito-frontal cortex is key factor for a successful post-operatory outcome.
authors.affiliation: Department of Psychiatry (UPK), University of Basel, Basel, Switzerland. davide.zanchi@upkbs.ch.
authors.forename: Davide
authors.initials: D
authors.lastname: Zanchi
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Gregory
authors.initials: G
authors.lastname: Cunningham
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland.|Faculty of Medicine of the University of Geneva, Geneva, Switzerland.|Division of Orthopaedic and Trauma Surgery, La Tour Hospital, Geneva, Switzerland.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lädermann
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozturk
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.affiliation: Faculty of Medicine of the University of Geneva, Geneva, Switzerland.|Affidea Carouge Radiologic Diagnostic Center, Geneva, Switzerland.|Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.|Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Haller
mesh_terms: D000328:Adult; D001931:Brain Mapping; D005625:Frontal Lobe / Q000502:physiology*; D006801:Humans; D007593:Joint Instability / Q000534:rehabilitation* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009778:Occipital Lobe / Q000502:physiology*; D011379:Prognosis; D012783:Shoulder Dislocation / Q000534:rehabilitation* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult