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Exploration of Glenohumeral Instability Under Anesthesia: The Shoulder Jerk Test

      Purpose: The purpose of this study was to develop a new protocol for the performance of jerk tests under anesthesia, and to study its correlation to intra-articular pathology and the diagnosis of a lax or unstable shoulder. Type of Study: Prospective controlled study. Methods: We performed a systematic examination, in the office as well as under anesthesia, of 300 patients (600 shoulders) divided into 3 homogeneous groups: 100 presented with instability resulting from recurrent dislocation of one or both shoulders, 100 presented with alternative shoulder symptomatology without signs of instability, and a further 100 underwent surgery for other locomotor system pathologies. Results: The following statistical sensitivity values were found: anterior jerk, 90.7%; inferior jerk, 96.2%. Correct interpretation of jerk tests under anesthesia will help us decide the type and scope of required surgical therapy. Level of Evidence: Level III, Diagnostic Study of Nonconsecutive Patients.

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      References

        • Neer C.S.
        • Foster C.R.
        Inferior capsular shift for involuntary and multidirectional instability of the shoulder.
        J Bone Joint Surg Am. 1980; 62: 897-907
        • Lippitt S.B.
        • Harris S.L.
        • Harryman II, D.T.
        • Sidles J.A.
        • Matsen III, F.A.
        In vivo quantification of the laxity of the normal and unstable glenohumeral joints.
        J Shoulder Elbow Surg. 1994; 3: 215-223
        • Altchek D.V.
        • Warren R.F.
        • Skyhar M.J.
        • Ortiz G.
        T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types.
        J Bone Joint Surg Am. 1991; 73: 105-112
        • Caspari R.B.
        • Geissler W.B.
        Arthroscopic manifestations of shoulder subluxation and dislocations.
        Clin Orthop. 1993; 291: 54-66
        • Cofield R.H.
        • Irving J.F.
        Evaluation and classification of shoulder instability.
        Clin Orthop. 1987; 223: 32-43
        • Cofield R.H.
        • Nessler J.P.
        • Weinstabl R.
        Diagnosis of shoulder instability by examination under anesthesia.
        Clin Orthop. 1993; 291: 45-53
        • Cofield R.H.
        Physical examination of the shoulder.
        in: Matsen III, F.A. Fu F.H. Hawkins R.J. The shoulder A balance of mobility and stability. American Academy of Orthopedic Surgeons, Rosemont1993: 331-343
        • Cohen S.B.
        • Altchek D.W.
        • Warren R.F.
        Selective capsular shift approach for treatment of anterior and multidirectional shoulder instability.
        Tech Shoulder Elbow Surg. 2001; 2: 225-233
        • Faber K.J.
        • Homa K.
        • Hawkins R.J.
        Translation of the glenohumeral joint in patients with anterior instability.
        J Shoulder Elbow Surg. 1999; 8: 320-323
        • Hawkins R.J.
        • Schutte J.P.
        • Janda D.H.
        • Huckell G.H.
        Translation of the glenohumeral joint with the patient under anesthesia.
        J Shoulder Elbow Surg. 1996; 5: 286-292
        • Miyazaki Y.
        • Yoneda M.
        • Takiuchi T.
        • Maeda A.
        • Yokota A.
        Diagnostic value of the load and shift test for the assessment of the glenohumeral joint laxity.
        J Shoulder Elbow Surg. 1999; 8: 394
        • Oliashirazi A.
        • Mansat P.
        • Cofield R.
        • Rowland C.M.
        Examination under anesthesia for evaluation of anterior shoulder examination.
        Am J Sports Med. 1999; 27: 464-468
        • Tillander B.
        • Norlin R.
        Intraoperative measurement of the shoulder translation.
        J Shoulder Elbow Surg. 2001; 10: 358-364
        • Yoldas E.A.
        • Faber K.J.
        • Hawkins R.J.
        Translation of the glenohumeral joint in patients with multidirectional and posterior instability.
        J Shoulder Elbow Surg. 2001; 10: 416-420
        • Gerber Ch.
        • Ganz R.
        Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests.
        J Bone Joint Surg Br. 1984; 66: 551-556
        • Harryman II, D.T.
        • Sidles J.A.
        • Clark J.M.
        • Mc Quade K.J.
        • Gibb T.D.
        • Matsen III, F.A.
        Translation of the humeral head on the glenoid with passive glenohumeral motion.
        J Bone Joint Surg Am. 1990; 72: 1334-1343
        • Harryman II, D.T.
        • Sidles J.A.
        • Harris S.L.
        • Matsen III, F.A.
        Laxity of the normal glenohumeral joint.
        J Shoulder Elbow Surg. 1992; 1: 66-76
        • Howell S.M.
        • Galinat B.J.
        • Renzi A.J.
        • Marone P.J.
        Normal and abnormal mechanics of the glenohumeral joint in the horizontal plane.
        J Bone Joint Surg Am. 1988; 70: 227-232
        • Norris T.R.
        Diagnostic techniques for shoulder instability.
        Instr Course Lect. 1985; 34: 239-257
        • Pagnani M.J.
        • Deng X.H.
        • Warren R.F.
        • Torzilli P.A.
        • Altchek D.W.
        Effect of lesions of the superior portion of the glenoid labrum on glenohumeral translation.
        J Bone Joint Surg Am. 1995; 77: 1003-1010
        • Poppen N.K.
        • Walker P.S.
        Normal and abnormal motion of the shoulder.
        J Bone Joint Surg Am. 1976; 58: 195-201
        • Lerat J.L.
        • Chotel F.
        • Besse J.L.
        • Moyen B.
        • Brunet Guedj E.
        Le ressaut dynamique antérieur de l’épaule.
        Rev Chir Orthop. 1994; 80: 461-467
        • Lippitt S.B.
        • Harryman II, D.T.
        • Sidles J.A.
        • Matsen III, F.A.
        Diagnosis and management of AMBRI syndrome.
        Tech Orthop. 1991; 6: 61-73
        • Cuéllar R.
        • González J.
        • Usabiaga J.
        A study of diagnostic reliability in inferior shoulder instability.
        Arthroscopy. 2002; 18: 287-291
        • Landsiedl F.
        Arthroscopic therapy of recurrent anterior luxation of the shoulder by capsular repair.
        Arthroscopy. 1992; 8: 296-304
        • Hayashida K.
        • Yoneda M.
        • Nagawa S.
        • Okamura K.
        • Fukushima S.
        Arthroscopic Bankart suture repair for traumatic anterior shoulder instability. Analysis of the causes of a recurrence.
        Arthroscopy. 1998; 3: 295-301
        • Yoneda M.
        • Hayashida K.
        • Izawa K.
        • Shimada K.
        • Shino K.
        A simple and secure anchoring system for Caspari’s transglenoid multiple suture technique using biodegradable poly-L-lactic acid button.
        Arthroscopy. 1998; 14: 295-301
        • Adolfsson L.
        • Lysholm J.
        Arthroscopy and stability testing for anterior shoulder instability.
        Arthroscopy. 1989; 5: 315-320
        • Neviaser T.J.
        The anterior labroligamentous periosteal sleeve avulsion lesion. A cause of anterior instability of the shoulder.
        Arthroscopy. 1993; 9: 17-21
        • Harryman II, D.T.
        • Sidles J.A.
        • Harris S.L.
        • Matsen III, F.A.
        The role of the rotator interval capsule in passive motion and stability of the shoulder.
        J Bone Joint Surg Am. 1992; 74: 53-66
        • McIntyre L.F.
        • Caspari R.B.
        • Savoie III, F.H.
        The arthroscopic treatment of multidirectional shoulder instability.
        Arthroscopy. 1997; 13: 418-425
        • Altchek D.V.
        • Warren R.F.
        • Wickiewicz T.L.
        • Ortiz G.
        Arthroscopic labral debridement.
        Am J Sports Med. 1992; 20: 702-706
        • Hawkins R.J.
        • Bokor D.J.
        Clinical evaluation of the shoulder problems.
        in: Rockwood C.A. Matsen III, F.A. The shoulder. WB Saunders, Philadelphia1990: 149-177
        • Minaci A.
        • Wai E.
        • Clarnette R.
        The Ortolani test of the shoulder.
        Arthroscopy. 1999; 15: S54
        • Silliman J.F.
        • Hawkins R.J.
        Classification and physical diagnosis of instability of the shoulder.
        Clin Orthop. 1983; 291: 7-19
        • Rockwood Jr, C.A.
        Dislocations about the shoulder.
        in: Rockwood C.A. Green D.P. Fractures. Vol 1. JB Lippincott, Philadelphia1975: 677-680
        • McFarland E.G.
        • Shaffer B.
        • Glousman R.E.
        • Conway J.E.
        • Jobe F.W.
        Anterior shoulder instability.
        in: Jobe F.W. Operative techniques in upper extremity sports injuries. Mosby-Year Book, St Louis1996: 177-190
        • McFarland E.G.
        • Torpey B.M.
        • Curl L.A.
        Evaluation of shoulder laxity.
        Sports Med. 1996; 22: 264-272
        • McFarland E.G.
        • Campbell G.
        • Mc Dowell J.
        Posterior shoulder laxity in asymptomatic athletes.
        Am J Sports Med. 1996; 24: 468-471
        • McFarland E.G.
        • Neira C.A.
        • Gutiérrez M.I.
        • Cosgarea A.J.
        • Magee M.
        Clinical significance of the arthroscopic drive-through sign in shoulder surgery.
        Arthroscopy. 2001; 17: 38-43
        • Pagnani M.J.
        • Warren R.F.
        Arthroscopic shoulder stabilization.
        Oper Tech Sports Med. 1993; 1: 276-284
        • McIntyre L.F.
        Arthroscopic capsulorrhaphy for multidirectional instability.
        Oper Tech Sports Med. 1997; 5: 233-237
        • Nelson B.J.
        • Arciero R.A.
        Arthroscopic management of glenohumeral instability.
        Am J Sports Med. 2000; 28: 602-614
        • Caspari R.B.
        • Beach W.R.
        Arthroscopy.
        in: Matsen III, F.A. Fu F.H. Hawkins R.J. The shoulder A balance of mobility and stability. American Academy of Orthopedic Surgeons, Rosemont1993: 369-378
        • Altchek D.V.
        • Dines D.W.
        The surgical treatment of anterior instability.
        Oper Tech Sports Med. 1993; 1: 285-292
        • Ellenbecker T.S.
        • Bailie D.S.
        • Mattalino A.J.
        • et al.
        Intrarater and interrater reliability of a manual technique to assess anterior humeral head translation of the glenohumeral joint.
        J Shoulder Elbow Surg. 2002; 11: 470-475