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. 2018 Oct 24;3(10):550-557.
doi: 10.1302/2058-5241.3.180007. eCollection 2018 Oct.

Shoulder apprehension: A multifactorial approach

Alexandre Lädermann  1   2 , Jérome Tirefort  3 , Davide Zanchi  4 , Sven Haller  2   5   6   7 , Caecilia Charbonnier  2   8 , Pierre Hoffmeyer  1 , Gregory Cunningham  1
Affiliations

Shoulder apprehension: A multifactorial approach

Alexandre Lädermann et al. EFORT Open Rev. .

Abstract

Shoulder apprehension is related to changes in functional cerebral networks induced by dislocations, peripheral neuromuscular lesions and persistent mechanical glenohumeral instability consisting of micro-motion.All the damage to the osseous and soft-tissue stabilizers of the shoulder, as well as neurologic impairment persisting even after stabilization, must be properly identified in order to offer the best possible treatment to the patient.There is growing evidence supporting the use of a global multimodal approach, involving, on the one hand, shoulder 'reafferentation', including proprioception, mirror therapy and even cognitive behavioural approaches, and, on the other hand, surgical stabilization techniques and traditional physical therapy in order to minimize persistent micro-motion, which may help brain healing. This combined management could improve return to sport and avoid dislocation arthropathy in the long term. Cite this article: EFORT Open Rev 2018;3:550-557. DOI: 10.1302/2058-5241.3.180007.

Keywords: anteroinferior glenohumeral dislocation; apprehension; shoulder instability.

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Conflict of interest statement

ICMJE Conflict of interest statement: A. Lädermann declares consultancy for Mitek, Arthrex, Medacta and Wright; royalties for Wright, activities outside the submitted work. P. Hoffmeyer declares board membership of SFITS; being Editor-in-Chief for EFORT Open Reviews, activities outside the submitted work. G. Bentley acted as Editor-in-Chief for double-blinded peer review of the current paper.

Figures

Fig. 1
Fig. 1
Apprehension may be related to a) central nervous system sequelae, b) peripheral neurological, muscular or capsular/ligamentous lesions consecutively to dislocation or c) mechanical instability as micro-movements. Reproduced from Lädermann A, Denard PJ, Tirefort J, et al. Does surgery for instability of the shoulder truly stabilize the glenohumeral joint? A prospective comparative cohort study. Medicine (Baltimore) 2016;95(31):e4369 with permission.
Fig. 2
Fig. 2
Patients vs control participants had a significantly (p < 0.05 corrected) higher task-correlated functional connectivity in two almost mirror symmetric components. Reproduced from Haller S, Cunningham G, Lädermann A, et al. Shoulder apprehension impacts large-scale functional brain networks. AJNR Am J Neuroradiol 2014;35(4):691-697 with permission.
Fig. 3
Fig. 3
Task related general linear model (GLM) shows higher activation in baseline vs follow-up for apprehension videos vs control videos, representing partial brain healing. Reproduced from Zanchi D, Cunningham G, Lädermann A, et al. Brain activity in the right-frontal pole and lateral occipital cortex predicts successful post-operatory outcome after surgery for anterior glenohumeral instability. Sci Rep 2017;7(1):498 with permission.
Fig. 4
Fig. 4
Arthroscopic view of a left shoulder through a posterior portal. This patient has sustained more than 50 subluxations. The axillary nerve is clearly identifiable (white asterisk). There is no more capsule or inferior glenohumeral ligament, and the subscapularis muscle is hardly recognizable. Reproduced from Lädermann A, Benchouk S, Denard PJ. Traumatic anterior shoulder instability: general concepts & proper management. In: Park J, ed. Sports injuries to the shoulder and elbow. Berlin/Heidelberg: Springer-Verlag, 2015, with permission.
Fig. 5
Fig. 5
a) Abduction simulation obtained from shoulder’s CT reconstruction and optical motion capture, b) and c) show a zoom in the shoulder (front and top views). In c), we clearly observe an anterior translation (arrow) of the humeral head centre (pink sphere) with respect to the glenoid centre (white sphere). Note that the clavicle is not shown for clarity. Reproduced from Lädermann A, Denard PJ, Tirefort J, et al. Does surgery for instability of the shoulder truly stabilize the glenohumeral joint? A prospective comparative cohort study. Medicine (Baltimore) 2016;95(31):e4369, modified with permission.
See this image and copyright information in PMC

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