A functional Magnetic Resonance Imaging study of patients with Polar Type II/III complex shoulder instability

Abstract

The pathophysiology of Stanmore Classification Polar type II/III shoulder instability is not well understood. Functional Magnetic Resonance Imaging was used to measure brain activity in response to forward flexion and abduction in 16 patients with Polar Type II/III shoulder instability and 16 age-matched controls. When a cluster level correction was applied patients showed significantly greater brain activity than controls in primary motor cortex (BA4), supramarginal gyrus (BA40), inferior frontal gyrus (BA44), precentral gyrus (BA6) and middle frontal gyrus (BA6): the latter region is considered premotor cortex. Using voxel level correction within these five regions a unique activation was found in the primary motor cortex (BA4) at MNI coordinates -38 -26 56. Activation was greater in controls compared to patients in the parahippocampal gyrus (BA27) and perirhinal cortex (BA36). These findings show, for the first time, neural differences in patients with complex shoulder instability, and suggest that patients are in some sense working harder or differently to maintain shoulder stability, with brain activity similar to early stage motor sequence learning. It will help to understand the condition, design better therapies and improve treatment of this group; avoiding the common clinical misconception that their recurrent shoulder dislocations are a form of attention-seeking.

Figure 1

Movements of forward flexion and abduction in the scanner [14].

Figure 2

Neuronal activation for the cluster level analysis (FWE, P < 0.05) where activation is greater in (A) patients versus controls and (B) controls versus patients, for the response to all movement >rest. MNI coordinates are given (x, y, z mm) for the most significant voxel in the cluster. L = left hemisphere, R = right hemisphere. Colour (including colour bars) corresponds to T-scores.