J Korean Orthop Assoc.  2016 Aug;51(4):327-337. 10.4055/jkoa.2016.51.4.327.

Evaluation of Clinical Applicability of Stress Radiography for Shoulder Instability: Correlation between the Degree of Displacement and the Physical Examinations

• Park JY
• Kim Y
• Lim HK
• Moon SW
• Bang JY
• Jang HS

• KMID: 2348640
• DOI: http://doi.org/10.4055/jkoa.2016.51.4.327

Abstract

PURPOSE
The purpose of this study is to examine the clinical applicability of stress radiography in patients presenting with shoulder instability.
MATERIALS AND METHODS
Fifty-six patients diagnosed with shoulder instability and 20 healthy volunteers participated in the study. Degree of displacement of the humeral head as measured on stress radiography using a Telos GA-IIE device was compared with the results of the physical examinations. Four types of stress radiography were captured while applying 15 daN of force anteriorly (AER0 and AER60) and posteriorly (PER0 and PER60) at two different positions: (1) 90° of abduction combined with 0° of external rotation, and (2) 90° of abduction combined with 60° of external rotation.
RESULTS
The degree of displacement of affected shoulders of 44 patients showed significantly larger displacement than normal shoulders (p<0.05), and the comparison between 56 affected shoulders of the patients and 40 normal shoulders of the volunteers showed significantly larger displacement only in PER0 and PER60 of the patients (p<0.05). Among the four radiographs of affected shoulders, AER60 showed significantly less displacement (p=0.046). The anterior drawer test under anesthesia of 16 patients who underwent surgery for anterior instability showed positive correlation with AER0 (Spearman's rho=0.56, p<0.024). Significantly larger anterior displacement of the load and shift test was observed in the subgroup with anterior displacement more than 3 mm (p=0.028), and higher positive frequency of the Kim's test was observed in the subgroup with posterior displacement more than 3 mm (p=0.005).
CONCLUSION
Stress radiography using a Telos GA-IIE device could discriminate the affected shoulder. Although it could not replace individual physical examinations, the degree of displacement correlates with some physical examinations for shoulder instability.

Keyword

shoulder; instability; Telos GA-IIE device; stress radiography; physical examination

MeSH Terms

Anesthesia
Healthy Volunteers
Humans
Humeral Head
Physical Examination*
Radiography*
Shoulder*
Volunteers

Figure

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  Figure 1 The Telos device mainly consists of a lower arm positioner for external rotation (1), shoulder fixation pads (2), and a pressure support (3).

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  Figure 2 Examples of anterior drawer stress radiography, AER0 and AER60. After seating the patient on the chair, the patient's arm is abducted by 90° and placed on the device, the axillary portion is placed in the middle of the cassette, and the coracoid process and scapular spine are fixed on the shoulder fixation pad. The pressure support pad is placed approximately 2 cm lateral to the margin of the acromion, and by using support devices, 15 daN pressure is steadily applied toward the back (abdomen), and under 60 Kvp and 10 mA film conditions, a beam is shot vertical to the acromioclavicular joint in the forward distal 30° direction with an source-image distance of 100 cm.

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  Figure 3 Example of posterior drawer stress radiography measurement in a patient. A line is drawn parallel to the glenoid articular surface (1), a line is drawn bisecting the glenoid articular surface perpendicular to line 1 (2), and a line is drawn from the rotation center of the humeral head perpendicular to line 1 (3). The distance between line 1 and 2 represents the posterior displacement.

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