Basic Science
Upper limb kinematics after arthroscopic and open shoulder stabilization

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Background

Shoulder joint stability mediated by proprioception is often quantified by arm repositioning tests (i.e., static end-position accuracy), overlooking ongoing movement quality. This study assessed movement quality by adopting smoothness-related kinematic descriptors. We compared performance of healthy controls with that of patients in arthroscopic shoulder stabilization and open shoulder stabilization groups. We hypothesized that arm kinematics after arthroscopic intervention would more closely resemble healthy movements compared with patients after open shoulder stabilization surgery.

Methods

Healthy controls (N = 14) were compared with patients after arthroscopic shoulder stabilization (N = 10) and open shoulder stabilization (N = 12). Right-hand dominant subjects (the affected side in patients) performed 135 unconstrained 3-dimensional pointing movements toward visual targets (seen through pinhole goggles; i.e., no arm vision). Arm kinematic data were recorded and offline analyzed to obtain hand tangential velocity profiles further used to compute the acceleration-to-movement time ratio, peak-to-mean velocity ratio, and number of velocity peaks (“symmetry,” “proportion,” and “fragmentation” features, respectively). Parametric and nonparametric statistics were used for comparisons (P ≤ .05).

Results

Control and arthroscopic shoulder stabilization groups presented similar acceleration-to-movement time ratio and peak-to-mean velocity ratio. Both groups differed from the open shoulder stabilization group (P = .001). Distributions of velocity peaks for control and arthroscopic shoulder stabilization groups were similar, whereas open shoulder stabilization and control subjects differed significantly (P = .028).

Conclusions

Movement quality mediated by proprioception in arthroscopic shoulder stabilization patients matches that of healthy controls, whereas performance in open shoulder stabilization patients seems inferior compared with that in healthy controls, as assessed by smoothness-related measures (less symmetrical, more fragmented movements).

Section snippets

Experimental design, participants, and procedures

A between-subjects experimental design was used in which 3 levels of the group factor were compared (controls, arthroscopic, and open surgery).

Subjects were selected from a cohort of 276 patients who underwent anterior shoulder stabilization between 2003 and 2008 (134 patients underwent open stabilization and 142 patients arthroscopic stabilization). Surgical procedures were performed by 1 of 2 senior shoulder surgeons (A.O. and M.P.), who decided which procedure to perform on an individual

Results

Smoothness parameters of upper limb movements of the 3 study groups are summarized in Table II.

Movement time was similar for all 3 groups (F[2,33] = 2.21; P = .12). However, acceleration time differed between the groups (F[2,33] = 6.56; P = .004). Tukey post hoc comparisons revealed significantly longer acceleration time in patients after open shoulder stabilization compared with healthy controls (P = .002) (no significant difference was found between patients after arthroscopic shoulder

Discussion

Recovery of proprioception after shoulder stabilization is often assessed by upper limb repositioning tests that measure accuracy at the end of the movement10, 23, 25, 26 and overlook the quality of the ongoing movement toward a target. This study presents an innovative method to assess preoperative and postoperative upper limb motor performance believed to be mediated by proprioceptive feedback.2, 5, 10, 21, 23, 25, 26

The main goal of this study was to assess the quality of upper limb

Conclusions

Kinematics of the dominant arm after arthroscopic shoulder stabilization was similar to healthy controls and significantly better in terms of smoothness parameters compared with results after open shoulder stabilization at a mean postoperative follow-up of 31 months. Because proprioception is a source of afferent feedback that mediates motion smoothness (particularly, when vision of the moving arm is precluded), the current findings may indicate that a less invasive procedure of shoulder

Disclaimer

The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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