Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2016 Aug;51(4):327-337. Korean.
    Published online Aug 11, 2016.
    https://doi.org/10.4055/jkoa.2016.51.4.327
    Copyright © 2016 by The Korean Orthopaedic Association
    Original Article

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

    Jin-Young Park, M.D., Ph.D.,*,† Youngbok Kim, M.D.,‡ Hwa-Kyung Lim, Ph.D.,§ Sang Won Moon, M.D.,‡ Jin-Young Bang, M.D.,‡ and Hyo-Seok Jang, M.D.‡
      • *Global Center for Shoulder, Elbow & Sports, NEON Orthopaedic Clinic, Korea.
      • †Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea.
      • ‡Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea.
      • §Institute of Statistics, Korea University, Seoul, Korea.
    • Correspondence to: Youngbok Kim, M.D. Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea. TEL: +82-51-979-0611, FAX: +82-51-979-0991, Email: neomed95@naver.com
    Received October 28, 2015; Revised December 12, 2015; Accepted March 03, 2016.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    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.

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

    Figures

    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).

    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.

    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.

    Tables

    Table 1
    Measured Values and Statistics from the Affected Shoulders and the Normal Shoulders of the Patients

    Table 2
    Measured Values and Statistics from the Affected Shoulders of the Patients and the Normal Shoulders of the Volunteers

    Table 3
    Intra-Group Comparison among 4 Radiographies from the Patients

    Table 4
    Intra-Group Comparison among 4 Radiographies from the Volunteers

    Table 5
    Cross-Tabulation of the Load and Shift Test and the Displacement on the Radiography

    Table 6
    Correlation between the Drawer Test under Anesthesia and the Displacement on the Radiography

    Notes

    CONFLICTS OF INTEREST:The authors have nothing to disclose.

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    MeSH Terms
    Anesthesia
    Healthy Volunteers
    Humans
    Humeral Head
    Physical Examination*
    Radiography*
    Shoulder*
    Volunteers
    Metrics
    Share
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    Tables
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