A modified Bristow-Helfet-May procedure for recurrent dislocation and subluxation of the shoulder. Report of two hundred and twelve cases.

A modified Bristow-Helfet-May procedure was performed for recurrent dislocation or subluxation of the glenohumeral joint in 207 patients (212 shoulders), whose average age at the time of surgery was 20.3 years (range, fourteen to forty-seven years). The procedure was modified by directing the coracoid segment and conjoined tendon over the superior border rather than through the substance of the subscapularis tendon and muscle. The indications were either documented recurrent anterior dislocation of the glenohumeral joint or subluxation with instability as demonstrated on examination with the patient under anesthesia. The procedure was evaluated on the basis of the rate of recurrence of dislocation and subluxation, postoperative complications, the patients' subjective evaluation, and the effect of the procedure on the motion of the glenohumeral joint and the strength of the muscles of the shoulder as related to overhead throwing. Eight (3.8 per cent) of the shoulders redislocated and ten (4.7 per cent) had one or more subjective episodes of subluxation after the procedure. Complications included postoperative infection in two patients and problems with the screw that required its removal in ten. One hundred and thirty-one (62 per cent) of the patients responded to a questionnaire regarding their subjective evaluation of the results of surgery. Eleven (8 per cent) were unable to perform daily activities that involved overhead work, and forty-five (34 per cent) stated that they still had some degree of discomfort or pain in the shoulder. One hundred and twenty-six patients (96.2 per cent) stated that they were happy with the results of the surgery and would have the procedure again. Thirty patients had Cybex testing of the muscles of the shoulder. Only three (16 per cent) of the nineteen athletes whose dominant arm had been operated on returned to their pre-injury level of throwing. Data obtained with regard to changes in the range of motion and strength of the glenohumeral joint indicate that this loss of throwing ability was not due solely to a loss of glenohumeral motion. It appeared to be also related to a concomitant loss of strength at the extreme of external rotation of the humerus and the initiation of internal rotation of the humerus.

A preliminary study on the measurement of static and dynamic motion at the glenohumeral joint.

Measurement of glenohumeral joint motion has, for the most part, been performed with the simple goniometer. The purpose of this paper is to describe a method for measuring and recording static and dynamic external rotation of the glenohumeral joint using the Cybex II Isokinetic Dynamometer and an MFE model 815 X-Y plotter. Static range of motion was assessed at 60 deg/sec using a slow arm action externally from a 90 degree abduction position. Dynamic motion was recorded at 300 deg/sec using a rapid rotational whipping action from a 90 degree abducted position. Measurements were recorded on three groups of athletes, and the influences of sex, hand dominance, overarm activity, and surgery were analyzed. The subjects in the first two groups were divided according to sex and their participation in overarm versus nonoverarm (control) activities. Static and dynamic motion in both groups was significantly influenced by sex and hand dominance (P less than 0.05). Although there was no overall difference in the motion measurements between the control and overarm groups, the interaction of this factor with sex and type of measurement was significant. Males who participated in overarm activities had, on the average, more static range of motion than males in the control group. A third group that had undergone a modified Bristow procedure for recurrent dislocation/subluxation of the shoulder demonstrated that static and dynamic range of motion were significantly reduced by the surgery (P less than 0.05). The average differences in static and dynamic motion between the surgical arm and its nonsurgical counterpart were 17.5 degrees and 21 degrees, respectively, resulting in an overall range of motion difference of 19 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)