Influence of the glenoid track and glenoid bone loss on the apprehension test for shoulder instability

André Couto Godinho; Pedro Couto Godinho; Elísio José Salgado Ribeiro; Daniel Carvalho de Toledo; Frederico de Menezes Figueiredo Couto Bem; Armando D'Lucca de Castro E Silva; Glaydson Gomes Godinho

doi:10.1016/j.jseint.2021.04.002

Influence of the glenoid track and glenoid bone loss on the apprehension test for shoulder instability

JSES Int. 2021 Apr 28;5(4):616-622. doi: 10.1016/j.jseint.2021.04.002. eCollection 2021 Jul.

Authors

André Couto Godinho¹, Pedro Couto Godinho¹, Elísio José Salgado Ribeiro², Daniel Carvalho de Toledo¹, Frederico de Menezes Figueiredo Couto Bem¹, Armando D'Lucca de Castro E Silva¹, Glaydson Gomes Godinho¹

Affiliations

¹ Department of Orthopedic, Orthopaedic Hospital of Belo Horizonte, Belo Horizonte, Brazil.
² Radiologist of Axial Diagnostic Medicine, Belo Horizonte, Brazil.

Abstract

Background: The investigation of Hill-Sachs and bony Bankart lesions continues to evolve. Patients with large bone lesions can present with a positive apprehension test even at ranges below 45° of abduction and external rotation of the shoulder. Modern concepts, such as glenoid track and quantification of glenoid bone loss, have been increasingly applied to shoulder instability. The objective of this study was to assess the correlation of the glenoid track and glenoid bone loss on the apprehension test conducted at 0°, 45°, and 90° of shoulder abduction.

Methods: Ninety-four shoulders of 90 patients with anterior glenohumeral instability were retrospectively assessed. The apprehension test was performed at 0°, 45°, and 90° of shoulder abduction. Computed tomography, magnetic resonance imaging, or magnetic resonance arthrogram scans were performed to calculate the glenoid track and glenoid bone loss. A descriptive analysis, an association analysis, and a logistic regression analysis were used in this study. Logistic regression analysis was used to assess the influence of glenoid track and glenoid bone loss when the apprehension test was positive in lower degrees of abduction.

Results: A positive apprehension test at 0°, 45°, and 90° of abduction revealed significant association with off-track lesions, glenoid bone losses greater than 13.5%, and bipolar bone lesions. Shoulders classified as off-track were 36.4 times more likely to test positive at 0°, 45°, and 90° than on-track shoulders. The logistic regression analysis revealed that the positive apprehension test at 0°, 45°, and 90° of abduction seems to be more influenced by off-track lesions than by glenoid bone loss greater than the 13.5% threshold.

Conclusion: Shoulders with a positive apprehension test at 0°, 45°, and 90° are significantly associated with off-track lesions, bipolar bone lesions, and glenoid bone losses greater than 13.5%.

Keywords: Apprehension; Bipolar bone loss; Glenoid bone loss; Glenoid track; Off track apprehension test; Shoulder instability.