gms | German Medical Science

54. Jahrestagung der Norddeutschen Orthopädenvereinigung e. V.

Norddeutsche Orthopädenvereinigung

16.06. bis 18.06.2005, Hamburg

The inferior capsular shift according to NEER in the operative treatment of the multidirectional instability of the shoulder with special reverence to the laxity

Meeting Abstract

  • corresponding author N. Hellmers - General Hospital Eilbek, Orthopedic and traumatologic surgery, Hamburg
  • H. Böhtig - Hamburg
  • A. Betthäuser - Hamburg
  • E. Hille - Hamburg

Norddeutsche Orthopädenvereinigung. 54. Jahrestagung der Norddeutschen Orthopädenvereinigung e.V.. Hamburg, 16.-18.06.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05novEP38

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Veröffentlicht: 13. Juni 2005

© 2005 Hellmers et al.
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The pathogenesis of the multidirectional instability (MDI) is not defined. When conservative therapy is not successful, operative capsular imbrication or shifting has been indicated. The inferior capsular shift was introduced by Neer and Foster (Neer and Foster,1980) to reduce redundancy of the inferior capsule and thus reduce excessive joint volume.

This study describes the clinical results of an inferior capsule shift according to NEER (Neer and Foster,1980) in 17 cases after intensive conservative therapy for more than one year. The postoperative mean follow-up time was between 1.5 to 6.5 years and each patient was invited postoperative examination 3 times. According to the history of trauma and dislocation all patients were divided into three groups.The external rotation, laxity, and instability of the operated shoulder were assessed compared to the contra lateral shoulder. The laxity of the metacarpophalangeal joint II was measured with a new computer controlled hyperextensometer and was compared with postoperative characteristic of the tissue strain.

Postoperatively 15 patients (88%) showed an excellent result according to the Rowe-Score, 1 good, and 1 bad. In two patients the operated shoulder dislocate again after a trauma in sports. They underwent a revision-surgery. Both patients with a voluntary shoulder instability dislocate again after 10 months respective two years. All patients showed typical results for their groups in the measurement of the laxity of the metacarpophalangeal joint II with the hyperextensometer. Two patients have to be divided in another group concerning their hyperextensometer results.

These results of this study are similar to the cases mentioned in literature. To make a prognostic statement concerning the postoperative results of the capsular shift and the intraoperative degree of shifting the capsule (patients with strong tissue strain → moderate capsular shift, patients with low tissue strain → strong capsular shift), we suggest to do a preoperative examination with computer controlled hyperextensometer to evaluate the degree of laxity.