- Volume 7 Issue 2
DOI QR Code
Painful Jerk Test: A Predictor of Success in Nonoperative Treatment of Posteroinferior Instability of the Shoulder
통증성 Jerk 검사: 견관절 후하방 불안정성의 보전적 치료 결과의 예측
Kim Seung-Ho;Jeong Woong-Kyo;Park Jae-Chul;Park Jun-Sic;Oh Irvin
- Published : 2004.12.01
The purposes of this study were to evaluate the presence or absence of pain with the jerk test as a predictor of the success of nonoperative treatment for posteroinferior instability of the shoulder and to identify pathologic lesion responsible for the pain in the jerk test. Eighty-nine shoulders(81 patients), which had posteroinferior instability with positive posterior clunk in the jerk test, were nonoperatively treated. The patients were divided into two groups with respect to the presence of pain in the jerk test: painless jerk group(54 shoulders) and painful jerk group(35 shoulders). Response to the nonoperative treatment was evaluated after at least 6 months rehabilitation program. Patients who did not respond to the rehabilitation underwent arthroscopic examination to identify any pathologic lesion. The painful jerk group had higher failure rate with nonoperative treatment (p<0.001). In the painless jerk group, fifty shoulders (93%) responded to rehabilitation program after a mean of 4 months. Four shoulders(7%) were unresponsive to the rehabilitation. In the painful jerk group, five shoulders(16%) were successful with the rehabilitation while the other thirty shoulders(84%) failed. All 34 shoulders, which were unresponsive to the rehabilitation, had a variable degree of posteroinferior labral lesions. In conclusion, the jerk test is a hallmark for predicting the prognosis of nonoperative treatment in the posteroinferior instability. Shoulders with symptomatic posteroinferior instability and a painful jerk test have posteroinferior labral lesion.
Shoulder;Posteroinferior instability;Prognosis;Jerk test
- Antoniou J, Duckworth DT and Harryman DT 2nd: Capsulolabral augmentation for the the management of posteroinferior instability of the shoulder. J Bone Joint Surg, 82-A:1220-1230, 2000.
- Bigliani LU, Pollock RG, Mcllveen SJ, Endrizzi DP and Flatow EL: Shift of the posteroinferior aspect of the capsule for recurrent posterior glenohumeral instability. J Bone Joint Surg,77-A:1011-1020, 1995.
- Blasier RB, Soslowsky LJ, Malicky DM and Palmer ML: Posterior glenohumeral subluxation: active and passive stabilization in a biome-chanical model. J Bone Joint Surg, 79-A:433-440,1997.
- Boublik M and Silliman J: Shoulder injuries in the athlete. 1st ed, New York, Churchill Livingstone Inc: 9-22,1996.
- Burkhead WZ Jr and Rockwood CA Jr: Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg, 74-A:890-896, 1992.
- Cousins M and I P: Acute and postoperative pain. In: Wall PD, Melzack R eds: Textbook of pain. 4th ed. Edinburgh, Churchill Livingstone Inc: 447-491, 1999.
- Ellman H, Hanker G and Bayer M: Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg, 68-A: 1136-1144,1986.
- Fronek J, Warren RF and Bowen M: Posterior subluxation of the glenohumeral joint. J Bone Joint Surg, 71-A:205-216, 1989.
- Hawkins RJ, Koppert G and Johnston G: Recurrent posterior instability (subluxation) of the shoulder. J Bone Joint Surg, 66-A:169-174, 1984.
- Kim SH and Ha KI: Arthroscopic treatment of symptomatic shoulders with minimally displaced greater tuberosity fracture. Arthroscopy, 16:695-700,2000. https://doi.org/10.1053/jars.2000.9237
- Kim SH, Ha KI, Park JH, et al: Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder. J Bone Joint Surg, 85-A: 1479-1487,2003.
- Kim SH, Ha KI, Yoo JC and Noh KC: Kim's lesion: an incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy, 20:712-720, 2004. https://doi.org/10.1016/j.arthro.2004.06.012
- Kim SH, Kim HK, Sun JI, Park JS and Oh I: Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder. Am J Sports Med, 32:594-607, 2004. https://doi.org/10.1177/0363546503262170
- Matsen FA 3rd, Thomas SC and Rockwood CA Jr: The shoulder. 3rd ed, Philadelphia, P.A., W.B., Saunders: 655-794,2004.
- McIntyre LF, Caspari RB and Savoie FH 3rd: The arthroscopic treatment of multidirectional shoulder instability: two-year results of a multiple suture technique. Arthroscopy, 13:418-425, 1997. https://doi.org/10.1016/S0749-8063(97)90118-3
- Mclntyre LF, Caspari RB and Savoie FH 3rd: The arthroscopic treatment of posterior shoulder instability: two-year results of a multiple suture technique. Arthroscopy, 13:426-432, 1997. https://doi.org/10.1016/S0749-8063(97)90119-5
- Neer CS 2nd and Foster CR: Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg, 62-A:897-908, 1980.
- Norwood LA and Terry GC: Shoulder posterior subluxation. Am J Sports Med, 12:25-30, 1984. https://doi.org/10.1177/036354658401200104
- Pollock RG and Bigliani LU: Recurrent posterior shoulder instability. Diagnosis and treatment. Clin Orthop, 291:85-96, 1993.
- Richard RR, An KN, Bigliani LU, et al: A standarized method for the assessment of shoulder function. J Shoulder Elbow Surg, 3:347-352, 1994. https://doi.org/10.1016/S1058-2746(09)80019-0
- Rowe CR, Patel D and Southmayd WW: The Bankart procedure: a long-term end-result study. J Bone Joint Surg, 60-A:1-16, 1978.
- Scott J and Huskisson EC: Graphic representation of pain. Pain, 175-184, 1976.
- Tibone JE and Bradley JP: The treatment of posterior subluxation in athletes. Clin Orthop 291:124-137,1993.
- Wall PD: Inroduction to the fourth edition. In: Wall PD, Melzack R eds: Textbook of pain. 4th ed. Edinburgh, Churchill Livingstone Inc: 1-8, 1999.
- Wirth MA, Groh GI and Rockwood CA Jr: Capsulorrhaphy through an anterior approach for the treatment of atraumatic posterior glenohumeral instability with multidirectional laxity of the shoulder. J Bone Joint Surg, 80-A:1570-1578,1998.
- Wolf EM and Eakin CL: Arthroscopic capsular plication for posterior shoulder instability. Arthroscopy, 14:153-163, 1998. https://doi.org/10.1016/S0749-8063(98)70034-9