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Shoulder Instability. Experimental Model and Related Anatomy

Thursday, 8 September, 2005 - 10:00
Campus: Brussels Health Campus
Faculty: Medicine and Pharmacy
Nicole Pouliart
phd defence

Anterior shoulder instability is increasing in incidence
because the general population is becoming more
and more active. Many factors influencing the
occurrence of a chronic problem have been
identified and many surgical solutions proposed.
Nevertheless, the recurrence rate after treatment
remains relatively high. We believe that
experimental investigations leading to improved
anatomic and biomechanical knowledge are an
important pathway for developing better treatment
In the first part of this thesis, we tried to develop and
validate an experimental model for anterior
shoulder instability. In cadaver shoulders with an
intact muscular envelope, a series of sequential
cutting experiments was done. Lesions of the
capsuloligamentous complex were created at
different locations of the joint and repeated in the
presence of rotator cuff lesions. The consequences
for stability were evaluated with five tests. An almost
linear relationship between the extent of the
created damage and the ensuing degree of
instability was found. The model, however, was
confronted with a few deviations from this
covariability. Because we had the feeling that
these could be explained by anatomic factors and
because an exhaustive literature review failed to
explain the aberrations, we initiated the second
part of thesis. Here, a series of anatomic and
anatomo-clinical studies led to an expansion of the
present anatomic knowledge. In the course of
these dissections, a new ligament – the
posterosuperior glenohumeral ligament - was
discovered as well as an expanded role for the
tendon of the latissimus dorsi.