A novel cadaveric model for anterior-inferior shoulder dislocation using forcible apprehension positioning.
A novel cadaveric model for anterior-inferior shoulder dislocation using forcible apprehension positioning is presented. This model simulates an in vivo mechanism and yields capsulolabral lesions. The scapulae of 14 cadaveric entire upper limbs (82 +/- 9 years, mean +/- standard deviation) were each rigidly fixed to a custom shoulder-testing device. A pneumatic system was used with pulleys and cables to simulate the rotator cuff and the deltoid muscles (anterior and middle portions). The glenohumeral joint was then positioned in the apprehension position of abduction, external rotation, and horizontal abduction. A 6-degree-of-freedom load cell (Assurance Technologies, Garner, North Carolina) measured the joint reaction force that was then resolved into three orthogonal components of compression force, anteriorly directed force, and superiorly directed force. With the use of a thrust bearing, the humerus was moved along a rail with a servomotor-controlled system at 50 mm/s that resulted in horizontal abduction. Force that developed passively in the pectoralis major muscle was recorded with an independent uniaxial load cell. Each of the glenohumeral joints dislocated anterior-inferior, six with avulsion of the capsulolabrum from the anterior-inferior glenoid bone and eight with capsulolabral stretching. Pectoralis major muscle force as well as the joint reaction force increased with horizontal abduction until dislocation. At dislocation, the magnitude of the pectoralis major muscle force, 609.6 N +/- 65.2 N was similar to the compression force, 569.6 N +/- 37.8 N. A cadaveric model yielded an anterior dislocation with a mechanism of forcible apprehension positioning when the appropriate shoulder muscles were simulated and a passive pectoralis major muscle was included. Capsulolabral lesions resulted, similar to those observed in vivo.