The effect of degenerative arthritis and prosthetic arthroplasty on shoulder proprioception

doi:10.1016/j.jse.2004.07.009

Journal of Shoulder and Elbow Surgery

Volume 14, Issue 4, July–August 2005, Pages 345-348

https://doi.org/10.1016/j.jse.2004.07.009 Get rights and content

The effect of glenohumeral arthritis and subsequent total shoulder arthroplasty (TSA) on shoulder proprioception has not been evaluated previously. A prospective analysis of 20 consecutive patients with unilateral advanced glenohumeral arthritis who underwent TSA was undertaken. Shoulder proprioception testing for passive position sense and detection of motion was performed 1 week before surgery and 6 months after TSA. The presence of glenohumeral arthritis had a significant effect on position sense for all 3 planes tested (flexion, abduction, and external rotation). There were significant differences (P < .05) compared with the uninvolved shoulder and with a group of 20 age- and gender-matched subjects without a history of shoulder problems. Six months after TSA, position sense was significantly improved (P < .05) and was not significantly different from that in the contralateral shoulder or the comparison group. Detection of motion was also significantly worse in the arthritic group compared with that in the uninvolved contralateral side (P < .05). Six months after TSA, the sensitivity to detection of motion improved (P < .01) and was not significantly different than that in the uninvolved contralateral shoulder. In addition, the postoperative values for the involved shoulder were not significantly different than those in the age- and gender-matched comparison group. This study demonstrates a significant decrease in proprioceptive function in patients with advanced glenohumeral arthritis. After TSA, there was a marked improvement in proprioception.

Section snippets

Patients and methods

Twenty consecutive patients with unilateral advanced glenohumeral arthritis underwent proprioception testing consisting of evaluation for passive position sense and detection of motion by use of a standardized protocol. Testing was performed within 1 week before and 6 months after TSR for unilateral glenohumeral osteoarthritis. The mean age was 69.8 years (range, 57–83 years). The dominant side was involved in 11 patients. There were 12 men and 8 women.

Twenty age-matched and gender-matched

Results

Osteoarthritis had a significant effect on position sense for all 3 planes tested (Table I). The uninvolved shoulder was able to reproduce a set angle of flexion, abduction, and external rotation within 5.2°, 5.4°, and 5.8°, respectively. The osteoarthritic shoulders were unable to reproduce the test angle as closely, averaging 7.1°, 7.3°, and 8.2°, respectively, in the 3 planes tested (P < .05). Six months after successful total shoulder arthroplasty, there was significant improvement (P <

Discussion

Although no previous work has been reported concerning proprioception in glenohumeral arthritis or TSR, studies have examined the effect of osteoarthritis and total joint replacement on proprioception of the hip⁷ and, more recently, of the knee.3, 16 Grigg et al⁷ studied proprioception in 16 total hip replacement patients preoperatively and postoperatively. They concluded that, because joint position sense persisted postoperatively after total capsulectomy and replacement of articular surfaces,

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Relationship between pain and proprioception among individuals with rotator cuff-related shoulder pain
2024, Journal of Hand Therapy
Individuals with rotator cuff-related shoulder pain (RCRSP) have altered proprioception. The relationship between shoulder pain and proprioception is not well understood.
This study aimed to investigate the relationship between shoulder pain and proprioception.
This was a cross-sectional comparative study.
Twenty-two participants with RCRSP (mean age 27.6 $\pm$ 4.8 years) and 22 matched pain-free participants (23.4 $\pm$ 2.5 years) performed two upper limb active joint position sense tests: (1) the Upper Limb Proprioception Reaching Test (PRO-Reach; reaching toward seven targets) in centimeters and (2) Biodex System at 90% of maximum internal rotation in degrees. Participants performed three memorization and three reproduction trials blindfolded. The proprioception error (PE) is the difference between the memorized and estimation trials. Pain levels were captured pre- and post-evaluation (11-point Likert Numerical Pain Rating Scale). Relationships between PE and pain were investigated using independent t-tests and Spearman rank correlations.
Overall, 22.7% RCRSP participants indicated an increase in pain following the PRO-Reach (X̅ increase of 1.4 ± 1.5 points), while 59% did so with the Biodex (X̅ increase of 2.3 ± 1.8 points), reflecting a clinically important increase in pain. Weak-to-moderate correlations between pain and PEs were found with the Biodex (r = 0.39-0.53) and weak correlations with the PRO-Reach (r = −0.26 to 0.38). Concerning PEs, no significant differences were found between groups with the Biodex (p = 0.32, effect size d = −0.31 [−0.90 to 0.29]). The RCRSP participants demonstrated lower PEs with the PRO-Reach in elevation compared to pain-free participants (global X̅ = 4.6 $\pm$ 1.2 cm vs 5.5 $\pm$ 1.5 cm; superior 3.8 $\pm$ 2.1 cm vs 5.7 $\pm$ 2.9 cm; superior-lateral nondominant targets 4.3 $\pm$ 2.2 cm vs 6.1 $\pm$ 2.8 cm; p = 0.02-0.05, effect size d = 0.72-0.74 [0.12-1.3]).
Individuals with RCRSP demonstrated better upper limb proprioception in elevation, suggesting a change to interoception (sensory reweighting) in the presence of pain.
Measuring upper limb active joint position sense: Introducing a new clinical tool - The Upper Limb Proprioception Reaching Test
2023, Musculoskeletal Science and Practice
Proprioception is our sense of body awareness, including the sub-category of active joint position sense (AJPS). AJPS is fundamental to joint stability and movement coordination. Despite its importance, there remain few confident ways to measure upper limb AJPS in a clinic.
To assess a new AJPS clinical tool, the Upper Limb Proprioception Reaching Test (PRO-Reach; seven targets), for discriminant validity, intra-rater and absolute reliability.
Cross-sectional measurement study.
Seventy-five healthy participants took part in a single session with 2 consecutive evaluations (E1 and E2) (within-day reliability). Twenty participants were randomly selected to perform a dominant shoulder fatigue protocol (discriminant validity), whereafter a third evaluation was repeated (E3). The PRO-Reach was analyzed with paired t tests (discriminant validity), intra-class correlation coefficients (ICCs) and minimal detectable change [MDC]) (intra-rater: within-day and between-trial relative and absolute reliability).
The PRO-Reach supports moderate (mostly superior targets) to excellent (mostly inferior targets) reliability. Between-trial ICCs (T1/T2/T3) varied between 0.72 and 0.90, and within-day (E1/E2) ICCs between 0.45 and 0.72, with associated MDC₉₅ values (3.9–5.0 cm). The overall scores (seven targets) supported the strongest within-day reliability (ICC = 0.77). The inferior targets demonstrated the highest between-trial and within-day reliability (ICCs = 0.90 and 0.72). A fatigue effect was found with the superior and superior-lateral targets (P < .05).
The inferior targets and overall scores demonstrate the strongest reliability. The use of the PRO-Reach tool may be suitable for clinical use upon further psychometric testing amongst pathological populations.
Level III cross-sectional study.
Long-term results of the uncemented resurfacing shoulder hemiarthroplasty (Global Conservative Anatomic Prosthesis)
2022, Journal of Shoulder and Elbow Surgery
Treatment with uncemented resurfacing shoulder hemiarthroplasty has proved to be viable for patients with end-stage osteoarthritis at short- and mid-term follow-up. This study was essential to determine whether those outcomes will endure. This study presents the long-term results of the Global Conservative Anatomic Prosthesis (CAP) uncemented resurfacing shoulder hemiarthroplasty (DePuy Synthes, Warsaw, IN, USA).
All patients with a diagnosis of glenohumeral osteoarthritis and an intact and clinically sufficient rotator cuff who underwent uncemented resurfacing shoulder hemiarthroplasty between 2007 and 2009 were included. The data of all patients who completed the 10-year follow-up assessments were used for analysis. The visual analog scale pain score, Dutch version of the Simple Shoulder Test score, Constant score, Short Form 12 scores, and physical examination findings were evaluated preoperatively and postoperatively on an annual basis. All complications and revisions were documented. Radiographs were evaluated for loosening, luxation or subluxation, migration, and glenoid erosion.
Of 48 shoulders, 23 (48%, 18 women and 5 men) were available for the 10-year follow-up assessments and their data were used for analysis. The main reasons for dropout were revision (27%) and death (10%). The mean follow-up period of the remaining patients was 10.9 years (range, 9-13 years). The visual analog scale pain score (from 6.5 ± 2.1 to 0.7 ± 1.6, P < .001), Simple Shoulder Test (Dutch version) score (from 22% ± 22% to 79% ± 22%, P < .001), Constant score (from 40 ± 29 to 70 ± 8, P < .001), and Short Form 12 physical score (from 36 ± 7 to 41 ± 12, P = .001) improved significantly compared with preoperative scores. Revision surgery was performed in 13 of the initial 48 shoulders (27%). Most revisions were seen within 7 years postoperatively.
Two revisions have been performed in the mid-term to long term because of increased functional outcome scores and the absence of signs of loosening. Nevertheless, the high overall revision rate of 27% between short- and long-term follow-up reflects the need to limit the use of uncemented resurfacing shoulder hemiarthroplasty for the treatment of glenohumeral osteoarthritis.
Shoulder Arthritis
2018, Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation
How does reverse shoulder replacement change proprioception in patients with cuff tear arthropathy? A prospective optical 3D motion analysis study
2017, Journal of Orthopaedics
Citation Excerpt :
Studies analyzing the evolution of the proprioception after shoulder arthroplasty are rare. Cuomo et al. 12 analyzed the proprioception for total shoulder arthroplasty, Kasten et al. 13 for different shoulder implants, and Maier et al. 14 for TSA and hemiarthroplasty. Cuomo et al. examined their patients one week before and six months after surgery.
Reverse total shoulder arthroplasty (RSA) can improve function in cuff tear arthropathy (CTA) shoulders, but limited data are available on the effect of RSA on proprioception. The purpose of this study was the evaluation of the proprioception after RSA.
This study included fifteen consecutive patients (n = 15) who received an RSA. We measured an active angle reproduction (AAR) by a novel 3D motion analysis using the Heidelberg upper extremity model (HUX).
The overall proprioception didn’t change significantly from 6.2° preoperatively to 6.2° postoperatively.
We conclude that, the overall proprioception remained the same or deteriorated for different movements.
Proprioceptive deficit after total elbow arthroplasty: an observational study
2017, Journal of Shoulder and Elbow Surgery
During total elbow arthroplasty (TEA), most of the joint capsule is removed, including many mechanoreceptors important for proprioception, which potentially limits the patient's postoperative functional recovery. We quantified proprioceptive loss by measuring the threshold to detection of passive motion (TTDPM) in patients after unilateral TEA compared with the contralateral side.
A continuous passive motion device moving the elbow at 0.5°/s was used to evaluate TTDPM in 8 patients (mean ± standard deviation age, 69.1 ± 9.93 years) at least 1 year after unilateral semiconstricted linked TEA for a range of diagnoses. Elbow function after TEA was assessed using the Mayo Elbow Performance Scale.
Postsurgical Mayo scores revealed 4 excellent results, 2 good, and 2 poor. The TTDPM in the elbows undergoing arthroplasty was still significantly higher compared with the contralateral elbow at 4.2° (15.6 ± 6.9 seconds vs. 7.2 ± 2.6 seconds; D = 3.23, P = .01) equivalent to 8.4 seconds.
Patients who have had severe joint disease requiring semiconstrained TEA have long-term proprioception deficits. A more conservative technique that maximally preserves insertions and soft tissues, might minimize upper limb proprioceptive deficit.

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Original articleThe effect of degenerative arthritis and prosthetic arthroplasty on shoulder proprioception

Section snippets

Patients and methods

Results

Discussion

Arthroscopy

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Shoulder proprioceptiona comparison between the shoulder joint in healthy and surgically repaired shoulders

Arch Orthop Trauma Surg

Functional performance of the knee after intra-articular anesthesia

Am J Sports Med

Joint proprioception in normal, osteoarthritic, and replaced knees

J Bone Joint Surg Br

Shoulder proprioception. Effect of joint laxity, joint position and direction of motion

Orthop Rev

Original article
The effect of degenerative arthritis and prosthetic arthroplasty on shoulder proprioception