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Knee Surg Sports Traumatol Arthrosc (2011) 19:20802084 DOI 10.1007/s00167-011-1438-8
SHOULDER
SHART: shoulder hyperabduction radiological test
Franck Jouve Charles Schlur Shahnaz Klouche
Thomas Bauer Benoit Rousselin Philippe Hardy
Received: 25 November 2010 / Accepted: 1 February 2011 / Published online: 22 February 2011 Springer-Verlag 2011
AbstractPurpose To evaluate and quantify laxity of the inferior glenohumeral ligament (IGHL) in post-traumatic anterior instability of the shoulder with the shoulder hyperabduction radiological test (SHART) and correlate it with arthroscopic ndings.
Methods This prospective study included 21 patients undergoing arthroscopic stabilization for anteroinferior shoulder instability. The SHART test was performed as follows: a bilateral AP radiograph was performed in the supine position, and radiographs were compared. The shoulder was positioned in passive maximum abduction in neutral rotation, and neither general nor regional anesthesia was used. The angle between the axis of the humeral shaft and the line drawn between the lateral border of the scapular tubercle and the inferior edge of the glenoid fossa was measured. During arthroscopy, IGHL distension was classied into 4 stages according to the Detrisac classication. Extensive distension was considered to be the stages 3 and 4.
Results The correlation between the SHART test and Detrisac staging was found to be statistically signicant (P = 0.02). In the presence of a difference of more than 15 between the pathological and the contralateral shoulder on radiographs, the SHART test shows 87% of IGHL distension, Detrisac stages 3 and 4.
Conclusion We suggest that the SHART test should be added to conventional preoperative imaging tests for anterior instability.
Level of evidence Development of diagnostic criteria in a consecutive series of patients, Level II.
Keywords Inferior glenohumeral ligament Anterior
instability Arthroscopy Shoulder
Introduction
Knowledge of the physiopathology of post-traumatic anterior instability of the shoulder has improved since the basic lesion was rst described by Bankart [1] in 1923. Certain authors emphasize the role of the inferior glenohumeral ligament (IGHL) and have shown its loss of tensile properties in anterior shoulder instability [4, 9, 11, 14, 16, 1822]. Surgical planning to repair injured tissue requires preoperative evaluation of capsular tissue, with a special attention to the IGHL [10, 20].
Numerous authors have proposed clinical tests such as the sulcus and drawer sign to assess IGHL laxity [17]. Gagey and Gagey...