Laxity of the normal glenohumeral joint: A quantitative in vivo assessment

It is critical that surgeons comprehend the normal laxity of the glenohumeral joint (1) to assist them in diagnosing conditions of clinical instability and (2) to help define a therapeutic end point for the management of shoulders with excessive stiffness. In clinical practice this joint laxity is judged by standard manual tests. We report a quantitative study of the clinical in vivo laxity of the normal shoulders of eight male volunteers. To our knowledge this is the first time that the laxity revealed on standard manual clinical tests has been quantified in vivo. The relative motions of the humerus and scapula were determined with an electromagnetic spatial tracker. This device was pinned percutaneously to the humerus and scapula of each of eight normal male volunteers of ages 25 to 45 years. An experienced shoulder surgeon carried out standard manual clinical tests of glenohumeral laxity while the resulting displacements of the humeral head relative to the glenoid were measured. Spatial tracker data indicated that for each of the different tests, the positions of the glenohumeral and scapulothoracic joints were reproducible for a given subject and among subjects. Substantial glenohumeral translations were measured during those manual laxity tests in which the joint was not at the limit of its range of motion: the drawer test, 7.8 ± 4.0 mm anterior and 7.9 ± 5.6 mm posterior; the sulcus test, 10.6 ± 3.8 mm inferior; and the push-pull test, 9.0 ± 6.3 mm posterior. A minimal translation of 0.3 ± 2.5 mm was measured during the fulcrum test in which the glenohumeral ligaments were under tension. The observed translations were reproducible in each subject's shoulder. On the other hand, there was marked variability among subjects. Even though manual laxity tests are a standard part of the clinical evaluation of the shoulder, our finding that normal glenohumeral joints show substantial translations indicates that translation on clinical manual laxity testing is not in and of itself a sufficient indication for surgical stabilization.