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Background Improved knowledge of normal shoulder girdle proprioception should benefit the treatment and rehabilitation of shoulder disorders. Whereas many of the available methods for assessing joint position sense (JPS) are costly and complex, Balke et al. have described a simple test. The primary objective of this study was to use this test to identify factors that influence shoulder-girdle JPS evaluation in healthy individuals. The secondary objective was to determine reference values based on the values obtained and on the factors associated with their variability. Hypothesis Age and dominant limb influence the results of shoulder girdle JPS evaluation, creating a need for reference values that take these factors in account. Patients and methods A single-centre prospective study of healthy volunteers was performed between September 2012 and January 2013. In each volunteer, shoulder repositioning accuracy was assessed bilaterally as described by Balke et al. A line was drawn on the floor parallel to and 1 metre away from a wall. A target on the wall showed marks corresponding to three angles of arm elevation: 55°, 90°, and 125°. The volunteer was asked to raise the arm to the three positions, in abduction and in flexion, while memorising the joint positions, then to replicate the same positions with the eyes closed. The absolute differences between the replicated positions and the reference positions, designated angle deviations, were measured in degrees. Age, sex, and dominant upper limb were recorded. Results The 88 shoulders of 44 healthy volunteers were studied. No significant difference was found between males and females (p > 0.05). The only significant difference between sides was better replication by the dominant arm of flexion at 55° (p = 0.03). By univariate analysis, age was the only factor significantly associated with repositioning errors (p = 0.003); neither dominant limb nor sex were significant (p = 0.29 and p = 0.59, respectively). In flexion, the angle deviation increased significantly with movement amplitude. The measurements were used to create a chart of expected angle deviations in healthy individuals according to age and to plane and amplitude of movement. Discussion The test described by Balke et al. is simple and feasible in everyday practice. Age, dominance, and plane of movement should be considered when evaluating abnormal shoulders. Further studies in larger numbers of individuals are needed to better define normal angle deviations related to these factors. Level of evidence IV.

SummaryIn patients for whom function is a priority, anatomic reduction and stable fixation are prerequisites for good outcomes. Several therapeutic options exist, including orthopedic treatment and internal fixation with pins (intra- and extrafocal), external fixation which may or may not bridge the wrist, and different internal fixation techniques with dorsal or palmar plates using or not, locking screws. Arthroscopy may be necessary in case of articular fracture. In the presence of significant metaphyseal bone defects, filling of the comminution with phosphocalcic cements provides better graft stability. The level of evidence is too low to allow recommending one type of fixation for one type of fracture; and different fixation options to achieve stable reduction exist, each with its own specific complications. With the new generations of palmar plate, secondary displacement is becoming a thing of the past.

IntroductionThe recurrence rate after primary shoulder dislocation in young subjects with high functional demand is close to 75%. The present study assessed the interest of emergency arthroscopic stabilization in this specific population.Material and methodsA non-randomized prospective study included 31 athletes under 30years of age with primary anterior shoulder dislocation. Fifteen were offered emergency stabilization; after informed consent, 14 were enrolled in the “emergency stabilization” group. This was compared to a group matched for age, sport and lesion, managed 1year previously by “non-operative” treatment (n=17), divided into 2 subgroups: “immobilization” and “secondary stabilization”. Continuous prospective assessment of recurrence, return to sport and function (QuickDASH, QDsport, Duplay and Rowe scores) enabled comparison between the 3 groups.ResultsMean follow-up was 19months for the “emergency stabilization” group and 25months for the “non-operative” group. There were no failures in the “emergency stabilization” group, compared to a 77% rate in the “non-operative” group with onset at a mean 7.5months and a mean 2.6episodes of recurrence. Seven (54%) of the failures of non-operative treatment required secondary stabilization. Ninety-three percent of the “emergency stabilization” group, 44% of the “immobilization” group and 71% of the “secondary stabilization” group resumed sport at least at their pre-dislocation level. Mean Quick DASH was 1.46 in the “emergency stabilization” group, versus 15.28 the “immobilization” group (P