DOI = 10.

1177/0363546503261719

Proprioception of the Shoulder Joint

After Surgical Repair for Instability
A Long-term Follow-up Study
Wolfgang Pötzl,*† MD, Lothar Thorwesten,‡ PhD, Christian Götze,† MD,
† †
Stefan Garmann, MD, and Jörn Steinbeck, MD
†
From the Department of Orthopaedics, University Hospital Münster, Münster, Germany,
‡
and the Department of Sports Medicine, University Hospital Münster, Münster, Germany

Background: Proprioceptive capabilities play an important role in stability of the shoulder joint.
Hypothesis: Decreased proprioceptive capabilities can improve by surgical repair of shoulder instability.
Study Design: Prospective long-term study.
Methods: The proprioceptive capabilities of 14 patients with recurrent anterior shoulder instability were examined preoperative
and with a minimum follow-up of 5 years postoperative using the angle reproduction test. The patients’ data were compared to
a healthy control group.
Results: The joint position sense improved significantly in abduction, flexion, and rotation (P < .05). The preoperative difference
from the target joint position was 9.3° (SD, 4.6°) for the summarized positions in abduction, 9.1° (SD, 4.5°) in flexion, and 10.1°
(SD, 5.1°) in rotation. Postoperatively, it improved to 5.6° (SD, 2.9°) in abduction, 5.6° (SD, 2.7°) in flexion, and 5.0° (SD, 1.8°) in
rotation. The joint position sense of the uninvolved contralateral shoulder improved too.
Conclusions: Five years after surgical repair for shoulder instability, the joint position sense improved significantly, to a level of
normal, healthy shoulders.
Keywords: proprioception; shoulder instability; Bankart repair; angle reproduction test

In addition to mechanical restraining function, the capsu-
loligamentous complex of the shoulder provides the neuro-
histological basis for a reflex arc to the shoulder muscles
on spinal and/or cortical level.8,9,19,23,28,29
Proprioception is a specialized variation of the sensory
modality and includes different qualities, such as active
and passive joint position sense, kinaesthesia, movement
replication, sensation of resistance, and appreciation of
joint velocity. Joint proprioception appears to play an
important role in stabilizing the glenohumeral joint by
providing information from the joint capsule and liga-
ments to the central nervous system for the management
of muscular activity.4 Recently, different aspects of propri-
oception of the shoulder joint have been evaluated in
anatomical, histological, and neurophysiological stud-
ies.4,9,13,23,24 Only a few clinical studies regarding proprio-
ception of the shoulder are published in the litera-
1,12,16,17
ture. We are not aware of any published study that
investigates proprioceptive capabilities before and after
surgical repair for shoulder instability in the same patient
group.
The joint position sense is 1 proprioceptive quality and
represents the angle of joints and therefore the position of
the joints to each other. The active angle reproduction test
is a clinical test that allows the assessment of the patient’s
capability to reproduce a given joint position using the
joint position sense.10
The purpose of this study was to investigate the propri-
oception of the shoulder joint using the angle reproduction
test in patients with glenohumeral instability before sur-
gical repair and with a minimum follow-up of 5 years after
the stabilizing operation.

* Address correspondence to Wolfgang Pötzl, Department of

Orthopaedics, University Hospital Münster, Albert Schweitzer Str. 33,
48149 Münster, Germany (e-mail: poetzl@uni-muenster.de).
The American Journal of Sports Medicine, Vol. 32, No. 2
DOI: 10.1177/0363546503261719
© 2004 American Orthopaedic Society for Sports Medicine
PATIENTS AND METHODS
The inclusion criteria were the following: recurrent anteri-
or shoulder dislocation, preoperative proprioception exam-
ination using the angle reproduction test, open or arthro-

425
426 Pötzl et al
scopic reconstruction, and at a minimum follow-up of 5
years, postoperative repetition of the angle reproduction
test. Patients with any prior surgery on the shoulder and
any neurologic pathology were excluded from the study.
Fourteen consecutive patients met the inclusion criteria.
The average age of the 7 women and 7 men was 28 years
(range, 16-52 years) at the time of operation and 36 years
(range, 22-58 years) at the time of latest follow-up. The
dominant shoulder was involved in 13 of the 14 patients
(Table 5).
A healthy control group, consisting of 15 volunteers with
no history or clinical evidence of any shoulder disease, was
examined at the time of the preoperative proprioception
testing. The mean age of the control group was 28 years
(range, 19-33 years).
Proprioception Testing
After a standardized warm-up program, the appropriate
joint positions were adjusted by the patients under control
of the examiner, using a water level and a goniometer.
Then, the patients had to actively reproduce 9 standard-
ized joint positions. To avoid influence of skin perception,
measurements were performed stripped to the waist in
males and with a bikini top in females. To reduce external
influence, the measurements were taken in a closed room
under standardized conditions with a temperature in the
room of 21°C and no external visual or acoustic influences.
All tests were performed on the dominant as well as on the
nondominant side with and without visual control. At first,
all joint positions were tested under visual control; then,
the subjects were blindfolded to exclude visual control. The
patients had to reproduce 36 joint positions each starting
from the neutral (0) position. The following joint positions
were tested:
1. 50°, 100°, and 150° abduction in the scapular plane;
2. 50°, 100°, and 150° flexion; and
3. 45° external rotation, 0° rotation, and 45° internal
rotation in 90° abduction.
The difference from the target joint position was averaged
for the 3 positions in abduction, the 3 positions in flexion,
and the 3 positions in rotation.
Testing Device
Angle reproduction tests were performed using a contact-
free motion analyzing system (Kinemetrix 3.0, Orthodata,
Germany) and low-weight passive reflective markers (size,
2 cm2; weight, 2 g). The markers were fixed at the elbow
joint and the wrist in a distance of approximately 30 cm
and illuminated by pulsed infrared light. A third marker
was fixed at the shoulder. During testing of abduction and
flexion, the patients were instructed to keep the elbow at
0° of flexion. During testing of rotation, the patients had to
keep the elbow at 90° of flexion. The correct elbow flexion
was controlled by the examiner and via the reflective
marker at the shoulder. This way, the shoulder position
The American Journal of Sports Medicine
could be measured with the markers at the elbow and the
wrist. The motion of the reflecting markers was recorded
by a change-coupled device (CCD) camera under normal
light conditions and transduced via an interface to a PC,
using a measuring frequency of 50 Hz. The accuracy
depends on the distance between the CCD camera and the
markers, which was 5 m, and on the marker size, which
was 2 cm. The resolution of the camera was 512 × 312 pix-
els. Under these conditions, the total maximum error was
≤ 0.98%, consisting of an error regarding angle calculation,
the error due to the skin movement, and the joint position
adjustment error by the examiner.
Operative Technique
Ten patients underwent an open Bankart repair using
suture anchors, and 4 underwent an arthroscopic repair
using the transglenoid suture technique as described by
Morgan et al.2,18 The detailed technique of the open and
the arthroscopic stabilization has been described previous-
ly.25 An open Bankart repair was performed if the detached
labral-ligamentous complex was thin and frayed and of
poor quality. Due to capsular hyperlaxity in 4 patients with
a positive sulcus sign, an additional medial-based capsular
shift was performed in combination with the open Bankart
procedure.2 Postoperatively, the patients were immobilized
in a sling for 3 weeks. Full range of motion was allowed 6
weeks postoperatively; strengthening exercises were start-
ed 12 weeks postoperatively.
The preoperative angle reproduction test was performed
in all patients within 1 week prior to the operation by an
independent examiner. After an average follow-up of 5.9
years (range, 5.5-7.5 years), the patients returned for physi-
cal examination and repetition of the angle reproduction
test. The follow-up (angle reproduction) test was performed
by the same independent examiner under identical condi-
tions as preoperatively. The constant score, the Rowe score,
and the American Shoulder and Elbow Surgeons (ASES)
score were used for assessment of the clinical results at the
time of the postoperative angle reproduction test.5,20,22
Statistical Analysis
The SPSS 10.0 software package (SPSS Science, Chicago,
Illinois) was used for statistical analysis. The Kolmogorov-
Smirnov test was used to prove normal distribution.
Regarding the prerequisites, the Student t test for paired
samples or Wilcoxon test was applied as well. The t test for
unpaired samples was used for calculating group differ-
ences. Furthermore, Pearson’s correlation coefficient was
calculated to identify interrelations. The statistical level of
significance was set at P < .05.
RESULTS
After an average follow-up of 5.9 years, the patients’ capa-
bility to reproduce a given joint position in the operated
shoulder without visual control improved significantly in
flexion, abduction, and rotation. The average preoperative
Vol. 32, No. 2, 2004 Proprioception of the Shoulder Joint 427

TABLE 1
16 ˚
Results of Involved Shoulders
14
12 * * * Abduction Flexion Rotation

10
Preoperative
8 Postopeartive
6
4 age Rowe score of the patients with stable shoulders was
2 85.9 (SD, 15.7). The average constant score was 90.6 (SD,
0 redislocations. The average ASES score was 74.6 (SD, 22.9)
Abduction Flexion Rotation
Figure 1. Preoperative and postoperative proprioceptive
capabilities of involved shoulders. Mean difference from the
target joint position. Asterisk indicates significant difference
between preoperative and postoperative.
difference from the target joint position was 9.3° (SD, 4.6°)
for the 3 positions in abduction, 9.1° (SD, 4.5°) in flexion,
and 10.1° (SD, 5.1°) in rotation. As the joint position sense
improved significantly in all planes postoperatively, the
average difference decreased. It was 5.6° (SD, 2.9°) in
abduction, 5.6° (SD, 2.7°) in flexion, and 5.0° (SD, 1.8°) in
rotation (Tables 1 and 5; Figure 1).
Mean values of the postoperative angle reproduction
tests were compared again to the original data of the
healthy control group. Preoperatively, the results of the
patients were worse compared to the healthy control
group, but only in rotation at a statistically significant
level. Five years postoperative, the patients’ data were bet-
ter than the data of the control group, but again only in
rotation at a statistically significant level (Table 2).
The joint position sense of the uninvolved contralateral
shoulder improved as well. The preoperative difference
from the target joint position in the uninvolved shoulder
was 7.7° (SD, 3.8°) in abduction, 7.2° (SD, 2.9°) in flexion,
and 6.8° (SD, 3.2°) in rotation. The follow-up angle repro-
duction test of the uninvolved shoulders showed a differ-
ence of 4.5° (SD, 2.1°) in abduction, 5.1° (SD, 2.4°) in flexion,
and 3.4° (SD, 1.3°) in rotation. This difference was signifi-
cant for abduction and rotation (Table 3 and Figure 2).
Three of the 14 patients had redislocations during fol-
low-up. The average Rowe score of the 14 patients was 75.7
(SD, 24.7) at the time of latest follow-up. When excluding
the 3 patients with postoperative redislocations, the aver-
Preoperative 9.3° (SD, 4.6°) 9.1° (SD, 4.5°) 10.1° (SD, 5.1°)
Postoperative 5.6° (SD, 2.9°) 5.6° (SD, 2.7°) 5.0° (SD, 1.8°)
P value <.05 <.05 <.01
9.3) in all patients and 92.8 (SD, 7.8) in patients without
in all patients and 79.1 (SD, 20.1) in the patients with sta-
ble shoulders.
The results of the follow-up angle reproduction test cor-
relate for abduction and flexion with the Rowe score, con-
stant score, and ASES score. The strongest correlation was
found between abduction and the constant score and
between flexion and the Rowe score. For rotation, we found
no correlation with the clinical scores. The operative pro-
cedure (open versus arthroscopic) did not correlate with
the results of the angle reproduction test. The postopera-
tive stability (no redislocations versus redislocations) cor-
related only with the joint position sense for flexion
(Table 4).
DISCUSSION
Proprioception is considered to play an important role in
the stabilization and coordination of the shoulder joint.
Tibone et al demonstrated an afferent electrical pathway
originating in the capsuloligamentous complex of the
shoulder to the central nervous system using somatosen-
sory cortical evoked potentials.26 Free nerve endings and
several mechanoreceptors as Pacinian corpuscles, Ruffini
receptors, and Golgi endings have been found to be the ori-
gin of proprioceptive qualities.8,21,24,27 Several studies on
the ankle6,7 and knee joint3,14,15 showed a significant
decrease of proprioception after ligament injury and with
instability of these joints.
The present study investigates proprioceptive capabili-
ties before and after surgical repair for shoulder instabili-
ty in the same patient group with a long-term follow-up.
Active joint position sense was tested using a contact-free
motion analyzing system. The active joint position sense
was tested in this study because we think that an active

TABLE 2
Preoperative and Postoperative Comparison of the Patients to the Control Group

Abduction Flexion Rotation

Preoperative Patients 9.3° (SD, 4.6°) 9.1° (SD, 4.5°) 10.1° (SD, 5.1°)
Control 7.4° (SD, 4.0°) 7.3° (SD, 3.8°) 6.8° (SD, 2.5°)
P value .19 .21 <.05
Postoperative Patients 5.6° (SD, 2.9°) 5.6° (SD, 2.7°) 5.0° (SD, 1.8°)
Control 7.4° (SD, 4.0°) 7.3° (SD, 3.8°) 6.8° (SD, 2.5°)
P value .15 .14 <.05
428 Pötzl et al The American Journal of Sports Medicine

TABLE 3 TABLE 4
Results of Uninvolved, Contralateral Shoulders Correlation Between Proprioceptive Results and Clinical
Scores, Operative Procedure, and Postoperative Stability
Abduction Flexion Rotation
Operative
Preoperative 7.7° (SD, 3.8°) 7.2° (SD, 2.9°) 6.8° (SD, 3.2°) Rowe Constant ASES Procedure Stability
Postoperative 4.5° (SD, 2.1°) 5.1° (SD, 2.4°) 3.4° (SD, 1.3°)
P value <.05 .055 <.01 Abduction –0.511 –0.662 –0.532 –0.185 –0.444
Flexion –0.775 –0.568 –0.54 –0.327 –0.69
Rotation –0.23 –0.202 –0.059 –0.245 –0.213

Similar results have been published by Blasier et al and

14 ˚ Lephart et al.4,16 At least 5 years after surgical repair, a
12 significant improvement of joint position sense was found
in the operated shoulders. One possible explanation of the
10 long-term improvement of proprioceptive capabilities is
8
* Preoperative
the retensioning of the capsuloligamentous structures

6
* Postopeartive after surgical stabilization.
Only a few clinical studies regarding proprioception
of the shoulder are published in the literature.1,4,12,16,17
4 Lephart et al reported deficits in proprioception in unsta-
2 ble shoulders. He used a proprioception testing device to
assess the threshold to detection of passive motion, repre-
0 senting the joint motion sense, and the reproduction of
Abduction Flexion Rotation passive positioning, representing the joint position sense.
In a patient group that had undergone surgical reconstruc-
Figure 2. Preoperative and postoperative proprioceptive tion for shoulder instability, he found the deficits in pro-
capabilities of uninvolved, contralateral shoulders. Mean dif- prioception to be normalized.15 Machner et al demonstrated
ference from the target joint position. Asterisk indicates sig- similar results testing the joint motion sense. He compared
nificant difference between preoperative and postoperative. patients with unstable shoulders to patients that have under-
gone arthroscopic stabilization and found an improvement
test system is more reliable in a clinical situation than a of proprioceptive deficits.17 Aydin et al compared the joint
passive test setting. The results of the preoperative propri- position sense of healthy subjects to patients after surgical
oception tests have been published previously and are repair for shoulder instability using an isokinetic dynamo-
comparable to the results published in literature.4,12,16 meter. He found neither an influence of hand dominance
Decreased proprioceptive capabilites in unstable shoulders nor significant differences between surgically repaired
were ascertained compared to a healthy control group. shoulders and uninvolved contralateral shoulders.1

TABLE 5
Clinical Data and Results of the Preoperative and Postoperative Angle Reproduction Testa

Patient Preoperative Preoperative

Number Age Gender Sport Diagnosis Dislocations Hyperlaxity Operative Procedure

1 25 Male 0 Traumatic Yes No Arthroscopic

2 28 Male 0 Traumatic Yes No Open Bankart
3 29 Male 1 Traumatic Yes No Open Bankart
4 51 Female 1 Traumatic Yes No Open Bankart
5 34 Female 1 Traumatic Yes No Arthroscopic
6 52 Male 0 Traumatic Yes No Arthroscopic
7 31 Female 1 Traumatic Yes No Open Bankart
8 27 Male 1 Traumatic Yes No Arthroscopic
9 23 Male 1 Traumatic Yes No Open Bankart
10 19 Male 0 Traumatic Yes No Open Bankart
11 16 Female 0 Nontraumatic Yes Yes Open Bankart + Shift
12 31 Female 0 Nontraumatic Yes Yes Open Bankart + Shift
13 19 Female 0 Nontraumatic Yes Yes Open Bankart + Shift
14 16 Female 0 Nontraumatic Yes Yes Open Bankart + Shift
a
Sport: 0, sport activities only occasionally at a recreational level; 1, sport activities regularly at a recreational level. Results of angle
reproduction test are cited as mean difference from the target joint position.
Vol. 32, No. 2, 2004 Proprioception of the Shoulder Joint 429

Interestingly, the joint position sense of the uninvolved
contralateral shoulder was also significantly worse in the
patients preoperatively. The uninvolved contalateral
shoulder improved postoperatively as well. This result is in
contrast to Lephart et al. He reported a normal joint posi-
tion sense of the uninvolved contralateral shoulder.16
Proprioceptive deficits of an uninvolved contralateral joint
have also been published in ACL-deficient knees.11 The
explanation of this phenomenon is that the joint position
sense is regulated on a central level also, and the injury of
one side can influence the proprioceptive capability of the
uninvolved contralateral side as well.
According to clinical scoring systems, a correlation
between clinical scores and joint position sense was found
in abduction and flexion but not in rotation. We do not
know yet why the joint position sense in rotation does not
correlate with the clinical scores. One possible explanation
is that the tasks of the clinical scores are not as dependent
on rotation in 90° abduction as on abduction and flexion
without rotation.
One weak point of the present study is the low number
of patients. To get more statistical power especially testing
the correlation between proprioceptive and clinical results,
it would be useful to examine a larger group of patients.
On the other hand, with an average of 5.9 years, the follow-
up is long enough to draw conclusions on the long-term
development of proprioceptive capabilities after surgical
repair for shoulder instability. The second weak point of
the study is that the healthy control group could be exam-
ined only 1 time, whereas the patients were tested preop-
eratively and postoperatively. Hence, we cannot say
whether the control group would have improved also if the
healthy volunteers had been retested after 5 years. In this
group of patients, the failure rate after surgical stabiliza-
tion is relatively high. One patient failed after arthroscop-
ic stabilization using a transglenoid suture technique, a
second patient after a conventional open Bankart proce-
dure using suture anchors, and a third patient with a non-
traumatic instability and capsular hyperlaxity who was
treated with a combined open Bankart procedure and
medial-based capsular shift.
In conclusion, this study compares joint position sense of
unstable shoulders preoperatively and under the same con-
ditions with the same examiner at least 5 years postoper-
atively. The results demonstrate the recovery of the joint
position sense after surgical repair for shoulder instability.
REFERENCES
1. Aydin T, Yildiz Y, Yanmis I, et al. Shoulder proprioception: a compari-
son between the shoulder joint in healthy and surgically repaired
shoulders. Arch Orthop Trauma Surg. 2001;121:422-425.
2. Bankart ASB. The pathology and treatment of recurrent dislocation of
the shoulder joint. Br J Surg. 1938;26:23-29.
3. Barrack RL, Skinner HB, Buckley SL. Proprioception in the anterior
cruciate ligament deficient knee. Am J Sports Med. 1989;17:1-6.
4. Blasier RB, Carpenter JE, Huston LJ. Shoulder proprioception: effect
of joint laxity, joint position and direction of motion. Orthop Rev.
1994;23:45-50.
5. Constant CR, Murley AH. A clinical method of functional assessment
of the shoulder. Clin Orthop. 1987;214:160-164.
6. Freeman MAR, Dean MRE, Hoffman WF. The etiology and prevention
of functional instability of the foot. J Bone Joint Surg. 1965;47B:678-
685.
7. Glencross D, Thorton E. Position sense following joint injury. J Sports
Med. 1981;21:21-23.
8. Gohlke F, Müller T, Sökeland T, et al. Distribution and morphology of
mechanoreceptors in the rotator cuff. J Shoulder Elbow Surg.
1996;5(supp):72.
9. Guanche CA, Knatt T, Solomonow M, et al. The synergistic action of
the capsule and the shoulder muscles. Am J Sports Med.
1995;23:301-306.
10. Jerosch JG. Effects of shoulder instability on joint proprioception. In:
Lephart SM, Fu FH, eds. Proprioception and Neuromuscular Control
in Joint Stability. Champaign, Ill: Human Kinetics; 2000:247-264.
11. Jerosch JG, Prymka M. Knee joint proprioception in normal volun-
teers and patients with anterior cruciate ligament tears, taking special

TABLE 5
Continued

Abduction Abduction Flexion Flexion Rotation Rotation

Redislocation Preoperative Postoperative Preoperative Postoperative Preoperative Postoperative

Yes 7 9,8 8 10 10,6 8,5

No 9 7,1 10,3 2,5 6,6 3,2
No 7,6 3,5 5,6 3,7 2,6 3,8
No 14,5 4,1 8 4,3 6,6 4,9
No 6,3 4 3,6 6,9 12 3
No 23,5 8,3 11,5 4,1 10,1 3,9
Yes 7,3 4,6 18 5 19,3 3,9
No 10 4,5 3,3 4,9 7 5,9
No 6,3 5,4 10,6 4,5 10,6 5,2
No 8,3 7,1 7,6 6,9 4,5 4,7
No 6,3 1,8 11 2,6 11 4,1
Yes 10,6 12,2 17,3 12,3 20,6 6,6
No 8 2,5 3,3 4,3 9,6 8,2
No 6,3 4,5 8 7 10,3 2,5
430 Pötzl et al
account of the effect of a knee bandage. Arch Orthop Trauma Surg.
1996;115:162-166.
12. Jerosch JG, Thorwesten L. Proprioceptive capability of the gleno-
humeral complex in patients with posttraumatic shoulder instability. Z
Orthop. 1998;136:230-237.
13. Jerosch JG, Thorwesten L, Steinbeck J, et al. Proprioceptive function
of the shoulder girdle in healthy volunteers. Knee Surg Sports
Traumatol Arthroscopy. 1995;3:219-225.
14. Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human
knee and its functional importance. Am J Sports Med. 1982;10:329-
335.
15. Lephart SM, Kocher MS, Fu FH, et al. Proprioception following ACL
reconstruction. J Sports Rehabil. 1992;1:188-196.
16. Lephart SM, Warner JJP, Borsa PA, et al. Proprioception of the shoul-
der joint in healthy, unstable and surgically repaired shoulders. J
Shoulder Elbow Surg. 1994;3:371-380.
17. Machner A, Wissel H, Heitmann D, et al. Changes in proprioceptive
capacities of the shoulder joint in ventral shoulder instability: a com-
parative study before and after arthroscopic labrum refixation.
Sportverletz Sportschaden. 1998;12:138-141.
18. Morgan CD, Bodenstab AB. Arthroscopic Bankart suture repair: tech-
nique and early results. Arthroscopy. 1996;3:111-122.
19. O’Brien SJ, Neves MC, Arnoczky SP, et al. The anatomy and histol-
ogy of the inferior glenohumeral ligament complex of the shoulder.
Am J Sports Med. 1990;18:449-456.
20. Richards RR, An KN, Bigliani LU, et al. A standardized method for the
assessment of the shoulder function. J Shoulder Elbow Surg.
1994;3:347-352.
The American Journal of Sports Medicine
21. Robinson AP, Tearse DS, Koch B, et al. Mechanoreceptors in capsu-
lar and juxta-labral tissue of the human shoulder. Paper presented at:
Tenth Open Meeting of the American Shoulder and Elbow Surgeons;
February 27, 1994; New Orleans, La.
22. Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-
term end-result study. J Bone Joint Surg. 1978;60A:1-16.
23. Solomonow M, Guanche CA, Wink C, et al. Mechanoreceptors and
reflex arc in the feline shoulder. J Shoulder Elbow Surg. 1996;5:139-
146.
24. Steinbeck J, Brüntrup J, Greshake O, et al. Neurohistological exami-
nation of the inferior glenohumeral ligament of the shoulder. J Orthop
Res. In press.
25. Steinbeck J, Jerosch JG. Arthroscopic transgleniod stabilization ver-
sus open anchor suturing in traumatic anterior instability of the shoul-
der. Am J Sports Med. 1997;26:373-377.
26. Tibone JE, Fechter J, Kao JT. Evaluation of a proprioception pathway
in patients with stable and unstable shoulders with somatosenory
cortical evoked potentials. J Shoulder Elbow Surg. 1997;6:440-443.
27. Vangsness T, Ennis M. Neural anatomy of the human glenoid labrum
and shoulder ligaments. Proceedings of the American Academy of
Orthopedic Surgeons; February 20-25, 1992; Washington, DC.
28. Warner JJP. The gross anatomy of the joint surface, ligament, labrum
and capsule. In: Matsen FA III, Fu FH, Hawkins RJ, eds. The Shoulder:
A Balance of Mobility and Stability. Rosemont, Ill: American Academy
of Orthopaedic Surgeons; 1993:7-28.
29. Warner JJP, Deng XH, Warren RF, et al. Static capsuloligamentous
restraints to superior-inferior translation of the glenohumeral joint. Am
J Sports Med. 1992;20:675-685.