Further, that instability is likely to be centrally driven rather than in response to peripheral damage, although the mechanism is unknown. Controls, compared to patients, demonstrate increased neural activity in the perirhinal and parahippocampal cortex. The exact role of these two regions is unclear, but may relate to the processing and onward transmission of somatosensory information required to maintain shoulder stability.
Clinically this group of patients is often poorly treated, as healthcare professionals are unable to explain the recurrent dislocations and instability. This is the first demonstration of an objective difference in brain activation.
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This may help to dispel the myth that these patients are inducing their instability and dislocations as a form of attention-seeking behaviour, and potentially offers opportunities for physiotherapy interventions. Bigliani, L. Inferior capsular shift procedure for anterior-inferior shoulder instability in athletes. Am J Sports Med. Lewis, A. The Classification of Shoulder Instability:new light through old windows. Current Orthopaedics.
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