Relation Between Shoulder Lateral Rotators Strength and Hand Grip Strength After Arthroscopic Bankart Repair Surgery

Anterior shoulder instability is a common clinical problem with a high incidence rate in athletes (Zacchilli and Owens., 2010). It may be a result of anterior force trauma to elevated, horizontally abducted, and externally rotated shoulder. In this position, stability is provided by the subscapularis, GH ligaments (particularly the anterior band of the inferior ligament), and the long head of the biceps (Ladd et al., 2021b). A high energy trauma may affect these structures, along with the attachment of the anterior capsule and glenoid labrum (Bankart lesion) (Ladd et al., 2021a) Traditionally, patients with first-time dislocation are managed conservatively however, the recurrence rate is high especially in the teenagers and younger population (Polyzois et al. 2016). in case of recurrent dislocation, surgical repair of the affected structures is performed either by open or arthroscopic approach (Kane et al., 2015).

After surgery, dynamic stability of the shoulder is important to ensure the repaired capsule, anteroinferior labrum and/or the inferior glenohumeral ligament are not vigorously stressed and compromised during daily living activities (Mueller et al., 2005) The muscles responsible for shoulder rotation serve as active stabilizers for the glenohumeral joint, and regaining strength in these muscles is crucial for stabilizing the joint during the recovery process after surgery (Edouard et al., 2012). In a previous study, researchers examined the progression of rotational muscle strength before and after open Bankart and modified Bristow procedures. The findings indicate that adequate muscle strength can be achieved six months post-surgery. Furthermore, the strength of these rotational muscles is closely linked to shoulder function and could serve as a useful indicator of glenohumeral instability following surgery (Amako et al., 2008).10 A cohort study found that after 4-8 months of postoperative Bankart repair, about 74% of patients regained their baseline range of motion and strength (Buckwalter V et al., 2018).

In a 13-year follow-up study, it was found that patients with less than 6 months of postoperative rehabilitation after arthroscopic Bankart repair surgery had an increased rate of recurrent dislocation (Aboalata et al., 2017).

Many studies found a positive correlation between hand gripping activity and rotator cuff muscle activity in healthy subjects. It was found that hand loading induces an elevation in intramuscular pressure within the supraspinatus (SSP) and infraspinatus (ISP) muscles (L. V. Roberts et al., 2008; Shenouda and El-Tokhy., 2014).

Previous literature advocates a relation between grip strength and the overall strength of the upper body, as well as it serves as an objective indicator of upper extremity function (Vaishya et al., 2024). Other studies have shown a positive correlation between isometric hand grip strength and isokinetic peak torque and work of the shoulder stabilizing muscles (Mandalidis and O'Brien 2010; Nascimento et al., 2012). This relationship suggests that a stable proximal shoulder girdle is necessary to facilitate optimal recruitment of distal muscles and effective transmission of force along the myofascial pathways (Huijing and Baan., 2003).