Cerebral activation related to shoulder apprehension in patients with glenohumeral instability: a ten years follow-up

DOI: 10.70885/hmsj.2026.08.001

Abstract

Background: Ten years ago, we presented evidence that shoulder apprehension is linked to reorganization in brain activation, involving areas associated with motor control, cognitive control of motor behaviour, as well as anxiety and emotional regulation.Purpose: The present study investigates whether a decade-long follow-up after surgery is connected to the normalization of apprehension-related brain activations.Methods: Ten patients (average age 38.6±9.7 years) who had undergone shoulder stabilisation and nine controls (average age 40.6±2.9 years) from the original study (Y0) took part in this ten-year follow-up prospective comparative study (Y10). We replicated the same experimental procedure, which included functional magnetic resonance imaging (fMRI) with videos designed to induce shoulder apprehension, and clinical assessments.Results: In terms of task-related functional imaging, patients exhibited a complete reduction in apprehension-related brain activations at Y10 compared to Y0. In terms of functional connectivity, the differences observed in several brain networks at Y0 between patients and controls nearly completely normalized at Y10. There were no significant structural differences in brain grey matter or white matter observed between Y0 and Y10 in both patients and controls. Regarding clinical parameters, patients showed improvement at Y10 compared to Y0 across all scores.Conclusion: In patients with shoulder apprehension, apprehension-related brain activation patterns showed near-complete normalization ten years after successful shoulder stabilisation, although subjective apprehension remained higher than in healthy controls.What this study adds to existing knowledge: Time allows near-complete normalization after successful shoulder stabilization. For a quicker return to sports, these results support the use of a comprehensive multimodal approach. This approach includes, on one hand, shoulder 'reafferentation', which involves proprioception, mirror therapy, and even cognitive-behavioural approaches. On the other hand, it suggests implementing improved surgical stabilization techniques to reduce persistent micro-motions.How this study might affect research, practice, or policy: This study may stimulate further research into the neurocognitive mechanisms of shoulder apprehension and encourage clinicians to integrate psychological readiness into rehabilitation and return-to-sport decision-making. It also highlights the potential for future research on incorporating cognitive-behavioral interventions into postoperative rehabilitation protocols for selected patients.Study Design: Prospective comparative longitudinal studyLevel of Evidence: Level IIKeywords: Shoulder; Functional magnetic resonance imaging (fMRI); Long-term results; Complications; PROMs; Brain; Recovery; Neurological lesion; Central nervous system.https://doi.org/10.70885/hmsj.2026.08.001

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