# Glenoid morphology variation between patients with hypermobile shoulder joints and controls: Identification of hyperlaxity-related morphologic bone changes

## TL;DR

This study finds that people with hypermobile shoulders have flatter glenoid bones, which can help diagnose hyperlaxity and improve treatment planning.

## Contribution

The study identifies a specific morphological bone change in hypermobile shoulders using the glenoid concavity angle (GCA) as a diagnostic marker.

## Key findings

- Hyper mobile shoulders have significantly lower glenoid concavity angles (GCA) compared to controls.
- A GCA below 4° has good sensitivity and specificity for detecting shoulder hyperlaxity.
- Flat or convex glenoid morphology is more common in hypermobile patients.

## Abstract

Our study aims to quantitatively determine the concavity of the glenoid articular surface in patients with hypermobile shoulders compared to those without.

We examined medical records of shoulder CTs from 2017 to 2022, selecting 50 patients with clinical signs of joint hypermobility for our case group and 54 for our control group. Two blinded readers independently assessed the glenoid morphology, calculating the glenoid concavity angle (GCA) and evaluating the articular surface shape as concave, flat, or convex. They also recorded the presence and severity of glenoid dysplasia. We compared these assessments between groups.

The mean GCA was significantly lower in the hypermobile group (2.3 ± 3.7° and 2.3 ± 3.8°) versus controls (6.6 ± 3.3° and 5.3 ± 3.8°) (P < 0.05). Interobserver reproducibility was high (ICC=0.76). A stark difference in glenoid morphology was noted between groups (P < 0.001), with a majority of hypermobile patients having a flat or convex glenoid. GCAs decreased with increasing shoulder laxity and dysplasia. GCA showed 77–81 % sensitivity and 55–82 % specificity for detecting shoulder hyperlaxity with a 4° cutoff.

There is a significant association between GCA and shoulder hyperlaxity, demonstrating diagnostic efficacy and substantial interobserver agreement.

GCA values lower than 4° warrant further clinical investigation for shoulder hyperlaxity and associated conditions, which is crucial for patient treatment planning.

•Shoulder hyperlaxity is underdiagnosed with potential implications in patient care.•The glenoid concavity is significantly smaller in hypermobile shoulders.•The glenoid concavity angle has a good diagnostic performance for hyperlaxity.•Low glenoid concavity angles (< 4°) should warrant a search for shoulder hyperlaxity.

Shoulder hyperlaxity is underdiagnosed with potential implications in patient care.

The glenoid concavity is significantly smaller in hypermobile shoulders.

The glenoid concavity angle has a good diagnostic performance for hyperlaxity.

Low glenoid concavity angles (< 4°) should warrant a search for shoulder hyperlaxity.