Shoulder apprehension impacts large-scale functional brain networks.

BACKROUND AND PURPOSE Shoulder apprehension is defined as anxiety and resistance in patients with a history of anterior glenohumeral instability. It remains unclear whether shoulder apprehension is the result of true recurrent instability or a memorized subjective sensation. We tested whether visual presentation of apprehension videos modifies functional brain networks associated with motor resistance and anxiety. MATERIALS AND METHODS This prospective study includes 15 consecutive right-handed male patients with shoulder apprehension (9 with right shoulder apprehension, 6 with left shoulder apprehension; 27.5 ± 6.4 years) and 10 healthy male right-handed age-matched control participants (29.0 ± 4.7 years). Multimodal MR imaging included 1) functional connectivity tensorial independent component analysis, 2) task-related general linear model analysis during visual stimulation of movies showing typical apprehension movements vs control videos, 3) voxel-based morphometry analysis of GM, and 4) tract-based spatial statistics analysis of WM. RESULTS Patients with shoulder apprehension had significant (P < .05 corrected) increase in task-correlated functional connectivity, notably in the bilateral primary sensory-motor area and dorsolateral prefrontal cortex and, to a lesser degree, the bilateral dorsomedial prefrontal cortex, anterior insula, and dorsal anterior cingulate cortex (+148% right, +144% left). Anticorrelated functional connectivity decreased in the higher-level visual and parietal areas (-185%). There were no potentially confounding structural changes in GM or WM. CONCLUSIONS Shoulder apprehension induces specific reorganization in apprehension-related functional connectivity of the primary sensory-motor areas (motor resistance), dorsolateral prefrontal cortex (cognitive control of motor behavior), and the dorsal anterior cingulate cortex/dorsomedial prefrontal cortex and anterior insula (anxiety and emotional regulation).