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PubMed1987

MR imaging of the normal shoulder: anatomic correlation.

The complex anatomy and the requirement to image in the peripheral magnetic field have made the shoulder difficult to examine with MR. However, the use of high-resolution scanning techniques and specialized surface coils has improved the quality of MR images obtained. Seventy-five scans of the shoulders of normal volunteers were correlated with multiplanar cryomicrosections of six cadaver shoulders to study the MR appearance of normal structures. MR was shown to provide excellent depiction of shoulder anatomy.

Cadaver↗
PubMed1997

MR arthrography of the shoulder: rethinking traditional imaging procedures to meet the technical requirements of MR imaging guidance.

OBJECTIVE: The purpose of this study was to determine the feasibility of and the appropriate technique for performance of MR imaging-guided arthrography of the shoulder. SUBJECTS AND METHODS: Thirty-eight MR imaging-guided glenohumeral joint punctures were performed using an open C-arm scanner with a vertically oriented magnetic field, adapted for interventional procedures. Two different approaches to the shoulder were used: a modification of the traditional anterior approach (seven procedures), and an anterosuperior approach (31 procedures) mimicking the anterior arthroscopy portal. The average procedure duration was determined. A retrospective review of needle mediolateral and anterioposterior position was determined for the anterosuperior approaches. RESULTS: Average procedure duration was 21 min for the anterior approach and 12 min for the anterosuperior approach. Subjectively, needle conspicuity was minimal with the anterior approach, contributing to prolonged imaging times. Needle visualization was much improved with the anterosuperior approach. Nine of the 31 anterosuperior procedures involved inadvertent injection of the subacromial or subdeltoid bursa. At the time of retrospective review, the needle was too laterally or too anteriorly positioned in six of these nine patients. CONCLUSION: With consideration of the technical demands of MR imaging guidance for interventional procedures, MR imaging-guided arthrography of the shoulder is feasible. The traditional radiologic approach to the shoulder must be modified to provide adequate visualization of the needle. The anterosuperior approach meets this needs.

Adult↗
PubMed2003

MR imaging of complications of loose surgical tacks in the shoulder.

OBJECTIVE: Loose surgical tacks in the shoulder joint are a potential cause of new-onset shoulder pain after arthroscopic repair of an anterior-to-posterior lesion of the superior labrum. We report the MR imaging appearance of loose surgical tacks in this anatomic location. CONCLUSION: MR imaging is valuable in the evaluation of postoperative shoulder pain. Synovitis is a commonly considered clinical diagnosis; our report illustrates that loose tacks are another potential complication after shoulder surgery

Adolescent↗
PubMed2005

[Modern aspects of shoulder injury treatment].

The article describes injuries of soft and bone structures of the shoulder region, with special emphasis on the following clinical forms: instabilities and luxations of the glenohumeral joint, fractures of the proximal humerus, clavicle and the states of painful shoulder. Fractures and dislocations, but also significant entities - painful states caused not only by fractures but also by minor trauma such as tendinitises and m.supraspinatus tendon and bicipital tendon ruptures are discussed in more detail. Moreover, their consequences - painful and stiff shoulder - as well as modern diagnostic and therapeutic procedures applied in the painful shoulder treatment are also discussed.

Humans↗
PubMed1993

Nonoperative management of secondary shoulder impingement syndrome.

Shoulder pain secondary to impingement of the rotator cuff tendons underneath the coracoacromial arch is a common problem seen in athletes who perform repetitive overhead activities. Shoulder impingement has been classified into primary and secondary types. Several factors contribute to impingement, including rotator cuff weakness, posterior capsule tightness, and subacromial crowding. Recently, it has been proposed that scapulothoracic muscle weakness could be a factor that contributes to impingement. Traditional rehabilitation protocols for shoulder impingement syndrome stress individualized rotator cuff strengthening. The authors propose that individualized scapulothoracic muscle strengthening should be a part of any protocol for nonoperative treatment of secondary shoulder impingement syndrome.

Compartment Syndromes↗
PubMed1993

Neuromuscular testing and rehabilitation of the shoulder complex.

The shoulder complex plays an integral role in performing an athletic skill involving the upper extremity. The intricacy of the neuromotor components controlling shoulder motion and athletic skill is an issue that the sports physical therapist deals with on a daily basis when rehabilitating athletic patients. The purpose of this article is to review neuromotor control of the shoulder complex and describe an exercise routine developed to enhance proprioception, kinesthesia, and neuromuscular control. Clinical research studies examining the strength of the rotator cuff and scapular stabilizers, in addition to joint position sense, are reviewed. The results of these studies are discussed as they apply to the exercises described in the article designed to improve dynamic stability. The results of these studies and implementation of these exercises will help the sports physical therapy clinician assist the athletic patient and improve dynamic and neuromotor control of the shoulder.

Adolescent↗
PubMed1999

Clinical impact of MR arthrography of the shoulder.

PURPOSE: To evaluate the effect of MR arthrography of the shoulder on diagnostic thinking and therapeutic decisions by orthopedic shoulder surgeons. MATERIAL AND METHODS: Orthopedic surgeons completed a questionnaire before and after MR arthrography for 73 consecutive patients. The main indications were suspected rotator cuff abnormalities. The clinical diagnosis, the degree of confidence in this diagnosis, and the therapeutic decision were noted before and after MR imaging. Surgical reports were available for 34 patients. RESULTS: Thirty-four percent of the pre-MR imaging diagnoses were withdrawn after MR imaging, and new diagnoses were made after MR imaging in 13% of the cases. Confidence in the diagnosis increased significantly after MR imaging for supraspinatus and infraspinatus lesions (p<0.05). Changes of therapeutic decision after MR imaging were noted in 36 of the 73 patients (49%). In 23 patients, more invasive therapeutic procedures were initiated after MR imaging, and a more conservative treatment was implemented for 13 patients. Agreement of MR diagnoses with surgery was 94% for supraspinatus tears, 87% for infraspinatus tears, 77% for subscapularis tears, and 81% for biceps tendon lesions. Agreement of clinical diagnoses with surgery was 56%, 83%, 50%, and 64%, respectively. CONCLUSION: MR arthrography of the shoulder has a major effect on diagnostic thinking and therapeutic decisions by orthopedic shoulder surgeons.

Adult↗
PubMed1996

Hemiplegic shoulder pain (HSP): natural history and investigation of associated features.

The prevalence of hemiplegic shoulder pain (HSP) and associated factors was studied in patients with a stroke followed for 6 months after discharge from hospital. A questionnaire was used to evaluate shoulder symptoms and an examination of the shoulder and arm was carried out three times over 6 months. A total of 108 patients were studied with a mean age of 71 years. Sixty-nine patients (63.8%) developed HSP at some time during the study period. The number with HSP was 39 at discharge from hospital, 59 at 8 weeks post-discharge and 36 at 6 months. Nine carers reported lifting the patient by pulling on the hemiplegic arm, even though six of them had received advice about correct lifting techniques. Reduced shoulder shrug was associated with HSP at all times and reduced pinch grip was also associated with HSP at discharge from hospital. Patients who required help with transfers were more likely to suffer with HSP. There was no difference in the prevalence of HSP in patients treated at the day hospital compared to those who received domiciliary physiotherapy. It is concluded that HSP is common after a stroke and the prevalence increases in the first weeks after discharge from hospital. Stroke patients and their carers need advice about correct handling of the hemiplegic arm, and more work is required to ensure that correct handling occurs after discharge in patients at high risk of this unpleasant complication.

Activities of Daily Living↗
PubMed1996

Shoulder injuries common in alcoholics. An analysis of 413 injuries.

We recorded prospectively all adult patients with a fracture of the proximal end of the humerus, clavicle and scapula or a primary shoulder or acromioclavicular dislocation in the city of Malmö in 1987. Altogether there were 413 injures. The hospital records from the Department of Alcohol Diseases were searched for these patients and for 2 age- and gender-matched controls for each patient. 12% of all patients with a shoulder injury were recorded as alcohol abusers. This number was significantly greater than that of the controls. The difference was more obvious in men than in women. In men between 30 and 64 years, almost half of the proximal humerus fractures and shoulder dislocations, one third of mid-clavicular fractures and two thirds of all lateral clavicle fractures were sustained by alcohol abusers. Our findings emphasize the significance of alcohol abuse in the etiology of shoulder injuries, especially in men. Most of the men with a fracture of the lateral clavicle are registered at the Department of Alcohol Diseases, making this injury a marker of alcohol abuse.

Acromioclavicular Joint↗
PubMed2026

Anti-inflammatory agents after hip and shoulder arthroplasty: A systematic review and meta-analysis.

BACKGROUND: Postoperative inflammation after arthroplasty contributes to pain, delayed mobilization and prolonged hospitalization. Recent randomized trials have evaluated pharmacological anti-inflammatory strategies within contemporary enhanced recovery pathways, but evidence after hip and shoulder arthroplasty remains scattered across different drug classes and perioperative regimens. OBJECTIVES: To synthesize recent randomized controlled trial (RCT) evidence on perioperative anti-inflammatory agents after hip and shoulder arthroplasty. METHODS: PubMed, Embase, Cochrane Library and Web of Science were searched for English-language RCTs published from January 2020 to March 2026. The 2020-2026 window was selected to update evidence generated under modern arthroplasty, anesthesia, multimodal analgesia and enhanced recovery after surgery (ERAS) pathways. Eligible trials included adults undergoing hip or shoulder arthroplasty and compared corticosteroids, cyclooxygenase-2 (COX-2) inhibitors, nonsteroidal anti-inflammatory drug (NSAID)-based/local anti-inflammatory regimens, or related anti-inflammatory interventions with placebo, saline, no treatment, or the same regimen without the target component. Weighted mean differences (WMDs) were pooled using random-effects models. RESULTS: Nine RCTs involving 800 patients were included. Anti-inflammatory interventions significantly reduced postoperative C-reactive protein (CRP) [WMD=-32.18, 95% confidence interval (CI) (-41.16, -23.21), P<0.001], interleukin-6 (IL-6) [WMD=-31.25, 95% CI (-41.79, -20.77), P<0.001], rest pain [WMD=-0.41, 95% CI (-0.58, -0.23), P<0.001], activity pain [WMD=-0.56, 95% CI (-0.83, -0.29), P<0.001] and hospital stay [WMD=-0.54, 95% CI (-0.92, -0.15), P=0.006]. CONCLUSION: Recent RCT evidence suggests that perioperative anti-inflammatory interventions can attenuate early inflammatory responses and improve short-term pain and recovery after hip and shoulder arthroplasty. Because data were limited and clinically heterogeneous, the findings should not be interpreted as evidence favoring a specific drug class, dose, route, or timing.

Humans↗
PubMed1998

Superior-inferior stability of the shoulder: role of the coracohumeral ligament and the rotator interval capsule.

OBJECTIVE: To study the superior-inferior stabilizing functions of the coracohumeral ligament (CHL) and the rotator interval capsule (RIC) with use of a material testing machine. MATERIAL AND METHODS: The axial translations of the humerus with the superior-inferior translation force of 30 N applied were recorded under the following joint capsule conditions: (1) intact, (2) vented, (3) the CHL sectioned, and (4) the RIC incised in six cadaver shoulders. The order of sectioning was changed for conditions 3 and 4 in six other cadaver shoulders. RESULTS: With the arm in internal and neutral rotations, venting the capsule significantly increased the superior-inferior translation, which was unaffected by further sectioning of the CHL and the RIC. With the arm in external rotation, only the CHL contributed significantly to inferior stability, whereas both this ligament and the RIC contributed to superior stability to a lesser degree. CONCLUSION: The CHL is a stabilizer in superior inferior directions with the arm in external rotation, and the intra-articular pressure that is maintained by the intact RIC is a stabilizer in superior-inferior directions with the arm in internal and neutral rotations. These findings may provide a scientific background to support closure of the interval space to stabilize the shoulder and may explain part of the superior instability observed in shoulders with rotator cuff tears.

Aged↗
PubMed2006

Natural course of nontraumatic rotator cuff tendinitis and shoulder symptoms in a working population.

OBJECTIVES: This study assessed the prevalence, incidence, and persistence of nontraumatic rotator cuff tendinitis and shoulder symptoms over a 1-year period in a working population and the predictive value of symptoms and physical findings. METHODS: A 1-year prospective study of 436 active workers was conducted at 12 different worksites. Detailed health interviews, psychosocial questionnaires, and physical examinations were conducted at baseline and again after 1 year, with shorter evaluations at 4 and 8 months. Individual observed exposure assessment of shoulder posture, arm-hand activity, and hand forces was conducted. RESULTS: The prevalence of rotator cuff tendinitis at baseline was 7.6% [95% confidence interval (95% CI 5.1-10.1%)] for the right and 4.8% (95% CI 3.0-7.0%) for the left, compared with shoulder symptoms of 18.6% (95% CI 14.9-22.3%) (right) and 11.2% (95% CI 8.2-14.2%) (left). The incidence of rotator cuff tendinitis was 5.5% (95% CI 2.8-6.8%) and 2.9% (95% CI 1.0-3.8%), respectively. Higher proportions of participants with current symptoms or physical findings at baseline became clinical cases after 1 year than those without symptoms or findings. The 1-year persistence of clinical case status was 31.3% (95% CI 26.9-35.7%) (right) and 31.6% (95% CI 27.2-36.0%) (left). There were significant differences at baseline between the asymptomatic participants and the clinical cases with respect to physical health on the 12-item Short-form Health Survey (P=0.0002), the perception of general health (P=0.0027), and the frequency of high hand force exposure (P=0.0177). CONCLUSIONS: Considerable movement occurs between different stages of shoulder problems. Symptoms and physical findings alone appear to predict clinical case status within 1 year. Frequent follow-up is necessary to capture changes in health and exposure status in prospective studies.

Adult↗
PubMed1994

Sonographic evaluation of posterior instability and dislocation of the shoulder: prospective study.

Owing to the exceptional mechanical precariousness of the glenohumeral joint, dislocations and instabilities are common. Because posterior dislocation or instability of the joint occurs infrequently, these abnormalities may be misdiagnosed on routine radiographic examinations in acute shoulder injuries. We present five patients in whom sonographic examination was used to diagnose posterior shoulder instability (three cases) and posterior shoulder dislocation (two cases). The sonographic technique demonstrates the presence of instability or dislocation and permits dynamic examination of the shoulder joint. Ultrasonography emerges as a useful and efficient novel technique for detecting these disorders. The accuracy, sensitivity, and specificity of the technique presented here are currently being determined.

Adult↗
PubMed1999

Position of immobilization after dislocation of the shoulder. A cadaveric study.

BACKGROUND: After reduction of a shoulder dislocation, the torn edges of a Bankart lesion need to be approximated for healing during immobilization. The position of immobilization has traditionally been adduction and internal rotation, but there is little direct evidence to support or discredit the use of this position. The purpose of the present study was to determine the relationship between the position of the arm and the coaptation of the edges of a simulated Bankart lesion created in cadaveric shoulders. METHODS: Ten thawed fresh-frozen cadaveric shoulders were used for experimentation. All of the muscles were removed to expose the joint capsule. A simulated Bankart lesion was created by sectioning the anteroinferior aspect of the capsule from the labrum. With linear transducers attached to the anteroinferior and inferior portions of the Bankart lesion, the opening and closing of the lesion were recorded with the arm in 0, 30, 45, and 60 degrees of elevation in the coronal and sagittal planes as well as with the arm in rotation from full internal to full external rotation in 10-degree increments. RESULTS: With the arm in adduction, the edges of the simulated Bankart lesion were coapted in the range from full internal rotation to 30 degrees of external rotation. With the arm in 30 degrees of flexion or abduction, the edges of the lesion were coapted in neutral and internal rotation but were separated in external rotation. At 45 and 60 degrees of flexion or abduction, the edges were separated regardless of rotation. CONCLUSIONS: The present study demonstrated that, in the cadaveric shoulder, there was a so-called coaptation zone in which the edges of a simulated Bankart lesion were kept approximated without the surrounding muscles.

Aged↗
PubMed1999

[Anatomy, physiology and clinical examination of the shoulder].

Shoulder pain is usually caused by periarthritis. Impingement syndrome and frozen shoulder (adhesive capsulitis) are the more frequently clinical aspect observed. A shoulder standardised clinical examination often give a precise lesional diagnostic. Complementary examinations are useful to distinguish other cause of shoulder pain.

Diagnosis, Differential↗
PubMed2000

Shoulder instability in the athlete.

Shoulder instability is a common malady affecting the athlete's shoulder. A basic knowledge of shoulder anatomy and biomechanics is essential to understanding the pathophysiology and treatment options. The history and physical examination can lead the investigator to the correct diagnosis in most cases. Diagnostic imaging modalities can provide useful clues and help rule out concomitant pathology. Most patients are suitable candidates for a trial of shoulder rehabilitation. Those who fail nonoperative treatment may be candidates for surgical intervention. A variety of surgical techniques are available to reliably prevent recurrent instability. There has been a recent trend towards arthroscopic stabilization, including thermal capsulorrhaphy, which may prove as effective as open techniques.

Arthroscopy↗
PubMed2001

Diagnostic capabilities of shoulder ultrasonography in the detection of complete and partial rotator cuff tears.

Our study assessed the accuracy of shoulder ultrasonography in detecting complete and partial rotator cuff tears. We performed a prospective study in 24 patients scheduled for shoulder arthroscopy for impingement, partial-thickness or full-thickness (complete) rotator cuff tears, adhesive capsulitis, or arthritis. Before surgery, all patients underwent diagnostic shoulder ultrasonography followed by a shoulder arthroscopy with examination of the rotator cuff. The arthroscopic findings of rotator cuff integrity were compared with the diagnoses made from ultrasonography. The ultrasonographer was not blinded to the history and examination findings, and the surgeon was not blinded to the results of the ultrasonography. Ultrasound had sensitivity and specificity rates of 80% and 100%, respectively (positive and negative predictive rates of 100% and 88%), in the diagnosis of full-thickness rotator cuff tears and sensitivity and specificity rates of 71% and 100%, respectively (positive and negative predictive values of 100% and 88%), for partial-thickness tears. Although the potential for bias exists in this study, the results suggest that diagnostic ultrasound is effective in the diagnosis of rotator cuff tears.

Adult↗
PubMed2001

Long-term results of the Boytchev procedure for the treatment of recurrent dislocation of the shoulder.

The authors present the long-term results obtained with the Boytchev technique in the treatment of recurrent anterior dislocation of the shoulder. Recurrence, clinical outcome and functional limitations were evaluated. A total of 27 shoulders in 25 patients were studied. The average follow-up period was 13.3 years. There were no immediate neurovascular complications and no residual pain. The average recovery time was 4.3 months. Dislocation recurred in five shoulders (18%) and 18.5% of the patients were left with restricted mobility. All patients resumed their previous employment although sporting capacity recovered to pre-injury levels in only 9 of 15 patients. The results were classified as good in 18.5% and as excellent in 40.7% of the patients, but the remaining 40.7% had a fair or poor result. In conclusion, the recurrence rate is high and nearly 20% of the patients are left with limited shoulder mobility. Furthermore, although all the patients were able to return to their job, only 60% of those engaged in sports regained their previous level. This technique, although attractive, is better avoided.

Activities of Daily Living↗

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