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PubMed1996

Neuroarthropathy: an overuse injury of the shoulder in quadriplegia.

The shoulder joint of the spinal cord injured patient is the primary joint used for transfer and wheelchair propulsion. In addition to ordinary use, the shoulder is subject to overuse injury with resultant functional impairment. Frequent overuse injuries of the shoulder include subdeltoid bursitis, bicipital tendonitis, rotator cuff tear and secondary degenerative arthritis. Neuroarthropathy of the shoulder, an overuse injury of an insensate shoulder girdle, has been rarely described in the literature. The case presented is that of an active 47 year old, right hand dominant, C7 complete quadriplegic male with a one week history of painless right shoulder girdle swelling. Radiologic evaluation documented right proximal humerus destruction. Magnetic Resonance Imaging (MRI) confirmed syringomyelia. The pathophysiology of neuroarthropathy is presented here and limited treatment options are discussed.

Arthropathy, Neurogenic↗
PubMed1983

Prevention of injury to the shoulder through exercises and therapy.

An injury prevention program for the athlete combines conditioning and warm-up with appropriate stretching and strengthening exercises. Rehabilitation after injury is necessary and must include not only re-establishment of strength but also an aggressive program for restoring and maintaining muscle length.

Athletic Injuries↗
PubMed2005

Functional outcome and health-related quality of life after surgical repair of full-thickness rotator cuff tear using a mini-open technique.

BACKGROUND: Rotator cuff tear, a common shoulder injury, can lead to shoulder pain and functional loss. HYPOTHESIS: Surgical repair of full-thickness rotator cuff tears using the mini-open surgical technique will improve shoulder function and health-related quality of life. STUDY DESIGN: Cohort study. Level of evidence, 2. METHODS: Patients with a full-thickness rotator cuff tear who underwent a mini-open repair were evaluated for (1) active shoulder range of motion preoperatively, and 6 months and 12 months postoperatively and (2) health-related quality of life preoperatively, 6 months postoperatively, and annually up to 5 years postoperatively. Satisfaction with the repair and return to work status were ascertained 1 year postoperatively. A subgroup analysis of tear size and patient age was also undertaken. RESULTS: Of the subjects, 61 (73%) were men, and the average age was 53.2 ( +/- 9.9) years. According to repeated-measures analysis of variance, shoulder range of motion (flexion and external rotation) improved significantly from before surgery to 1 year after surgery (P <.001). The mean American Shoulder and Elbow Surgeons scores improved from 53.3 ( +/- 20.6) preoperatively to 90.6 ( +/- 11.7) 1 year postoperatively (P <.001). The mean Western Ontario Rotator Cuff scores also improved from 43.2 ( +/- 20.2) preoperatively to 87.2 ( +/- 14.3) 1 year postoperatively (P <.001). No differences were seen in either the American Shoulder and Elbow Surgeons scores or Western Ontario Rotator Cuff scores between the 1-year examination and the last follow-up assessment undertaken at a median of 5 years postoperatively (P >.05). Ninety-six percent of patients were satisfied or very satisfied with the results of their repair; 78% of patients who were working before surgery returned to work without modification by 1 year postoperatively. For the most part, patient age and size of tear did not influence postoperative range of motion or health-related quality of life. CONCLUSION: Mini-open rotator cuff repair led to improved shoulder function and health-related quality of life up to 5 years postoperatively.

Adult↗
PubMed1990

Peripheral nerve injuries of the shoulder in the athlete.

Athletic injuries about the shoulder resulting in lesions of the suprascapular, axillary, long thoracic, musculocutaneous, and spinal accessory nerves are uncommon. Yet these lesions are well described in the literature, and they may occur as isolated injuries. Rarely do they occur following surgical procedures about the shoulder of the athlete. Furthermore, these injuries may mimic other more commonly occurring athletic injuries thus giving rise to diagnostic confusion. The clinical syndromes that result from these isolated lesions have been discussed, along with their mechanisms of injury. Increased awareness, careful physical examination, and EMGs may greatly simplify the diagnosis. The treatment and prognosis for these injuries has been outlined.

Athletic Injuries↗
PubMed2000

Rotator cuff injuries.

Different types of rotator cuff injuries frequently present to Accident and Emergency departments and minor injury units but can be difficult to differentiate clinically. This brief case study describes the examination and diagnosis of related shoulder injuries, specifically rotator cuff tears/disruption and calcifying supraspinatus tendinitis. The relevant anatomy and current therapies for these injuries is also discussed to enable the emergency nurse practitioner to have a greater understanding of the theory surrounding their diagnosis and treatments.

Braces↗
PubMedDate not supplied

Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries.

In the examination and rehabilitation of patients with shoulder injuries it is necessary to isolate the individual rotator cuff muscles as much as possible. We subscribe to the belief that, independent of the deltoid, the rotator cuff muscles can become fatigued, injured, or atrophied individually, Accordingly, we feel that these muscles must be considered separately during examination and rehabilitation. This paper describes methods and positions to isolate the cuff and, thus, enable the examiner to be more precise in diagnosis and treatment. In addition, individual exercises for each component are described.

Athletic Injuries↗
PubMed1983

Shoulder problems of adolescents. How they differ from those of adults.

The adolescent athlete with an open epiphyseal plate presents with different shoulder problems than does the adult. Most shoulder injuries in the adolescent athlete can be treated conservatively with a good prognosis for full return of function. The exception is a glenohumeral dislocation, which will probably recur and need a surgical reconstruction.

Acromioclavicular Joint↗
PubMed2006

Nerve injury following shoulder dislocation: the emergency physician's perspective.

We describe the case of a 57-year-old woman who presented to the emergency department with a right anterior shoulder dislocation following a fall onto the right shoulder and right upper arm. She also complained of numbness in the right forearm and dorsum of the right hand. The examination revealed a bruise to the upper aspect of the right arm resulting from the impact following the fall. The patient also had a right wrist drop and loss of sensation in the lateral border of the right forearm and on the dorsum of the right hand, suggesting a radial nerve injury. She also had altered sensation in the ulnar distribution of her right hand, suspicious of concomitant ulnar nerve injury. No loss of sensation in the distribution of the axillary nerve (regimental patch) was observed. These findings were carefully documented and the patient subsequently had the shoulder reduced under entonox and morphine. The neurological deficits remained unchanged. The patient was sent home from the emergency room with arrangements for orthopaedic and physiotherapy follow-up. After a 3-month period, she had clinical and electromyography evidence of persistent radial and ulnar nerve deficit. She continues to have physiotherapy. This case highlights the need for awareness of the potential for nerve damage following shoulder dislocation and also to ensure that appropriate follow-up plan is instituted on discharge from the emergency department.

Electromyography↗
PubMed2006

The effect of arm position on stretching of the supraspinatus, infraspinatus, and posterior portion of deltoid muscles: a cadaveric study.

BACKGROUND: The stretching of the supraspinatus and infraspinatus muscles is important to prevent shoulder injuries. Although several authors have advocated various stretching techniques, a general opinion has not been reached owing to the lack of quantitative analysis. METHODS: Nine fresh cadaveric shoulders were used to measure the strain on the supraspinatus, the middle and inferior portions of the infraspinatus, and the posterior portion of the deltoid muscles during eleven arm positions. The strain on the muscles was measured by precise displacement sensors attached to the center of each muscle belly. FINDINGS: In case of the supraspinatus muscle, abduction at extension showed significantly larger strain than that in the neutral position (P < 0.05). Internal rotation at extension showed significantly larger strain in the middle portions of the infraspinatus (P < 0.05). Internal rotation at 30 degrees and 60 degrees elevation as well as extension showed significantly larger strain in the inferior portion of the infraspinatus (P<0.05). Adduction at 60 degrees elevation did not show large strain in the infraspinatus muscle; however, significantly larger strain was observed in the posterior portion of the deltoid muscle. INTERPRETATION: Shoulder stretching techniques that are based on these experimental data can enhance the selective stretching of the corresponding muscles. Application of these techniques is considered to be useful for the prevention and treatment of shoulder injuries.

Aged↗
PubMed1998

The use of padding in rugby union. An overview.

In any contact sport where impact and collision are an accepted feature, the use of various forms of external padding has become more common. Rugby union players experience a combination of characteristic extrinsic forces through the acts of tackling and scrummaging. The laws which are part of the international regulation of rugby union only permit the wearing of certain, clearly delineated forms of padding. Only then is such padding permitted on medical recommendation, provided that this padding is attached to the body or sewn into the jersey. This article discusses the padding of the shoulders, shins and thighs of rugby union players and highlights the need to address these issues with respect to the increasing number of women who are now playing this sport, particularly in the Southern hemisphere. There is little evidence to show that shoulder pads decrease the incidence of severe shoulder injuries. However, well-fitting shoulder pads constructed of materials that effectively disperse the force of impact appear to reduce the effect of direct contact and reduce the potential for soft tissue damage. Shin guards that are made of light, soft, compliant materials are effective in reducing impact to the shin and thereby reduce the risk of bruising injuries which are common to the pretibial region. Similarly, thigh pads are considered to be able to modify the effects of direct contact forces to the anterior thigh where deep contusional injuries with the potential for myositis ossificans are well reported. Informed advice for women rugby players regarding the use of specific padding is unavailable at present. Current information is anecdotal and not confirmed by statistical studies or well-conducted research. In these circumstances, women rugby players should observe the same recommendations that apply to their male counterparts.

Female↗
PubMed2005

Whiplash injury of the shoulder: is it a distinct clinical entity?

The pathophysiology of shoulder pain after whiplash injury remains uncertain. Patients with shoulder pain after a whiplash injury were recruited from the accident and emergency department in a prospective study to determine the nature of indirect shoulder trauma after a whiplash injury. Twenty patients fulfilled the inclusion criteria. Magnetic resonance imaging (MRI) was obtained in 18 patients. Three MRI scans confirmed acute shoulder injuries. Two patients underwent arthroscopic subacromial decompression after failure of non- operative treatment. In conclusion, whiplash injuries can result in indirect acute shoulder trauma, possibly through an acceleration-deceleration mechanism, and may be a distinct entity.

Adult↗
PubMed2006

[Transfer of trapezius muscle for reconstruction of abduction of the shoulder].

INTRODUCTION: After brachial plexus injuries, shoulder function is frequently impaired or lost. For reconstruction of the most important functions muscle transfers are indicated. To restore abduction and external rotation of the shoulder the trapezius muscle transfer is mainly used. PATIENTS AND METHODS: We demonstrate 16 patients with insufficient abduction of the shoulder joint. All patients were treated with the transfer of trapezius muscle (pars horizontalis). We used a modification of the technique of Saha. After the operation, the arm was immobilized in 80 degrees abduction for 6 weeks followed by 10 degrees adduction of the shoulder per week. Afterwards physiotherapy was started. Evaluation was done by the DASH score and Gilbert score. RESULTS: In all cases, an improvement of shoulder mobility was seen, assessed clinically and individually by the patient. The average DASH score was 37.4. For ten patients the results of the operation were very good, good, or satisfactory. Active abduction increased from 15 degrees (0-30 degrees) to 54 degrees (35-80 degrees) postoperatively. The external rotation was 9 degrees (-20-40 degrees) preoperatively and 19 degrees (0-70 degrees ) postoperatively. DISCUSSION: Trapezius muscle transfer for reconstruction of abduction is an easy and practicable method without serious complications. We achieved good stability and functionality of the shoulder. Intensive pre- and postoperative physiotherapy may provide greater improvement of mobility.

Adolescent↗
PubMed1997

Recruitment patterns of the scapular rotator muscles in freestyle swimmers with subacromial impingement.

Athletes with shoulder pathology consistently demonstrate abnormalities in scapular rotator activity, suggesting that muscle dysfunction is a factor to consider in the aetiology or recurrence of shoulder pain. However, one important measure of the coordinated activity between the scapular rotators, their timing or temporal recruitment pattern, remains undetermined. The purposes of this study were to 1. provide normative data on the temporal recruitment pattern of the scapular rotators in freestyle swimmers, 2. determine the effect of a unilateral shoulder injury on this pattern, 3. determine whether these effects extend to the non-injured side, and 4. determine the effect of injury on the consistency (variability) of muscle recruitment. Surface EMG data for the upper and lower trapezius and serratus anterior were recorded bilaterally from two groups of competitive freestyle swimmers during controlled bilateral elevation in the plane of the scapula. An injured group comprising nine swimmers with unilateral shoulder pathology and a control group of nine non-injured swimmers were included. Temporal data determined for the onset of muscle activation for each muscle were then compared between groups using an ANOVA and a one-sided F test. The results of the study indicate that in non-injured swimmers, upper trapezius is activated 217 ms prior to shoulder motion, followed by serratus anterior activation 53 ms after motion commences. Lower trapezius was not recruited until 349 ms after shoulder motion, when the arm had attained 15 degrees elevation. In injured swimmers, all three muscles on the injured side displayed significantly increased variability in the timing of activation (p < 0.05), whilst the serratus anterior was significantly delayed in its activation on the non-injured side (p < 0.05). Skill hand preference was shown to have no effect on muscle recruitment. The findings of this study indicate that a relationship does exist between shoulder injury and the temporal recruitment patterns of the scapular rotators, such that injury reduces the consistency of muscle recruitment. They further suggest that injured subjects have muscle function deficits on their unaffected side.

Adult↗
PubMed1998

Premature degenerative shoulder changes in spinal cord injury patients.

Shoulder pain and the resultant dysfunction is an expected problem in individuals with spinal cord injury. But there is a remarkable lack of information about the natural history, diagnosis, prevention and long term outcomes. Degenerative changes may develop prematurely in their shoulders, due to overuse and altered mechanical stresses, with or without symptoms was the hypothesis of this prospective study. Information from this study is expected to assist in identification of high risk SCI individuals, and ultimately in development of preventive strategies. The shoulders of 53 spinal cord injury patients from the onset of injury until 15 years duration were subjected to clinical and radiological examination at the Rehabilitation Institute of Chicago. Thirty-eight out of 53 (72%) patients demonstrated radiological evidence of degenerative changes, but only six (11%) complained of pain in the shoulders. This study demonstrated a correlation between individuals with higher level of wheelchair activity (72%), higher age (92% above and 8% less than 30 years) and female gender (89% females versus 65% males) more prone to develop degenerative changes in the shoulders. Acromioclavicular joint was predominantly affected. Detailed radiological findings, etiopathological factors and long term recommendations are discussed. The need for further studies and consistent management strategies are stressed.

Adult↗
PubMed1999

The postoperative shoulder.

Because disability and pain may persist or recur after shoulder surgery, visualization of the postoperative shoulder before further treatment is of great interest. Postoperative status is reevaluated most frequently after rotator cuff repair, capsulorrhaphy in patients with chronic instability, and acromioplasty, where postoperative symptoms are clinically difficult to distinguish from rerupture or inadequate surgical results. Postoperative evaluation or follow-up after surgical treatment of tumors or surgical repair of shoulder injuries are other potential indications. Whereas surgical procedures for osseous components primarily will be evaluated by plain film radiographs, magnetic resonance imaging is a valuable tool for other sites of surgical treatment, such as soft-tissue components, with further potential indication for magnetic resonance arthrography. This article focuses on normal and abnormal postoperative findings in the shoulder, with emphasis of magnetic resonance imaging, and discusses specific findings based on magnetic resonance arthrography.

Acromion↗
PubMed1984

[Electrotherapy of pain relief using the Tenzcare stimulator. A clinico-experimental study].

Electrotherapy was introduced into the aftercare programme for patients with serial rib fractures in the acute stage, shoulder injuries or fractures of the radius. Electrical stimulation was carried out with the Tenzcare Nr. 6240 apparatus. The results were significantly better in each of the three groups than in the respective control group. Patients after thorax trauma complained less of pain in the acute phase: there was less pulmonary secretion on X-ray and, on average, their blood gas values returned to normal three days earlier. None of them required assisted respiration. Patients with shoulder injuries or fractures of the radius complained less frequently of pain during physio-therapy after removal of their plaster casts. They attained their optimum range of movement on average ten and eight days earlier, respectively than the controls.

Adult↗
PubMed1989

[Computed tomography of the rotator cuff--a comparison with other imaging technics].

We consider CT to be suitable for investigating the following lesions of the rotator cuff: 1) tendopathia calcarea. 2) Rotator cuff atrophy suitable for surgery. 3) Bone defects. 4) Inflammatory changes with effusions. For demonstrating rotator cuff defects that might require surgery, we recommend CT arthrography, if possible with sagittal sections. This is particularly the case for younger patients with a history of trauma and evidence of a complex shoulder injury and in cases with persistent symptoms after surgical intervention of ineffective conservative treatment. CT, however, is only indicated if sonography supplies limited information or if sonography is negative with positive clinical findings.

Adolescent↗
PubMed1997

Fractures of the coracoid process.

We reviewed 67 consecutive patients with fractures of the coracoid process, classifying them by the relationship between the fracture site and the coracoclavicular ligament. The 53 type-I fractures were behind the attachment of this ligament, and the 11 type-II fractures were anterior to it. The relationship of three fractures was uncertain. Type-I fractures were associated with a wide variety of shoulder injuries and consequent dissociation between the scapula and the clavicle. Treatment was usually by open reduction and fixation for type-I fractures and conservative methods for type-II. At follow-up of the 45 available patients, 87% had excellent results, with no significant differences between the operative and non-operative groups or between the type-I and type-II fractures. We consider that operative treatment should be reserved for patients with multiple shoulder injuries with severe disruption of the scapuloclavicular connection.

Adolescent↗