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PubMed1996

[Diagnostic reliability of radiography in shoulder trauma. Considerations on the use and choice of more radiographic projections].

The radiographic examination of the shoulder, one of the most common studies performed in the emergency department of examine trauma patients, very often yields poor and incorrect results. A radiographic study of the shoulder requires at least two radiographs, and different projections-namely, a frontal anteroposterior view and some additional projections, at right angles to one another. The shoulder radiographs of 126 patients examined for acute trauma were retrospectively reviewed to investigate the adequacy of lateral and oblique apical views in detecting shoulder injuries missed on anteroposterior view. The antero-posterior view was the most effective one, showing 88% of the injuries. Even though the oblique apical and the lateral views were less sensitive than the antero-posterior view, detecting 82% and 60% of the injuries, respectively, they were more sensitive for some specific injuries missed by the other views. Thus, glenohumeral dislocations with or without fracture and some clavicular fractures were best depicted by the oblique apical view, while the fractures of the body and coracoid process of the scapula were best detected by the lateral view. However, the two views had a complementary role and, in our series of patients, both of them showed four injuries missed by the anteroposterior view. Therefore, we conclude that the radiologist should collaborate with the orthopedist to choose which projections to use in each patient on the basis of physical and clinical examinations.

Female↗
PubMed1997

Fracture of the superior border of the scapula.

Twenty-four patients who sustained a fracture of the superior border of the scapula are reviewed. All were associated with a fracture of the coracoid process and other shoulder injuries. There were 19 long fracture lines and 5 short. The former and 3 of the latter were extensions of a coracoid fracture; in 2, there appeared to be an avulsion fracture by traction through the superior transverse scapular ligament resulting from the upward displacement of the coracoid.

Adolescent↗
PubMed1989

Rehabilitation of the throwing shoulder.

Rehabilitation of the injured throwing arm should not be directed simply toward beginning strengthening exercises and returning the athlete to throwing as soon as possible. The total comprehensive program has been described and consists of seven phases that begin with making the proper diagnosis of a shoulder injury. Once the proper diagnosis is made, the pathophysiology of throwing injuries has to be understood by the physician, the trainer, and the athlete, and then the actual treatment begins in phase III. Initial treatment many times consists of a short period of relative rest as well as physical therapy modalities to relieve pain, and once pain is relieved phase IV begins, which is the actual techniques of range of motion, flexibility, and strengthening maneuvers. Once adequate flexibility, range of motion, and pain-free motion have been achieved, as well as adequate endurance strength, proper warm-up techniques are begun, and then a return to throwing is achieved in phase VI. The total rehabilitative cycle is concluded with phase VII, which consists of an off-season conditioning program to verify that the athlete will maintain year-round maximum condition of not only the throwing shoulder but of the entire athlete.

Biomechanical Phenomena↗
PubMed2002

Identification of feigned shoulder flexion weakness in normal subjects.

OBJECTIVE: The purpose of this study was to compare the effect of three related test protocols on the power of a specific index relating to the difference between the eccentric to concentric strength ratios (DEC) to identify feigned shoulder flexion effort. DESIGN: Seventeen normal subjects were instructed to exert maximal concentric and eccentric shoulder flexion effort and then to feign weakness, pretending the presence of a shoulder injury. RESULTS: For both range of motions (ROMs), the DEC scores in the feigned effort were significantly greater than their maximal counterparts. A case by case analysis revealed that the DEC correctly identified 100% of the feigned efforts when derived from the 40 and 160 degrees/sec combination. CONCLUSIONS: The findings indicate that the DEC retains its efficiency even under very short muscle length variation as long as adequate velocity gradients are applied. Consequently, maximality of effort may be tested outside compromised ROMs, particularly where pain or instability denies the performance of a standard full ROM protocol.

Adult↗
PubMed1999

[A prospective study on the detection of lesions of the labrum glenoidale by indirect MR arthrography of the shoulder].

PURPOSE: Aim of this prospective study was the evaluation of signal-alterations of anatomic shoulder structures before and after intravenous application of Gd-DTPA. Furthermore the tested clinical value of indirect MR-arthrography in detecting labrum lesions was tested. MATERIAL AND METHODS: 52 patients with suspected shoulder injury were examined on a 1.5 T system: Sequences were T1-weighted axial and oblique-coronary, additionally oblique-coronary T2-weighted, PD-weighted- and axial FLASH-2D-Sequences. After intravenous injection of contrast medium T1-weighted sequences were repeated. Signal-intensities (SI) of anatomic structures were measured by ROI-technique, the percentual contrast-enhancement (CE) and alterations in SNR (signal-noise-ratio) and CNR (contrast-noise-ratio) were calculated. Labrum tears were graded by three observers, their results could be confirmed by arthroscopy or open surgery in 24 patients. RESULTS: Contrast-enhancement was shown in all structures, most remarkable in the joint cavity. In pathologic findings of the labrum the SI and CE were significantly higher compared to intact strictures (p < 0.05). Sensitivity and specificity in the detection of labrum tears were 70% and 71.4% without contrast media, respectively 100% and 71.4% with indirect arthrography. CONCLUSIONS: The indirect arthrography improves the signal parameters of the structures. The detection of labrum lesions is improved, but still remains difficult.

Adolescent↗
PubMed1991

[Shoulder girdle injury in childhood. Operation or conservative procedure?].

The fracture of the clavicle is a very frequent injury to children and young adults. Using a figure-of-eight bandage for treatment leads to good functional result and acceptable cosmetical appearance. Indications for an open reduction are rare: they are confined to brachial plexus lesions, injuries to the subclavian vessels, open fractures or fractures of the outer third of the clavicle combined with an acromioclavicular separation. Fractures of the scapula merely require immobilization and subsequent physiotherapy to yield satisfactory results. Distorsions and subluxations of the joints of the clavicle are to be managed conservatively, too. Only in cases of complete ruptures of the acromioclavicular, coracoclavicular or sternoclavicular ligaments, it is necessary to perform an open reduction and repair of the ligaments.

Acromioclavicular Joint↗
PubMed1996

[Impingement syndrome following direct injuries of the shoulder joint].

Impingement is the most common cause of pain and limitation of movement in the shoulder, with painful arc syndrome its major clinical sign. It usually becomes manifest at between 70 degrees-120 degrees of abduction, but in severe cases, this may be reduced to only 50 degrees-70 degrees. We studied 22 patients who had developed shoulder impingement following direct injuries and who had been treated by anterior acromioplasty and decompression, with an average follow-up of 32 months. 5 had sustained fractures of the greater tuberosity of the humerus at the time of injury, 14 had tears of the rotator cuff of various sizes (1 in both shoulders) and 3 had developed fibrotic scars of the subacromial bursa. Excellent or good results were achieved in 86.6%. Healing time was shorter, and there was return of full range of shoulder movement in those with subacromial scars, undisplaced fractures of the greater tuberosity, or those with a small tear of the rotator cuff. Recovery took longer in those with larger tears of the rotator cuff and in those with displaced fractures of the greater tuberosity. Recovery time was proportional to the size of the rotator cuff tear. It is concluded that direct trauma to the shoulder bears a direct relationship to the development of impingement syndrome, and that at surgery a concomitant tear in the rotator cuff is seen more than 2/3. Because of the high rate of success in surgical treatment of this syndrome, operation is indicated when a few months of physical therapy and analgesics fail to provide relief. In the presence of fractures, decompression surgery should be postponed until the fracture has united.

Acromion↗
PubMed1988

Rotator cuff injuries in baseball. Prevention and rehabilitation.

Rotator cuff and ligamentous capsule injuries are common in the young baseball player. In order to understand these injuries, it is important to first appreciate the delicate balance between shoulder mobility and stability as well as the biomechanics of throwing. This background information makes it easy to see how shoulder injuries are really part of a progressive continuum beginning with instability leading to subluxation, and later impingement which can result in a rotator cuff tear. A detailed and precise history and physical is crucial in determining where a patient might be on the continuum. An accurate evaluation will also help appropriately place a patient in one of the following 4 groups: pure impingement, anterior instability due to trauma with secondary impingement, anterior stability due to a hyperelasticity with secondary impingement, and pure anterior instability. A kinesiological repair is the initial treatment of choice. It is the best preventative or early treatment available, and consists of a specific strengthening programme. If this fails (as in only 5 to 10% of the cases), an anatomical repair is instituted. There are 4 basic guidelines when doing this surgery: (a) maintain muscle attachments and proprioceptive fibres; (b) do not shorten the capsule significantly; (c) build up the anterior labrum; and (d) regain full range of motion quickly through abduction splinting and rehabilitation. A postoperative rehabilitation programme is then diligently adhered to, as it is at least as important as the surgery itself.

Adolescent↗
PubMed2004

Chronic labral tears: value of magnetic resonance arthrography in evaluating the glenoid labrum and labral-bicipital complex.

PURPOSE: In the magnetic resonance (MR) evaluation of the glenoid labrum, all studies to our knowledge have included mixed populations of patients, those with acute shoulder injuries as well as patients with chronic shoulder disorders. The focus of this investigation was to assess the effectiveness of MR arthrography in patients with chronic labral tears, excluding those with acute injuries. TYPE OF STUDY: Prospective case series. METHODS: Conventional MR images and MR arthrograms were obtained in 36 patients from April 1994 to April 1997. A single experienced musculoskeletal radiologist read all MR images. Each patient subsequently underwent shoulder arthroscopy performed by a single highly experienced shoulder arthroscopist. Detailed arthroscopic reports were then reviewed and compared with the MR findings documented before surgery, with arthroscopic findings being the standard of reference for comparison. Inclusion criteria required greater than 6 months of shoulder symptoms before imaging, thus eliminating acute injuries. RESULTS: SLAP lesions were diagnosed at the time of surgery in 11 of 36 patients (31%). The sensitivity was 100% (11 of 11 patients) and the specificity was 88% (22 of 25 patients). Accuracy for SLAP lesions was 92% (33 of 36 patients). Anterior labral tears were diagnosed surgically in 12 of 36 patients (33%). The sensitivity was 86% (12 of 14 patients) and specificity was 86% (19 of 22 patients). Accuracy for labral tears was 86% (31 of 36 patients). CONCLUSIONS: MR arthrography is an accurate technique for assessing the glenoid labrum in patients with chronic labral tears. LEVEL OF EVIDENCE: Level I.

Adult↗
PubMed1989

Rehabilitation of overuse injuries of the shoulder.

The most common overuse injuries in sports medicine are rotator cuff tendinitis and shoulder impingement. Anatomic and biomechanical analysis of the shoulder complex demonstrates the likelihood of overuse injury to this region. Total rehabilitation includes relief of inflammation, restoration of normal joint arthrokinematics, and rotator cuff strengthening. The reduction of force overload to the shoulder in sport-specific activities and total arm strengthening are also emphasized in a comprehensive rehabilitation program.

Athletic Injuries↗
PubMed1998

Primary traumatic anterior shoulder dislocation in patients 40 years of age and older.

During three consecutive ski seasons (1991 to 1994), 125 patients 40 years of age and older without previous shoulder injuries or surgery sustained a traumatic first-time anterior shoulder dislocation. At a minimum of 2 years' follow-up, patients were contacted to determine long-term outcome and to identify factors leading to prolonged morbidity or the need for surgical intervention. Fifty-two patients were available for interview. A modified Rowe shoulder score showed 32 excellent, nine good, eight fair, and three poor results. Eighteen (35%) rotator cuff tears were subsequently identified, with only 11 (61%) of these patients obtaining an excellent or good outcome (P = .011). Of the 11 patients with a fair or poor result, seven (64%) had a rotator cuff tear. Of the 12 patients with isolated cuff tears, 84% had an excellent or good result when treated surgically, compared with 50% when treated nonsurgically. Our findings indicate that recurrence is not a frequent complication of traumatic anterior shoulder dislocation in this age-group (4%). However, prolonged morbidity secondary to rotator cuff tear is more prevalent than in a younger population. We believe early diagnosis of rotator cuff pathology by either magnetic resonance imaging (MRI) or arthrogram with subsequent surgical repair can lead to faster restoration of function and a better outcome in these select individuals.

Adult↗
PubMedDate not supplied

A prospective study of high school wrestling injuries.

We performed a prospective study to evaluate injury patterns in a large population of high school wrestlers during one season. Preseason screening was performed on 458 male wrestlers from 14 different high schools. Certified athletic trainers submitted detailed weekly team and individual injury reports. There were 219 injuries in 418 wrestlers followed throughout the season for an overall injury incidence of 52 injuries per 100 wrestlers per season and an injury rate of 6.0 injuries per 1,000 exposures. The most commonly injured areas were the shoulder (24%) and knee (17%). Injured wrestlers were an average of 5 months older and had a 32% higher experience level than noninjured wrestlers. Wrestlers with ligamentous laxity suffered fewer shoulder injuries than the other wrestlers. The majority of injuries occurred in practice (63%), although the injury rate was higher in match competitions. Sixty-eight percent of practice injuries occurred during hard wrestling, 23% during drills, and 9% during conditioning. The most common wrestling situation resulting in injury was the takedown position (68%). Our results show that the older and more experienced wrestler may be at greater risk of injury. Hard wrestling during practice and the takedown position resulted in the highest occurrence of injury.

Adolescent↗
PubMed1990

[Sport-specific injuries in weight lifting].

121 weight-lifters reported their past injuries due to their sport. 32% never had had any sports related medical problem. From the remaining 68%, 202 instances of injuries related to weight lifting were reported. They affected the knees (25%), scapular girdle (22%), back (21%), wrist (12%) and the elbows (6%). In about 10% of the known cases of knee injury, the rest period without any sports activity lasted more than 28 days. More often than not, it was due to degenerative processes of the joint. Sportsmen fear particularly shoulder injuries during the snatch movements. Accidents could be prevented to a large extent by relevant preventive actions such as warm-up exercises, a strict hygiene of the weights and devices and, most importantly, stable footwear.

Adult↗
PubMedDate not supplied

Injuries to the shoulder in the throwing athlete. Part one: Biomechanics/pathophysiology/classification of injury.

Over the last decade, significant advances have been made in the study and understanding of shoulder mechanics. Much of this may be attributed to the use of more sophisticated technology to improve our ability to assess the shoulder in real-time athletics. As a consequence of these advances, our understanding of the pathophysiology of injury has also increased. Our manual examination skills have improved and our noninvasive diagnostic techniques have advanced greatly. New insight into forces at play during actions as complex as the throwing motion has allowed us to develop better protocols for the prevention and treatment of the most common injuries. Additionally, paralleling improvements in the understanding of shoulder kinematics and the pathophysiology of injury, advances in surgical techniques, particularly arthroscopy, have aided in the diagnosis of and the development of less invasive surgical treatments for injuries that do not respond to nonoperative measures. Undoubtedly, an up-to-date understanding of the developments in shoulder biomechanics, pathophysiology of injury, diagnostic techniques, and surgical management is necessary for the clinician who wishes to continue to apply proper skills in the sports medicine setting.

Athletic Injuries↗