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PubMed2006

Sensorimotor contribution to shoulder stability: effect of injury and rehabilitation.

Shoulder joint stability is the humeral head remaining or promptly returning to proper alignment within the glenoid fossa. This is mediated by both mechanical and dynamic restraint mechanisms. Coordination of these restraint systems is required for shoulder joint stability. The sensorimotor system is defined as all of the sensory, motor, and central integration and processing components involved in maintaining joint stability. The sensorimotor system is comprised of several components including proprioception, joint position sense, kinesthesia, sensation of force, and neuromuscular control. With joint injury, not only are the mechanical restraints disrupted (joint capsule, glenoid labrum, etc.) but also, the sensorimotor system is affected. Restoration of the sensorimotor system has been shown to occur through both surgical and conservative intervention and rehabilitation. Surgery has been shown to restore both mechanical restraints and the sensorimotor system. Specific rehabilitation techniques have also been effective at improving the sensorimotor system in healthy and pathological patients.

Humans↗
PubMed1999

Sports-specific concerns in the young athlete: football.

There are over 1.5 million males playing American football at all levels in the United States. American football is the most common participant sport among high-school-aged males. Owing to its high rate of injury per exposure hour, American football injuries are commonly treated in the emergency department during the autumn sports season. This article will review the history, epidemiology, and specific injury patterns seen in American football, with a focus on head and shoulder injuries.

Adolescent↗
PubMed2006

Isolated teres minor atrophy: manifestation of quadrilateral space syndrome or traction injury to the axillary nerve?

This article prospectively determines through magnetic resonance imaging (MRI) the incidence of isolated teres minor atrophy and its gender and age distribution, and documents associated findings related to the rotator cuff, labroligamentous complex, and quadrilateral space. Two hundred seventeen consecutive shoulder MRI examinations performed over a 3-month period were prospectively reviewed and evaluated for isolated teres minor atrophy. Twelve (5.5%) patients had non-compressive isolated teres minor atrophy. Ninety-two percent (n=11) of these patients had rotator cuff or labroligamentous complex tears. No patients had an associated mass within the quadrilateral space. The average patient age was 60 years and 11 of the 12 patients were male. Isolated teres minor atrophy on MRI is most commonly seen in older patients who do not fit the expected clinical presentation of quadrilateral space syndrome. The anatomical relationship of the teres minor nerve to the joint capsule and the frequency of associated shoulder injuries in these patients raises the possibility of an association between humeral decentering and teres minor atrophy. Quadrilateral space syndrome would appear to be a very rare cause of isolated teres minor atrophy.

Adult↗
PubMed1998

In-season management of shoulder pain in a collegiate swimmer: a team approach.

Shoulder pain is a common problem among competitive swimmers, often limiting their ability to train and compete. Although a number of rehabilitation programs for shoulder injuries have been reported in the literature, there is a lack of objective data regarding the effectiveness of these protocols in the competitive swimming population. This case report describes the evaluation and treatment of shoulder pain in an NCAA Division I swimmer during the competitive season. Once a physical therapy diagnosis was made, a plan of care was developed to address each component impairment. This required the input of the team trainers, the team physician, and an orthopaedic surgeon. A chief component of the athlete's rehabilitation involved allowing the athlete to compete, but not practice. Excellent results were achieved, as evidenced by symptom reduction and swimming performance. This case report highlights the interactive, team approach necessary for optimal management of the injured athlete.

Adult↗
PubMed2006

[Magnetic resonance imaging of glenohumeral instability].

Conventional MR imaging and MR arthrography are established diagnostic imaging modalities for investigating shoulder instability. Since there are currently various surgical shoulder stabilization methods as well as conservative treatment strategies, the role of imaging is to provide diagnostic information to help determine the therapeutic approach. Whereas conventional MR imaging is usually sufficient for the evaluation of acute shoulder injuries due to the presence of a posttraumatic joint effusion, MR arthrography is the imaging modality of choice for chronic shoulder instability. Atraumatic and microtraumatic instability of the shoulder must be distinguished from traumatic instability since clinical findings and secondary or associated injuries differ from those of traumatic instability. Injuries of the IGHL-complex can be reliably diagnosed with MR arthrography. Traumatic anteroinferior luxation causes labroligamentous injuries at the glenoid insertion (Bankart-, Perthes-, ALPSA-, and non-classifiable chronic lesions) and injuries of the IGHL and its humeral insertion (HAGL-, BHAGL-, and floating AIGL-lesions). The type of injury and extent of degenerative changes or scarring that can be assessed with MR arthrography influence the therapeutic approach and in particular the decision between arthroscopic and open surgical methods of stabilization.

Arthrography↗
PubMed1993

Current concepts in the rehabilitation of the athletic shoulder.

The rehabilitative process of the overhead athlete represents a significant challenge to the clinician. Overhead athletes (thrower, tennis player, swimmer) repetitively subject their shoulder joints to high microtraumatic stresses that, due to the accumulative effects, may lead to a variety of shoulder injuries. This type of athletic patient exhibits uniquely specific physical characteristics, such as hypermobility of the anterior shoulder capsule, excessive external rotation, hypomobility of the posterior capsule, limited internal rotation, and generalized ligamentous laxity of the glenohumeral joint. However, the overhead athlete must exhibit functional stability for pain-free sports participation. Functional stability is accomplished through the proficient balance of static (passive) and dynamic (active) stabilizers. During the rehabilitation process, various concepts, such as neuromuscular control, proprioception, force couple efficiency, plyometrics, eccentrics, and scapular stability, can enhance dynamic functional stability for the overhead athlete. The evaluation and treatment of the shoulder patient is in perpetual change, and the purpose of this paper is to discuss several current concepts in the rehabilitative treatment of the athletic shoulder patient.

Athletic Injuries↗
PubMed1998

[Isolated coracoid fracture--open reposition and osteosynthesis--report of 3 cases].

UNLABELLED: Usually coracoid-fractures are "chain-injuries" in association with complex shoulder injuries. Isolated fractures of the coracoid process are uncommon. In the literature there is no consensus about the treatment. The conservative method is generally advocated. For better recognizing the particularities of coracoid-anatomy and fracture-analysis we performed dissections on cadaver shoulders and also evaluated a useful radiologic technique for diagnosis. Between 1995 and 1997 three patients with isolated displaced coracoid-fractures had open surgical repair. The postoperative course was very good in all three cases with complete recovery of shoulder function. DISCUSSION: We believe that isolated coracoid-fractures with infero-lateral dislocation and loss of function should sustain open reduction and internal fixation with functional after treatment.

Adolescent↗
PubMed2001

Mountain biking injuries in rural England.

BACKGROUND: Off road mountain biking is now an extremely popular recreation and a potent cause of serious injury. AIM: To establish the morbidity associated with this sport. METHODS: Data were collected prospectively over one year on all patients presenting with an injury caused by either recreational or competitive off road mountain biking. RESULTS: Eighty four patients were identified, 70 males and 14 females, with a mean age of 22.5 years (range 8-71). Most accidents occurred during the summer months, most commonly in August. Each patient had an average of 1.6 injuries (n = 133) and these were divided into 15 categories, ranging from minor soft tissue to potentially life threatening. Operative intervention was indicated for 19 patients (23%) and several required multiple procedures. The commonest injuries were clavicle fractures (13%), shoulder injuries (12%), and distal radial fractures (11%). However, of a more sinister nature, one patient had a C2/3 dislocation requiring urgent stabilisation, one required a chest drain for a haemopneumothorax, and another required an emergency and life saving nephrectomy. CONCLUSION: This sport has recently experienced an explosion in popularity, and, as it carries a significant risk of potentially life threatening injury across all levels of participation, the use of protective equipment to reduce this significant morbidity may be advisable.

Adolescent↗
PubMed1992

MR imaging in the evaluation of SLAP injuries of the shoulder: findings in 10 patients.

OBJECTIVE: Injuries to the superior portion of the glenoid labrum, called SLAP (superior labrum, anterior and posterior) injuries, are recently recognized injuries consisting of tears of the long head of the biceps tendon anchor/superior labral complex. The purpose of this study was to determine if the MR imaging findings in patients with surgically proved SLAP injuries correspond to the abnormalities found at arthroscopy. MATERIALS AND METHODS: Four variants of SLAP lesions have been described; they are based on the degree of compromise of the superior portion of the glenoid labrum, biceps tendon, and labral-biceps anchor. A type I lesion has superior labral fraying in the region of the biceps anchor. A type II lesion has superior labral fraying and stripping of the superior part of the glenoid labrum and attached biceps off the underlying glenoid fossa. A type III lesion has a bucket-handle tear of the superior portion of the glenoid labrum in the region of the biceps anchor. A type IV lesion has a bucket-handle tear of the superior part of the glenoid labrum with extension of the tear into the proximal biceps tendon. Standard spin-echo MR imaging studies in 10 patients with surgically proved SLAP lesions were evaluated retrospectively. Correlations were made between MR imaging findings and the SLAP injury type determined from descriptions in the surgical report. MR imaging studies in a control group of seven symptomatic patients surgically proved not to have SLAP injuries also were evaluated. RESULTS: MR imaging examinations of two patients with type I lesions showed irregularity of the labral contour and a slight increase in signal intensity on all imaging sequences. MR imaging examinations of two patients with type II lesions showed globular high signal interposed between the superior part of the glenoid labrum and the superior portion of the glenoid fossa. One case showed high signal in the labral-biceps anchor. The other case showed paired cleavages in the superior and inferior aspects of the superior part of the glenoid labrum at the labral-biceps anchor. MR imaging examinations of two patients with type III lesions showed superior labral tears identified as high signal intensity within the superior part of the labrum separate from the normal superior part of the labral cavity. MR imaging examinations of the four patients with type IV lesions showed diffuse high signal intensity within the superior part of the glenoid labrum with marked abnormal high signal intensity extending into the proximal high signal intensity within the superior part of the labrum separate from the normal superior part of the labral cavity. MR imaging examinations of the four patients with type IV lesions showed diffuse high signal intensity within the superior part of the glenoid labrum with marked abnormal high signal intensity extending into the proximal biceps tendon. None of the MR imaging studies of patients in the control group showed findings seen on MR imaging studies of patients with surgically proved SLAP lesions. CONCLUSION: Although prospective data are required to document accuracy, these preliminary data suggest that an MR examination can be useful in detecting SLAP abnormalities and establishing the type of SLAP lesion before surgery, thereby permitting better operative planning.

Adult↗
PubMed2001

Infant shoulder sonography: technique, anatomy, and pathology.

BACKGROUND: In the infant, shoulder injury due to birth trauma and infection in joint and bone may be difficult to detect radiographically. Shoulder ultrasound provides a dynamic, noninvasive method of evaluation. OBJECTIVE: To develop a technique to evaluate the infant shoulder and to successfully demonstrate pathology. MATERIALS AND METHODS: Using a multiplanar, dynamic technique, 24 normal and 12 symptomatic infants (age range, 3 days to 9 months) were examined (49 shoulders). RESULTS: Sonographic findings were normal in 41 shoulders and abnormal in 8 shoulders. Abnormalities included subluxation, fracture, abnormal cartilage, soft-tissue mass, and inflammatory collections, including effusion. CONCLUSION: Ultrasound can be used successfully to evaluate the infant shoulder for instability, fracture, and infection.

Birth Injuries↗
PubMedDate not supplied

An electromyographic analysis of shoulder function in tennis players.

Shoulder injuries in tennis players are common because of the repetitive, high-magnitude forces generated around the shoulder during the various tennis strokes. An understanding of the complex sequences of muscle activity in this area may help reduce injury, enhance performance, and assist the rapid rehabilitation of the injured athlete. The supraspinatus, infraspinatus, subscapularis, middle deltoid, pectoralis major, latissimus dorsi, biceps brachii, and serratus anterior muscles were studied in six uninjured male Division II collegiate tennis players using dynamic electromyography (EMG) and synchronized high-speed photography. Each subject performed the tennis serve and the forehand and backhand groundstrokes, and each stroke was divided into stages. The tennis serve contains four stages. Three stages characterize the forehand and backhand groundstrokes. Our results indicate that the subscapularis, pectoralis major, and serratus anterior display the greatest activity during the serve and forehand. The middle deltoid, supraspinatus, and infraspinatus are most active in the acceleration and follow-through stages of the backhand. The biceps brachii increases its activity during cocking and follow-through in the serve with a similar pattern noted in the acceleration and follow-through stages of the forehand and backhand. The serratus anterior demonstrates intense activity in the serve and forehand, thus providing a stable platform for the humeral head and assisting in gleno-humeral-scapulothoracic synchrony. The tennis serve and forehand and backhand groundstrokes are accomplished by complex sequences of muscle activity that incorporate contributions from the lower extremities and trunk into smooth, coordinated patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Alpine ski injuries and their prevention.

Alpine skiing is a popular sport with significant risk of injury. Since the 1970s, injury rates have dropped from approximately 5 to 8 per 1000 skier-days to about 2 to 3 per 1000 skier-days. The nature of the injuries has also been transformed over the same period. Lower leg injuries are becoming less common while the incidence of knee sprains and upper extremity injuries is becoming more common. Much of this change can be attributed to advancements in binding technology, which effectively reduces lower leg injury, but does not adequately address the issue of knee sprains. Along with design, binding adjustment and maintenance are important preventative factors. Poorly adjusted bindings have been correlated with increased injury rates. Upper extremity injuries constitute approximately one-third of skiing injuries, with ulnar collateral ligament sprains and shoulder injuries being the most common. Strategies to prevent these include proper poling technique and avoidance of non-detachable ski pole retention devices. Spinal injuries in skiers have been traditionally much less common than in snowboarders, but this disparity is likely to diminish with the recent trend of incorporating snowboarding moves into skiing. Strategies to help reduce these injuries include promoting the development of terrain parks and focussing on proper technique during such moves. Head injuries have been increasing in incidence over recent decades and account for more than half of skiing-related deaths. The issue of ski helmets remains controversial while evidence for their efficacy remains under debate. There is no evidence to demonstrate that traditional ski instruction reduces injury frequency. More specific programmes focussed on injury prevention techniques are effective. The question of pre-season conditioning to prevent injuries needs further research to demonstrate efficacy.

Anterior Cruciate Ligament Injuries↗
PubMed2000

Upper extremity injuries in the paediatric athlete.

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.

Adolescent↗
PubMed1997

A biomechanical study of fast throwing movements of the shoulder in baseball pitching.

OBJECTIVE: To define the biomechanic function of the shoulder in fast throwing movements in baseball pitching. METHODS: Using NAC high-speed video and PIAS LA-555 computer system, overhand pitching movements carried out by 12 healthy Japanese professional baseball pitchers were analyzed in three dimensions. The pitching motion was displayed as stick to sick figures dynamically. RESULTS: Pitching motion was a combination of translational and rotational movements. Acceleration and deceleration, being two typical motion patterns, worked sequentially through the anatomic link system from the pivot leg to the pitching hand. During the acceleration phase, the shoulder joint acted as a junction point and a fulcrum, supporting the rotational acceleration motion, shoulder forward flexion and elbow extension. According to the changing glenohumeral angles of the pitching shoulder, shearing force turned into tension force which worked on the anterior shoulder structures and then shifted to the posterior part of the joint. CONCLUSIONS: In fast throwing motion, the shoulder functions as an important fulcrum to support the pitching arm during the acceleration phase. Avoiding excessive stress and shearing force on the joint components and enhancing coordination of muscle action are important to a successful throwing motion and the prevention of shoulder injury.

Athletic Injuries↗