[RESULTS OF TREATMENT OF LUXATION-FRACTURES OF THE SHOULDER JOINT].
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Fracture Fixation↗
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Results for “SHOULDER JOINT”
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[Exact method for the measurement of the rotation of the humerus head in the shoulder joint using computed tomography].
An exact method of measuring the degree of inward-and outward rotation in the humero-scapular joint is demonstrated. The advantage of the use of computed tomography as compared with the clinical method of measurement is the accurate differentiation of the mobility of the individual parts of the arm's mobile elements with respect to the trunk and the documentation of the result. For inward rotation we have measured a mean value of 38 degrees on the right side and of 37 degrees on the left; the corresponding values for outward rotation were 37 and 41 degrees. In eleven patients who had undergone Bankart's operation we found the outward rotation of the arm in the shoulder joint decreased to a mean value of 15 degrees.
Anthropometry↗
[Fulminant air embolism in arthroscopy of the shoulder joint using CO2].
We report on a case of an unexpected gas embolism during an arthroscopy of a newly injured shoulder joint. We used carbon dioxide as an arthroscopic medium which has not been considered hazardous up to now. The sudden decrease of the endtidal CO2 concentration in connection with a decrease of peripheral oxygen saturation as well as the clinical symptoms led to an immediate diagnosis of gas embolism. In this case external cardiac massage and aspiration of gas from the right ventricle proved an effective treatment.
Arthroscopy↗
[Partial prosthesis of the shoulder joint--personal experience].
Hemiarthroplasty of the shoulder is a treatment of choice for severe types of proximal humeral fractures. From 2001 to 2003, 8 hemiarthroplasties were performed at the University Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Novi Sad. The aim of this study was to retrospectively assess functional outcomes of those patients. By determing the factors that affected the outcome, we would try to improve results of future patients.
Aged↗
Power Doppler sonography with and without echo-enhancing contrast agent and contrast-enhanced MRI for the evaluation of rheumatoid arthritis of the shoulder joint: differentiation between synovitis and joint effusion.
OBJECTIVE: To evaluate patients with clinically active rheumatoid arthritis (RA) of the shoulder for joint effusion and synovitis using conventional sonography, power Doppler (PD) sonography with and without echo-enhancing contrast agent, and contrast-enhanced MRI. DESIGN AND PATIENTS: Twenty-four patients (mean age 64 years) with known RA had one symptomatic shoulder evaluated by conventional gray-scale sonography and PD sonography before and after intravenous administration of the echo-enhancing contrast agent Levovist (300 mg/ml, 2.5 g). The degree and extent of the altered echo pattern in the subacromial bursa, axillary recess and glenohumeral joint seen by conventional gray-scale sonography and the intensity of vascular signals of PD sonography were compared with the findings of MRI obtained with T2-weighted turbo spin-echo sequences and contrast-enhanced T1-weighted fat-saturated spin-echo sequences. MRI was evaluated by two readers in consensus without knowledge of the sonographic findings. RESULTS: MRI, which was used as the reference examination, detected joint effusion in 71% (17/24) and synovitis in 92% (22/24) of the patients. Conventional sonography revealed an abnormal articular echo pattern in 96% (23/24) of the patients, especially in the axillary recess and subacromial bursa, but failed to attribute the altered echo pattern to either fluid or specific synovitis. PD sonography allowed a specific diagnosis of synovitis in 33% (8 patients), which increased to 50% (12 patients) after administration of an echo-enhancing contrast agent. In 42% (10/24) of the patients, the findings of synovitis demonstrated by MRI corresponded to an altered echo pattern by conventional sonography, but vascular signals were absent by PD sonography with or without echo-enhancing contrast agent. CONCLUSIONS: Using MRI as the "gold standard," PD sonography with and without echo-enhancing contrast agent cannot reliably identify synovitis or distinguish synovial inflammation from effusion in the shoulder joint.
Adult↗
Arthroscopic management of septic arthritis of the shoulder joint.
BACKGROUND: Nineteen patients with septic arthritis of the glenohumeral joint were treated with a combination of arthroscopic irrigation and débridement and systemic antibiotics according to bacterial sensitivity. We retrospectively reviewed the series to determine the efficacy and safety of this treatment. METHODS: There were seventeen men and two women, with a mean age of fifty-nine years. Underlying medical disease was present in thirteen patients, with six of them having diabetes. The average duration of symptoms prior to the arthroscopic lavage was three weeks. Fifteen patients had had local injections into the shoulder joint. The arthroscopic staging of the infection was based on the modified criteria of Gächter. The functional outcome was evaluated with use of the UCLA scoring system. RESULTS: As determined at arthroscopy, one infection was classified as stage I; seven, as stage II; nine, as stage III; and two, as stage IV. Staphylococcus was the most common organism identified. The infection was eradicated completely with a single arthroscopic procedure in fourteen patients. The mean UCLA score at the time of the last follow-up was 26 points, with a mean score of 23.7 points for the eleven patients with a rotator cuff tear and 29 points for the eight with an intact rotator cuff. Patients who had had symptoms for no more than two weeks prior to the arthroscopic lavage had better results than those who had had symptoms for longer than two weeks. CONCLUSIONS: Arthroscopic débridement for the treatment of septic arthritis of the shoulder is safe and efficient, particularly in the early stages of the disease. Underlying medical diseases such as diabetes, prior injections, or a preexisting rotator cuff tear were seen in a high proportion of these patients.
Adult↗
[Ultrasound examination of the shoulder joint].
The ultrasound examination of the shoulder is an effective, quick and painless diagnostic method. The skilled examiner has no problem to detect rotator cuff tears, bursitis, tendinitis and instabilities as well as arthrosis or hematoma of the acromioclavicular joint and biceps tendon rupture. In the literature the sensitivity of ultrasound examination of the shoulder depended from 91 to 100% and specificity from 83 to 100%. The dynamic examination gives a special view of gliding tendons, muscles and bony landmarks of the shoulder. With standardized pictures the orthopedic surgeon should be able to diagnose and document almost every shoulder soft tissue pathology.
Arthritis↗
The relationship between isometric contraction durations and improvement in shoulder joint range of motion.
Proprioceptive Neuromuscular Facilitation (PNF) flexibility techniques are now being used in health and sports related activities, yet it is unclear as to the relationship between various isometric contraction time increments and joint range of motion. The purpose of this study, therefore, was to determine the relationship between a three-second, six-second, and ten-second maximum voluntary isometric contraction (MVIC). A modified PNF procedure referred to as the slow-reversal-hold-relax (SRHR) flexibility technique was employed in the investigation. It was hypothesized that longer MVIC time increments used with the SRHR flexibility technique would provide greater range of motion (ROM). Specifically, the ten-second MVIC was believed to be superior to the six-second and three-second MVIC. Furthermore, it was hypothesized that the six-second MVIC was superior to the three-second MVIC. Sixty subjects, ages 14-57 were randomly assigned to one of three treatment groups. Using a Leighton Flexometer, acute internal rotation of the shoulder joint was measured in degrees for six trials. Three passive stretch trials served as the baseline measurement for each subject (trials 1-3). The SRHR flexibility technique was used as the treatment for trials 4-6. A sixty-second rest interval common to clinical settings was integrated between each trial. The hypothesis was not accepted that a positive correlation existed between increased MVIC time and greater ROM.
Adolescent↗
Measurement of shoulder joint kinaesthesia.
SUMMARY. Loss of kinaesthesia has been identified as a factor in recurrent or persistent problems following glenohumeral dislocation. However, accurate measurement of shoulder kinaesthesia remains a difficult task in the clinical setting. This study investigated the use of the Kincom dynamometer for measuring the ability of a subject to reproduce a shoulder joint angle with a passive and active test. The tests were applied to two subject groups, (normal and patient) and the results were compared with those of a standard clinical test. The results of the Kincom tests demonstrate a statistically significant difference between the normal and patient groups (F((1,140)) = 53.0; P < 0.001). The difference between the means for the two groups was 1.2 degrees which indicates the precision of shoulder kinaesthetic sense. All subjects were more accurate with the active test compared to the passive test (F((1,140)) = 36.5; P < 0.001). Reliability of the Kincom tests was evaluated over 3 days and a significant difference was found between day one and day three for both groups (F((2,140)) = 3.5; P < 0.05) suggesting a learning effect had occurred. There was no significant difference between the Kincom active test and the clinical test (F((1,28)) = 1.86; P = 0.18); however, the difference between the Kincom passive test and the clinical test was significant (F((1,28)) = 10.74; P < 0.01). The clinical test did not demonstrate a statistically significant difference between the two subject groups (t(28 = 1); P = 0.05). Copyright 1996 Harcourt Publishers Ltd.
Journal Article↗
Cryotherapy does not impair shoulder joint position sense.
OBJECTIVE: To determine the effects of a cryotherapy treatment on shoulder proprioception. DESIGN: Crossover design with repeated measures. SETTING: University athletic training and sports medicine research laboratory. PARTICIPANTS: Thirty healthy subjects (15 women, 15 men). INTERVENTION: A 30-minute cryotherapy treatment. MAIN OUTCOME MEASURES: Joint position sense was measured in the dominant shoulder by using an inclinometer before and after receiving 30 minutes of either no ice or a 1-kg ice bag application. Skin temperature was measured below the tip of the acromion process and recorded every 5 minutes for the entire 30 minutes and immediately after testing. Three different types of error scores were calculated for data analyses and used to determine proprioception. RESULTS: Separate analyses of absolute, constant, and variable error failed to identify changes in shoulder joint proprioception as a function of the cryotherapy application. CONCLUSIONS: Application of an ice bag to the shoulder does not impair joint position sense. The control of proprioception at the shoulder may be more complex than at other joints in the body. Clinical implications may involve modifying rehabilitation considerations when managing shoulder injuries.
Adult↗
[Traumatic lesions of the capsula and tendons of the shoulder joint, rupture of the rotator cuff, strain fractures (author's transl)].
Traumatic lesions of the soft tissues in the region of the rotatory cuff of the shoulder and disinsertion of the tendons in the region of the shoulder joint are rare. They are seen in older patients and--without injury--in tendons which are damaged through degeneration. The diagnosis of such disinsertions is very difficult. Therefore, special diagnostic methods are described. Disinsertions, strain fractures and traumatic lesions of the rotator cuff can be treated surgically. The operation should be done only in case of adequate indication. Function, age and clinical symptoms should be carefully considered.
Adolescent↗
[Surgical treatment of habitual luxation of the shoulder joint using the Dickson-O'Dell method. Our modification].
The authors have presented their experience in the treatment of 40 patients with habitual dislocation of the shoulder joints using the method of Dickson-O'Dell during a period of 10 years. They have compared their results with results obtained by other methods and consider their modification as the method of choice on the basis of excellent results obtained in their patients.
Adolescent↗
The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint.
The purpose of this study was to investigate the ligamentous stabilizing mechanisms preventing anterior instability in the glenohumeral joint. Six freshly thawed, unembalmed cadaveric shoulders were dissected, preserving the joint capsule and glenohumeral ligaments, the coracohumeral ligament, and the subscapularis tendon. Hall-effect strain transducers were placed on the superior, middle, and inferior glenohumeral ligaments. The humerus and scapula were fixed in a specifically designed mounting apparatus that allowed the glenohumeral joint to be placed in 0 degree, 45 degrees, or 90 degrees of abduction. The mounting apparatus was placed in a model TTC Instron Universal Testing Instrument, which applied an external rotation torque to the humerus. Strain produced in the three glenohumeral ligaments was recorded on a three-channel X-Y chart recorder. At 0 degree of abduction, the superior and middle glenohumeral ligaments developed the most strain. At 45 degrees of abduction, the inferior and middle glenohumeral ligaments developed the most strain, with considerable strain also being developed in the superior glenohumeral ligament. At 90 degrees of abduction, the inferior glenohumeral ligament developed the most strain, with strain also seen in the middle glenohumeral ligament.
Biomechanical Phenomena↗
Recurrent anterior dislocations of the shoulder joint treated by the Bristow-Latarjet procedure. Historical review, operative technique and results.
Thirty patients who underwent a Bristow-Latarjet procedure for unilateral recurrent anterior dislocation of the shoulder joint were studied in retrospect. Using both subjective and objective criteria, a detailed scoring system was devised to assess the efficacy of the repair.
Adolescent↗
[Post-traumatic expert assessment of the shoulder joint in pre-existing os acromiale].
It often is difficult to assess a posttraumatic status if there is a skeleton anomaly in the region involved. A rare case of contusion of a shoulder joint with an os acromiale is presented. The os acromiale itself is unimportant in respect of the posttraumatic evolution. Posttraumatic damage can only be accepted if it can be verified objectively.
Acromion↗
[The diagnostic concept of acute infection of the shoulder joint].
INTRODUCTION: It is generally accepted that septic conditions of the shoulder often lead to an earnest situation with joint damage. Because of the low incidence of shoulder infections there are only a few cases reported in the literature. Therefore, unlike joint infections of the knee no diagnostic and therapeutic standard procedure is documented for the shoulder. MATERIALS AND METHODS: In a retrospective study the results of 15 patients with a surgical revision at the BG-Clinic-Bergmannsheil-Bochum between 1 January 1989 and 31 August 1999 after an infection of the shoulder joint were analyzed. We registered the following parameters: etiology, intervall until the first clinical symptoms, clinical signs, diagnostic procedure, intraoperative site (Gächter classification), and operative treatment. The diagnostic procedure followed an algorithm, including CRP-determination, ultrasound of the shoulder, ultrasound-guided aspiration and a Gram stain. If the result was positive, surgical joint revision followed. The infection stage was classified intraoperatively according to the criteria of the Gächter classification. Eight patients were reexamined after an average follow-up of 4.8 years. RESULTS: Fourteen infections followed injection. All patients demonstrated increasing CRP levels and a painful limited range of motion. In all Gram stains we detected bacterial organisms. The diagnosis of an acute infection according to the criteria of this diagnostic algorithm was verified intraoperatively in all 15 joints. Two patients with delayed admission died postoperatively due to septic multiorgan failure despite maximal treatment under intensive care conditions. CONCLUSION: If there are suspicious clinical symptoms after a typical anamnesis, we recommend an immediate diagnostic algorithm, including CRP determination, ultrasound of the shoulder, ultrasound-guided joint puncture and a Gram stain. If there is acute joint infection, time-consuming diagnostic procedures must be avoided because of the risk of secondary reduced joint mobility or life-threatening complications.
Acute Disease↗
[Shoulder girdle and shoulder joint tuberculosis].
From 1955 to 1980 inclusive, 50 patients with tuberculous omarthritis and 11 with specific shoulder girdle disorders (nine sternoclavicular joints, one isolated clavicular shaft focus, as well as one acromioclavicular joint focus) were treated at this clinic with a combined tuberculostatic and surgical therapy. The youngest patient was nine years old, and the oldest patient was 89 years old (36 females, 25 males). The patients (average age 49.4 years) comprised 11 foreign workers. From the beginning of the symptoms up to diagnosis, an average of 1.4 years elapsed. 34 patients (56%) had already been treated earlier for tuberculosis, and 12 (20%) were suffering at the same time from an active specific infection of other localisation. Independently of abscesses and fistulae (35 patients = 57%) as well as other simultaneous tuberculosis, the one-hour value of the erythrocyte sedimentation rate was in the normal range, or it was only marginally to slightly raised (under 20 mm according to W.). In 28 patients (46%), arthrodeses were performed in the shoulder joint, whereas the focus was cleared in the remaining patients. One patient (89 years old) died of senile debility. All complications (16 reactivations, two dislocations of the bone chip implantations, one fail joint) healed without complications after secondary operations. In the follow-up examination (on average, after 3.1 years), we diagnosed one recurrence (sternoclavicular joint process). Of the 45 patients (74%) followed up, 36 (80%) had started working again on average 12 months after the end of hospital treatment, or had resumed their former occupation (pensioners, housewives). Three (7%) of those followed up needed a different occupation or were given a new job within their firm.
Acromioclavicular Joint↗
[Shoulder joint replacement].
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Arthroplasty↗