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PubMed1995

Origin of the calcitonin gene-related peptide-immunoreactive nerve fibers in the rat shoulder joint.

The rat shoulder joint capsule is innervated by thin sympathetic and sensory nerve fibers, most of which contain calcitonin gene-related peptide (CGRP). In order to establish the origin and distribution of CGRP-immunoreactive (IR) fibers, wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP) was injected into the shoulder joints of rats via a dorsal surgical approach. After WGA-HRP injection, the cervico-thoracic dorsal root ganglia (DRG) were removed and processed using both HRP histochemistry and CGRP immunohistochemistry. In the C4 to C7 DRG, small to medium-sized neurons (20-40 microns) were labeled by this combined method. The number and size of the labeled neurons were measured in the cervical 4th-7th DRG. The number of double-labeled neurons was one quarter of the total number of HRP-labeled neurons and 1/20 of the CGRP-IR neurons. Most of the double-labeled cells were located in the C6 ganglion, and the mean number of double-labeled neurons was 13 at this level. This distribution and function of the CGRP-IR fibers in the rat shoulder joint capsule are discussed.

Animals↗
PubMed1998

[Changes in proprioceptive capacities of the shoulder joint in ventral shoulder instability. A comparative study before and after arthroscopic labrum refixation].

Measurements of movement sense determined by threshold levels for the perception of motion of the shoulder were performed in 10 patients with unilateral posttraumatic shoulder instabilities, in 30 patients who underwent arthroscopic labrum repair for recurrent anterior shoulder instability, and in 15 age-related controls. In patients with anterior shoulder instabilities threshold levels for the perception of motion were higher. In addition, movement sense measurements revealed a marked, but time dependent improve of proprioceptive abilities in patients who underwent arthroscopic labrum repair. While in the shoulders of patients with an postoperative period shorter than 18 months elevated threshold levels for the perception of motion still could be observed, after a postoperative period of 18 moths or more movement sense was not different from normal, uninjured shoulders. In conclusion, our study gives evidence for a proprioceptive deficit with anterior shoulder instability which improves significantly after arthroscopic labrum repair. The restitution of proprioceptive abilities, however, seems to be a time dependent process.

Adult↗
PubMed1996

Contracture of the shoulder joint.

The movements of the shoulder joint may sometimes be markedley limited due to posttraumatic or inflammatory changes in the shoulder joint or in adjacent organs, a condition designated as contracture of the shoulder joint or frozen shoulder. The routine treatment consists of positioning the arm as often as possible in abduction, and of diligent active and passive mobilization exercises. In those patients who started the treatment after a long delay so that the articular as well as the periarticular tissues were very shrunken, manipulation of the shoulder joint was carried out under general anesthesia this led to the return of full motion of the joint in the great majority of these patients. However, in those patients who did not benefit by manipulation, surgical revision of the joint and of periarticular structures was carried out for excision of all scarified tissues. The result was restoration of the mobility of the joint to an adequate although not total range.

Adult↗
PubMed2001

Anatomical composition of the anterior shoulder joint capsule. A cadaver study on 12 glenohumeral joints.

Twelve right cadaver shoulder joints were investigated after alcohol-formalin-glycerol fixation. The tendons of the "rotator cuff" were separated from the joint capsule. The capsulo-ligamentous structures: Lig. coracohumerale, Lig. coracoglenoidale and Ligg. glenohumeralia were dissected. In addition to the Ligg. glenohumerale superius, medium et inferius, an "unknown glenohumeral ligament" coursed in the midline of the superficial layer of the anterior shoulder joint capsule. It arose from the axillary part of the Lig. glenohumerale inferius and the insertion tendon of the Caput longum m. tricipitis brachii, coursed upwards laterally and fused with the Lig. glenohumerale medium. Between the Ligg. glenohumerale medium et inferius it was connected with the shoulder joint capsule by loose connective tissue. Craniolaterally it melted into the superior portion of the M. subscapularis and inserted together with its tendon to the Tuberculum minus of the Humerus. The ascending fibres of the "unknown glenohumeral ligament" and the oblique, descending fibres of the Ligg. glenohumeralia medium et inferius crossed twice and formed X-shape connections between the ligaments. In external rotation and abduction or anteversion the course of fibres of the "unknown glenohumeral ligament" was spiral. According to the shape and anatomical position of the "unknown glenohumeral ligament" we propose to name it "Lig. glenohumerale spirale".

Aged↗
PubMed1994

Immunohistochemical approach for the investigation of nerve distribution in the shoulder joint capsule.

Twenty six shoulder joint capsules obtained from 13 autopsy cases were studied to evaluate the nerve distribution using immunohistochemical techniques. Immunohistochemical staining of polyclonal S-100 protein or protein gene product 9.5 was more sensitive, specific, and reproducible compared with conventional gold chloride methods. A small number of clustered nerve fibers were found in the superficial layer, and many nerve fibers with large diameters were found in anteroinferior portions of the deep layer. Nerve fibers of various sizes were more numerous in posterosuperior and anterosuperior portions of the boundary zone between labrum and capsule. A Pacinian corpuscle was clearly recognized in a capsule. In the central portion of the long head of some biceps brachii tendons, relatively large nerve fibers continued from capsules. The results suggest that the capsule and long head of the biceps brachii tendon may play a partial role in the stability of the shoulder joint through afferent feedback.

Aged↗
PubMed2003

Stability of inter-joint coordination during circle drawing: effects of shoulder-joint articular properties.

The present study addressed the effect of articular conformity of the shoulder joint on the stability of inter-joint coordination during circular drawing movements. Twelve right-handed participants performed clockwise and counter-clockwise circular drawing movements at nine locations in the mid-sagittal plane. The task was paced acoustically at 1.0, 1.5 and 2.0 Hz and performed without visual control. Displacements of seven infrared light emitting diodes that were fixated at relevant joints were sampled at 100 Hz by means of a 3D-motion tracking system (Optotrak 3020). From these data, shoulder, elbow and wrist angular excursions were derived as well as the continuous relative phase of the proximal and distal joint pairs of the arm. The results confirmed earlier observations that the shoulder and elbow are more strongly coupled than the elbow and wrist in sagittal-plane movements. However, a typical characteristic of the architecture of the shoulder joint, that is, its built-in mechanical "joint play", was shown to induce a position-dependent variation in inter-joint coordination stability. We conclude that besides polyarticular-muscle induced synergies and inertial coupling, articular conformity of the shoulder joint constitutes an additional determinant of inter-joint coordination stability that, to date, has been neglected.

Adolescent↗
PubMed1993

[Ultrasonographic diagnosis in inflammatory-rheumatic changes of the shoulder joint].

Inflammatory rheumatoid changes of the shoulder joint are often diagnosed rather late, so therapy is largely directed towards pain reduction and less towards maintenance of full joint function. When considering the mutilating type of chronic polyarthritis, it becomes evident how important the role of the shoulder joint is in the patients performance of basic everyday activities. In this paper the important structures of the shoulder joint that can be visualized by ultrasound are described as to their rheumatological significance, and pathological findings are discussed along with the appropriate therapy.

Acromioclavicular Joint↗
PubMed1983

External compression arthrodesis of the shoulder joint.

Compression arthrodesis of the shoulder was carried out in 16 patients. One case of postoperative infection healed by conservative treatment, and all but one had primary fusion. With a median of 12 years follow-up, 12 patients were examined clinically and radiologically; one patient was lost to follow-up and three patients were dead. The result was rated as good by 10 patients and as improved by two patients. External compression arthrodesis was found to be a safe and easy way to achieve solid fusion of the shoulder joint. Arthroplasty and arthrodesis of the shoulder joint are complementary operations, applicable in different clinical situations.

Adolescent↗
PubMed1992

Magnetic resonance imaging of the shoulder joint.

Because the shoulder is the most mobile joint in the body, it is naturally predisposed to several disorders. The most commonly encountered disorders requiring diagnostic imaging are rotator cuff disease and glenohumeral instability. Plain film radiography and arthrography have for many years been the mainstays of shoulder imaging. CT added a third dimension to shoulder imaging, improving its sensitivity with respect to glenoid labral pathology. Ultrasonography of the rotator cuff showed early promise in noninvasive evaluation of cuff tears, but it did not gain universal acceptance because of various negative factors, including inadequate visualization of the cuff, poor results regarding partial tears, and most importantly, operator dependency. The development of MR imaging afforded the radiologist improved comprehensive visualization of the shoulder joint in a noninvasive manner.

Humans↗
PubMedDate not supplied

[Tuberculosis of the shoulder joint].

In contrast to specific shoulder girdle processes tuberculoses of the shoulder joint are observed relatively frequently. From 1955 up to and including 1980, 50 patients with omarthritis tuberculosa were surgically treated at the authors' clinic. Thirty were male, 20 female, 42 were Germans, 8 immigrant workers. Arthrodeses were performed in 28 cases, removal of bone or soft-tissue foci, or a combination of these, in 22. The left joint was affected in 26 cases (52%) and the right in 24 (48%). The youngest patient was 9, the oldest 78 years of age (average age 42.6 years). The time from the onset of complaints to diagnosis was about 1.6 years. Twenty-eight patients (56%) had previously had treatment for tuberculosis and 9 (18%) also had active tuberculosis localized elsewhere. Even though there were clear radiological changes in all cases, abscesses and fistulae or a combination of these in 27 cases (54%), the 1-hour ESR was normal or only slightly elevated (under 20 mm acc. to W.) in 29 patients (58%). The recurrences which occurred immediately after surgery or in the subsequent course of the disease healed without sequelae after secondary interventions. While they prolonged hospitalization they did not influence the result of surgery. Of the 38 (76%) patients who were followed up on average 3 years after the end of inpatient treatment, 30 (79%) had returned to work on average 1.1 year after being discharged from the hospital. Three had meanwhile been retrained for lighter work. In the discussion the etiology and pathogenesis, incidence, side localization, age and sex distribution, complaints, clinical and radiological findings, diagnosis, therapy, prognosis, and differential diagnosis of shoulder joint tuberculosis are reported on with reference to the relevant literature.

Abscess↗
PubMed1997

[Sports and work capacity after stabilization of recurrent shoulder joint dislocations].

Eighty-one patients (83 shoulder joints) underwent surgical procedures for recurrent shoulder joint dislocations. All patients had an extra-articular osteotomy with subcapital derotation according to Weber's technique. In all, 46% of the patients underwent additional intra-articular reconstructions. After a mean follow-up of 4.6 years, redislocations (6%) were observed only when a singular derotation technique had been used. Complications were minor (2.4%). External rotation of the operated shoulder joints was normal in most patients with a mean of 48.5 degrees. Improvement in sporting activities was seen in 80% and in working activities in 70%. The mean Constantscore was 89.2. Subacromial pain was rare and correlated with reduced scores in functional strain tests postoperatively. There was no postoperative arthritis owing to the derotation technique. Because of unrestricted rotation and early functional therapy, we observed a good indication for an additional derotation technique when a Hill-Sachs defect is evident.

Adolescent↗
PubMed1989

Double-contrast computed tomographic arthrography of the shoulder joint.

Dislocation of the shoulder joint can cause post-traumatic injury to certain anatomical structures, which may lead to recurrent dislocation. The operative visualization of some of these abnormalities may be difficult and their identification preoperatively allows selection of the appropriate surgical approach and avoids the necessity for lengthy surgery. Fifty-one patients with a history of recurrent dislocation, single dislocation or suspected recurrent subluxation as a cause of pain were examined over a 3-year period by double-contrast computed tomographic (CT) arthrography. Thirty-five patients had a demonstrable abnormality and 13 were considered suitable for surgical intervention on radiological criteria. A further 12 patients were advised to have surgery on a combination of clinical and radiological grounds. Eleven of these have so far had surgery, eight of which required an arthrotomy and the CT findings have been confirmed in all these cases. The results of CT arthrography in the patients examined are reported and the technique, normal anatomy and pathological findings are described. The technique is suggested as the imaging method of choice in recurrent dislocation.

Adolescent↗
PubMed1980

[Experiences with the use of shoulder joint endoprosthesis].

Total shoulder replacement has been successful as treatment for patients with irreparably damaged and painful glenohumeral joints, though improvement of joint motion is limited. Our experiences with 101 alloplastic operations on the human shoulder are reported for further design and construction of total shoulder joint prostheses. The type of prosthesis chosen depends on the degree of joint damage. A dorsal approach is recommended, carefully preserving or restoring function of the musculo-tendinous cuff mechanism.

Adult↗