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PubMed2006

[Forensic identification of floating shoulder injury].

OBJECTIVE: To discuss forensic identification of floating shoulder injury (FSI). METHODS: To analyze fifteen cases of FSI which were accepted from Jan. 1993 to Jan. 2006, including 15 shoulder neck fracture, 13 clavide stem fracture and 2 distal end clavide fracture, the function of shoulder joint was evaluated six months after injure considering the following three aspects: result of forensic examination such as X-ray photograph, CT and MRI, the injurers' symptom, objective sign and joint function, shoulder joint territory, degree of pain and local muscle power. RESULTS: Basing on the curative effect standard of Herscovic, all cases were divided into good. Modest, worst, which included 2, 4, 9 cases respectively; referring the standard of GA35-92, GB18667-2002, all cases were divided into six, seven, eight, nine and ten degree, which included 2,9,2,1,1 cases respectively. CONCLUSION: As a special powerful injure, FSI always companied with concurrent and multiple injure, and characterized by missed, incorrect and delayed diagnosis and infelicitous treatment, which lead to the high frequency and degree of injure. To prevent missed and incorrect forensic identification, we should have a full realization of the particularity of FSI, and evaluate the function of shoulder all-sidely, objectively and synseticaly.

Accidents, Traffic↗
PubMed1996

Common shoulder injuries among athletes: evaluation and management.

Shoulder injuries in athletics, especially throwing sports, are a relatively common phenomenon. Assessment and evaluation of shoulder problems require a systematic approach that should be both comprehensive and efficient. This article outlines a sequential process of evaluation that incorporates the following different components of a thorough examination: taking a history, inspecting the shoulder, palpating the structures, assessing active and passive range of motion, testing strength, and performing special tests. Guidelines for management of the most common diagnoses are included.

Athletic Injuries↗
PubMed1986

Mechanisms of shoulder injuries.

In this article, we discuss our review of 284 shoulder injuries that were seen and treated arthroscopically during a five-year period. All of the injuries were related to the athletes' particular sport. We describe the biomechanical basis for these injuries and review the data gathered on the forces involved in the act of throwing.

Athletic Injuries↗
PubMed2001

A descriptive epidemiological study of shoulder injury in top level English male volleyball players.

The aims of this study were to estimate the prevalence and incidence of shoulder sports injuries, to discover the main shoulder injury, and to survey outcome of treatment or injuries in top level male volleyball athletes. Furthermore, the actions which most commonly cause injuries and the differences of physical characteristics between injured and healthy players were also investigated. Fifty-nine English Volleyball Federation division one athletes were recruited in the 1997/98 and 1998/99 seasons. All subjects completed two different questionnaires; a First recruitment and monthly Follow-up questionnaire throughout the period in question. Twenty-seven of the fifty-nine athletes had a history of shoulder sports injury, with a total of 29 injuries reported. The results of the First recruitment showed that overuse type injuries (19/29) were the main shoulder injuries. Cuff muscle tendinitis was predominant in these injuries (14/29). Furthermore, spiking was the major action during which a shoulder injury (23/29) first occurred. In the follow-up phase the incidences of shoulder chronic injury (or pain), re-injury, and new injury in these twenty-seven players were 3.0, 9.3 and 1.0 injuries/1,000 hours of exposure respectively. The mean duration of chronic injury or pain was 2.3 +/- 1.3 (+/- SD) months. The distribution of history of regular training, between injured and healthy subject groups, was significantly different (p = 0.008). This study has identified rotator cuff muscle/tendon injuries or involved lesions as the main shoulder injuries in top level English male volleyball athletes. These injuries result in prolonged shoulder pain symptoms.

Adult↗
PubMed1997

Shoulder injuries in the athlete.

Musculoskeletal injuries constantly provide challenges to the team physician, including those to the shoulder. Shoulder injuries are common in athletes, whether as a result of direct contact from a collision or from repetitive overhead motion. This article reviews sports-related injuries to the shoulder, including similarities between sports, clinical evaluation, and rehabilitation of the athletes.

Acromioclavicular Joint↗
PubMed1989

Shoulder injuries in archery.

Twenty-one elite-calibre archers (M = 12, F = 9) were investigated concerning all past and present archery-related shoulder injuries, using a questionnaire and physical examination. The questionnaire revealed that 11 of 21 archers had complained of significant shoulder injuries either currently or during their careers. While 9/12 men never had shoulder problems during an average of 13.5 years, only 4/9 women escaped injury during a mean 10.9 year competitive career. Deficits in training programs were noted, including lack of training and non-specific exercises. Clinical examination demonstrated shoulder asymmetry and decreased flexibility in the drawing arm (DA) shoulder. Functional testing revealed a positive impingement sign in 6/21 DA shoulders. Supraspinatus testing showed abnormalities in 4/21 DA shoulders. Pain was referred posteriorly with the impingement maneuver in 5/21 DA shoulders and abnormal external rotation testing was observed in 8/21 DA shoulders. Generally, the females had proportionally more signs and symptoms of shoulder injury than the men, especially involving the DA shoulder. Testing implicated supraspinatus impingement/tendonitis and infraspinatus/teres minor traction tendonitis. These clinical findings correlated with cadaver prosection observations.

Acromion↗
PubMed2000

Preventing home health nursing assistant back and shoulder injuries.

BACKGROUND: Franklin County Home Health Agency (St Albans, Vermont) undertook a performance improvement project in 1996 to reduce employee injuries. A review of recent injuries led to the prevention of licensed nursing assistants' (LNAs') back and shoulder injuries as the first priority. Root causes of injuries were agency communication, employee training, patient home environment, nursing assistant body mechanics, and failure to use safety measures. Given that injury causality is complex and multifactorial, a variety of improvement strategies were implemented over the following two to three years. IMPLEMENTATION OF POTENTIAL SOLUTIONS: Short-term (a few months), mid-term (six months), and long-term (one year) potential solutions to the LNA back and shoulder injury problem were charted. Safety and health training was the major focus of the team's short-term plan. Risk management forms were to be used to identify and follow up on hazardous situations. RESULTS: Project plans that were successfully implemented included revision of LNA plans of care, standardization of the return-to-work process after injury, development of guidelines for identifying unsafe patient lifts and transfers, improved follow-up of employee reports of injury-risk situations in patient homes, improved body mechanics screening of new employees, and a stronger injury-prevention training program for current employees. A less successful initiative was aimed at collecting more data about injuries and causal factors. Employee injuries were gradually reduced from 4-10 per quarter to 0-3 per quarter. CONCLUSIONS: Injury prevention requires commitment, persistence, and patience--but not expensive improvements. Multiple interventions increase the chances of success when there are many root causes and lack of evidence regarding the effectiveness of various approaches.

Back Injuries↗
PubMed2000

Shoulder injury in the throwing athlete.

Successful nonoperative management of shoulder injury in the throwing athlete requires a comprehensive team approach. The cornerstone of management is physical therapy to restore strength, balance, and endurance to the shoulder girdle musculature followed by a return to a throwing program. The return to competitive throwing is usually a lengthy process requiring patience from the medical team and the athlete.

Athletic Injuries↗
PubMed2005

Medicolegal aspects of the orthopaedic care for shoulder injuries.

The medicolegal aspects of orthopaedic care increasingly are becoming an important focus of physicians. Because of the rarity of publications on the subject, I will examine medical litigation in orthopaedics, specifically in regards to shoulder injuries. There are several reasons for recent increases in malpractice litigation. Increased orthopaedic specialization and advanced technologies have raised patient expectations while the media have informed patients of the potential financial rewards of litigation. I will discuss three cases of litigation regarding shoulder injuries including reasons for malpractice and what can be done to avoid it. In Case 1 I examine an implant failure of a rotator cuff repair. The failure was caused by a manufacturing error; therefore, the importance of being familiar with the equipment and the companies that a physician deals with is emphasized in this case. Case 2 is another failed rotator cuff repair; this litigation stemmed from poor patient selection and a lack of preoperative patient-physician communication. Finally, Case 3 involved retained hardware, a surgical mistake that often results in a substantial settlement because it is considered indefensible. These cases highlight the potential for malpractice and can be applied more broadly to all branches of orthopaedics. Most litigation, however, can be avoided with careful diagnostic procedures, greater experience with equipment, and better communication.

Adult↗
PubMed1995

Comparison of shoulder injury in collegiate- and master's-level swimmers.

The need to investigate shoulder injury in swimmers other than the young and elite is evident, as all ages and levels are represented in the 100 million Americans who classify themselves as swimmers. To investigate the differences between young, highly competitive collegiate swimmers and older, less elite swimmers, a survey questionnaire was distributed to 100 collegiate and 100 master's swim teams. Questions regarding swimming routines, performance standards, and several possible predisposing factors associated with "swimmer's shoulder," as implicated in the literature, were investigated. As expected, the results revealed that the collegiate group swam the higher yardage, with considerably faster times in both the 50- and the 1,000-yd freestyle, and more than double the number of workouts per week. However, the collegiate and master's group reported similar percentages, 47 and 48%, respectively, experiencing shoulder pain lasting 3 weeks or more, despite the lesser distances and intensities associated with the latter group. Chi-square analysis revealed no association between shoulder pain and perceived level of flexibility, hand paddle usage, or breathing side for either group. However, over 50% of the swimmers with shoulder pain in both groups perceived that increased intensities and/or distance provoked shoulder pain, indicating that fatigue may be the issue to avoid and on which to focus. Strengthening the muscles of the shoulder, specifically those shown to have a propensity to fatigue, provides a strong defense against injury, as fatigue of the shoulder muscles may be the initial antecedent to swimmer's shoulder. These results give the swimmer, coach, and medical practitioner feedback to consider for a swimmer of any age or level.

Adult↗
PubMed1996

Shoulder injuries common in alcoholics. An analysis of 413 injuries.

We recorded prospectively all adult patients with a fracture of the proximal end of the humerus, clavicle and scapula or a primary shoulder or acromioclavicular dislocation in the city of Malmö in 1987. Altogether there were 413 injures. The hospital records from the Department of Alcohol Diseases were searched for these patients and for 2 age- and gender-matched controls for each patient. 12% of all patients with a shoulder injury were recorded as alcohol abusers. This number was significantly greater than that of the controls. The difference was more obvious in men than in women. In men between 30 and 64 years, almost half of the proximal humerus fractures and shoulder dislocations, one third of mid-clavicular fractures and two thirds of all lateral clavicle fractures were sustained by alcohol abusers. Our findings emphasize the significance of alcohol abuse in the etiology of shoulder injuries, especially in men. Most of the men with a fracture of the lateral clavicle are registered at the Department of Alcohol Diseases, making this injury a marker of alcohol abuse.

Acromioclavicular Joint↗
PubMed2006

Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test.

BACKGROUND: Physical examination of patients with shoulder injury not involving actual rotator cuff tears frequently demonstrates decreased rotator cuff strength on manual muscle testing. This decrease has been attributed to supraspinatus muscle weakness, but it may be owing to alterations in scapular position. HYPOTHESIS: The position of stabilized scapular retraction, by minimizing proximal kinetic chain factors and providing a stable base of muscle origin, positively influences demonstrated supraspinatus strength. STUDY DESIGN: Controlled laboratory study. METHODS: Supraspinatus strength was tested in 20 injured patients and 10 healthy controls in both the empty-can arm position and a position of scapular retraction using a handheld dynamometer. Pain in both maneuvers was measured by use of a visual analog scale. RESULTS: Paired t tests indicated the scapular retraction position resulted in statistically significantly (P = .001) higher supraspinatus strength values within both groups. There was no significant difference between the 2 positions in visual analog scale scores. CONCLUSION: This study shows that demonstrated apparent supraspinatus weakness on clinical examination in symptomatic patients may be dependent on scapular position. The weakness may be owing to other factors besides supraspinatus muscle weakness, such as a lack of a stable base in the kinetic chain or scapula. CLINICAL RELEVANCE: The clinical examination that addresses scapular posture and includes scapular retraction will allow more accurate determination of absolute supraspinatus muscle strength and allow efficacious rehabilitation protocols to address the source of the demonstrated weakness.

Adult↗
PubMed1989

Axillary aneurysm after shoulder injury. A report of 2 cases.

Two cases of false aneurysm of the axillary artery occurred after closed shoulder injuries. One was a dislocation of the shoulder, and the other was a fracture of the lesser tuberosity. In both cases the diagnosis was delayed, and only became apparent after excessive bruising was seen.

Aged↗
PubMed1995

Shoulder Injuries in the Throwing Athlete.

The throwing athlete with shoulder pain presents a diagnostic and treatment challenge to the orthopaedic surgeon. Because pitching a baseball requires the arm to accelerate at 7,000 degrees per second, tremendous forces are experienced at the shoulder joint. Electromyographic studies have shown that the larger scapular and trunk muscles are primarily responsible for arm acceleration. The smaller and more fragile rotator cuff muscles play a significant role in decelerating the arm. During the entire throwing mechanism, the rotator cuff and the capsulolabral complex act to stabilize the humeral head on the glenoid fossa. As a result, the labrum, the capsule, and the rotator cuff are frequently the site of shoulder injury in throwers. The diagnosis of injury to these structures is based on the findings from the history, physical examination, and imaging studies. The majority of throwing injuries respond well to a carefully designed rehabilitation program. Athletes who do not improve within 6 months are candidates for surgical repair. The procedure is planned so as to minimize the amount of surgical trauma and thereby to facilitate an early return to sport. Arthroscopy is a valuable first step to confirm the pathologic diagnosis. The arthroscope alone is used to perform subacromial debridement, labral repair, or debridement of undersurface partial-thickness rotator cuff tears. If the athlete has clinical evidence of shoulder instability and arthroscopic evidence of capsular stretch, an open stabilization procedure is performed.

Journal Article↗
PubMed2000

[Shoulder injury in general practice].

Injuries to the shoulder and shoulder-girdle represent a demanding diagnostic and therapeutic challenge. The complex and minimally constrained anatomic construction of the joints is critical. Although a large majority of the injuries are relatively trivial it is essential to recognize critical lesions that deserve intensive investigation and appropriate treatment. In view of the severity of the consequences of particular injury patterns this article focuses on fractures of the proximal humerus, gleno-humeral dislocations and on acute ruptures of the rotator cuff. In particular, attention will be drawn on fractures with avascular head fragment, primarily undisplaced fractures of the anatomic neck, unrecognized posterior dislocation and on under diagnosed acute ruptures of the rotator cuff. The key issue for a secure diagnosis are a precise physical examination and an adequate conventional radiologic investigation. Both aspects are discussed with practically relevant suggestions.

Arthroscopy↗