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PubMed2005

Arthroscopic treatment of posterior shoulder instability: results in 33 patients.

BACKGROUND: Posterior shoulder instability is a relatively rare condition and a surgical challenge. Arthroscopic techniques have allowed for a potential improvement as well as diagnosis and management of this condition. PURPOSE: To evaluate the outcomes of arthroscopic posterior shoulder stabilization and to evaluate preoperative and intraoperative variables as predictors of success. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-three consecutive patients with a mean age of 25 years (range, 19-34 years) who underwent posterior arthroscopic shoulder stabilization with suture anchors (mean, 3 anchors) or suture capsulolabral plication (mean, 5.3 stitches) or both were reviewed at a mean follow-up of 39.1 months (range, 22-60 months). Shoulder outcomes rating scores were determined using the American Shoulder and Elbow Surgeons Rating Scale, the Western Ontario Shoulder Instability Index, the Subjective Patient Shoulder Evaluation, and the Single Assessment Numeric Evaluation. RESULTS: There were 7 failures: 4 for recurrent instability and 3 for symptoms of pain. Overall, outcomes scores demonstrated mean values of the American Shoulder and Elbow Surgeons Rating Scale of 94.6, Subjective Patient Shoulder Evaluation of 20.0, Western Ontario Shoulder Instability Index of 389.4 (81.5% of normal), and Single Assessment Numeric Evaluation of 87.5. Patients with voluntary instability demonstrated worse outcomes (P = .025), and those with prior surgery of the shoulder also did worse (P = .02). CONCLUSION: Arthroscopic treatment of posterior shoulder instability is an effective means to improve symptoms associated with recurrent posterior subluxation of the shoulder. It can provide predictable success in the setting of unidirectional, nonvoluntary posterior instability without prior surgery.

Adult↗
PubMed1996

Amyloidosis of the shoulder in patients on chronic hemodialysis: sonographic findings.

OBJECTIVE: The purpose of this study was to determine the sonographic findings of amyloidosis in shoulders of patients on chronic hemodialysis. SUBJECTS AND METHODS: Sonograms were obtained for 19 shoulders of 11 patients on chronic hemodialysis with clinical findings suggestive of amyloidosis. Five patients had biopsy-proven amyloidosis, and one patient had positive shoulder joint fluid aspirate. The thicknesses of the following structures were measured: the rotator cuff, the subacromial-subdeltoid bursa, and the long head of the biceps tendon and its synovial sheath. The presence of intra- or periarticular masses or nodules, hyperechoic areas, bony erosions, and calcifications was specifically assessed. Shoulder sonograms from dialysis patients were compared with normal sonograms obtained for 20 asymptomatic shoulders of patients without renal disease. RESULTS: The mean rotator cuff thickness in the patients with amyloidosis was significantly greater than that in the normal group (p < .0001). Ten shoulders of six patients with amyloidosis but none of the control subjects had a rotator cuff thickness greater than 7 mm. The synovial sheath of the long head of the biceps tendon was thickened in 10 shoulders of patients with amyloidosis and in one normal shoulder. The subacromial-subdeltoid bursa was thickened in seven shoulders of patients with amyloidosis but not in any shoulders in the control group. Eight shoulder sonograms from dialysis patients showed intra- or periarticular nodules. CONCLUSION: Sonographic findings associated with amyloidosis of the shoulder include thickening of the rotator cuff, the synovial sheath of the long head of the biceps tendon, and the subacromial-subdeltoid bursa and the presence of nodules within or around the joint. Shoulder sonography may be useful as a noninvasive technique for the diagnosis of dialysis-related amyloidosis in the proper clinical setting.

Adult↗
PubMed1980

[Shoulder mechanism - study based on cineradiography and radiography with the arm elevated (author's transl)].

In order to better understand the shoulder mechanism and make a clinical assessment of the "zero-position", a study by means of cineradiography and radiography was performed on normal and disordered shoulders with arm elevated. The conception of the "scapular plane" has been widely accepted as the reference plane for the mechanism at the shoulder joint, but practically this plane is not easily defined. Thus, a cineradiographic study of 50 normal joints has been carried out in 7 planes between the frontal and the sagittal plane, during upward and downward movement of the arm. As a result, it was determined that the "scapular plane" should be inclined forward at an angle of 30 degrees to the frontal plane. In evaluating the anatomical relationship between the humeral head and the glenoid during upward and downward movement of the arm, 50 normal shoulders and 22 disordered shoulders composed of 12 loose shoulders and 10 rotator cuff injuries were analyzed in the "scapular plane" using devised method of measurement. Concerning the "zero-position", information was gained mostly from radiographies of 600 normal and 32 disordered shoulder joints. Especially o the disordered joints, a radiographic study of the shoulder with arm elevated was made pre- and postoperatively with the arm elevated. The results obtained are as follows, 1. In the "zero-position", the humerus must be elevated to 150 degrees in the "scapular plane", with individual variations. 2. Regularization of the glenohumeral rhythm of the normal shoulder joints was observed between the end of the "setting phase" and the "zero-position". 3. Glenohumeral mechanism of the normal and disordered shoulders was different between upward and downward movement of the arm, especially more remarkable at the disordered joints. 4. Lateral deviation of the humeral head toward the glenoid was found in the loose shoulder during upward and downward movement of the arm, especially during maximum elevation of the arm. 5. Glenoid osteotomy was determined to be the reasonable procedure for stabilizing loose shoulders, from the aspect of radiographic study with the arm elevated. 6. In rotator cuff injuries, the glenohumeral rhythm was disturbed, and in some patients instability at the glenohumeral joint was observed. From postoperative radiographic evaluation with the arm elevated, it has been observed that the anatomical situations at the glenohumeral joint have recovered to nearly norma conditions. 7. In conclusion the author emphasizes the mechanism of normal and disordered glenohumeral joints, using radiography of the shoulder with the arm elevated.

Adolescent↗
PubMed2000

Outcome analysis following open rotator cuff repair. Early effectiveness validated using four different shoulder assessment scales.

Evaluation of upper extremity function after reconstructive surgery is increasingly important both to predict outcome and for the control of cost-effectiveness. Three validated, self-administered shoulder questionnaires were applied prospectively in 23 otherwise healthy patients with rotator cuff deficiency and correlated to the Constant-Murley Shoulder Score and a visual analogue scale for satisfaction. Seven women and 16 men with combined tears of supraspinatus and infraspinatus (mean age 55.3 +/- 10.5 years, r/l: 14/9, follow-up 57.8 +/- 15.7 weeks) were gathered prospectively and evaluated pre- and postoperatively with the American Shoulder and Elbow Surgeons (ASES) Shoulder Index, the Simple Shoulder Test (SST) and the Disabilities of the Arm, Shoulder and Hand Module (DASH questionnaire). Additionally, a visual analogue scale for satisfaction was employed. All four scores and the visual analogue scale revealed improvement at a statistically significant level (P < 0.01) after surgery. All questionnaires showed a significant correlation with the Constant-Murley Shoulder Score (ASES: r = 0.871, P < 0.01; DASH: r = -0.758, P < 0.01, SST: r = 0.494, P < 0.05, Pearson's correlation coefficient). Taken together, all questionnaires were easy to apply, and reliable evaluation of shoulder function was possible with significant correlation to the Constant-Murley Shoulder Score postoperatively. The SST was easy to apply, and compound outcome analysis was possible with the ASES Shoulder Index and DASH questionnaire. The DASH scale was the most complex evaluation instrument. The Constant-Murley Shoulder Score comprises a physical examination, which is advantageous but restricts the application to the office. For postoperative assessment without the patient having to return to the clinic, the ASES Shoulder Index is preferred because of its good correlation to the Constant-Murley Shoulder Score (r = 0.871) and the visual analogue scale for satisfaction (r = 0.762).

Adult↗
PubMed2001

Incidence of shoulder pain after neck dissection: a clinical explorative study for risk factors.

BACKGROUND: It is the purpose of this study to determine the incidence of shoulder pain and restricted range of motion of the shoulder after neck dissection, and to identify risk factors for the development of shoulder pain and restricted range of motion. METHODS: Clinical patients who underwent a neck dissection completed a questionnaire assessing shoulder pain. The intensity of pain was assessed using a visual analog scale (100 mm). Range of motion of the shoulder was measured. Information about reconstructive surgery and side and type of neck dissection was retrieved from the medical records. RESULTS: Of the patients (n = 177, mean age 60.3 years [SD, 11.9]) 70% experienced pain in the shoulder. Forward flexion and abduction of the operated side was severely reduced compared to the non-operated side, 21 degrees and 47 degrees, respectively. Non-selective neck dissection was a risk factor for the development of shoulder pain (9.6 mm) and a restricted shoulder abduction (55 degrees ). Reconstruction was risk factor for a restricted forward flexion of the shoulder (24.5 degrees ). CONCLUSIONS: Shoulder pain after neck dissection is clinically present in 70% of the patients. Non-selective neck dissection is a risk factor for shoulder pain and a restricted abduction. Reconstruction is a risk factor for a restricted forward flexion of the shoulder.

Aged↗
PubMed2006

The value of ultrasonography in the preoperative diagnostic evaluation of patients with recurrent anterior shoulder dislocation: a prospective study of 44 patients.

The purpose of this study was to investigate the value of ultrasonography in the pre-operative assessment of patients with recurrent post-traumatic, anterior shoulder instability. Forty-four consecutive patients, 44 men and 12 women, with unilateral, post-traumatic, recurrent instability of the shoulder were included in the study. One experienced radiologist examined all patients, using a 5.0 or 7.5 MHz linear-array transducer, with the arm in different positions, one of which was used to provoke apprehension of the shoulder. Special attention was paid to the evaluation of the joint capsule, the anterior labrum, especially in terms of the presence of a Bankart lesion. All patients were subsequently treated surgically. After a diagnostic arthroscopy either an open or arthroscopic stabilisation of the shoulder was performed. Ultrasonography disclosed an unstable anterior labrum (equivalent to a Bankart lesion) in 36 shoulders; the lesion was verified in all 36 shoulders during arthroscopy. In three shoulders, arthroscopy disclosed an injured labrum, which had healed in an anterio-medial position on the scapular neck. In these three shoulders, ultrasonography failed to show any lesion. In five shoulders no Bankart lesion was found at arthroscopy. All these patients had increased shoulder laxity, and ultrasonography did not show any Bankart lesion. Furthermore a judgement of the joint capsule was not possible either. A bony Bankart lesion was found in four shoulders, using both arthroscopy and ultrasonography. The sensitivity of the ultrasonographic evaluation was 92%, and the specificity 100%. The positive predictive value was 100%, and the negative predictive value 63%. Ultrasonography showed a high correlation with the arthroscopic findings, with a high sensitivity and specificity. Therefore, we conclude that US can give important pre-operative information in patients with recurrent, unilateral, post-traumatic, anterior shoulder instability.

Adult↗
PubMed2004

Painful jerk test: a predictor of success in nonoperative treatment of posteroinferior instability of the shoulder.

BACKGROUND: The jerk test has been used as a diagnostic test of the posteroinferior instability of the shoulder. Pain may or may not be associated with posterior clunking during the jerk test. PURPOSE: To evaluate the presence or absence of pain with the jerk test as a predictor of the success of nonoperative treatment for posteroinferior instability of the shoulder and to identify the pathologic lesion responsible for the pain in the jerk test. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Eighty-one patients (89 shoulders) who had posteroinferior instability with a positive posterior clunk in their shoulders during the jerk test were nonoperatively treated. The patients were divided into 2 groups with respect to the presence of pain in the jerk test: the painless jerk group (54 shoulders) and the painful jerk group (35 shoulders). Response to the nonoperative treatment was evaluated after at least a 6-month rehabilitation program. Patients who did not respond to the rehabilitation underwent arthroscopic examination to identify any pathologic lesions. RESULTS: The painful jerk group had a higher failure rate with nonoperative treatment (P < .001). In the painless jerk group, 50 shoulders (93%) responded to the rehabilitation program after a mean of 4 months. Four shoulders (7%) were unresponsive to the rehabilitation. In the painful jerk group, 5 shoulders (16%) were successful with the rehabilitation, whereas the other 30 shoulders (84%) failed. All 34 shoulders that were unresponsive to the rehabilitation had a variable degree of posteroinferior labral lesions. CONCLUSIONS: The jerk test is a hallmark for predicting the prognosis of nonoperative treatment for posteroinferior instability. Shoulders with symptomatic posteroinferior instability and a painful jerk test have posteroinferior labral lesions.

Adolescent↗
PubMed1997

Bankart repair for anterior instability of the shoulder. Long-term outcome.

Anterior instability of the shoulder is a commonly encountered entity in orthopaedic practice. The Bankart procedure is considered by many surgeons to be the treatment of choice for this condition. Despite its widespread popularity, there have been no studies on the long-term outcome of the Bankart procedure as far as we know. Sixty shoulders (fifty-six patients) that had been followed for a minimum of eight years after a Bankart procedure were evaluated for range of motion, stability, and strength according to the data form of the American Shoulder and Elbow Surgeons for examination of the shoulder. The results for the involved shoulder were compared with the findings for the contralateral, normal shoulder. All patients completed a questionnaire regarding the history of the instability of the shoulder, the level of participation in sports before and after the operation, the preoperative and postoperative level of pain, and whether the patient had ever sustained a dislocation that needed reduction by a physician. Information about the current ability of the patient to function at home, at work, and during sports also was requested. In addition, the patients were asked to rate the results of the operation and to indicate whether they would have the same procedure again for the same problem. At a mean of 11.9 years after the operation, the mean loss of external rotation was 12 degrees (range, 0 to 30 degrees) (p < 0.0001). There were no significant differences in forward elevation, abduction, or internal rotation between the involved shoulder and the contralateral, normal shoulder. One patient had crepitus on glenohumeral motion. Fifty-five of the fifty-six patients returned to the occupation that they had had preoperatively, without having to alter their activities. Twenty-eight patients had mild pain with strenuous activity, and one patient had pain at rest. Three patients had a dislocation of the involved shoulder because of a new traumatic event more than three years postoperatively. Fifty-two patients rated the result as good or excellent; three, as fair; and one, as poor. Fifty-four patients said that they would have a Bankart procedure performed again for the same problem. We present a new system for rating the shoulder that emphasizes function and is based specifically on the goals stated by the patients to be most important with regard to the shoulder. Using this system, we found that the Bankart procedure offers an excellent objective long-term outcome with a high degree of patient satisfaction.

Activities of Daily Living↗
PubMed1987

Total shoulder arthroplasty.

A prospective study was done of fifty total shoulder replacements in forty-four patients who were followed for an average of 3.5 years (range, 2.0 to 7.5 years). The preoperative diagnosis was osteoarthritis in thirty-three shoulders, rheumatoid arthritis in eleven, and a previous fracture of the humeral head in six shoulders. Nine of the shoulders had a tear of the rotator cuff. The Neer-II system of total shoulder replacement with a non-metal-backed component was used in all fifty shoulders. At follow-up, forty-four shoulders (88 per cent) had no significant pain. Of the six painful shoulders, four had loosening of the glenoid component and one had malposition of both components. Three of the six shoulders had no significant pain after revision. The average range of active forward elevation in all of the shoulders improved from 71 to 100 degrees, and both external and internal rotation improved as well. Five specific activities of daily living were evaluated, and the patients' ability to perform them improved from 14 to 78 per cent. Thirty-five shoulders (68 per cent) were rated by the patients as much better; thirteen shoulders (26 per cent), as better; and three (6 per cent), as no better. An incomplete lucent line was noted around five (10 per cent) of the cemented humeral stems and around thirty-seven (74 per cent) of the glenoid prostheses. Four arthroplasties (8 per cent) required revision: three for loosening of the glenoid component and one for malposition of both components.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMedDate not supplied

Shoulder strength and range of motion in symptomatic and pain-free elite swimmers.

To evaluate differences in shoulder strength and range of motion between painful and pain-free shoulders we examined two matched groups of athletes. Fifteen competitive swimmers were allocated to two groups. Group 1 consisted of seven swimmers with unilateral shoulder pain related to swimming (Neer and Welsh phase I to II). The control group (Group 2) consisted of eight swimmers with no present or previous history of shoulder pain. Concentric and eccentric internal rotational torques were reduced in painful shoulders in between-group comparisons as well as in side-to-side comparisons. The decrease in internal rotational torque resulted in significantly greater concentric and eccentric external-to-internal rotational strength ratios of the painful shoulder in Group 1 swimmers compared with the controls. Furthermore, the functional ratio (eccentric external rotation:concentric internal rotation) was significantly greater in the painful shoulder in both between-group and side-to-side comparisons. Both groups of swimmers exhibited increased external range of motion and reduced internal range of motion compared with normalized data, but no between-group or side-to-side differences were detected. Our findings suggest that prevention or rehabilitation of swimmer's shoulder might not solely involve strengthening of the external rotators of the shoulder joint. Attention might also be drawn toward correction of a possible deficit in internal rotational strength. Changes in shoulder range of motion seem unrelated to the occurrence of shoulder pain.

Adolescent↗
PubMed2004

Changes in corticomotor excitability of hand muscles in relation to static shoulder positions.

We examined whether the recruitment properties of the corticospinal pathway to intrinsic hand muscles are influenced by variations of the shoulder joint angle. Abductor digiti minimi (ADM) motor evoked potentials (MEPs) in response to transcranial magnetic stimulation were examined during different static positions of the shoulder joint in the horizontal plane from 30 degrees adduction to 30 degrees abduction with respect to the neutral position at 0 degrees, while elbow and wrist joints were constrained statically at 90 degrees and 180 degrees respectively. We found that 30 degrees abduction of the shoulder significantly depressed MEP size and prolonged MEP latency in comparison with 30 degrees shoulder adduction. The neutral shoulder angle position (at 0 degrees ) significantly reduced MEP size but had no effect on MEP latency in comparison with 30 degrees shoulder abduction. The input-output relationship between MEP size and stimulus intensity was sigmoidal. The plateau value and maximum slope were significantly lower at 30 degrees abduction than at 30 degrees adduction of the shoulder. However, the threshold value did not differ significantly between the two positions. To differentiate excitability changes at cortical versus subcortical sites, intracortical inhibition (ICI) and intracortical facilitation (ICF) were assessed using a paired-magnetic pulse paradigm. A significant decrease in ICF was observed after changing shoulder position from 30 degrees adduction to 30 degrees abduction. In contrast, no variation in the amount of ICI occurred in relation to the same changes in shoulder position. ADM F-waves elicited by electrical stimulation of the ulnar nerve at the wrist were significantly decreased at 30 degrees shoulder abduction in comparison with 30 degrees adduction. A similar pattern was observed in one subject in whom the H-reflex could be exceptionally elicited in ADM. We conclude that shoulder position influences the recruitment efficiency (gain) of the corticospinal volleys to motoneurons of intrinsic hand muscles. It is proposed that activity of peripheral receptors signalling static shoulder position influences corticomotor excitability of hand muscles both at the cortical and at the spinal level. This modulation may be functionally relevant when reaching to grasp objects.

Action Potentials↗
PubMed2005

Cortico-motoneuronal output to intrinsic hand muscles is differentially influenced by static changes in shoulder positions.

We investigated whether shoulder position influenced the recruitment properties of the abductor digiti minimi muscle (ADM) and first dorsal interosseous muscle (FDI). ADM and FDI motor evoked potentials (MEPs) in response to transcranial magnetic stimulation (TMS) were obtained in seven healthy volunteers at two different static positions of the shoulder joint (30 degrees adduction vs 30 degrees abduction) while the arm was passively supported at shoulder level (90 degrees in the horizontal plane) and the elbow joint was fixed at 90 degrees . ADM and FDI voluntary activity was also examined during (1) externally paced finger abductions at 2 Hz in the two different shoulder positions (EMG(ADM) and EMG(FDI) was back-averaged time-locked to the end of finger abduction) and (2) maximal voluntary abduction of the little finger and the index finger. Maximal EMG power and force were analysed in the two shoulder positions. H-reflexes from ADM and FDI were also obtained in two subjects. The ADM stimulus-response curve to TMS showed that the slope and plateau level were significantly reduced with the shoulder at 30 degrees abduction. In contrast, the FDI stimulus-response curve to TMS was not influenced by shoulder position. The back-averaged EMG(ADM) showed a significant decrease in peak amplitude and area with the shoulder at 30 degrees abduction, while no change in EMG(FDI) was observed under the same condition. Similarly, maximal EMG(ADM) and force exertion by the little finger were significantly reduced with the shoulder at 30 degrees abduction, while no such effect was observed for FDI. ADM H-reflex, but not FDI, was also decreased with shoulder abduction. These results indicate that the corticospinal pathway to ADM is less accessible to TMS and to voluntary command when the shoulder is placed at 30 degrees abduction. In contrast, activation of FDI, whether by TMS or by volition, is not influenced by shoulder position. This finding suggests that there are differences in the corticospinal innervation to ADM and FDI, possibly due to the different role of these muscles in hand function.

Adult↗
PubMed2006

Ultrasound in adhesive capsulitis of the shoulder: is assessment of the coracohumeral ligament a valuable diagnostic tool?

OBJECTIVE: To determine the accessibility of the coracohumeral ligament (CHL) by ultrasound (US) and to determine CHL thickness in adhesive capsulitis of the shoulder. DESIGN AND PATIENTS: US examinations were carried out in 498 consecutive shoulders of 306 individuals (194 women and 112 men), mean age 47.4 years (range 15-92 years), in order to identify and measure the maximum thickness of the CHL. The patients were divided into three study groups: asymptomatic shoulders (n=121), painful shoulders (n=360) and shoulders with arthrographic evidence of adhesive capsulitis (n=17). The mean maximal thickness of CHL was compared among the 3 study groups (non-parametric test of Kruskal-Wallis, p<0.05). RESULTS: The CHL was visualized in 92 out of 121 shoulders in the asymptomatic group (76.0%), in 227 out of 360 shoulders in the painful shoulder group (63.0%), and in 15 out of 17 shoulders in the adhesive capsulitis group (88.2%). The average thickness of the CHL was significantly greater in adhesive capsulitis (3 mm) than in the asymptomatic (1.34 mm) and painful (1.39 mm) shoulders. No significant difference was found between asymptomatic and painful shoulders. CONCLUSION: CHL depiction can be achieved in a reasonable proportion of shoulders. A thickened CHL is suggestive of adhesive capsulitis. More studies are needed for clinical validation of these data.

Adolescent↗
PubMed1995

Perinatal implications of shoulder dystocia.

OBJECTIVE: To assess the antecedents of shoulder dystocia, the risk of recurrence, and the perinatal morbidity associated with the different maneuvers used for its management. METHODS: We conducted a 10-year (1980-1989) retrospective case record review of all instances of shoulder dystocia in a teaching maternity hospital. RESULTS: There were 254 cases of shoulder dystocia in 40,518 vaginal cephalic deliveries (0.6%), with 33 cases (13.0%) of brachial plexus palsy and 13 fractures (5.1%). There were no perinatal deaths attributable to shoulder dystocia. The risk of shoulder dystocia was increased with prolonged pregnancy (threefold), prolonged second stage of labor (threefold), mid-forceps deliveries (tenfold), and increasing birth weight. Of the maneuvers used to deal with shoulder dystocia, strong downward traction on the head was significantly correlated with brachial plexus palsy compared with other individual methods of delivering the shoulders. There was only one case of recurrent shoulder dystocia in 80 women having 93 cephalic vaginal deliveries after their original delivery coded with shoulder dystocia. CONCLUSION: Shoulder dystocia is not a reliably predictable event in labor. Although the risk of shoulder dystocia is increased with prolonged pregnancy, prolonged second stage of labor, increasing birth weight, and mid-forcepts delivery, the majority of cases occur without these risk factors. Strong downward traction on the head is associated with the greatest degree of neonatal trauma, whereas McRoberts maneuver has the least. The risk of recurrent shoulder dystocia is low.

Birth Injuries↗
PubMed2005

Arthroscopic study of the shoulder joint in fetuses.

PURPOSE: The purpose of this study was to macroscopically examine the fetal shoulder joint using arthroscopy. We attempted to identify and describe the specific characteristics of the fetal shoulder joint, how it evolves during the last few weeks of intrauterine development, and any possible variations with regard to the adult shoulder. TYPE OF STUDY: Observational anatomic case series. METHODS: We used 20 frozen fetuses with a gestational age of 24 to 40 +/- 2 weeks, obtained from spontaneous abortions. Examination was performed with standard arthroscopic surgical equipment, using a 2.7-mm optical lens. Whenever possible, we tried to use the standard arthroscopic portals. Images were obtained for comparison with the adult shoulder. RESULTS: The arthroscopic images of the fetal glenohumeral joint are similar to those of an adult shoulder, with the only differences being those related to the stage of development. In this study we observed no so-called bare spot in the glenoid cavity such as has been described in treatises on the adult shoulder joint. The arthroscopic images of the anterosuperior region of the fetal joint show more highly defined structures than in the adult shoulder, especially the coracohumeral and glenohumeral ligaments. CONCLUSIONS: To our knowledge, this is the first arthroscopic study to target the fetal shoulder joint. The results indicate minimal differences when compared with the adult shoulder joint; for some structures, particularly in the anterosuperior region, the anatomy observed was easier to discern than what is observed in adult shoulder arthroscopy. CLINICAL RELEVANCE: Our study obtained clear images of virgin shoulder joints that had never been subjected to deterioration from wear or other distorting forces. The clarity of these images is useful for locating and identifying structures in the adult shoulder.

Arthroscopy↗
PubMedDate not supplied

Cementless surface replacement arthroplasty (Copeland CSRA) for osteoarthritis of the shoulder.

Clinical experience with the Copeland cementless surface replacement arthroplasty (CSRA) of the shoulder now spans 17 years. Between 1986 and 1997, 79 CSRAs (42 total shoulder replacements and 37 hemiarthroplasties) were performed for primary osteoarthritis of the shoulder. Total shoulder replacement was done in 12 men and 30 women with a mean age of 71.5 years (range, 50-87 years). Hemiarthroplasty was used in 9 men and 28 women; 5 patients had bilateral hemiarthroplasty. The mean age was 73.4 years (range, 53-88 years). Thirty-nine total shoulder arthroplasties and thirty hemiarthroplasties with a follow-up of more than 2 years were available for review. The mean follow-up was 7.6 years (range, 48 months to 13 years) for total shoulder replacement and 4.4 years (range, 24 months to 6.5 years) for hemiarthroplasty. The Constant scores improved from an age-adjusted Constant score of 33.8% (20.0 points) to 94% (61.9 points) for total shoulder replacement and from an age-adjusted Constant score 40.0% (25.3 points) to 91% (58.1 points) for hemiarthroplasty. Active elevation improved by a mean of 59.9 degrees to a mean of 128 degrees for total shoulder replacement and to a mean of 124 degrees for hemiarthroplasty. Of the patients, 89.9% considered the shoulder to be much better or better as a result of the operation. Radiographically, one humeral implant and three glenoid implants had evidence of loosening. Four revisions were performed in the total shoulder replacement group. No revision surgery was needed in the hemiarthroplasty group. The results of this series are at least comparable to those reported for stemmed prostheses with a comparable length of follow-up. The results of total shoulder replacement and hemiarthroplasty in osteoarthritis of the shoulder seem to be comparable. With use of the CSRA prosthesis, several severe complications mainly concerning the humeral shaft and periprosthetic fractures can be avoided. Should the need for revision surgery or arthrodesis arise, these procedures are easily performed, as bone stock has been maintained and no loss of length has been encountered. It does seem that the humeral component does not need a stem or cement for fixation.

Aged↗
PubMed2006

Shoulder adaptive changes in youth baseball players.

Shoulder adaptive changes in response to overhand throwing have been observed in adults, but the age of onset and progression of these adaptive changes have not been established. Two-hundred ninety-eight youth baseball players (8- to 28-year-olds) were studied to determine whether shoulder range of motion and laxity differences between the dominant and non-dominant shoulders exist between different age groups. The subjects were separated into 3 different age groups of 100 8- to 12-year-olds (Group 1), 100 13- to-14 year-olds (Group 2), and 98 15- to 28-year-olds (Group 3). For dominant shoulder external rotation with the humerus in abduction, all groups were significantly different from each other, with Group 2 having the greatest range and Group 1 having the smallest range (P < .05). When comparing dominant shoulder internal rotation in abduction among different groups, Group 3 and Group 2 motion was significantly less than that for Group 1 (P < .05.) When comparing dominant to non-dominant shoulder motion within each group, a significant increase in dominant shoulder external rotation in abduction was found in all 3 age groups (P < .05). Comparison of the differences in external rotation in abduction between the dominant and non-dominant shoulders demonstrated an increase with increasing age, Group 1 (1.5 +/- 6.8 degrees), Group 2 (9.6 +/- 15.3 degrees), and Group 3 (15.0 +/- 11.2 degrees; P < .05). Comparison of differences in internal rotation in abduction between dominant and non-dominant shoulders demonstrated a decrease with increasing age, Group 1 (4.6 +/- 8.2 degrees), Group 2 (8.4 +/- 14.5 degrees), and Group 3 (15.5 +/- 11.7 degrees; P < .05). For shoulder laxity, Groups 2 and 3 had significantly more inferior shoulder laxity when compared to Group 1. In summary, our results indicate that shoulder range of motion and laxity of youth baseball players are caused by adaptive changes that manifest during adolescence.

Adaptation, Physiological↗
PubMed2002

Correlation of radiographic, clinical, and patient assessment of shoulder balance following fusion versus nonfusion of the proximal thoracic curve in adolescent idiopathic scoliosis.

STUDY DESIGN: Retrospective clinical, radiographic, and patient outcome review of surgically treated adolescent idiopathic scoliosis. OBJECTIVES: To correlate radiographic and clinical features of shoulder balance and the proximal thoracic curve with patient satisfaction outcomes at a minimum 2-year follow-up. SUMMARY OF BACKGROUND DATA: Traditionally, radiographic features of a structural proximal thoracic curve have been T1 tilt, proximal thoracic Cobb angle, and proximal thoracic side-bending Cobb; however, these do not always correlate with clinical shoulder balance. METHODS: A total of 112 patients (single surgeon) with adolescent idiopathic scoliosis and a proximal thoracic curve >or=20 degrees (average 32 degrees, range 20-78 degrees) were evaluated in terms of shoulder balance and curve flexibility/correction. Four groups were analyzed: Group 1, posterior spinal fusion to T2 (proximal thoracic curve included, n = 24); Group 2, posterior spinal fusion to T3 (proximal thoracic curve partially included, n = 23); Group 3, posterior spinal fusion to T4 or T5 (proximal thoracic curve not included, n = 21); and Group 4, anterior spinal fusion to T4 or below (proximal thoracic not included, n = 44). Proximal thoracic, main thoracic, and thoracolumbar-lumbar upright coronal, side-bending, and sagittal Cobb measurements were assessed before surgery, 1 week after surgery, and at a minimum 2-year postoperative follow-up (average 3.8 years, range 2.0-7.6 years). In addition to T1 tilt, clavicle angle (intersection of a horizontal line and the tangential line connecting the highest two points of each clavicle), coracoid height difference, trapezius length (horizontal distance of the T2 pedicle to second rib-clavicle intersection), first rib-clavicle height difference (vertical distance of first rib apex to superior clavicle), and proximal thoracic, main thoracic, and thoracolumbar-lumbar apical vertical translation were determined. Shoulder asymmetry as measured by the radiographic soft tissue shadow was graded as balanced (<1 cm), slight (1-2 cm), moderate (2-3 cm), or significant (>3 cm). A postoperative patient questionnaire addressed shoulder balance and overall appearance at most recent follow-up. RESULTS: The four groups were found to be statistically equivalent in terms of preoperative proximal thoracic curve (P = 0.4146), proximal thoracic side-bending Cobb (P = 0.2199), main thoracic curve (P = 0.6999), and main thoracic side-bending curves (P = 0.7307). Radiographic: Preoperative proximal thoracic measurements correlating with postoperative shoulder balance (P < 0.05) included the clavicle angle (three of four groups with a trend toward statistical significance in the fourth group, P = 0.07) and coracoid height (two of four groups). No other measurement, including T1 tilt and proximal thoracic side-bending Cobb, correlated in more than one group. Proximal thoracic curve correction was greatest in Group 1 (posterior spinal fusion to T2; average 12 degrees) and Group 4 (anterior spinal fusion to T4 or below; average 12 degrees). Clinical: Shoulder balance improved in all four groups (range 0.38-1.00 grades). There was no difference in shoulder balance between groups (P = 0.2723). Patient assessment: All four groups also reported improvement in self-perceived shoulder balance (63% up to one grade, 37% over two-grade improvement), whereas no patient reported worsening of shoulder balance. There was no significant difference in patient outcomes between the four groups (P = 0.3654). CONCLUSION: The clavicle angle, not T1 tilt, upright proximal thoracic, or side-bending proximal thoracic Cobb, provided the best preoperative radiographic prediction of postoperative shoulder balance. In each of the four groups, postoperative shoulder balance and clinical appearance also improved and correlated with patient postoperative assessments.

Adolescent↗