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PubMed2002

Reliability by surgical status of self-reported outcomes in patients who have shoulder pathologies.

STUDY DESIGN: A test-retest design was used to evaluate the reliability of the self-report sections of 4 shoulder pain and disability scales. OBJECTIVE: The objective of the study was to compare interitem consistency and test-retest reliability by surgical status (postoperative versus nonoperative) and to evaluate the effect of surgical status in the prediction of retest scores. BACKGROUND: Patients and healthcare providers evaluate shoulder status based on self-evaluations of pain and disability. Shoulder outcome measures have been developed that include self-reports, but the properties of these measures have not been assessed by surgical status. METHODS AND MEASURES: A questionnaire containing self-report sections of 4 shoulder scales was administered to study participants twice with 1 week between administrations. The outcome measures examined were the: (1) University of California at Los Angeles (UCLA) Shoulder Score; (2) Constant-Murley Scale (CMS); (3) American Shoulder and Elbow Society (ASES) Shoulder Index; and (4) Shoulder Pain and Disability Index (SPADI). Intraclass correlation coefficients (ICC) were calculated to estimate the test-retest reliability of each of the scales and subscales. The interitem consistencies of the multi-item subscales were assessed using Cronbach's alpha. The effect of surgical status on shoulder outcome scale reliability was evaluated using a general linear models approach. RESULTS: The interitem consistency estimates for the multi-item scales were high with both operative and nonoperative participants (0.88 to 0.96). With the exception of the satisfaction subscale of the UCLA Shoulder Score for the nonsurgical group, the estimated intraclass coefficients ranged from 0.51 to 0.91. The prediction of UCLA-satisfaction and ASES-disability, pain, and total retest scores was improved with the addition of surgical status into a regression model. CONCLUSIONS: The examined scales exhibited good internal consistency across surgical status. The postsurgical sample's reproducibility estimates tended to be higher than those of the nonsurgical sample. Reliability of shoulder outcome scales can be affected by patient surgical status.

Adult↗
PubMed2004

Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial.

BACKGROUND: Dysfunction of the cervicothoracic spine and the adjacent ribs (also called the shoulder girdle) is considered to predict occurrence and poor outcome of shoulder symptoms. It can be treated with manipulative therapy, but scientific evidence for the effectiveness of such therapy is lacking. OBJECTIVE: To study the effectiveness of manipulative therapy for the shoulder girdle in addition to usual medical care for relief of shoulder pain and dysfunction. DESIGN: Randomized, controlled trial. SETTING: General practices in Groningen, the Netherlands. PATIENTS: 150 patients with shoulder symptoms and dysfunction of the shoulder girdle. INTERVENTIONS: All patients received usual medical care from their general practitioners. Only the intervention group received additional manipulative therapy, up to 6 treatment sessions in a 12-week period. MEASUREMENTS: Patient-perceived recovery, severity of the main complaint, shoulder pain, shoulder disability, and general health. Data were collected during and at the end of the treatment period (at 6 and 12 weeks) and during the follow-up period (at 26 and 52 weeks). RESULTS: During treatment (6 weeks), no significant differences were found between study groups. After completion of treatment (12 weeks), 43% of the intervention group and 21% of the control group reported full recovery. After 52 weeks, approximately the same difference in recovery rate (17 percentage points) was seen between groups. During the intervention and follow-up periods, a consistent between-group difference in severity of the main complaint, shoulder pain and disability, and general health favored additional manipulative therapy. LIMITATIONS: The sample size was small, and assessment of end points was subjective. CONCLUSION: Manipulative therapy for the shoulder girdle in addition to usual medical care accelerates recovery of shoulder symptoms.

Adrenal Cortex Hormones↗
PubMed2001

Mobility impairment, muscle imbalance, muscle weakness, scapular asymmetry and shoulder injury in elite volleyball athletes.

BACKGROUND: The aim of this study was to evaluate the relationship between shoulder mobility, rotator muscles' strength and scapular symmetry, and shoulder injuries and/or pain in elite volleyball athletes. METHODS: An isokinetic shoulder muscle strength test, which was performed at speeds of 60/sec and 180/sec, and shoulder mobility and scapula lateral slide tests were conducted bilaterally on 16 subjects, who represented the England elite volleyball players. The subjects also prospectively completed monthly questionnaires during the competition season to report on their shoulder condition. RESULTS: The results showed that the active range of shoulder internal rotation and concentric external rotators' strength in the dominant arm were significantly less, than in the non-dominant arms, but the internal rotators were significantly stronger in both concentric and eccentric tests at both testing speeds. Seven of 16 subjects indicated overt shoulder injury or pain during their training season, nine subjects had shoulder mobility impairment, seven had muscle imbalance, 13 had relative muscle weakness and five had scapular asymmetry. The association between shoulder muscle strength imbalance (eccentric external < concentric internal) of rotators in the dominant arm and shoulder injuries was statistically significant (Fisher's exact test, p<0.05). CONCLUSIONS: We conclude that rotator muscle strength imbalance may play an important role in shoulder injuries in high-level volleyball players.

Adult↗
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↗
PubMed1984

Recurrent anterior dislocation of the shoulder after surgical repair. Apparent causes of failure and treatment.

We analyzed the cases of thirty-nine patients who were treated for recurrent anterior dislocation of the shoulder after unsuccessful surgical repair for the same condition in order to identify factors responsible for failure of the earlier operations and to determine the results of treatment of the post-surgical recurrence. The prior operations included nineteen Bankart, seven Putti-Platt, five Magnuson, three duToit, two Bristow, and three Nicola procedures. Thirty-two shoulders were treated by reoperation. At reoperation the most common pathological lesion associated with recurrence of the dislocation after the prior repair was a Bankart lesion (avulsion of the capsule and labrum from the anterior glenoid rim). This was present in 84 per cent of the thirty-two shoulders that were treated by reoperation. Excessive laxity of the capsule was found in 83 per cent of the twenty-nine shoulders in which laxity was assessed, and was considered to be the primary cause of instability in four shoulders. A Hill-Sachs lesion of the humeral head was found in 76 per cent of the twenty-nine shoulders that were evaluated for this lesion and was large in three of the shoulders. Other factors that were associated with recurrent instability were scarring of the subscapularis muscle, generalized ligament laxity, technical errors at surgery, and severe reinjury. The success rate of reoperation after previous failure was very encouraging. Of the twenty-four shoulders that were reoperated on and were followed for two years or longer, ten were graded excellent; twelve, good; and two, poor. One (4 per cent) of the twenty-four shoulders that were reoperated on continued to dislocate and another shoulder continued to subluxate, making the incidence of recurrent instability after reoperation 8 per cent. Seven of the thirty-nine shoulders did not have a reoperation but were treated with specific resistive exercises. The results in these were one excellent, four good, one fair, and one poor. Eight patients were lost to follow-up.

Adolescent↗
PubMed1994

[Arthroscopy of post-traumatic shoulder pain].

Thirty-two consecutive patients suffering chronic shoulder pain for more than six months after a non-dislocating shoulder trauma were examined clinically and with arthroscopy of the shoulder. The trauma was blunt or simple distortion of the shoulder. The patients complained of pain during loading, especially during over the head activities. Symptoms of dead arm and feeling of instability with a popping sensation inside the shoulder were also present. Patients with previous dislocations, trauma or radiographic signs of degenerative shoulder lesions were excluded. Clinically, 21 patients had decreased range of motion, 19 patients had a positive anterior apprehension sign and four of these had signs of shoulder instability. Nine patients had signs of impingement. The suspected preoperative diagnoses included a tear of the rotator cuff (17), a tear of the labrum (12), tendinitis of the biceps tendon (2) and periarthrosis of the shoulder (1). Arthroscopic findings consisted of 22 labral tears, six partial and three total rotator cuff lesions and three cases of synovitis of the rotator cuff with signs of subacromial impingement. Four patients had tendinitis of the biceps tendon. One patient had a lesion of the greater tubercle. Only two shoulders were found to be unstable under anaesthesia. In conclusion, patients with posttraumatic chronic shoulder pain after a non-dislocating trauma of the shoulder should be evaluated with arthroscopy in order to diagnose possible intraarticular lesions.

Adolescent↗
PubMed2003

Physiotherapy interventions for shoulder pain.

BACKGROUND: The prevalence of shoulder disorders has been reported to range from seven to 36% of the population (Lundberg 1969) accounting for 1.2% of all General Practitioner encounters in Australia (Bridges Webb 1992). Substantial disability and significant morbidity can result from shoulder disorders. While many treatments have been employed in the treatment of shoulder disorders, few have been proven in randomised controlled trials. Physiotherapy is often the first line of management for shoulder pain and to date its efficacy has not been established. This review is one in a series of reviews of varying interventions for shoulder disorders, updated from an earlier Cochrane review of all interventions for shoulder disorder. OBJECTIVES: To determine the efficacy of physiotherapy interventions for disorders resulting in pain, stiffness and/or disability of the shoulder. SEARCH STRATEGY: MEDLINE, EMBASE, the Cochrane Clinical Trials Regiter and CINAHL were searched 1966 to June 2002. The Cochrane Musculoskeletal Review Group's search strategy was used and key words gained from previous reviews and all relevant articles were used as text terms in the search. SELECTION CRITERIA: Each identified study was assessed for possible inclusion by two independent reviewers. The determinants for inclusion were that the trial be of an intervention generally delivered by a physiotherapist, that treatment allocation was randomised; and that the study population be suffering from a shoulder disorder, excluding trauma and systemic inflammatory diseases such as rheumatoid arthritis. DATA COLLECTION AND ANALYSIS: The methodological quality of the included trials was assessed by two independent reviewers according to a list of predetermined criteria, which were based on the PEDro scale specifically designed for the assessment of validity of trials of physiotherapy interventions. Outcome data was extracted and entered into Revman 4.1. Means and standard deviations for continuous outcomes and number of events for binary outcomes were extracted where available from the published reports. All standard errors of the mean were converted to standard deviation. For trials where the required data was not reported or not able to be calculated, further details were requested from first authors. If no further details were provided, the trial was included in the review and fully described, but not included in the meta-analysis. Results were presented for each diagnostic sub group (rotator cuff disease, adhesive capsulitis, anterior instability etc) and, where possible, combined in meta-analysis to give a treatment effect across all trials. MAIN RESULTS: Twenty six trials met inclusion criteria. Methodological quality was variable and trial populations were generally small (median sample size = 48, range 14 to 180). Exercise was demonstrated to be effective in terms of short term recovery in rotator cuff disease (RR 7.74 (1.97, 30.32), and longer term benefit with respect to function (RR 2.45 (1.24, 4.86). Combining mobilisation with exercise resulted in additional benefit when compared to exercise alone for rotator cuff disease. Laser therapy was demonstrated to be more effective than placebo (RR 3.71 (1.89, 7.28) for adhesive capsulitis but not for rotator cuff tendinitis. Both ultrasound and pulsed electromagnetic field therapy resulted in improvement compared to placebo in pain in calcific tendinitis (RR 1.81 (1.26, 2.60) and RR 19 (1.16, 12.43) respectively). There is no evidence of the effect of ultrasound in shoulder pain (mixed diagnosis), adhesive capsulitis or rotator cuff tendinitis. When compared to exercises, ultrasound is of no additional benefit over and above exercise alone. There is some evidence that for rotator cuff disease, corticosteroid injections are superior to physiotherapy and no evidence that physiotherapy alone is of benefit for Adhesive Capsulitis REVIEWER'S CONCLUSIONS: The small sample sizes, variable methodological quality and heterogeneity in terms of population studied, physiotherapy intervention employed and length of follow up of randomised controlled trials of physiotherapy interventions results in little overall evidence to guide treatment. There is evidence to support the use of some interventions in specific and circumscribed cases. There is a need for trials of physiotherapy interventions for specific clinical conditions associated with shoulder pain, for shoulder pain where combinations of physiotherapy interventions, as well as, physiotherapy interventions as an adjunct to other, non physiotherapy interventions are compared. This is more reflective of current clinical practice. Trials should be adequately powered and address key methodological criteria such as allocation concealment and blinding of outcome assessor.

Humans↗
PubMed2004

Surgical versus non-surgical treatment for acute anterior shoulder dislocation.

BACKGROUND: Acute anterior shoulder dislocation is the commonest type of shoulder dislocation. Subsequently, the shoulder is less stable and more susceptible to re-dislocation, especially in active young adults. OBJECTIVES: We aimed to compare surgical versus non-surgical treatment for acute anterior dislocation of the shoulder. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (August 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2003), MEDLINE (1966 to September week 3 2003), EMBASE (1988 to 2003 week 39), the National Research Register (UK) (Issue 3, 2003), conference proceedings and reference lists of articles. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing surgical with conservative interventions for treating acute anterior shoulder dislocation. DATA COLLECTION AND ANALYSIS: Selection of the included trials was by all three reviewers. Two reviewers independently assessed methodological quality and extracted data. Where appropriate, results of comparable studies were pooled. MAIN RESULTS: Five studies were included. These involved a total of 239 young (mainly aged around 22 years) active and mainly male people, all of whom had had a primary (first time) traumatic anterior shoulder dislocation. Methodological quality was variable, but notably there was insufficient information to judge whether allocation was effectively concealed in all five trials. Two trials, involving 115 participants, were only reported in conference abstracts.One trial involving military personnel reported that all had returned to active duty. Another trial reported similar numbers in the two intervention groups with reduced sports participation, and a third trial reported that significantly fewer people in the surgical group failed to attain previous levels of sports activity. Pooled results from all five trials showed that subsequent instability, either redislocation or subluxation, was statistically significantly less frequent in the surgical group (relative risk (RR) 0.20; 95%confidence interval (CI) 0.11 to 0.33). This result remained statistically significant (RR 0.32, 95%CI 0.17 to 0.59) for the three trials reported in full. Half (17/33) of the conservatively treated patients with shoulder instability in these three trials opted for subsequent surgery.Different, mainly patient-rated, functional assessment measures for the shoulder were recorded in the five trials. The results were more favourable, usually statistically significantly so, in the surgically treated group. Aside from a septic joint in a surgically treated patient, there were no other treatment complications reported. There was no information on shoulder pain, long-term complications such as osteoarthritis or on service utilisation and resource use. REVIEWER'S CONCLUSIONS: The limited evidence available supports primary surgery for young adults, usually male, engaged in highly demanding physical activities who have sustained their first acute traumatic shoulder dislocation. There is no evidence available to determine whether non-surgical treatment should not remain the prime treatment option for other categories of patient. Sufficiently powered, good quality and adequately reported randomised trials of good standard surgical treatment versus good standard conservative treatment for well-defined injuries are required; in particular, for patient categories at lower risk of activity-limiting recurrence. Long term surveillance of outcome, looking at shoulder disorders including osteoarthritis is also required. Reviews comparing different surgical interventions and different conservative interventions including rehabilitation are needed.

Adult↗
PubMed2004

Shoulder complaints after nerve sparing neck dissections.

The purpose of the study was to analyse the prevalence of shoulder complaints after nerve sparing neck dissection at least 1 year after surgery, and to analyse the influence of radiation therapy on shoulder complaints. Patients were interviewed for shoulder complaints, and patients filled out the shoulder disability questionnaire to evaluate shoulder disability in daily activities. In total 137 patients; 51 after modified radical neck dissection (MRND), 21 after postero-lateral neck dissection (PLND), and 65 after supraomohyoid neck dissection (SOHND) were analysed. After MRND 33.3% of the patients experienced shoulder complaints, after PLND 66.7%, and after SOHND 20% of the patients experienced shoulder complaints. Type of neck dissection was significantly (P < 0.001) related to shoulder complaints. Outcome on the shoulder disability questionnaire also showed a significant (P < 0.01) difference in outcome for type of neck dissection. The prevalence of shoulder complaints after SOHND are low, and reduce disability in daily activities. Radiation therapy does not have a significant effect on shoulder complaints and disability.

Accessory Nerve↗
PubMed2006

Shoulder impairment following treatment of diaphysial fractures of humerus by functional brace.

INTRODUCTION: Treatment of humeral shaft fractures by functional bracing has been reported to be effective in achieving high rate of fracture union and good function of the adjacent shoulder and elbow joints. Since our previous clinical impression indicated an occurrence of shoulder function impairment following this treatment, we investigated the shoulder function in a consecutive series of patients treated by functional bracing for fractures of humeral shaft in order to estimate their residual shoulder function. MATERIALS AND METHODS: We followed 15 consecutive patients with humeral shaft fractures treated by functional brace. The mean follow up was 30 months (range 12-57 months); seven patients with midshaft fracture, four patients with proximal third, and four patients with fractured distal third of the humeral diaphysis. All the patients were evaluated by the Constant score of the injured limb in comparison to the contra-lateral not injured shoulder and by the Oxford shoulder score of the injured limb. RESULTS: We found that all the fractures were united with mean varus angulation of 13 degrees and with mean angulation in the saggital plane of 9 degrees antecurvatum, Constant scores were significantly lower in the injured shoulders (P < 0.001) and the function of the shoulders in the injured extremities were estimated as having mean Oxford shoulder score of 34 (range 17-54). CONCLUSIONS: The evaluation of the present series revealed an impaired functional outcome in the shoulders after humeral shaft fracture. Our results indicate that although the fracture union is usually achieved following the functional bracing of humeral shaft fractures, the shoulder function in the injured limb may remain impaired.

Adult↗
PubMed1987

Shoulder dystocia: a fetal-physician risk.

Trauma that occurs as a result of shoulder dystocia is an important cause of neonatal morbidity. If the occurrence of severe shoulder dystocia, resulting in fetal asphyxia and trauma, could be accurately predicted from maternal risk factors, then a cesarean section would be indicated to prevent the poor outcome. The information available in the obstetric literature, however, is contradictory regarding whether shoulder dystocia can be predicted. In the present study, the patients at greatest risk of shoulder dystocia (all 394 mothers delivering neonates with birth weights greater than or equal to 4000 gm over a 2-year period) were examined. A three-way discriminant analysis was used to determine if a model could be developed that could effectively predict those patients who would be included in each of the groups of no shoulder dystocia, shoulder dystocia without trauma (29 patients), and shoulder dystocia with trauma (20 patients). Three factors, including birth weight, prolonged deceleration phase, and length of second stage labor, were found individually to contribute significantly to the classification. However, when examined in detail, it was noted that while 94% of cases with no shoulder dystocia would be detected, only 16% of the cases of shoulder dystocia with trauma would be predicted by this model. We conclude that in the group of pregnancies delivering neonates greater than or equal to 4000 gm, the occurrence of shoulder dystocia cannot be predicted from clinical characteristics or labor abnormalities, and that the occurrence of shoulder dystocia is not evidence of medical malpractice.

Birth Injuries↗
PubMed2006

Determining factors associated with shoulder dystocia: a population-based study.

OBJECTIVE: The study was aimed to define obstetric factors associated with shoulder dystocia. METHODS: A population-based study comparing all singleton, vertex, term deliveries with shoulder dystocia with deliveries without shoulder dystocia was performed. Statistical analysis was done using multiple logistic regression analysis. RESULTS: Shoulder dystocia complicated 0.2% (n = 245) of all deliveries included in the study (n = 107965). Independent risk factors for shoulder dystocia in a multivariable analysis were birth-weight > or =4000 g (OR = 24.3; 95% CI 18.5-31.8), vacuum delivery (OR = 5.7, 95% CI 3.4-9.5), diabetes mellitus (OR = 1.7, 95% CI 1.2-2.5) and lack of prenatal care (OR = 1.5, 95% CI 1.1-2.3). A significant linear association was found between birth-weight and shoulder dystocia, using the Mantel-Haenszel procedure. Pregnancies complicated with shoulder dystocia had higher rates of third-degree perineal tears as compared to the comparison group (0.8% versus 0.1%; P < 0.001). Similarly, perinatal mortality was higher among newborns delivered after shoulder dystocia as compared to the comparison group (3.7% versus 0.5%; OR = 7.4, 95% CI 3.5-14.9, P < 0.001). In addition, these newborns had higher rates of Apgar scores lower than 7 at 1 and 5 min as compared to newborns delivered without shoulder dystocia (29.7% versus 3.0%; OR = 13.8, 95% CI 10.3-18.4, P < 0.001 and 2.1% versus 0.3%; OR = 7.2, 95% CI 2.8-18.1, P < 0.001, respectively). Combining risk factors such as large for gestational age, diabetes mellitus and vacuum delivery increased the risk for shoulder dystocia to 6.8% (OR = 32.6, 95% CI 10.1-105.8, P < 0.001). CONCLUSIONS: Independent factors associated with shoulder dystocia were birth-weight > or =4000 g, vacuum delivery, diabetes mellitus and lack of prenatal care.

Adult↗
PubMed2006

Shoulder muscle recruitment patterns during a kayak stroke performed on a paddling ergometer.

Precise muscle co-ordination is required to maintain normal shoulder function and alterations in synchrony between shoulder muscles can result in loss of full range of movement and pain. Although shoulder pain in kayakers is high with 53% of elite international paddlers reporting shoulder injuries, little information is available regarding the pattern of shoulder muscle recruitment during paddling. The aim of this study was to investigate the normal recruitment pattern of shoulder muscles during the kayak stroke. Nine recreational paddlers without shoulder pain were examined. EMG data from eight shoulder muscles of the dominant arm were collected simultaneously with video data during simulated paddling on an ergometer. EMG data was normalized to time and peak amplitude. Intersubject consistency was evaluated using Pearson correlation analysis. The results of this study indicated a fair to high correlation in at least one phase of the kayak stroke in five of the muscles examined: upper trapezius, supraspinatus, latissimus dorsi, serratus anterior and rhomboid major. This normative data will enable comparisons with the shoulder muscle recruitment patterns in kayakers with shoulder pain in order to determine the role of altered motor control in the painful kayaking shoulder.

Adult↗
PubMed2006

The role of the biceps brachii in shoulder elevation.

The biceps brachii is a bi-articular muscle affecting motion at the shoulder and elbow. While its' action at the elbow is well documented, its role in shoulder elevation is less clear. Therefore, the purpose of this project was to investigate the influence of shoulder and elbow joint angles on the shoulder elevation function of the biceps brachii. Twelve males and 18 females were tested on a Biodex dynamometer with the biceps brachii muscle selectively stimulated at a standardized level of voltage. The results indicated that both shoulder and elbow joint angles influence the shoulder joint elevation moment produced by the biceps brachii. Further analysis revealed that the elevation moment was greatest with the shoulder joint at 0 degrees and the elbow flexed 30 degrees or less. The greatest reduction in the elevation moment occurred between shoulder angles of 0 degrees and 30 degrees . The shoulder elevation moment was near zero when shoulder elevation reached or exceeded 60 degrees regardless of elbow angle. These results clarify the role of the biceps in shoulder elevation, as a dynamic stabilizer, and suggest that it is a decelerator of the arm during the throwing motion.

Adult↗
PubMedDate not supplied

Manipulation for frozen shoulder: long-term results.

Although much has been published regarding shoulder manipulation under anesthesia for the treatment of frozen shoulder, there are no reported long-term results. In 25 patients (26 shoulders) in whom nonoperative treatment for idiopathic frozen shoulder had failed, we performed manipulation under anesthesia. All had had physical therapy for a mean of 6.2 months. Follow-up was by examination until the end of active treatment. Longer-term follow-up was obtained in 18 patients (19 shoulders) by questionnaire and averaged 15 years (range, 8.1 to 20.6 years). There were significant improvements in forward elevation from a mean of 104 degrees before manipulation (range, 70 degrees to 140 degrees ) to 168 degrees (range, 90 degrees to 180 degrees ) and in external rotation from 23 degrees (range, -5 degrees to 70 degrees ) to 67 degrees (range, 0 degrees to 90 degrees ). There were 16 shoulders with no pain or slight pain and 3 with occasional moderate or severe pain. There were no fractures, dislocations, or other complications. Of the 19 shoulders, 18 required no further surgery. At long-term follow-up, the mean Simple Shoulder Test score was 9.5 out of 12 and the mean American Shoulder and Elbow Surgeons score was 80 out of 100. Treatment of idiopathic frozen shoulder by manipulation under anesthesia leads to sustained improvement in shoulder motion and function at a mean of 15 years after the procedure.

Adult↗
PubMed2002

Erb's palsy without shoulder dystocia.

OBJECTIVES: The purpose of this commentary is to review certain articles which have provided evidence that Erb's palsy can occur without associated shoulder dystocia. The mechanism of the specific cause of the injury will be described. METHODS: Prior to the last 10-12 years it was assumed that Erb's palsy occurred exclusively with and was the result of shoulder dystocia. Gonik et al. [Am J Perinat 1991;8:31-34], reported on a research study based on the premise that when Erb's palsies occurred there must have been shoulder dystocia present but it went undetected by the delivering physician. Subsequently Gherman [Am J Obstet Gynecol 1998;178:423-427], published a detailed study which carefully looked at multiple aspects of shoulder dystocia including those similar injuries occurring with and without associated shoulder dystocia. RESULTS: Both Gonik's and Gherman's research revealed distinct maternal and newborn differences when comparing Erb's palsy occurring with and without associated shoulder dystocia. These differences, which have nothing to do with the ability to recognize shoulder dystocia, provide conclusive evidence that Erb's palsy does occur without associated shoulder dystocia. CONCLUSIONS: Therefore, Gonik's original premise, that shoulder dystocia must have been present if Erb's palsy occurred, is not supported. This brings into question the cause of Erb's palsy in those cases without shoulder dystocia. The maternal forces are the most likely cause both with and without shoulder dystocia.

Birth Injuries↗
PubMed2003

Evaluation of shoulder proprioception following muscle fatigue.

OBJECTIVE: To investigate the effect of shoulder muscle fatigue on glenohumeral proprioception. DESIGN: A repeated proprioception test was performed. BACKGROUND: The role of conditioning and fatigue in sport injuries remains controversial. It has been hypothesized that proprioceptive information plays an important role in joint stabilization and that muscle fatigue may alter proprioceptive ability. However, the effect of shoulder muscle fatigue on glenohumeral proprioception is still controversial. METHODS: Eleven normal subjects (mean age 27.3 years) participated in this study. Proprioception tests (on the dominant shoulder) were performed in which proprioception of the active reproduced and passive reproduced shoulder position was measured using an isokinetic dynamometer and a proprioception testing apparatus, respectively. The speed of active repositioning was at 2 deg/s and passive repositioning was at 0.5 deg/s. The mean value of maximum voluntary contraction and the number of repetitions for muscle fatigue were recorded. Post-fatigue proprioception test was started within 3 min after muscle fatigue. RESULTS: There was no significant difference of shoulder proprioception between pre- and post-fatigue determinations of passive repositioning in shoulder internal rotation, passive repositioning in external rotation and active repositioning in internal rotation. There was a significant difference between pre- and post-fatigue determination of active repositioning in external shoulder rotation (mean degrees: 2.57 (SD 1.02) vs. 4.96 (SD 1.73), P<0.05). CONCLUSION: Shoulder proprioception in active repositioning in external rotation was major affected by muscle mechanoreceptors in the presence of muscle fatigue. RELEVANCE: This study revealed that the shoulder proprioception after muscle fatigue in active repositioning in shoulder external rotation was affected more sensitively by the muscle mechanoreceptors than the joint mechanoreceptors. Increasing resistance of muscle fatigue would increase the shoulder proprioceptive ability.

Adaptation, Psychological↗
PubMedDate not supplied

Minimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger.

Seventy-eight Neer hemiarthroplasties and thirty-six Neer total shoulder arthroplasties were performed in patients aged 50 years or younger between January 1, 1976, and December 31, 1985. Sixty-two hemiarthroplasties and twenty-nine total shoulder arthroplasties with complete preoperative evaluation, operative records, and a minimum 15-year follow-up (mean, 16.8 years) or follow-up until revision were included in the clinical analysis. Sixteen patients died, and seven were lost to follow-up. All 114 shoulders were included in the survival analysis. There was significant long-term pain relief (P < .01) and improvement in active abduction (P < .01) and external rotation (P < .01) with both procedures. There was not a significant difference between total shoulder arthroplasty and hemiarthroplasty with regard to pain relief, abduction, or external rotation. Radiographs were available for 53 hemiarthroplasties and 25 total shoulder arthroplasties with a minimum 10-year follow-up. Humeral periprosthetic lucency was present more frequently after total shoulder arthroplasty (60%) compared with hemiarthroplasty (34%) (P = .0079). Glenoid erosion was present in 38 of 53 hemiarthroplasties (72%). Glenoid periprosthetic lucency was present in 19 of 25 total shoulder arthroplasties (76%). The results were graded by use of a modified Neer result rating system. Among the hemiarthroplasties, there were 6 excellent (10%), 19 satisfactory (30%), and 37 unsatisfactory results (60%). Among total shoulder arthroplasties, there were 6 excellent (21%), 9 satisfactory (31%), and 14 unsatisfactory results (48%). The estimated survival rate for hemiarthroplasty was 82% (95% CI, 74%-92%) at 10 years and 75% (95% CI, 64%-86%) at 20 years. The estimated survival rate for total shoulder arthroplasty was 97% (95% CI, 91%-100%) at 10 years and 84% (95% CI, 68%-98%) at 20 years. The data from this study indicate that there is marked long-term pain relief and improvement in motion with shoulder arthroplasty. However, there is a moderate rate of hemiarthroplasty revision for painful glenoid arthritis. Unsatisfactory result ratings were most commonly a result of motion restriction from soft-tissue abnormalities. Great care must be exercised, and alternative methods of treatment considered, before either hemiarthroplasty or total shoulder arthroplasty is offered to patients aged 50 years or younger.

Adult↗