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PubMed1995

Reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI).

Many long term wheelchair users develop shoulder pain. The purpose of this study was to examine the reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI), an instrument which measures shoulder pain associated with the functional activities of wheelchair users. This 15-item functional index was developed to access shoulder pain during transfers, self care, wheelchair mobility and general activities. To establish test-retest reliability, the index was administered twice in the same day to 16 long term wheelchair users and their scores for the two administrations were compared by intraclass correlation. To establish concurrent validity, the index was administered to 64 long term wheelchair users and index scores were compared to shoulder range of motion measurements. Results showed that intraclass correlation for test-retest reliability of the total index score was 0.99. There were statistically significant negative correlations of total index scores to range of motion measurements of shoulder abduction (r = -0.485), flexion (r = -0.479) and shoulder extension (r = -0.304), indicating that there is a significant relationship of total index score to loss of shoulder range of motion in this sample. The Wheelchair User's Shoulder Pain Index shows high levels of reliability and internal consistency, as well as concurrent validity with loss of shoulder range of motion. As a valid and reliable instrument, this tool may be useful to both clinicians and researchers in documenting baseline shoulder dysfunction and for periodic measurement in longitudinal studies of musculoskeletal complications in wheelchair users.

Activities of Daily Living↗
PubMed2006

The effects of shoulder load and pinch force on electromyographic activity and blood flow in the forearm during a pinch task.

The object of the current study was to determine whether static contraction of proximal musculature has an effect on the blood flow more distally in the upper extremity. Static contractions of muscles in the neck shoulder region at three levels (relaxed, shoulders elevated and shoulders elevated loaded with 4.95 kg each) were combined with intermittent pinch forces at 0, 10 and 25% of the maximum voluntary contraction (MVC). Blood flow to the forearm was measured with Doppler ultrasound. Myoelectric activity of the forearm and neck-shoulder muscles was recorded to check for the workload levels. Across all levels of shoulder load, blood flow increased significantly with increasing pinch force (21% at 10% MVC and by 44% at 25% MVC). Blood flow was significantly affected by shoulder load, with the lowest blood flow at the highest shoulder load. Interactions of pinch force and shoulder load were not significant. The myoelectric activity of forearm muscles increased with increasing pinch force. The activation of the trapezius muscle decreased with increasing pinch force and increased with increasing shoulder load. The precise mechanisms accounting for the influence of shoulder load remains unclear. The results of this study indicate that shoulder load might influence blood flow to the forearm.

Adult↗
PubMed2002

Abnormal sonographic findings in the asymptomatic arthritic shoulder.

OBJECTIVE: To assess the diagnostic value of ultrasonography (US) in the evaluation of arthritic shoulder joints, especially in painless shoulders. METHODS: US examinations were performed in 57 consecutive patients with rheumatoid arthritis (114 shoulders) and in 32 controls (32 shoulders), using a 7.5 MHz linear probe and a standardized study protocol. US findings were compared with clinical, laboratory, and radiological data to find any relationship. RESULTS: Abnormal sonographic findings were found in 80 shoulders (70%); the most common were lesions in the supraspinatus tendon (38%), subacromial-subdeltoid bursitis (29%), bone erosions of the humeral head (20%), glenohumeral joint ellusion (19%), and biceps tendinitis (13%). Although US abnormalities were most frequent in patients with painful shoulders or abnormal findings on physical examination or radiography, a high rate of alterations was found in asymptomatic shoulders (51%), in normal shoulders on physical examination (44%) and in normal shoulders on radiographic assessment (61%). Differences of US findings in relation to time of evolution of rheumatoid arthritis, patient's age, and radiographic stage in hand and/or wrist joints were not found. CONCLUSION: US abnormalities in the shoulder joint are frequent in rheumatoid arthritis, both in patients with and without shoulder complaints as well as in patients with normal findings on physical examination.

Adult↗
PubMed2004

Proper shoulder position for subclavian venipuncture: a prospective randomized clinical trial and anatomical perspectives using multislice computed tomography.

BACKGROUND: Although the Trendelenburg position and shoulder bracing are recommended for safe subclavian venipuncture, the optimal shoulder position remains unclear. The current study observed spatial relations between the subclavian vein and surrounding structures using multislice computed tomography to determine optimal shoulder position for safe subclavian venipuncture and then conducted a small follow-up clinical trial to confirm these findings. METHODS: Thoracic multislice computed tomography was performed for seven adult volunteers at three shoulder positions: elevated (up); neutral; and lowered caudally (down). Overlap and distance between the clavicle and the subclavian vein and the diameter of the subclavian vein were measured. Anatomical relations between the subclavian artery and vein were also observed. The success rate for subclavian venipuncture was then compared between the up and down shoulder positions in 30 patients. RESULTS: In the multislice computed tomography study, the mean overlap ratios between clavicle and subclavian vein in the up, neutral, and down positions were 33.5, 36.9, and 40.0%, respectively. Overlap increased with lower shoulder position (up < neutral < down; P < 0.05). The mean distances between the clavicle and the subclavian vein in the up, neutral, and down positions were 6.8, 5.0, and 3.6 mm, respectively. Again, distance decreased with lower shoulder position (up < neutral < down; P < 0.05). The diameter of the subclavian vein did not differ among the three shoulder positions. The success rate for subclavian venipuncture was significantly higher in the down position compared with the up position (P = 0.003). CONCLUSIONS: Lowered shoulder position increases both overlap and proximity between the clavicle and the subclavian vein, producing a more constant relation between the clavicle and the subclavian vein, without affecting vein diameter. Proper use of a lowered shoulder position should thus increase the safety and reliability of subclavian venipuncture compared with other shoulder positions.

Adult↗
PubMed1997

Biceps activity during shoulder motion: an electromyographic analysis.

Electromyographic responses in 44 shoulders from 30 subjects were examined. Fourteen shoulders from 13 patients had documented rotator cuff tears. The remaining volunteers had normal cuff integrity by history and examination. Electromyographic responses were recorded from the long head of the biceps, brachioradialis (elbow control), and from the supraspinatus (shoulder control). Elbow related biceps activity was minimized by using a brace locked in neutral forearm rotation and 100 degrees flexion. Analysis of normal and rotator cuff deficient data was performed in a masked fashion and electromyographic activity normalized as a percent of maximal muscle contraction during 10 shoulder motions based on the scapular plane. Normal shoulders in all ranges of active motion exhibited significant supraspinatus activity (20%-50% maximum muscle contraction). The response followed patterns expected for a shoulder stabilizer. In contrast, with every normal shoulder, biceps and brachioradialis activity remained insignificant (1.7%-3.6% maximum muscle contraction) and did not follow a patterned response. In patients with rotator cuff tears, biceps activity remained low (1.6%-4.4% maximum muscle contraction). As opposed to previous studies using electromyography about the shoulder, this trial examined shoulder specific biceps activity by relaxing the elbow. No significant biceps activity was observed in any shoulder, including patients with rotator cuff tears. Given these findings, any function of the long head of the biceps in shoulder motion does not involve active contractions.

Adult↗
PubMed1992

Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 2: Relationship to neck and shoulder pain.

The prevalence rate of neck and shoulder trouble and considerable neck and shoulder pain in a randomly selected sample of 1773 construction workers were studied. The relationship to physical and psychosocial factors was analyzed. The workers answered a postal questionnaire. Workload was measured by means of eight manual materials handling indices and ten psychosocial indices, based on results from factor analyses. The 1-year prevalence rate of considerable neck and shoulder trouble was 56% and of neck and shoulder pain 12%. To work with hands above shoulder level showed a dose-response relationship to both neck and shoulder trouble and neck and shoulder pain. The psychosocial factors were more prominently associated with neck and shoulder trouble and neck and shoulder pain than the physical workload factors. The psychosocial indices; psychosomatic and psychic symptoms, stress and job satisfaction showed the highest age-standardized prevalence rate ratios for both neck and shoulder trouble and neck and shoulder pain.

Adult↗
PubMed2003

Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain.

BACKGROUND: Shoulder pain from inflammatory arthritis and/or degenerative disease is a common cause of morbidity in the community. It is difficult to treat and there are limited data on the efficacy of most interventions. Suprascapular nerve block has shown promise in limited trials in reducing shoulder pain. There have been no large randomised placebo controlled trials examining the efficacy of suprascapular nerve block for shoulder pain in arthritis and/or degenerative disease using pain and disability end points. OBJECTIVE: To perform a randomised, double blind, placebo controlled trial of the efficacy of suprascapular nerve block for shoulder pain in rheumatoid arthritis (RA) and/or degenerative disease of the shoulder. METHODS: 83 people with chronic shoulder pain from degenerative disease or RA took part in the trial. If a person had two painful shoulders, these were randomised separately. A total of 108 shoulders were randomised. Patients in the group receiving active treatment had a single suprascapular nerve block following the protocol described by Dangoisse et al, while those in the other group received a placebo injection of normal saline administered subcutaneously. The patients were followed up for 12 weeks by an observer who was unaware of the randomisation and reviewed at weeks 1, 4, and 12 after the injection. Pain, disability, and range of movement data were gathered. RESULTS: Clinically and statistically significant improvements in all pain scores, all disability scores, and some range of movement scores in the shoulders receiving suprascapular nerve block compared with those receiving placebo were seen at weeks 1, 4, and 12. There were no significant adverse effects in either group. CONCLUSION: Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain in degenerative disease and/or arthritis. It improves pain, disability, and range of movement at the shoulder compared with placebo. It is a useful adjunct treatment for the practising clinician to assist in the management of a difficult and common clinical problem.

Adult↗
PubMed1997

Occupational factors related to shoulder pain and disability.

OBJECTIVES: To determine, in a population based study, the influence of occupational factors on the occurrence of shoulder pain and disability. METHODS: A random sample of patients was selected from the register of a general practice in the Greater Manchester area of the United Kingdom. Information was collected by a posted questionnaire with specific enquiries about symptoms in the shoulder region and related disability. A lifetime occupational history was obtained including physical exposures, working conditions, and psychosocial aspects of each workplace. Analysis has been conducted as a case-control study, comparing occupational exposures at the time of onset of symptoms in those with shoulder pain and disability with corresponding occupational exposures in those without shoulder pain and disability. RESULTS: An increased risk of shoulder pain and disability in men was associated with carrying weights on one shoulder (relative risk (RR) 5.5, 95% confidence interval (95% CI) 1.8 to 17), whereas those who reported working with hands above shoulder level, using wrists or arms in a repetitive way, or stretching down to reach below knee level had about twice the risk of shoulder pain and disability. Men working frequently in very cold or damp conditions had a fourfold and sixfold risk respectively of shoulder pain and disability. Reporting of shoulder pain and disability was also more common among men and women who reported that their work caused a lot of stress (RR 1.9, 95% CI 0.9 to 4.1) or was very monotonous (RR 2.7, 95% CI 1.3 to 5.4). The relations between physical exposures, working conditions, and psychosocial factors were independent. CONCLUSIONS: This population based study has shown that physical activities carried out at work, the physical conditions under which the work is conducted, psychosocial aspects of work, or the working environment are all independently related to the occurrence of shoulder symptoms and disability, emphasising the multifactorial nature of this condition.

Activities of Daily Living↗
PubMed2001

A prospective study of work related factors and physical exercise as predictors of shoulder pain.

OBJECTIVES: To evaluate the effects of work related and individual factors as well as physical activity and sports on the incidence and persistence of shoulder pain among forestry workers. METHODS: Workers in a large Finnish forestry company replied to a questionnaire (a modified version of the Nordic questionnaire) on musculoskeletal pain and its possible risk factors for 4 consecutive years 1992-5. This 1 year follow up study covers the time 1994-5. Year 1994 was chosen as baseline because in that year the questionnaire contained for the first time more detailed questions about different sports. The response rate in 1995 was 90%. The effects of the predictors on 1 year incidence and persistence of shoulder pain were studied with multivariate logistic regression modelling. RESULTS: At baseline, 2094 subjects had been free of shoulder pain during the preceding 12 months. After 1 year, 14% (n=285) reported having mild or severe shoulder pain. Higher age, obesity, and mental stress as well as physically strenuous work and working with trunk forward flexed or with a hand above shoulder level increased the risk of incident shoulder pain. Of the different sports activities, dancing increased the risk of incident pain whereas jogging decreased the risk significantly. Of those 419 workers who had severe shoulder pain at baseline, 55% (n=230) still had severe pain 1 year later. Higher age, overload at work, and working with a hand above shoulder level increased the risk of persistent severe shoulder pain whereas cross country skiing and general sports activity decreased the risk. CONCLUSION: Our results support the current view that shoulder pain is the result of many factors, including occupational and individual factors. In this longitudinal study, physical work with a heavy load, awkward work postures, mental stress, and obesity were the risk factors at which preventive measures could be aimed. As a new finding, physical exercise had more protective than impairing effects on the shoulders.

Adult↗
PubMed2006

The modified Bristow procedure for anterior shoulder instability: 26-year outcomes in Naval Academy midshipmen.

BACKGROUND: Many procedures have been proposed for the correction of anterior shoulder instability. Some of these procedures address the problem anatomically, such as the Bankart procedure, and some prevent instability nonanatomically, such as the Bristow-Latarjet procedure. A modified Bristow procedure was the procedure of choice for anterior shoulder instability among midshipmen at the United States Naval Academy from 1975 to 1979. HYPOTHESIS: The modified Bristow procedure for anterior shoulder instability provides good shoulder function and stability in the long term. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: There were 52 shoulders in 49 patients reviewed at a mean follow-up of 26.4 years. The Rowe score, Single Assessment Numeric Evaluation, and Western Ontario Shoulder Instability Index were used to assess outcomes. RESULTS: The mean Rowe score was 81.8 (range, 5-100), and the mean Single Assessment Numeric Evaluation score was 82.9 (range, 30-100), with an overall Single Assessment Numeric Evaluation of 71.2% (37 of 52 shoulders) rated as good and excellent. The mean Western Ontario Shoulder Instability Index was 376 of 2100 (range, 0-1560). Overall, recurrent instability occurred in 8 of 52 shoulders (15.4%), with recurrent dislocation in 5 shoulders (9.6%) and recurrent subluxation in 3 shoulders (5.8%). The mean time to recurrent dislocation was 7.0 years. CONCLUSION: This study represents the longest follow-up in the literature of the modified Bristow procedure. The authors have shown nearly 70% good and excellent results and recurrent instability comparable with other long-term follow-up studies of open instability procedures.

Adolescent↗
PubMedDate not supplied

Glenohumeral translation in the asymptomatic athlete's shoulder and its relationship to other clinically measurable anthropometric variables.

To determine the degree of shoulder translation in uninjured athletes, we examined 76 Division I collegiate athletes (44 women and 32 men) for passive range of motion in both shoulders and for knee and elbow hyperextension. Translation was based on a scale of 0 to 3+. Shoulders with symptoms of pain or a history of instability or dislocation were excluded from this study. Forty-six shoulders had 0 anterior translation, 75 had 1+, and 31 had 2+. Thirteen shoulders had 0 posterior translation, 56 had 1+, and 83 had 2+. Thirty-eight shoulders had 0 inferior translation, 105 had 1+, and 9 had 2+. No shoulder had translation of 3+ in any direction. Twenty-four athletes, 12 men and 12 women, had translational asymmetry of a minimum of one grade in at least one direction. No shoulder was asymmetric in all three directions. There was a significant correlation between dominant hand and increased translation; 19 of 24 athletes with asymmetric shoulders had greater translation in the nondominant extremity. There was no relationship between translation and range of motion, knee or elbow hyperextension, thumb-to-forearm distance, or years spent in sports participation. Asymmetry of shoulder translation may exist in the normal shoulder. This review shows that up to 2+ translation in any direction cannot be considered abnormal.

Elbow Joint↗
PubMed2024

Bioinformatics analysis of ferroptosis in frozen shoulder.

OBJECTIVES: Frozen shoulder is a common shoulder disease that significantly affects the patient's life and work. Ferroptosis is a new type of programmed cell death, which is involved in many diseases. However, there have been no studies reporting the relationship between frozen shoulders and ferroptosis. This study identified potential molecular markers of ferroptosis in frozen shoulders to provide more effective strategies for the treatment of frozen shoulders. METHODS: GSE238053 was downloaded from the Gene Expression Omnibus (GEO) dataset and intersected with ferroptosis genes to obtain differentially expressed genes (DEGs). The signaling pathways and biological functions of DEGs were performed by WebGestalt and Metascape. The interactions related to these DEGs and the key genes between frozen shoulders and ferroptosis was performed by STRING and Cytoscape. A frozen shoulders rat model was used to validate our predicted genes, Western Blot and qRT-PCR was used to assess the expression levels of our genes of interest. RESULTS: A total of 34 DEGs between GSE238053 and Ferroptosis Database were obtained, most of which were involved in the HIF-1 signaling pathway and inflammatory response. A protein-protein interaction network was obtained by Cytoscape and the key genes (IL-6, HMOX1 and TLR4) were screened by MCODE. Our results of Western Blot showed that the protein expression level of TLR4 and HMOX1 were elevated, and the protein level of IL-6 decreased in frozen shoulders rat model. The mRNA level after frozen shoulders showed that IL-6 was upregulated, whereas TLR4 and HMOX1were downregulated. CONCLUSIONS: The results demonstrated that ferroptosis may affect the pathological process of frozen shoulders through these signaling pathways and genes. The identification of IL-6, HMOX1 and TLR4 genes can provide new therapeutic targets for frozen shoulders.

Ferroptosis↗
PubMed1992

Interscalene brachial plexus block for shoulder surgery: a proximal paresthesia is effective.

This study was designed to determine whether the location of paresthesias is related to the success of interscalene blocks in providing anesthesia for shoulder surgery. Interscalene blocks were performed in 45 patients presenting for elective shoulder surgery. Interscalene injections of 33-55 mL of 1.5% mepivacaine with epinephrine were performed after the first elicited paresthesia to the shoulder, arm, forearm, or hand. In 20 patients (45%), the initial elicited paresthesia was to the shoulder, whereas in 25 patients (55%), the first paresthesia was reported as distal to the shoulder. All patients developed brachial plexus anesthesia adequate for shoulder surgery. The time-course of onset of motor block as evaluated at the shoulder and elbow was not different between patients with shoulder paresthesias and those with more distal paresthesias. Handgrip strength was quantitatively evaluated with a dynamometer, and both paresthesia groups showed similar decrements in hand strength except at the end of the measurement period, when patients with distal paresthesias had a significantly weaker handgrip than patients with shoulder paresthesias. We recommend that paresthesias to the shoulder be accepted in performing interscalene blocks for patients undergoing shoulder surgery.

Adult↗
PubMed2004

Shoulder arthroplasty for the treatment of inflammatory arthritis.

BACKGROUND: Prosthetic replacement of the glenohumeral joint can relieve pain and improve shoulder function for patients with end-stage inflammatory arthritis. The purpose of this study was to prospectively analyze the clinical, functional, and radiographic outcomes of shoulder reconstruction with hemiarthroplasty or total shoulder arthroplasty. METHODS: In this multicenter prospective study, clinical history, physical examination, and self-assessment tools including a visual analogue scale, the Simple Shoulder Test, and an activities questionnaire were used to measure comfort, quality of life, and function. Radiographic outcome was determined by assessing the severity of the disease, the adaptation of the prosthesis to the anatomy, the implant position and relationships, and the restoration of glenohumeral alignment. RESULTS: At the time of follow-up, at a minimum of twenty-four months (mean, thirty-nine months), the thirty-six shoulders treated with a hemiarthroplasty and the twenty-five treated with a total shoulder arthroplasty showed significant improvement (p < 0.0001) as demonstrated by the visual analogue scale and the Simple Shoulder Test as well as improvements in the components of the activities questionnaire. Active forward elevation was significantly better (p < 0.004) after the total shoulder arthroplasties than after the hemiarthroplasties. The presence of extremely severe disease did not affect the clinical outcome. Prosthetic adaptation to the anatomy and restoration of glenohumeral alignment resulted in significant improvement in certain motion parameters and were associated with one another (p < 0.001). Restoration of glenohumeral alignment resulted in significant improvements in overall quality of life (p = 0.038), use of the arm for work and play (p = 0.014), and range of motion (p = 0.0004) compared with those parameters when alignment had not been restored. Glenoid erosion occurred in four of the shoulders treated with hemiarthroplasty. Two of the glenoid components used in the total shoulder arthroplasties loosened. CONCLUSIONS: Patients with inflammatory arthritis treated with hemiarthroplasty or total shoulder arthroplasty can be expected to have improved comfort, range of motion, and function. Restoration of glenohumeral alignment appears to lead to even greater improvement in these clinical parameters.

Adult↗
PubMed2005

Uncemented glenoid component in total shoulder arthroplasty. Survivorship and outcomes.

BACKGROUND: Glenoid component loosening continues to be a major factor affecting the long-term survivorship of total shoulder replacements. Radiolucent lines, cement fracture, migration, and loosening requiring revision are common problems with cemented glenoid components. The purpose of this study was to evaluate the results of total shoulder arthroplasty with an uncemented glenoid component and to identify predictors of glenoid component failure. METHODS: One hundred and forty-seven consecutive total shoulder arthroplasties were performed in 132 patients (mean age, 63.3 years) with use of an uncemented glenoid component fixed with screws between 1988 and 1996. One hundred and forty shoulders in 124 patients were available for follow-up at an average of 7.5 years. One shoulder in which the arthroplasty had failed at 2.4 years and for which the duration of follow-up was four years was also included for completeness. The preoperative diagnoses included osteoarthritis in seventy-two shoulders and rheumatoid arthritis in fifty-five. RESULTS: Radiolucency was noted around the glenoid component and/or screws in fifty-three of the 140 shoulders. The mean modified ASES (American Shoulder and Elbow Surgeons) score (and standard deviation) improved from 15.6 +/- 11.8 points preoperatively to 75.8 +/- 17.5 points at the time of follow-up. Eighty-five shoulders were not painful, forty-two were slightly or mildly painful, ten were moderately painful, and three were severely painful. Fifteen (11%) of the glenoid components failed clinically, and ten of them also had radiographic signs of failure. Eleven other shoulders had radiographic signs of failure but no symptoms at the time of writing. Three factors had a significant independent association with clinical failure: male gender (p = 0.02), pain (p < 0.01), and radiolucency adjacent to the flat tray (p < 0.001). In addition, the annual risk of implant revision was nearly seven times higher for patients with radiographic signs of failure. Clinical survivorship was 95% at five years and 85% at ten years. CONCLUSIONS: The failure rates of the total shoulder arthroplasties in this study were higher than those in previously reported studies of cemented polyethylene components with similar durations of follow-up. Screw breakage and excessive polyethylene wear were common problems that may lead to additional failures of these uncemented glenoid components in the future.

Adult↗
PubMed2005

Subscapularis muscle function and structure after total shoulder replacement with lesser tuberosity osteotomy and repair.

BACKGROUND: Recent studies have suggested that tenotomy and repair of the subscapularis tendon carried out for anterior approaches to the shoulder can be followed by failure of the tendon repair and by changes resulting in permanent loss of subscapularis function. We hypothesized that release of the subscapularis with use of a superficial osteotomy of the lesser tuberosity followed by repair of the two opposing bone surfaces would lead to consistent bone-to-bone healing, which would be possible to monitor radiographically, and would lead to satisfactory clinical and structural outcomes. METHODS: Thirty-nine shoulders in thirty-six consecutive patients who, at an average age of fifty-seven years, had undergone total shoulder replacement through an anterior approach involving an osteotomy of the lesser tuberosity were evaluated at an average of thirty-nine months. Assessment included a standardized interview and physical examination, scoring according to the system described by Constant and Murley, and imaging with conventional radiography and computed tomography to assess healing of the osteotomy site and changes in the subscapularis. RESULTS: The osteotomized tuberosity fragment healed in an anatomical position in all shoulders, and no cuff tendon ruptures were observed. At the time of follow-up, thirty-three (89%) of thirty-seven shoulders evaluated with a belly-press test had a negative result and twenty-seven (75%) of thirty-six shoulders evaluated with a lift-off test had an unequivocally normal result. Fatty infiltration of the subscapularis muscle increased after the operation (p < 0.0001) and was at least stage two in eleven (32%) of thirty-four shoulders. The fatty infiltration had progressed by one stage in eight (24%) of the thirty-four shoulders, by two stages in five shoulders (15%), and by three stages in two shoulders (6%). CONCLUSIONS: Osteotomy of the lesser tuberosity provides an easy anterior approach for total shoulder replacement and is followed by consistent bone-to-bone healing, which can be monitored, and good subscapularis function. In the presence of documented anatomical healing of the osteotomy site, postoperative fatty infiltration of the subscapularis muscle remains unexplained and needs to be investigated further as it is associated with a poorer clinical outcome.

Adult↗
PubMed2006

Primary unconstrained shoulder arthroplasty in patients with a fixed anterior glenohumeral dislocation.

BACKGROUND: Reports of shoulder arthroplasty for the treatment of fixed glenohumeral dislocation are rare. The purpose of this study was to analyze the results following shoulder arthroplasty in patients with a fixed anterior shoulder dislocation. METHODS: Eleven patients were evaluated at a minimum of twenty-four months after they underwent an arthroplasty for the treatment of a fixed anterior shoulder dislocation. Four patients underwent a total shoulder arthroplasty, and the remainder were treated with a hemiarthroplasty. Four shoulders had osseous reconstruction of the anterior aspect of the glenoid. The patients were evaluated with use of the Constant score, measurement of active anterior elevation and external rotation, the patient's subjective grading of the result, and a radiographic examination. RESULTS: The mean Constant score improved from 21.1 points preoperatively to 46.0 points following the arthroplasty, and the mean active anterior elevation improved from 48.6 degrees to 90.0 degrees . The pain component of the Constant score was the most reliably improved parameter, increasing from a mean of 4.8 points preoperatively to a mean of 11.0 points postoperatively. Eight patients reported that the result was excellent or good, and the remaining three considered it to be fair. We observed seven complications in five patients, including four cases of anterior instability of the shoulder. Two of the four patients treated with a total shoulder replacement were seen to have definite loosening of the glenoid component on follow-up radiographs. CONCLUSIONS: Shoulder arthroplasty in patients with a fixed anterior shoulder dislocation is fraught with difficulties and complications. Although arthroplasty reliably relieved shoulder pain in this population, limited functional results should be expected.

Aged↗
PubMed2006

Lesser tuberosity osteotomy for total shoulder arthroplasty. Surgical technique.

BACKGROUND: Recent studies have suggested that tenotomy and repair of the subscapularis tendon carried out for anterior approaches to the shoulder can be followed by failure of the tendon repair and by changes resulting in permanent loss of subscapularis function. We hypothesized that release of the subscapularis with use of a superficial osteotomy of the lesser tuberosity followed by repair of the two opposing bone surfaces would lead to consistent bone-to-bone healing, which would be possible to monitor radiographically, and would lead to satisfactory clinical and structural outcomes. METHODS: Thirty-nine shoulders in thirty-six consecutive patients who, at an average age of fifty-seven years, had undergone total shoulder replacement through an anterior approach involving an osteotomy of the lesser tuberosity were evaluated at an average of thirty-nine months. Assessment included a standardized interview and physical examination, scoring according to the system described by Constant and Murley, and imaging with conventional radiography and computed tomography to assess healing of the osteotomy site and changes in the subscapularis. RESULTS: The osteotomized tuberosity fragment healed in an anatomical position in all shoulders, and no cuff tendon ruptures were observed. At the time of follow-up, thirty-three (89%) of thirty-seven shoulders evaluated with a belly-press test had a negative result and twenty-seven (75%) of thirty-six shoulders evaluated with a lift-off test had an unequivocally normal result. Fatty infiltration of the subscapularis muscle increased after the operation (p < 0.0001) and was at least stage two in eleven (32%) of thirty-four shoulders. The fatty infiltration had progressed by one stage in eight (24%) of the thirty-four shoulders, by two stages in five shoulders (15%), and by three stages in two shoulders (6%). CONCLUSIONS: Osteotomy of the lesser tuberosity provides an easy anterior approach for total shoulder replacement and is followed by consistent bone-to-bone healing, which can be monitored, and good subscapularis function. In the presence of documented anatomical healing of the osteotomy site, postoperative fatty infiltration of the subscapularis muscle remains unexplained and needs to be investigated further as it is associated with a poorer clinical outcome.

Adult↗