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PubMed2001

Shoulder and arm problems after radiotherapy for primary breast cancer.

There is little, if any, difference in disease-free or overall survival for patients with stage I and II breast cancer treated by either breast conservation therapy or mastectomy. With either treatment, there may be cosmetic and functional problems related to arm edema, limited shoulder motion, and shoulder pain. The extent to which factors such as surgery, radiotherapy, systemic therapy, and patient characteristics affect development of arm edema, limited shoulder motion, and shoulder pain is not well documented. We undertook a prospective study of arm edema, limited shoulder motion, and shoulder pain in every patient (N = 331) seen during a 6-month period for follow-up after radiotherapy postlumpectomy or mastectomy for primary breast cancer. Local treatment included lumpectomy and breast irradiation with (n = 232) or without (n = 97) axillary dissection. Ten other women underwent mastectomy and postoperative radiotherapy. Doses to each region treated were 50 Gy in 25 fractions. The operative area was treated with an additional 1,000 Gy in approximately 60% of patients. Twelve patients received axillary irradiation without axillary dissection, and 11 patients received supraclavicular irradiation. Chemotherapy with or without tamoxifen was used in 71 patients and tamoxifen alone was used in 150 patients. One hundred ten patients did not receive any adjuvant therapy. Ipsilateral arm edema occurred in 20 women (6.0%), limited ipsilateral shoulder motion in 5 (1.5%), and ipsilateral shoulder pain in 5 (1.5%). Edema was mild (1+) in 15 patients and moderate (2+) in five patients. Multivariate analysis revealed that the risk of arm edema was significantly increased in black women (p = 0.005, 4/18 versus 16/313 whites) and with mastectomy (p = 0.048, 2/10 versus 18/321 with lumpectomy). There is a low incidence of arm edema, decreased range of motion of the ipsilateral shoulder, and shoulder-arm pain in patients undergoing postlumpectomy or postmastectomy radiotherapy. The risk of arm edema is increased in black women and in patients after mastectomy as opposed to lumpectomy.

Adult↗
PubMed2006

Shoulder pain -- a common problem in world-class badminton players.

Badminton is a sport that requires a lot of over-shoulder motion, with the shoulder in abduction/external rotation. This questionnaire study on 188 international top-level badminton players during the World Mixed Team Championships showed that previous or present shoulder pain on the dominant side was reported by 52% of the players. Previous shoulder pain was reported by 37% of the players and on-going shoulder pain by 20% of the players. There were no significant differences in the prevalence of shoulder pain between men and women. The majority of the shoulder pain had started gradually. The pain was usually associated with shoulder activity, and stiffness was a common, associated symptom. Furthermore, the shoulder pain was associated with consequences such as sleeping disturbances, changes in training and competition habits, and it also affected activities of daily living. The majority of the players had sought medical advice and had been given different kinds of treatment. The study showed that shoulder pain is a common and significant problem in world-class badminton players, and the consequences are most likely of importance for their training and playing capacity.

Activities of Daily Living↗
PubMedDate not supplied

Clinical findings in competitive swimmers with shoulder pain.

We clinically evaluated 36 competitive swimmers who had shoulder pain; the majority were women. Twenty-three swimmers had unilateral shoulder pain and 13 had bilateral pain, making a total of 49 painful shoulders. Shoulder pain had been present significantly longer in swimmers with bilateral shoulder pain (mean, 104 weeks) than in swimmers with unilateral pain (mean, 33 weeks). Twelve shoulders exhibited signs of impingement without excessive humeral head translation. In 25 shoulders, concomitant signs of impingement and increased glenohumeral translation, together with a positive apprehension sign, were found. Four swimmers, who were generally joint hypermobile, exhibited bilateral impingement signs and excessive humeral head translation, most commonly in the anteroinferior direction. Four shoulders had excessive humeral head translation and apprehension without impingement. Lack of coordination in the scapulohumeral joint was seen significantly more often in symptomatic than in asymptomatic shoulders. Hawkin's test for impingement was more sensitive than Neer's test. Swimmers with shoulder pain have variable clinical findings. The majority demonstrate signs of impingement and increased humeral head translation in the anteroinferior direction together with a positive apprehension sign. This nontraumatic instability might result from wearing of the anteroinferior capsuloligamentous complex. The different clinical findings might represent different stages of the same condition.

Adolescent↗
PubMed2000

The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study.

BACKGROUND: An osseous defect of the glenoid rim is sometimes caused by multiple recurrent dislocations of the shoulder. It is generally thought that a large defect should be treated with bone-grafting, but there is a lack of consensus with regard to how large a defect must be in order to necessitate this procedure. Some investigators have proposed that a defect must involve at least one-third of the glenoid surface in order to necessitate bone-grafting. However, it is difficult to determine (1) whether a defect involves one-third of the glenoid surface and (2) whether a defect of this size is critical to the stability of the shoulder after a Bankart repair. The purposes of the present study were (1) to create and quantify various sizes of osseous defects of the glenoid and (2) to determine the effect of such defects on the stability and motion of the shoulder after Bankart repair. METHODS: The glenoids from sixteen dried scapulae were photographed, and the images were scanned into a computer. The average shape of the glenoid was determined on the basis of the scans, and this information was used to design custom templates for the purpose of creating various sizes of osseous defects. Ten fresh-frozen cadaveric shoulders then were obtained from individuals who had been an average of seventy-nine years old at the time of death, and all muscles were removed to expose the joint capsule. With use of a custom multiaxis electromechanical testing machine with a six-degrees-of-freedom load-cell, the humeral head was translated ten millimeters in the anteroinferior direction with the arm in abduction and external rotation as well as in abduction and internal rotation. With a fifty-newton axial force constantly applied to the humerus in order to keep the humeral head centered in the glenoid fossa, the peak force that was needed to translate the humeral head a normalized distance was determined under eleven sequential conditions: (1) with the capsule intact, (2) after the creation of a simulated Bankart lesion, (3) after the capsule was repaired, (4) after the creation of an anteroinferior osseous defect with a width that was 9 percent of the glenoid length (average width, 2.8 millimeters), (5) after the capsule was repaired, (6) after the creation of an osseous defect with a width that was 21 percent of the glenoid length (average width, 6.8 millimeters), (7) after the capsule was repaired, (8) after the creation of an osseous defect with a width that was 34 percent of the glenoid length (average width, 10.8 millimeters), (9) after the capsule was repaired, (10) after the creation of an osseous defect with a width that was 46 percent of the glenoid length (average width, 14.8 millimeters), and (11) after the capsule was repaired. RESULTS: With the arm in abduction and external rotation, the stability of the shoulder after Bankart repair did not change significantly regardless of the size of the osseous defect (p = 0.106). With the arm in abduction and internal rotation, the stability decreased significantly as the size of the osseous defect increased (p<0.0001): the translation force in shoulders in which the width of the osseous defect was at least 21 percent of the glenoid length (average width, 6.8 millimeters) was significantly smaller than the force in shoulders without an osseous defect. The range of external rotation in shoulders in which the width of the osseous defect was at least 21 percent of the glenoid length was significantly less than that in shoulders without a defect (p<0.0001) because of the pretensioning of the capsule caused by closing the gap between the detached capsule and the glenoid rim. The average loss of external rotation was 25 degrees per centimeter of defect. CONCLUSIONS: An osseous defect with a width that is at least 21 percent of the glenoid length may cause instability and limit the range of motion of the shoulder after Bankart repair.

Aged↗
PubMed1993

Stability in relation to humeral head retroversion after surgical treatment of recurrent anterior shoulder dislocations.

This study reports the influence of the retroversion angle on the postoperative stability in 50 patients operated on for recurrent shoulder dislocations. Fifty-two shoulders were reviewed by radiographic and clinical examinations. Particular attention was focused on humeral head retroversion, shoulder stability, and range of motion in relation to surgical technique. The retroversion angle was significantly reduced in 30 of 47 shoulders, for which satisfactory radiographs could be achieved. Mean humeral head retroversion was 24 degrees for both dominant and nondominant shoulders. Forty-eight of 52 reexamined shoulders became stable. Four had remaining instability following a Putti-Platt procedure, with a mean retroversion angle of 18 degrees. A reduced humeral head retroversion is therefore proposed as an important factor in creating instability, and may be one explanation for failed stability after soft tissue repair. Irrespective of the type of surgical procedure (Bristow or Putti-Platt), there was a significant decrease in range of shoulder rotation in the operated shoulder compared to the contralateral stable shoulder and to reference values for normal controls. However, decreased rotation was not found to impair shoulder function, and 48 of the 50 reexamined patients generally improved after surgery.

Adolescent↗
PubMed1993

A kinematic and electromyographic study of shoulder rehabilitation exercises.

The role of shoulder muscles during passive, active, and resistive phases of shoulder rehabilitation exercises was investigated in ten normal subjects with no history of shoulder pathology. Using the scapular plane as a reference, three-dimensional motion of the shoulder was recorded with a computer-aided motion analysis system (VICON) to determine total shoulder elevation. Simultaneously, electromyographic data were acquired on nine shoulder muscles while performing the three phases of shoulder rehabilitation exercises as described by Neer. Fine wire intramuscular electrodes were placed in the following muscles: trapezius, serratus anterior, deltoid (anterior, middle, and posterior separately), supraspinatus, infraspinatus, biceps, and latissimus dorsi. Phase I (passive) exercises performed in the supine position showed the least electromyography (EMG) activity. There was a gradation of EMG activity as one progressed from Phase I (passive) to Phase II (active) to Phase III (resistive) shoulder exercises. Isometric exercises and Phase III resistive exercises showed high levels of activity in the rotator cuff and deltoid muscles. Supine Phase I exercises should be considered in the early postoperative period after shoulder surgery to achieve maximum motion while minimizing shoulder muscle activity. Progression to Phase II and Phase III exercises may proceed as soft tissue and bony healing permit. Phase III exercises performed with an elastic band should provide a satisfactory method to strengthen these muscles.

Adult↗
PubMed2005

Acupuncture for shoulder pain.

BACKGROUND: There are many commonly employed forms of treatment for shoulder disorders. This review of acupuncture is one in a series of reviews of varying interventions for shoulder disorders including adhesive capsulitis (frozen shoulder), rotator cuff disease and osteoarthritis. Acupuncture to treat musculoskeletal pain is being used increasingly to confer an analgesic effect and to date its use in shoulder disorder has not been evaluated in a systematic review. OBJECTIVES: To determine the efficacy and safety of acupuncture in the treatment of adults with shoulder pain. SEARCH STRATEGY: The Cochrane Controlled Trials Register, MEDLINE, EMBASE and CINAHL were searched from inception to December 2003, and reference lists from relevant trials were reviewed. SELECTION CRITERIA: Randomised and quasi-randomised trials, in all languages, of acupuncture compared to placebo or another intervention in adults with shoulder pain. Specific exclusions were duration of shoulder pain less than three weeks, rheumatoid arthritis, polymyalgia rheumatica, cervically referred pain and fracture. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted trial and outcome data. For continuous outcome measures where the standard deviations were not reported it was either calculated from the raw data or converted from the standard error of the mean. If neither of these was reported, authors were contacted. Where results were reported as median and range, the trial was not included in the meta-analysis, but presented in Additional Tables. Effect sizes were calculated and combined in a pooled analysis if the study end-points population and intervention were homogenous. Results are presented separately for rotator cuff disease, adhesive capsulitis, full thickness rotator cuff tear and mixed diagnoses, and, where possible, combined in meta-analysis to indicate effect of acupuncture across all shoulder disorders. MAIN RESULTS: Nine trials of varying methodological quality met the inclusion criteria. For all trials there was poor description of interventions. Varying placebos were used in the different trials. Two trials assessed short-term success (post intervention) of acupuncture for rotator cuff disease and could be combined in meta analysis. There was no significant difference in short-term improvement associated with acupuncture when compared to placebo, but due to small sample sizes this may be explained by Type II error. Acupuncture was of benefit over placebo in improving the Constant Murley Score (a measure of shoulder function) at four weeks (WMD 17.3 (7.79, 26.81)). However, by four months, the difference between the acupuncture and placebo groups, whilst still statistically significant, was no longer likely to be clinically significant (WMD 3.53 (0.74, 6.32)). The Constant Murley Score is graded out of 100, hence a change of 3.53 is unlikely to be of substantial benefit. The results of a small pilot study demonstrated some benefit of both traditional and ear acupuncture plus mobilization over mobilization alone. There was no difference in adverse events related to acupuncture when compared to placebo, however this was assessed by only one trial AUTHORS' CONCLUSIONS: Due to a small number of clinical and methodologically diverse trials, little can be concluded from this review. There is little evidence to support or refute the use of acupuncture for shoulder pain although there may be short-term benefit with respect to pain and function. There is a need for further well designed clinical trials.

Acupuncture Therapy↗
PubMed1996

An arthroscopic and electromyographic study of painful shoulders in elite gymnasts.

Shoulder problems are common in overhead sports like baseball, basketball and volleyball. Although gymnastics also includes overhead activities, there are few reports about shoulder problems in this sports activity. During the time period 1992-1995 we treated five young competitive gymnasts for shoulder pain. Arthroscopy revealed that they were all suffering from SLAP lesions or other labral pathology, although they had never dislocated their shoulders. These injuries have not been described earlier in connection with gymnastics. In a survey of 13 gymnasts in an elite club, we found that six (46%) complained about shoulder pain. Since four of these athletes explained that their shoulder pain started acutely during ring exercises in suspension while one suffered a slower onset with pain also during parallel bar exercises, we undertook an electromyographic study of the shoulder musculature of three normal elite gymnasts during exercises on the parallel bars and rings. We found that during the ring exercises in suspension there was a "critical phase" during which the muscle activity around the shoulder was very low, leading to great articular stresses. This might explain the occurrence of labral lesions like the SLAP lesions in this type of athlete. If shoulder pain in elite gymnasts does not respond to rest and physical therapy over 2-3 months, a shoulder arthroscopy should be considered.

Adolescent↗
PubMed2001

[Therapy of traumatic anterior shoulder dislocation: current status of therapy in Germany. Are there scientifically verified therapy concepts?].

There are no generally accepted concepts for the treatment of traumatic anterior shoulder dislocation. The objective of this study was to ascertain the current treatment for traumatic shoulder dislocations in German hospitals and to compare this with the data reported in the literature. A total of 210 orthopedic surgery departments were asked for their treatment strategy in an anonymous country-wide survey; 103 questionnaires (49%) were returned for evaluation. Additional imaging (ultrasound, CT, MRI) beyond the routine X-rays is performed in 82% of clinics for primary shoulder dislocation (94% in recurrent dislocation). A young, athletic patient (< 30 years old) would be operated on for a primary traumatic shoulder dislocation in 73% of hospitals (98% in recurrent dislocation). In contrast, a patient of the same age, with a moderate level of sporting activity would be treated conservatively in 67% of cases (14% in recurrent dislocation). Similarly, for an active, middle-aged patient with a demanding job, 74% of responses favored conservative treatment after a primary dislocation and 6% after a recurrent dislocation. Older patients (> 65 years old) are usually treated conservatively after a primary or recurrent shoulder dislocation (99%, 69%). For a primary shoulder dislocation the most popular surgical reconstruction is a Bankart repair (75%). For recurrent shoulder dislocation several different operative techniques are seen (Bankart 29%, T-shift 26%, Putti-Platt 8%, Eden-Lange-Hybbinette 22%, Weber osteotomy 13%). Based on our literature review, we found: (1) The clinical examination of both shoulders is important to diagnose hyperlaxity; (2) Routine CT or MRI is not necessary for primary traumatic shoulder dislocations; (3) A young, athletic patient should undergo surgical reconstruction after a primary shoulder dislocation; (4) The operation of choice for primary and recurrent dislocation is the Bankart repair; (5) There is no sufficient evidence that an arthroscopic Bankart repair is as good as an open procedure; (6) There are limited indications for other operative techniques, as they are associated with a higher recurrence and arthrosis rate.

Adolescent↗
PubMed2006

Recurrent shoulder instability among athletes: changes in quality of life, sports activity, and muscle function following open repair.

BACKGROUND: Recurrent anterior shoulder instability is a disabling condition in young athletes with possibly underestimated impact on quality of life and sports activity. Commonly used clinical scoring systems do not reflect the impairment of quality of life and sports activity. It was our aim to assess the return to preinjury levels of quality of life and sports activity as well as the changes in muscle function among competitive and recreational athletes. HYPOTHESIS: Patients suffering from post-traumatic recurrent shoulder instability have to adopt their participation in sports and therefore discover a reduction in quality of life. Open stabilization procedures are able to improve shoulder function and to reduce recurrence rates. However, return to preinjury shoulder function is not guaranteed. STUDY DESIGN: Retrospective longitudinal cohort study on 19 consecutive athletes with recurrent, post-traumatic shoulder instability. All patients were treated with an open, capsulo-labral repair. The minimum follow-up was 24 months. METHODS: Life quality (SF12) and sports activity data (Athletic Shoulder Outcome Scoring System) were retrospectively collected for the time before injury (time 1) and for the time with recurrent instability (time 2). Two years after surgical stabilization (time 3), we followed our patients with different clinical outcome scores, rotator surface EMG measurement, isokinetic muscle strength testing, and a radiological evaluation. This design of a three-step follow-up allowed for calculating the impact on quality of life and sports activity following the injury. RESULTS: Two years after surgery, the clinical scoring systems revealed good-to-excellent results in all patients. Quality of life physical component summary remained diminished by 9.2% despite the surgical procedure and was therefore significantly lower as compared to preinjury levels (p < 0.05). Sports activity was also significantly lower at the time of follow-up (p < 0.05). In this specific procedure, external rotation was not impaired postoperatively. EMG testing showed an overall reduction of muscle activity, however not significant. Isokinetic muscle strength was significantly diminished for external rotation and shoulder abduction. CONCLUSIONS: Open reconstruction procedures for recurrent shoulder instability can restore shoulder function and stability to near-normal values. Despite good-to-excellent clinical results, there is a significant impairment of quality of life and sports activity 2 years after surgery. Muscle activity and muscle strength are diminished. Recurrent shoulder instability remains a disabling condition to the young athlete. Future strategies have to emphasize restoration of quality of life, sports activity, and muscle function.

Adolescent↗
PubMed2002

Bone mineral density measurement over the shoulder region.

The purpose of this study was to (1). establish a method for measuring bone mineral density (BMD) over the shoulder region; (2). compare the relationship between shoulder BMD levels with hip BMD and body mass index (BMI); and (3). discuss the relevance of the shoulder scan as an early indicator of osteoporosis compared with hip scans, the latter representing a weight-bearing part of the skeleton. We developed a scanning procedure, including a shoulder fixation device, and determined the most appropriate software in order to establish a reference material with the highest possible precision. Duplicate scans of the dominant side shoulder on 80 healthy, non-osteoporotic Danish women revealed a coefficient of variation (CVSD) on BMD measurements of 1.7%, with no difference between young and old subjects. Shoulder BMD values were significantly lower than hip BMD values (P <0.00001). Both hip and shoulder values decreased with age (P <0.001). The difference between hip and shoulder BMD levels increased significantly with increased body mass index (BMI) (P <0.002). The positive relationship between the increased hip/shoulder BMD differential with BMI supports the conclusion that the shoulder is subject to the least relative influence of weight and stress loading because of migration of calcium to weight and stress-bearing areas. Since the effect of this migration could mask local osteoporotic bone loss, shoulder BMD measurement is likely to minimize false indicators of healthy bone in women with high BMI, and might therefore be a relevant early stage indicator of osteoporosis.

Absorptiometry, Photon↗
PubMed2000

Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability.

OBJECTIVE: To assess the shape of the posterior glenoid rim in patients with recurrent (atraumatic) posterior instability. DESIGN AND PATIENTS: CT examinations of 15 shoulders with recurrent (atraumatic) posterior instability were reviewed in masked fashion with regard to abnormalities of the glenoid shape, specifically of its posterior rim. The glenoid version was also assessed. The findings were compared with the findings in 15 shoulders with recurrent anterior shoulder instability and 15 shoulders without instability. For all patients, surgical correlation was available. RESULTS: Fourteen of the 15 (93%) shoulders with recurrent (atraumatic) posterior shoulder instability had a deficiency of the posteroinferior glenoid rim. In patients with recurrent anterior instability or stable shoulders such deficiencies were less common (60% and 73%, respectively). The craniocaudal length of the deficiencies was largest in patients with posterior instability. When a posteroinferior deficiency with a craniocaudal length of 12 mm or more was defined as abnormal, sensitivity and specificity for diagnosing recurrent (atraumatic) posterior instability were 86.7% and 83.3%, respectively. There was a statistically significant difference in glenoid version between shoulders with posterior instability and stable shoulders (P=0.01). CONCLUSION: Recurrent (atraumatic) posterior shoulder instability should be considered in patients with a bony deficiency of the posteroinferior glenoid rim with a craniocaudal length of more than 12 mm.

Adolescent↗
PubMed2004

Recovery of shoulder joint function after humeral shaft fracture: a comparative study between antegrade intramedullary nailing and plate fixation.

INTRODUCTION: Antegrade intramedullary (IM) nailing of humeral shaft fractures is reported to cause shoulder joint impairment. This retrospective study compared shoulder joint symptoms, range of motion (ROM), and isometric strength after antegrade IM nailing and dynamic compression (DC) plating of humeral shaft fractures. MATERIALS AND METHODS: We compared 29 patients with DC plating and 44 with antegrade IM nailing of their humeral shaft fractures. Shoulder pain, L'Insalata and Constant scores, shoulder joint ROM and isometric shoulder strengths were measured after mean follow-up of 6.2 (1-15) years (DC plating) and 5.5 (2-10) years (IM nailing). RESULTS: Patients had nonsignificantly more shoulder pain after IM nailing than after DC plating. Shoulder scores and isometric strength measurements showed no difference between the groups. Flexion was significantly better after DC plating, but none of the other ROM parameters differed between the groups. The shoulder scores and all ROM and strength parameters of the injured side were significantly lower than on the uninjured side in both groups. CONCLUSIONS: Shoulder joint ROM and strength does not recover to normal after humeral shaft fracture. Antegrade IM nailing if performed properly is not responsible for shoulder joint impairment.

Adolescent↗
PubMed2006

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

We examined whether the recruitment properties of the corticospinal pathway to forearm muscles are influenced by variations of the shoulder joint angle. Flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles motor evoked potentials (MEPs) in response to transcranial magnetic stimulation were examined during different static positions of shoulder joint in the horizontal plane: from 30 degrees abduction to 30 degrees adduction. We found that at 30 degrees shoulder adduction, maximum slope and plateau phase of the ECR and FCR input-output relationship (i.e., relation between MEP size and stimulus intensity) were significantly higher and lower than at 30 degrees abduction of the shoulder joint, respectively. Intracortical inhibition (ICI) and intracortical facilitation (ICF) of the FCR were assessed using a paired-magnetic pulse paradigm. A significant decrease in ICF was observed after changing shoulder position from 30 degrees abduction to 30 degrees adduction. On the contrary, no variation in the amount of ICI occurred in relation to the same changes in shoulder position. FCR H-reflex to electrical stimulation of median nerve at elbow did not differ significantly between the two shoulder positions. We conclude that shoulder position influences the recruitment efficiency (gain) of the corticospinal volleys to motoneurones of forearm muscles. It is proposed that activity of peripheral receptors signaling static shoulder position influences corticomotor excitability of forearm muscles mainly at cortical level, although C3-C4 propriospinal system could be also involved. It is proposed that the above changes in corticomotoneuronal excitability to forearm muscles as function of shoulder joint position are part of a global proximal-distal synergy operating throughout reaching movements.

Adult↗
PubMed1997

Development and prevention of frozen shoulder after acute aneurysm surgery.

BACKGROUND: We conducted a study on periarthritis humeroscapularis or "frozen shoulder," a postoperative complication of aneurysm surgery. The purpose of this study was to seek the cause of this complication and the methods of preventing it in patients who undergo aneurysm surgery. METHODS: The diagnosis of frozen shoulder was based on the clinical presence of shoulder pain and difficulty in raising arms that developed within 3 months of surgery. Sixty-four patients who underwent aneurysm surgery with no motor deficit were examined and classified into three groups: (1) early surgery (29 patients in the acute stage after subarachnoid hemorrhage); (2) delayed surgery (19 patients in the chronic stage); and (3) elective surgery (16 patients with unruptured aneurysms). RESULTS: The incidence of frozen shoulder was 41% in the early surgery group, 16% in the delayed surgery group, and 13% in the elective surgery group. The highest incidence of frozen shoulder was found to occur in the early surgery group and was attributed to the immobility of their upper extremities during postoperative treatment. Since patients who undergo surgery in the acute stage are often delirious and confused for several days after surgery, their arms are tied down by their sides in order to prevent them from inadvertently removing catheters such as the one for ventricular drainage. It seems that this manner of immobilizing the patient's arms is the cause of the development of frozen shoulder: Our study showed that if each arm was passively raised by turns above the patient's shoulder, the patient was able to maintain the range of motion of the upper arms and was less likely to develop frozen shoulder. CONCLUSION: Inactivity of the shoulder joints due to immobilizing the upper extremities of patients after acute aneurysm surgery seemed to cause the development of frozen shoulder. The incidence of this complication was greatly reduced by keeping the patient's upper arms raised alternately to maintain their range of motion after acute aneurysm surgery.

Craniotomy↗
PubMed1991

Shoulder pain in acute traumatic quadriplegia.

Fifty two patients with traumatic quadriplegia admitted to a spinal cord injury program within 6 months of injury were studied retrospectively. Seventy five per cent had shoulder pain documented in their medical records during initial rehabilitation, and 60% had shoulder pain for 2 weeks or more. When shoulder pain was documented it was bilateral in 61% of the cases. Age greater than 50 years, decreased shoulder range of motion, and not receiving shoulder exercise during the first 2 weeks after injury were positive risk factors associated with the onset of shoulder pain. At discharge 42% of the patients with shoulder pain were pain-free, 35% were noted to have improvement of their pain, and 23% had the same or worse shoulder pain. Study results demonstrate the high incidence of shoulder pain during initial rehabilitation of patients with traumatic quadriplegia and the importance of starting shoulder exercises during early acute care.

Accidents, Traffic↗
PubMed1999

Relationship between shoulder muscle strength and functional independence measure (FIM) score among C6 tetraplegics.

The degree of disability varies widely among C6 tetraplegic patients in comparison with that at other neurological levels. Shoulder muscle strength is thought to be one factor that affects functional outcome. The aim of this study was to examine the relationship between shoulder muscle strength and the Functional Independence Measure (FIM) motor score among 14 complete C6 tetraplegic patients. The FIM motor score and American Spinal Injury Association (ASIA) motor score of these patients were assessed upon discharge. We evaluated muscle strength of bilateral scapular abduction and upward rotation, shoulder vertical adduction and shoulder extension by manual muscle testing (MMT). The total shoulder strength score was calculated from the summation of those six MMT scores. The relationships among ASIA motor score, total shoulder strength score and FIM motor score were analyzed. The total shoulder strength score was significantly correlated with the FIM motor score and the score of the transfer item in the FIM. In the transfer item of the FIM, the total shoulder strength score showed a statistically significant difference between the Independent and Dependent Group. Shoulder muscle strength appears to be an important factor in the functional abilities of those with C6 complete tetraplegia. Functional variation depends on the strength of shoulder muscles, especially among C6 tetraplegics.

Activities of Daily Living↗
PubMed2000

The relation of shoulder pain and range-of-motion problems to functional limitations, disability, and perceived health of men with spinal cord injury: a multifaceted longitudinal study.

OBJECTIVES: To determine if shoulder pain and range-of-motion (ROM) problems can be predicted by demographic, injury-related, body weight, and radiographic data over 3 years and to determine the relationships among these shoulder problems and functional limitations, disability, and perceived health. DESIGN: A longitudinal, 2-panel study in which data were collected at 2 points in time, 3 years apart. SETTING: The community. PARTICIPANTS: Eighty-nine adult men with traumatic spinal cord injury (SCI) in the Houston-Galveston, TX, area. MAIN OUTCOME MEASURES: The acromioclavicular (AC) and the glenohumeral (GH) joints were x-rayed on plain film in standard anteroposterior position. Functional limitations were determined with the FIM instrument; disability was measured with the Craig Handicap Assessment and Reporting Technique (CHART). RESULTS: Thirty percent had shoulder pain and 22% had shoulder ROM problems. Men with shoulder pain had lived longer with SCI, were more likely to report shoulder ROM problems, had lower CHART mobility scores, and were more likely to rate their health as fair than those without shoulder pain. Shoulder ROM problems were more common among men who were older, had AC joint narrowing, had lower FIM scores, and reported poorer health. CONCLUSION: Shoulder pain and ROM problems were relatively prevalent. Demographic, injury-related, and radiographic variables were identified that were predictive of these problems over a period of at least 3 years. The shoulder problems were related to functional limitations, disability, and perceived health.

Activities of Daily Living↗