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At least 523 records · Page 29Linked to original sources
PubMed2004

Shoulder function after accessory nerve-sparing neck dissections.

BACKGROUND: This study was designed to observe the effect of preserving the spinal accessory nerve (SAN) during neck dissection (ND) and adjuvant radiotherapy (ART) after ND on shoulder function. METHODS: Fifty-seven patients with head and neck cancer who had undergone primary tumor resection and various types of NDs were enrolled in this prospective study. Postoperative shoulder joint range of motion was evaluated by goniometry, and muscle strength was measured manually. SAN function was evaluated with electromyography (EMG) with respect to percentage of denervation and presence of neurogenic involvement. Patients were grouped by treatment as follows: radical ND (RND) versus modified radical ND (MRND)/selective ND (SND) and ART versus no ART. RESULTS: Shoulder joint range of motion and shoulder muscle strength were significantly better in the MRND/SND group than in the RND group. However, EMG findings were similar in the RND and MRND/SND groups. When all patients who underwent ND, RND, or MRND/SND were compared with the control group, statistically significant changes in shoulder joint range of motion and shoulder muscle strength were found. Also, denervation and neurogenic involvement of the SAN were significantly higher after all NDs than in the control group. ART did not affect range of motion of the shoulder joint, shoulder muscle strength, or the degree of denervation and neurogenic involvement in any of the ND groups. CONCLUSIONS: ART does not have a negative effect on shoulder function after ND. SAN is always functionally impaired even if we preserve it macroscopically during ND.

Accessory Nerve↗
PubMed2004

Shoulder and elbow joint power differ as a general feature of vertical arm movements.

Consistent patterns of joint power underlie coordinated lower extremity behaviors such as running and walking. Recent work found that shoulder and elbow power consistently differed during reaching movements in the horizontal plane. Moreover, joint power during horizontal reaching appears correlated with motor cortical activity. It is not known if the feature of differential joint power extends to vertical plane reaches or to reaches of different movement conditions. The purpose of this study was to test for differential shoulder and elbow power during the acceleratory and deceleratory phases of fast and normal speed vertical reaches in sitting and supine positions. Our results suggest that shoulder and elbow power typically differed both within and across conditions. First, shoulder power values were positive or negative dependent largely on movement direction and movement phase. That is, for each direction and phase, the shoulder either generated or absorbed energy independent of speed or body position. Second, and unexpectedly, reaches of certain condition combinations had similar shoulder power magnitudes across directions. In contrast, elbow power values for each direction varied between positive and negative values depending on phase, speed and position, and no two condition combinations overlapped across directions. Third, as target direction, movement phase and body position varied, shoulder power at fast and normal speeds were linearly correlated, as was shoulder power in sitting and in supine. In contrast, elbow power was linearly correlated only between speeds. These results join other studies to suggest that the neuromotor control of the shoulder may be less complex as compared to the elbow as a general feature of reaching movements. This differential control has important implications for the study of reaching impairments in neurorehabilitation populations, and provides a potentially important variable in the study of cortical firing patterns.

Acceleration↗
PubMed2005

Persistence of inter-joint coupling during single-joint elbow flexions after shoulder fixation.

Single-joint elbow flexions are associated with muscle activity at the shoulder that opposes interaction torques arising from rotation of the elbow. We have previously shown that this activity is linearly related to elbow muscle torque and is robust in the presence of novel dynamic loads. Here we examined this relationship in the context of shoulder joint fixation. We tested the hypothesis that after mechanically fixing the shoulder the relationship between shoulder muscle activity and elbow muscle torque will be preserved. In contrast, proposals in which energetic variables are optimized predict that shoulder muscle activity should cease. Subjects performed single-joint elbow flexions in a horizontal plane while interacting with the KINARM robotic exoskeleton. After repeated movements with the shoulder joint fixed we observed a slight and gradual decrease in the activity of pectoralis major relative to movements in which the shoulder was free to rotate. However the strength of the coupling between the shoulder and elbow did not change after shoulder fixation. This is consistent with our previous findings and suggests that the nervous system maintains this inter-joint coupling relationship even when activity at the fixed joint is no longer needed for movement accuracy.

Adult↗
PubMed2006

Shoulder and elbow function 2 years following long head triceps interposition flap transfer for massive rotator cuff tear reconstruction.

INTRODUCTION: Patient outcomes were determined at a minimum of 2 years following massive rotator cuff tear ( > or = 5 cm(2)) reconstruction using a triceps brachii long head interposition flap. A physiotherapist at an independent clinic performed all measurements. PATIENTS AND METHODS: Of 24 total eligible patients, 19 completed pre-operative and follow-up UCLA Shoulder Scores and ASES Function Scores. Of these 19 patients, 14 who did not have co-morbidities that negatively impacted their ability to perform intense exercise underwent a comprehensive clinical examination of involved and uninvolved side shoulder and elbow active range of motion and strength (both isometric instrumented manual muscle testing and concentric isokinetic measurements). RESULTS: At 2 years following surgery, pre-operative UCLA Shoulder Scores improved from 10.6 +/- 3 to 27.4 +/- 5 and pre-operative ASES Function Scores improved from 20.1 +/- 10 to 43.2 +/- 5. However, isometric involved side shoulder abductor torque was decreased by 28.2% with instrumented manual muscle testing, and concentric shoulder external rotator torque was decreased by 44.6% at 60 degrees/s and by 53.8% at 120 degrees/s with isokinetic testing. Isometric involved side elbow extensor torque was decreased by 39% with instrumented manual muscle testing, and concentric elbow extensor torque was decreased by 17.7% and 19.2% at 60 and 120 degrees/s, respectively, with isokinetic testing. Including three additional patients who were contacted via telephone, the majority of patients (21 of 22, 95.4%) were satisfied with their improved shoulder function and reduced pain. CONCLUSIONS: Despite reduced pain and improved shoulder function, residual involved side shoulder abductor; shoulder external rotator and elbow extensor strength deficits were evident at 2 years following surgery. This suggests the need for more focused rehabilitation, particularly for involved side elbow extensor strengthening to further improve patient function and minimize disability.

Aged↗
PubMed2006

Shoulder muscle strength in paraplegics before and after kayak ergometer training.

The purpose was to investigate if shoulder muscle strength in post-rehabilitated persons with spinal cord injury (SCI) was affected by kayak ergometer training and to compare shoulder strength in persons with SCI and able-bodied persons. Ten persons with SCI (7 males and 3 females, injury levels T3-T12) performed 60 min kayak ergometer training three times a week for 10 weeks with progressively increased intensity. Maximal voluntary concentric contractions were performed during six shoulder movements: flexion and extension (range of motion 65 degrees ), abduction and adduction (65 degrees ), and external and internal rotation (60 degrees ), with an angular velocity of 30 degrees s(-1). Position specific strength was assessed at three shoulder angles (at the beginning, middle and end of the range of motion) in the respective movements. Test-retests were performed for all measurements before the training and the mean intraclass correlation coefficient was 0.941 (95% CI 0.928-0.954). There was a main effect of kayak ergometer training with increased shoulder muscle strength after training in persons with SCI. The improvements were independent of shoulder movement, and occurred in the beginning and middle positions. A tendency towards lower shoulder muscle strength was observed in the SCI group compared to a matched reference group of able-bodied persons. Thus, it appears that post-rehabilitated persons with SCI have not managed to fully regain/maintain their shoulder muscle strength on a similar level as that of able-bodied persons, and are able to improve their shoulder muscle strength after a period of kayak ergometer training.

Adult↗
PubMed1995

Recurrence rate of shoulder dystocia.

OBJECTIVE: Shoulder dystocia continues to be a major complication of obstetrics, and several factors have been identified to help predict its occurrence. A previous shoulder dystocia is one of the risk factors. However, the recurrence rate is unknown. The purpose of this study is to report the recurrence rate of shoulder dystocia. STUDY DESIGN: Our obstetric database was used to identify all vaginal deliveries between January 1983 through December 1992. A subset of vaginal deliveries complicated by shoulder dystocia was selected from this database. These records were reviewed to identify subsequent pregnancies, outcomes, risk factors, and demographic data. RESULTS: During the study period there were 37,465 total vaginal deliveries, with shoulder dystocia complicating 747 (overall rate 2%). Of these 747 cases, 101 patients had 123 subsequent vaginal deliveries, with shoulder dystocia complicating 17 of these pregnancies (13.8% recurrence rate, p < 0.0001). Comparisons were made between those patients with recurrent shoulder dystocia. CONCLUSION: Shoulder dystocia recurred at a rate approximately seven times higher than our primary rate. Whether patients with a history of shoulder dystocia should be offered an elective abdominal delivery requires further investigation.

Adolescent↗
PubMed2006

The relationship of fetal position and ethnicity with shoulder dystocia and birth injury.

OBJECTIVE: The objective of this study was to examine factors associated with the occurrence of shoulder dystocia and subsequent perinatal outcomes. STUDY DESIGN: We conducted a retrospective cohort study of 29,612 consecutive term, singleton, vertex vaginal deliveries. The primary outcome was reported shoulder dystocia. Fetal position, ethnicity, and their interaction terms were examined along with maternal characteristics, induction and length of labor, operative vaginal delivery, epidural, and birth weight in both bivariate and multivariate analyses. RESULTS: Among women who met study criteria, 524 (1.8%) experienced a shoulder dystocia. African American women had the highest risk of shoulder dystocia (2.6%), compared with other races/ethnicities (P = .001). Women who delivered in occiput posterior position were noted to have a lower risk for shoulder dystocia (1.1%) as compared with occiput anterior position (1.8%, P = .046). However, in the setting of a shoulder dystocia, a higher risk of brachial plexus injury was observed in neonates delivered in occiput posterior position (adjusted odds ratio 10.4, 95% confidence interval 3.03 to 35.88) by vacuum-assisted vaginal delivery (adjusted odds ratio 3.24, 95% confidence interval 1.37 to 7.67) and neonates weighing 4000 g or more (adjusted odds ratio 2.53, 95% confidence interval 1.09 to 5.85). CONCLUSION: Overall African American women have an increased risk of shoulder dystocia, but their neonates are not more likely to experience birth injury. Although occiput posterior position has a protective effect for shoulder dystocia, the risk of brachial plexus injury is increased in the setting of a persistent occiput posterior delivery. These factors should be used to consider a patient's prospective risk for shoulder dystocia and associated outcomes.

Adult↗
PubMed2004

Conservative treatment for shoulder pain: prognostic indicators of outcome.

OBJECTIVES: To investigate the long-term clinical outcome and to identify factors that predict that outcome, after conservative treatment of patients who have shoulder pain with or without accompanying stiffness. DESIGN: Cohort study. SETTING: Outpatient clinic. PARTICIPANTS: Eighty-two subjects who had participated in a randomized controlled trial that compared the short-term effectiveness of conservative treatment for chronic, unilateral shoulder pain of mechanical origin with and without accompanying stiffness, and who were available for longer term follow-up 6 months after the cessation of formal treatment. INTERVENTIONS: Conservative treatment consisting of various combinations of exercise therapy, passive joint mobilization, electrophysical modalities, and corticosteroid injections. MAIN OUTCOME MEASURES: Pain intensity, functional limitation, perceived change in symptoms, active range of motion, muscle force, and clinical and demographic variables. RESULTS: Patients showed significant improvement in all outcome measurements in the long-term whether or not their shoulder pain was accompanied by stiffness. Long-term outcome was not predicted by hand dominance, clinical history of the shoulder condition, severity of the shoulder problem, or shoulder mechanics. CONCLUSIONS: Patients with chronic shoulder pain, with or without accompanying stiffness, can expect significant decreases in shoulder pain and improvements in shoulder function in the long term after conservative treatment.

Activities of Daily Living↗
PubMed2006

A kinematic model of the shoulder complex to evaluate the arm-reachable workspace.

Upper-arm evaluation including shoulder motion in physiotherapy has no three-dimensional tool for an arm-functioning evaluation, which hampers an uniform, objective comparison. Human shoulder complex models suffer from lack of shoulder girdle kinematic data. A kinematic shoulder-complex model with six degrees of freedom is proposed as the composition of the inner joint representing the shoulder-girdle joints and outer joint representing the glenohumeral joint. The outer shoulder joint has three perpendicular rotations: adduction/abduction, retroflexion/flexion and internal/external rotation of the humerus. The inner shoulder joint has two rotations, depression/elevation and retraction/protraction, and one translation, which are all dependent on the elevation angle of the humerus. The human arm-reachable workspace that represents the area within reach of the wrist is calculated on the basis of the shoulder-complex model and the additional elbow-joint direct kinematics. It was demonstrated that cross-sections of the calculated workspace are in agreement with the measured arm-reachable workspace in all three anatomical planes. The arm-reachable workspace volume and graphics were calculated and a comparison of the arm's workspaces during a patient's shoulder treatment was made. The obtained numerical and graphical arm-reachable workspaces can be used for arm-functioning evaluations in rehabilitation and ergonomics.

Arm↗
PubMedDate not supplied

One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study II-the evolution of dislocation arthropathy.

Dislocation arthropathy after surgical treatment of recurrent anterior dislocation of the shoulder has been a subject of discussion over the years. The objective of this prospective study was to evaluate the Bristow-Latarjet repair at 2 and 15 years after surgery with respect to arthropathy and to evaluate factors responsible for this development. At 2 and 15 years after a Bristow-Latarjet repair for recurrent anterior dislocation, we prospectively analyzed the radiographs of 115 of 118 shoulders. The majority of the patients also had radiography of the nonindex shoulder (111/118). Dislocation arthropathy was found on ordinary anteroposterior views in 46 of 115 shoulders (mild in 39, moderate in 5, and severe in 2). The anteroposterior view angulated 45 degrees from above gave the best visualization of the humeral osteophyte and, together with the axial view, doubled the incidence of moderate and severe arthropathy at follow-up (mild in 40, moderate in 11, and severe in 5). Of 38 shoulders with a postoperative position of the transferred coracoid process 2 to 4 mm medial to the glenoid rim and the screw and transplant parallel to the glenoid, 3 had moderate arthropathy (8%) compared with 8 shoulders with moderate arthropathy and 5 with severe arthropathy out of 77 shoulders with a nonoptimal position of the coracoid (17%) (P = not significant). The degree of restriction of outward rotation at 2 years did not influence the degree of arthropathy after 15 years. Global assessment of the operative result was not related to arthropathy at follow-up. When the first dislocation occurred before age 23 years, the incidence of arthropathy was significantly lower than when it occurred in age 23 years or older (P = .006). When all views were included, moderate or severe dislocation arthropathy was found in 14% of the shoulders, and a further 35% had mild arthropathy. When follow-up studies of operated series of shoulder dislocations with the Bristow-Latarjet method are done, it is important to have the same radiologic views to compare the incidence of dislocation arthropathy correctly.

Adolescent↗
PubMed2006

Biomechanical effects of glenoid retroversion in total shoulder arthroplasty.

The purpose of this study was to evaluate the effects of glenoid retroversion after total shoulder arthroplasty on glenohumeral joint contact pressures, contact areas, and forces. We studied 8 cadaveric shoulders with a custom shoulder testing system that permits anatomic loading of the rotator cuff and the humerothoracic muscles. Each shoulder was tested intact and after total shoulder arthroplasty with the glenoid component in a neutral position and with the glenoid component retroverted 15 degrees . Glenohumeral contact pressures and areas were measured with Fuji pressure-sensitive film, and the glenohumeral forces were measured with a 6-df load cell. Glenohumeral contact areas decreased significantly, and contact pressures increased after total shoulder arthroplasty with both neutral glenoid components and retroverted glenoid components (P < .0002 to .04). Inferior forces decreased significantly after total shoulder arthroplasty with the retroverted glenoid components when compared with the intact, native shoulder (P < .02). Posterior forces also decreased significantly with the retroverted glenoid when compared with the neutral glenoid (P < .03). Placement of the glenoid in 15 degrees of retroversion significantly decreased glenohumeral contact area, increased contact pressure, and decreased inferior and posterior glenohumeral forces. Glenoid component retroversion may result in eccentric loading of the glenoid component and possibly lead to wear and loosening, signifying the importance of correct anatomic placement during total shoulder arthroplasty.

Arthroplasty, Replacement↗
PubMed2004

Reflexes in the shoulder muscles elicited from the human coracoacromial ligament.

Morphological studies have demonstrated mechanoreceptors in the capsuloligamentous structures of the shoulder joint, however knowledge of the role these joint receptors play in the control of shoulder stability is limited. We therefore investigated the effect of electrically induced afferent activity from mechanoreceptors in the coracoacromial ligament (CAL) on the activity of voluntary activated shoulder muscles in healthy humans. In study I, wire electrodes, for electrical stimulation, were inserted into the CAL in eight normal shoulders. In study II, a needle electrode was inserted into the CAL in seven normal shoulders. Electric activity was recorded from eight shoulder muscles by surface and intramuscular electrodes. During isometric contractions, electrical stimulation was applied to the CAL at two different stimulus intensities, a weak stimulus (stim-1) and a stronger stimulus (stim-2). In both experiments, electrical stimulation of the CAL elicited a general inhibition in the voluntary activated shoulder muscles. In study I the average latencies (mean+/-SE) of the muscular inhibition were 66+/-4 ms (stim-1) and 62+/-4 ms (stim-2) during isometric flexion and 73+/-3 ms (stim-1) and 73+/-5 ms (stim-2) during isometric extension. In study II the average latency (mean+/-SE) of the response was 66+/-4 ms (stim-1) during isometric flexion. Our results demonstrated a response, probably of reflex origin, from mechanoreceptors in the CAL to the shoulder muscles. The existence of this synaptic connection between mechanoreceptors in CAL and the shoulder muscles suggest a role of these receptors in muscle coordination and in the functional joint stability.

Adult↗
PubMed1997

The McRoberts' maneuver for the alleviation of shoulder dystocia: how successful is it?

OBJECTIVE: Our purpose was to determine the rate of success of the McRoberts' maneuver as the initial treatment for shoulder dystocia and to compare the rate of maternal and neonatal morbidity with those cases of shoulder dystocia requiring additional obstetric maneuvers. A secondary goal was to assess those factors associated with successful McRoberts' maneuvers. STUDY DESIGN: A retrospective review of shoulder dystocia cases occurring between 1991 and 1994 was performed. The identified cases were divided into two groups on the basis of the maneuvers used to relieve the shoulder dystocia. The first group comprised cases in which the McRoberts' maneuver was used as the sole treatment and the second group consisted of cases in which additional maneuvers were subsequently used. Exclusion criteria included lack of documentation concerning the maneuvers used or cases in which the McRoberts' maneuver was not the initial technique used. The two groups were compared with respect to various antepartum, intrapartum, and neonatal characteristics. RESULTS: During the study period we identified 250 cases of shoulder dystocia among 44,072 vaginal deliveries, for an incidence of 0.57%. Of these, 236 cases (94%) fulfilled entry criteria. The McRoberts' position alone successfully alleviated the shoulder dystocia in 98 cases (42%). In the group of cases where the McRoberts' maneuver was the sole maneuver used, there were significantly lower mean birth weights (p = 0.008), shorter durations of the active phase of labor (p = 0.009), and shorter second stages (p < 0.0001). In the group of cases that required additional maneuvers to relieve the shoulder dystocia, there was a trend toward an increased incidence of postpartum hemorrhage and brachial plexus injury (p = 0.07). CONCLUSIONS: These data suggest that the McRoberts' maneuver is associated with a significant degree of success in relieving shoulder dystocia and may be associated with decreased morbidity compared with other maneuvers. On the basis of these findings, we recommend the McRoberts' maneuver as the initial technique for disimpaction of the anterior shoulder.

Adult↗
PubMed1988

An analysis of factors affecting the long-term results of total shoulder arthroplasty in inflammatory arthritis.

The authors studied 36 patients undergoing 50 total shoulder arthroplasties for inflammatory arthritis with an average follow-up period of 5 years (range, 2-9 years). There were 7 men and 29 women. Twenty-nine patients (38 shoulders) had rheumatoid arthritis, 6 patients (11 shoulders) had systemic lupus erythematosus, and 1 patient (1 shoulder) had psoriatic arthritis. Twenty-four of the procedures were performed on the dominant hand. Twenty-one patients (32 shoulders) were receiving steroids, chemotherapeutic agents, or Gold therapy at the time of arthroplasty. Using the Hospital for Special Surgery scoring system, 22 shoulders had excellent, 18 good, 1 fair, and 9 poor results. Forty-eight of 50 shoulders had satisfactory pain relief. The average shoulder score was 85 points (range, 50-100 points). There were no reoperations, infections, or persistent nerve palsies and no symptomatically loose prostheses, although there were three cases of glenoid component shift. Eighteen glenoid components and 4 humeral components had radiolucent lines and in two cases metaphyseal bone atrophy was noted about the proximal humerus with firm cement fixation and bone hypertrophy about the stem tip. Total shoulder arthroplasty provides a predictable reconstructive alternative for patients with inflammatory arthritis. Overall functional results are related to the biologic condition and motivation of the patient, the status of the rotator cuff, and prosthesis alignment.

Adult↗
PubMed2002

Shoulder reflexes.

Dynamic shoulder stability is dependent on muscular coordination and sensory inputs. In the shoulder, mechanoreceptors are found in the coracoacromial ligament, the rotator cuff tendons, the musculotendinous junctions of the rotator cuff and in the capsule. The number of receptors in the capsule is small compared to the number in the other shoulder structures. Proprioceptive information from numerous receptors in muscles and tendons is mediated via fast conducting nervefibers and probably contribute more to kinaestethic sensation than information from capsule and ligaments. Therefore it seems likely that the joint receptors have a more distinct role for the kinaestethic sense than muscle receptors. In cats a direct reflex from the afferents innervating the shoulder to the muscles around the shoulder has been presented. The reflex had an extremely short latency (2.7-3.1 ms). In man, a very long latency (300 ms) excitatory reflex has been found when nerves in the capsule were stimulated electrically during shoulder surgery. In addition, when the anterior-inferior capsule was excited in conscious humans with modest amplitude electrical stimuli during muscle activity, a strong inhibition was found with an average latency of 33 ms. Stimulation of the sensory nerves in the coracoacromial ligament has also been found to modify muscle activity strongly. Even though our understanding of the control of shoulder motion is incomplete, it is clear that sensory inputs can strongly modify muscle activity around the shoulder. This has implications for rehabilitation and shoulder surgery.

Electric Stimulation↗
PubMed1998

Rotational action of the supraspinatus muscle on the shoulder joint.

The shoulder joint allows three-dimensional movement. In order to analyze the function of the muscles which act on the shoulder joint, three-dimensional movements, including rotation, must be considered. Among muscles participating in the shoulder joint movement, the supraspinatus muscle is known to have abduction and stabilization effects on the shoulder joint. However, the rotational function of the supraspinatus muscle has not been identified, because few studies have been reported on it. This study investigates the rotating function of the supraspinatus muscle using electrical stimulation, magnetic resonance imaging (MRI) and anatomical examination. Electrical stimulation was applied selectively to the supraspinatus muscle of healthy subjects using percutaneous wire electrodes. The electrical stimulation was given at different positions of the shoulder joint. It was found that the electrically induced rotational movements changed their direction depending on the position of the shoulder joint. When the humerus was relatively in internal rotation, internal rotation resulted. When it was in external rotation, external rotation occurred. Regarding the abduction angle of the shoulder joint, external rotation was induced with an increase in the abduction angle, whereas internal rotation occurred when the abduction angle was decreased. By the dissection of cadavers and MRI examination, it was indicated that the relation between the running direction of the supraspinatus muscle and the center of rotation of the humeral head was dependent on the position of the shoulder joint. Those findings supported the results of electrical stimulation of the supraspinatus muscle at various shoulder positions. These results indicate that the bi-directional rotating function of the supraspinatus muscle is characterized by an anatomical relationship between the running direction of the supraspinatus muscle and the center of rotation of the humeral head.

Adult↗
PubMed1999

The incidence and severity of shoulder dystocia correlates with a sonographic measurement of asymmetry in patients with diabetes.

The objective of this paper is to examine the relationship between fetal asymmetry measured sonographically and the incidence and severity of shoulder dystocia in diabetic patients. Ultrasound data were collected retrospectively from examinations of women with gestational and pregastational diabetes who delivered at University of California, Irvine Medical Center from 1993-1995. Sonographic fetal asymmetry was quantified by calculating the difference between the abdominal diameter and the biparietal diameter in centimeters (AD-BPD). The residual AD-BPD was a patient's actual AD-BPD at the time of the ultrasound minus the mean AD-BPD obtained in our population at the patient's gestational age. The correlations between fetal asymmetry and the incidence and severity of shoulder dystocia were assessed using an analysis of variance as well as a logistic regression analysis. Mild shoulder dystocia was defined as a delivery requiring McRobert's maneuver and/or suprapubic pressure, while severe shoulder dystocia was assessed when delivery of the posterior arm with Wood's corkscrew maneuver was required. One hundred twenty-three women met the inclusion criteria for the study. Dividing the cohort into three groups based on AD-BPD residual values resulted in the following AD-BPD residual ranges and incidences of shoulder dystocia: Group I, -1.80 to -0.32 cm (9.8%), Group II, -0.31 to 0.32 cm (19.5%), and Group III .33 to 2.0 cm (34.1%), (p <0.03). The residual AD-BPD difference correlated with the incidence of shoulder dystocia after controlling for maternal age, weight, parity, birth weight, and the gestational age at ultrasound (P <0.03). Similar results were found with regards to dystocia severity as the mean residual AD-BPD difference between those with no dystocia, mild dystocia, and severe shoulder dystocia was -0.09, 0.23, and 0.46 cm, respectively, (p <0.006). The residual AD-BPD correlated with the severity of shoulder dystocia after controlling for the above-mentioned confounding variables (p <0.05) in a regression analysis. There is a direct correlation in diabetic patients between the level of fetal truncal asymmetry measured sonographically and the incidence and severity of shoulder dystocia.

Abdomen↗
PubMed2001

How to predict recurrent shoulder dystocia.

OBJECTIVE: Our aim was to determine the rate and risk factors for recurrent shoulder dystocia. STUDY DESIGN: A retrospective analysis of patients diagnosed with shoulder dystocia was performed by searching a computerized database from January 1, 1993, to June 30, 1999 for the following information: (1) vaginal deliveries, either spontaneous or operative, (2) shoulder dystocia, (3) birth weight, (4) duration of second stage of labor, (5) parity, and (6) gestational diabetes. Statistical analyses included chi(2) and t test. RESULTS: There were 39,681 vaginal deliveries with 602 (1.5%) complicated by shoulder dystocia. Sixty-six patients underwent a subsequent vaginal delivery, and 11 (16.7%) experienced another shoulder dystocia. The odds ratio for a recurrent shoulder dystocia was 10.98 (P <.000001). Nine of the 11 patients with recurrent shoulder dystocia compared with 28 of 55 without a recurrence were nulliparous women in their index pregnancy (P <.001). The mean fetal weights were 3885 g in the recurrent dystocia group and 3702 g in the group without recurrence (P <.03). Gestational age, operative delivery, and gestational diabetes were similar in the two groups. CONCLUSION: Factors that appear to increase the recurrence risk of shoulder dystocia include fetal weight and maternal parity. Prior shoulder dystocia is the single greatest predictive factor.

Dystocia↗