The isoelastic prosthesis for the shoulder joint.
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CT is able to demonstrate the predisposing factors for recurrent and posttraumatic subluxation of the shoulder. In addition to demonstrating bony changes in the glenoid (Bankart lesion) and in the humeral head (Hill-Sachs lesion), CT can measure the degree of retroversion of the glenoid and torsion of the humerus. Measurements on 17 shoulders with habitual and 24 shoulders with recurrent posttraumatic subluxation showed low values for glenoid retroversion as compared with a control group. Particularly patients with habitual anterior subluxation frequently showed anteversion of the glenoid. Measurements of humeral torsion showed wide scatter amongst all groups, indicating wide biological variability. The results were compared with those published in the literature and the indications and limitations of CT for the investigation of shoulder instability are discussed.
OBJECTIVE: To evaluate whether cervical spine changes are associated with the destruction of shoulder or peripheral joints and with bone mineral density (BMD) in patients with long-term RA. METHODS: An inception cohort of 67 patients with seropositive and erosive RA were followed up for 20 years. Cervical spine, shoulder, hand and foot radiographs, and the BMD of the lumbar spine and femoral neck were evaluated. RESULTS: A positive relationship was detected between the occurrence of atlantoaxial disorders and the destruction of both shoulder (p < 0.001) and peripheral (p = 0.001) joints. In addition, the severity of anterior atlantoaxial subluxation and atlantoaxial impaction positively correlated with the grade of destruction in the evaluated joints. Furthermore, patients with atlantoaxial disorders presented decreased BMD of the femoral neck (p = 0.019). The occurrences of subaxial subluxations (SAS) and subaxial disc space narrowings only associated with higher onset age of RA. CONCLUSIONS: Patients with severe RA and osteoporosis have an increased risk for atlantoaxial disorders. The co-existence of shoulder destruction and cervical spine disorders makes the differential diagnosis of shoulder and neck pain challenging.
UNLABELLED: The joint capsules and the glenohumeral ligaments of 12 human shoulder specimens were histologically investigated by light microscopy. Serial sections of 15 microns thickness were cut. The tissue was stained following the haematoxylin-eosin and van Giesson techniques. For specific identification of neural elements we made use of a special silver impregnation technique, described by Novotny, for staining axons in peripheral nerves. Axons of different diameters ranging from 0.2 microns to 70 microns were discovered within the ligaments. Close to the humeral site we found small nerves forming neurovascular bundles. Within their connective tissue sheaths, the axons exhibited a serpentine configuration, which may give extra length and may allow stretching of the nerve during motion. Most of the axons discovered were located in the subsynovial layer of the ligaments. In general the diameter of these subsynovial axons did not exceed 10 microns. In addition to these axonal structures, we detected nerve endings which can be classified according to Freeman and Wyke as type II mechanoreceptors (Pacinian corpuscles). These mechanoreceptors had a diameter of approximately 150 microns. They were also positioned directly beneath the synovial membrane and close to the humeral site of insertion of the ligaments. CLINICAL SIGNIFICANCE: The described neural structures in the glenohumeral ligaments are of particular clinical importance in the light of the high incidence of recurrent shoulder dislocation and concomitant Bankart lesions. The mechanoreceptors located in the glenohumeral ligaments may control the stabilising shoulder musculature. On this premise, rupture or detachment of these ligaments will lead to a loss of a feedback mechanism.
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Purpose of this study was the evaluation of distribution and morphology of mechanoreceptors in the glenohumeral joint capsule and rotator cuff in comparison to the coracoacromial ligament by means of specific immunfluorescence microscopy. The complemente joint capsules, rotator cuffs and coracoacromial ligaments of three fresh cadaver shoulder were harvesed. Serial cryostate sections were taken and alternately incubated with antiserum against neurofilament, lamin or myelin of peripheral nerves. The antibody-reaction was visualized with fluorescin lg-G. The nerve endings were photographed and computer-aided 3-dimensional reconstructions were performed. Three types of corpuscular and free nerve endings of different morphology were found in different distributions: whereas the Ruffini corpuscles were much more frequent in the coracoacromial ligament and rotator cuff, Pacini endings were predominantly found in the joint capsule. Generally corpuscular nerve endings were more frequent in the coracoacromial ligament and the rotator cuff than in the antero-inferior capsule and the number of corpuscles increased from medial to lateral within the anterior and inferior parts of the capsule. The dense ligamentous tissue was almost aneural whereas the periarticular fatty or loose connective tissue contained nerve fibres and nerve endings. In view of the results of other experimental and clinical studies the high frequency of Ruffini and Pacini endings in the rotator cuff and coracoacromial ligament suggest, that both are involved in the neurosensory control of glenohumeral stability and subacromial impingement. In contrast our findings in the joint capsule do not clearly prove, that those joint receptors predominantly maintain joint stability.
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