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At least 559 records · Page 31Linked to original sources
PubMed2003

Shoulder arthroplasty for the treatment of postinfectious glenohumeral arthritis.

BACKGROUND: Currently, no studies on shoulder arthroplasty after a previous infection of the shoulder have been published, as far as we know. The purpose of this study was to evaluate the rates of reinfection and the clinical results after shoulder arthroplasty for the treatment of postinfectious glenohumeral arthritis. METHODS: Between 1975 and 2000, thirteen patients with a history of infection of the shoulder that resulted in severe glenohumeral arthritis underwent shoulder arthroplasty. One patient who had been followed for less than two years was excluded. Therefore, twelve shoulders that had been followed for a minimum of two years (mean, 9.7 years) or until the time of revision surgery were included in the study. Complications, clinical results (pain, satisfaction, and range of motion), and radiographic results were documented at the time of the latest follow-up. RESULTS: No patient in this study had had a known reinfection at the time of the latest follow-up. Overall pain scores improved from 4.8 to 2.5 points after implantation of a prosthesis. Eight of the twelve patients had no pain or mild or moderate pain only after vigorous activity. The mean shoulder abduction improved from 75 degrees to 117 degrees, and the mean external rotation improved from 13 degrees to 36 degrees. Subjectively, only six of the twelve patients rated the result as much better or better. The results in the eight patients who underwent a full rehabilitation program were better than those in the four patients who underwent a limited-goals rehabilitation program. CONCLUSION: Shoulder arthroplasty for the treatment of the sequelae of an infected shoulder can be performed with a low risk of reinfection. While overall pain and motion can be expected to improve, unsatisfactory clinical results that are related to the destructive effects of the initial infection are not uncommon.

Adult↗
PubMed2004

Copeland surface replacement arthroplasty of the shoulder in rheumatoid arthritis.

BACKGROUND: Shoulder arthroplasty with a stemmed prosthesis is a recognized treatment for rheumatoid arthritis of the shoulder. The humeral component of the Copeland cementless surface replacement arthroplasty consists of a cup for surface replacement with a short central peg for primary fixation to the bone. We hypothesized that surface replacement may offer some advantages over stemmed prostheses. METHODS: Between 1986 and 1998, seventy-five shoulders underwent surface replacement arthroplasty (thirty-three hemiarthroplasties and forty-two total shoulder arthroplasties) for the treatment of rheumatoid arthritis. The results of these procedures were reviewed after an average duration of follow-up of 6.5 years. Patients were assessed with use of the Constant score, a patient satisfaction score, and radiographs. RESULTS: The average Constant score was 47.9 points (age and sex-adjusted score, 71%) in the hemiarthroplasty group and 53.4 points (age and sex-adjusted score, 76%) in the total shoulder replacement group. The mean range of active flexion improved from 50 degrees in the hemiarthroplasty group and 47 degrees in the total shoulder replacement group to 101 degrees and 104 degrees, respectively. Seventy-two of the seventy-five shoulders were considered by the patients to be much better or better at the time of the review. Of the sixty-eight humeral implants that were evaluated radiographically, fifty-six (82%) showed no lucencies, eleven (16%) showed localized lucencies of <1 mm in width, and one was definitely loose. Of the thirty-nine glenoid implants that were evaluated radiographically, nineteen (49%) showed no lucencies, nineteen showed localized lucencies of <1 mm, and one was definitely loose. No lucencies were observed adjacent to the hydroxyapatite-coated implants. Thirty-nine (57%) of the sixty-eight shoulders showed some degree of superior subluxation. Three patients required a major reoperation: two required a revision because of loosening of both components, and one patient with pain at the site of a hemiarthroplasty had a revision to a total shoulder arthroplasty to provide relief. CONCLUSIONS: The indications for this surface replacement are the same as those for the conventional stemmed prostheses, but the surface replacement has the advantage of bone preservation as well as avoidance of the potential complications associated with a long humeral stem in rheumatoid bone. This procedure is not suitable for severely damaged joints in which the humeral head is insufficient or too soft. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Activities of Daily Living↗
PubMed2004

Posterior shoulder dislocation in infants with neonatal brachial plexus palsy.

BACKGROUND: Glenoid dysplasia and posterior shoulder subluxation with resultant shoulder stiffness is a well-recognized complication in infants with neonatal brachial plexus palsy. It is generally considered to be the result of a slowly progressive glenohumeral deformation secondary to muscle imbalance, physeal trauma, or both. Recent publications about infantile posterior shoulder dislocation have suggested that the onset of dysplasia occurs at an earlier age than has been previously recognized. The prevalence of early dislocation in infants with this disorder has not been previously reported, to our knowledge. METHODS: We studied 134 consecutive infants with neonatal brachial plexus palsy who were seen at our institution over a period of two years. All infants were examined at monthly intervals to assess neurological recovery and the status of the upper extremity until recovery occurred or a treatment plan was established. The type of brachial plexus involvement was classified. Specific clinical signs associated with subluxation and dislocation were recorded. These included asymmetry of skin folds of the axilla or the proximal aspect of the arm, apparent shortening of the humeral segment, a palpable asymmetric fullness in the posterior region of the shoulder, or a palpable click during shoulder manipulation. The infants who were identified as having these clinical signs were evaluated with ultrasonographic imaging studies. RESULTS: Eleven (8%) of the 134 infants had a posterior shoulder dislocation. The mean age at the time of diagnosis was six months (range, three to ten months). There was no correlation between the occurrence of dislocation and the type of initial neurological deficit. A rapid loss of passive external rotation between monthly examinations indicated a posterior shoulder dislocation. CONCLUSIONS: Posterior shoulder dislocation can occur earlier (before the age of one year) and more rapidly in infants with neonatal brachial plexus palsy than has been appreciated previously. As with developmental dysplasia of the hip, a high index of suspicion, recognition of clinical signs, and the use of ultrasonography will allow the diagnosis to be established. Following early diagnosis, attention should be focused on improving the stability and congruency of the shoulder joint.

Brachial Plexus Neuropathies↗
PubMed2004

Preoperative factors associated with improvements in shoulder function after humeral hemiarthroplasty.

BACKGROUND: The relationship between the characteristics of the shoulder that can be determined before humeral hemiarthroplasty and the functional improvement after surgery is not known. The goal of this study was to test the hypothesis that the functional outcome of this procedure correlated significantly with factors that are identifiable preoperatively. METHODS: The study group included seventy-one shoulders in sixty-eight patients undergoing hemiarthroplasty, performed by the same surgeon, for diagnoses other than acute fracture. The mean age of the patients was sixty-one years (range, thirty to eighty-three years). The results were characterized in terms of the change in self-assessed shoulder function and general health status at an average of forty-nine months (range, twenty-four to 142 months) after surgery. RESULTS: The preoperative absence of erosion of the glenoid was associated with greater improvement in shoulder function and level of comfort after hemiarthroplasty (p < 0.001). Shoulders that had not had previous surgery had greater functional improvement than did those that had previous surgery (p = 0.012). Shoulders with an intact rotator cuff showed significantly (p < 0.5) greater improvement in the ability to lift weight above shoulder level after hemiarthroplasty (p <0.5). With regard to diagnoses, shoulders with rheumatoid arthritis, capsulorrhaphy arthropathy, and cuff tear arthropathy had the least functional improvement, whereas those with osteonecrosis (p = 0.0004) and with primary (p = 0.02) and secondary degenerative joint disease (p = 0.03) had the greatest improvement. Patient age and gender did not significantly affect the outcome. CONCLUSIONS: These results suggest that the functional improvement following humeral hemiarthroplasty is related to factors that are identifiable before surgery. These data may be of benefit in preoperative discussions with patients who have a shoulder disorder and are considering treatment with hemiarthroplasty.

Adult↗
PubMed2006

Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years.

BACKGROUND: Reverse total shoulder arthroplasty is currently being used to treat selected patients with disabling shoulder arthropathy. The purposes of this study were to investigate the medium-term results of reverse total shoulder arthroplasty and to analyze the influence of etiology on the result. METHODS: We carried out a multicenter study with a minimum follow-up of five years and determined the survival rate of the prosthesis according to the initial etiology of the shoulder arthropathy. Eighty prostheses were implanted in seventy-seven patients between 1992 and 1998. Sixty-six shoulders had an arthropathy with a massive rotator cuff tear, and fourteen shoulders had a disorder with another etiology (rheumatoid arthritis, trauma, or revision arthropathy). At the time of review, eighteen patients had died and two were lost to follow-up. The remaining fifty-seven patients (sixty shoulders) were examined or interviewed by telephone at a mean follow-up of 69.6 months. Cumulative survival curves were generated with replacement of the prosthesis, glenoid loosening, and a functional Constant score of <30 as the end points. RESULTS: The survival rate with replacement of the prosthesis and glenoid loosening as the end points were 91% and 84%, respectively, at 120 months, with shoulders that had arthropathy with a massive rotator cuff tear demonstrating a significantly better result than those that had a disorder with another etiology (p < 0.05). On the other hand, the survival rate with an absolute Constant score of <30 as an end point was 58% at 120 months, with no significant difference with respect to etiology. Two breaks were observed in the survival curves. The first concerned survival until replacement of the prosthesis and occurred at around three years, reflecting early loosening of the prosthesis. The curve then became stable. A second break started at around six years and reflected progressive deterioration of the functional result. CONCLUSIONS: Our findings indicate that the reverse total prosthesis should be reserved for the treatment of very disabling shoulder arthropathy with a massive rotator cuff rupture, and it should be used exclusively in patients over seventy years old with low functional demands.

Aged↗
PubMed2005

Diffuse FDG shoulder uptake on PET is associated with clinical findings of osteoarthritis.

OBJECTIVE: Our objective was to examine the degree and pattern of (18)F-FDG uptake within the shoulder as a potential marker of joint inflammation or injury. SUBJECTS AND METHODS: Twenty-four patients undergoing (18)F-FDG PET for clinical oncologic assessment completed questionnaires regarding history of shoulder disease, trauma, pain, and/or functional impairment. Thorough physical examination of the shoulder was performed. A clinical diagnosis of specific shoulder derangement or normal was established for each patient. PET scans were evaluated blindly by a nuclear medicine physician and a musculoskeletal radiologist qualitatively for location, distribution, and intensity of shoulder uptake. Standardized uptake values (SUV) were measured. RESULTS: Twenty-one patients had shoulder PET findings. Fourteen had clinical findings consistent with a specific diagnosis in the PET-positive shoulder. The remaining seven PET-positive patients were clinically normal. Three recognizable patterns of uptake were appreciable. Eight of 10 patients with diffuse uptake had findings of osteoarthritis (n = 7) or bursitis (n = 1). Two of four patients with focal greater tuberosity uptake had findings of rotator cuff injury. Two of four patients with focal glenoid uptake had findings of frozen shoulder. SUV showed a positive correlation with subject age (p < 0.01), but no association with clinical findings was identified. CONCLUSION: The pattern of FDG uptake within the shoulder may point to specific clinical entities. While focal uptake is less reliably related to clinical findings, diffuse uptake is associated with signs and symptoms of osteoarthritis or bursitis.

Adult↗
PubMed1999

Dependence of deltoid muscle activity upon initial angles of shoulder abduction prior to flexion.

The present study was undertaken to investigate the hypothesis that the direction and selectivity of an appropriately modified version of shoulder flexion is dependent upon initial angles of shoulder abduction. Analysis indicated that initial small angles of shoulder abduction were associated with longer electromyographic (EMG) durations of the agonist (anterior deltoid) muscle. Moreover, as initial angles became smaller, EMG onsets of the antagonist (posterior deltoid muscle) occurred nearer to those of the agonist. Modulations of duration of the agonist EMG activity can be explained by changes in amplitude of movement. Two possible interpretations of the changes of EMG onset of the antagonist in accordance with different initial angles of shoulder abduction are considered. One concerns the effect of the change on the load of the upper limb, dependent on different angles of shoulder abduction. The second concerns the changing role of the antagonist to a synergist, dependent upon decreased initial angles of shoulder abduction prior to the shoulder flexion. Based on the present findings, it is suggested that angles of shoulder abduction are an important determinant of agonist-antagonist muscle activity of the deltoid during flexion of the shoulder.

Adult↗
PubMed1993

Postsurgical shoulder strength in the older patient.

Following surgery, a goal of rehabilitation is to return the surgical extremity to its original strength. However, for the older rotator cuff repair patient, we are unsure if this is a realistic goal. The purpose of this study was to determine the quality of shoulder strength in older males who had undergone rotator cuff repair and acromioplasty surgery and to determine if test position and test velocity effects for rotation at the shoulder existed. Nine patients (mean age = 60.8 years) were tested bilaterally on the Cybex II isokinetic dynamometer for two movements (internal/external rotation), two velocities (60 degrees/sec, 120 degrees/sec), and two positions (neutral, 90 degrees abduction) to determine the peak torques for the shoulders. Following a three-way analysis of variance (ANOVA) with repeated measures, results indicated that the surgical shoulder had torque values approximating the nonsurgical shoulder and that test position had no significant effect on the internal or external rotation torques produced. As seen with nonshoulder-impaired younger subjects, peak torque decreased with increased test velocities. It was concluded that the older rotator cuff repair patient may be expected to attain a level of strength in the surgical shoulder similar to or exceeding the nonsurgical shoulder and that either test position recommended by Cybex for testing of the shoulder rotators was acceptable. Clinically, a full functional recovery similar to the nonsurgical shoulder should be expected in the older patient with postsurgical rotator cuff repair and acromioplasty.

Acromion↗
PubMed1995

Shoulder kinesthesia in healthy unilateral athletes participating in upper extremity sports.

Shoulder kinesthesia has not been extensively studied in upper extremity athletes. The purpose of this study was to determine if there were differences in threshold to detection of passive motion between dominant and nondominant shoulders of healthy overhead athletes in two positions, 0 degrees and 75 degrees of external rotation. In addition, the study attempted to determine if there was a relationship between the range of external rotation (ER) and internal rotation (IR) and the threshold to detection of passive motion values. Shoulder kinesthesia was assessed in the dominant and nondominant shoulders of 20 collegiate athletes participating in unilateral upper extremity sports. A proprioceptive testing device passively moved the shoulder into internal and external rotation. The dominant shoulder had a significantly greater difficulty detecting motion compared with the nondominant arm at both 0 degrees and 75 degrees of external rotation. Both shoulders exhibited enhanced kinesthesia (lower threshold to detection of passive motion scores) at 75 degrees of external rotation compared with 0 degrees, where the glenohumeral joint capsule is relatively taut. The results of this study suggest that healthy upper extremity athletes may have kinesthetic deficits in their throwing shoulder compared with their nondominant shoulder.

Adolescent↗
PubMed2002

A study of antagonist/agonist isokinetic work ratios of shoulder rotators in men who play badminton.

STUDY DESIGN: Normative descriptive study. OBJECTIVES: Exploring the isokinetic work ratios of eccentric antagonist/concentric agonist shoulder rotators in the late cocking and deceleration phases of a forehand overhead smash in badminton players. Comparing the work ratios between dominant and nondominant shoulders. BACKGROUND: The strength of shoulder muscles for badminton players has been studied but there is little information on the work output of these muscles for a specific range of movement. METHODS AND MEASURES: Twenty-five skilled men who play badminton at club level with a mean age of 29.4 years (SD = 6.1) were measured for concentric and eccentric isokinetic work (joules) of shoulder internal (IR) and external (ER) rotators on both upper extremities at 120 degrees/s. Bilateral isokinetic work ratios for eccentric IR/concentric ER between 60 degrees and 90 degrees of shoulder external rotation were calculated to denote strength profile in the late cocking phase of the badminton smash. Work ratios for eccentric ER/concentric IR between 10 degrees external rotation and 30 degrees internal rotation were calculated to denote strength profile in the deceleration phase of the badminton smash. The respective work ratios were compared between both shoulders. RESULT: The eccentric IR/concentric ER work ratios in late cocking were 1.9:1 and 1.3:1 (P = 0.001) for the dominant and nondominant shoulders, respectively. The eccentric ER/concentric IR work ratios in the deceleration phase were 1.1:1 and 1.3:1 (P = 0.003) for the dominant and nondominant shoulders, respectively. CONCLUSION: The work ratios of eccentric antagonist/concentric agonist are different between dominant and nondominant shoulders of skilled badminton players. Rehabilitation for injuries of these athletes should aim at developing the optimal antagonist/agonist work ratios to return them to this sport.

Adult↗
PubMed2003

Shoulder musculature activation during upper extremity weight-bearing exercise.

STUDY DESIGN: Repeated-measures design comparing 7 static weight-bearing shoulder exercises. OBJECTIVE: The purpose of this study was to determine the demand on shoulder musculature during weight-bearing exercises and the relationship between increasing weight-bearing posture and shoulder muscle activation. BACKGROUND: Weight-bearing shoulder exercises are commonly prescribed in the rehabilitation of shoulder injuries. Limited information is available as to the demands placed on shoulder musculature while these exercises are performed. METHODS: Eighteen healthy college students volunteered for this study. Surface bipolar electrodes were applied over the infraspinatus, posterior deltoid, anterior deltoid, and pectoralis major muscles. Fine-wire bipolar intramuscular electrodes were inserted into the supraspinatus muscle. Electromyographic (EMG) root mean square signal intensity was normalized to 1 second of EMG obtained with a maximal voluntary isometric contraction (MVIC). Subjects were tested under 7 isometric exercise positions that progressively increased upper extremity weight-bearing posture. RESULTS: There was a high correlation between increasing weight-bearing posture and muscular activity (r = 0.97, P < 0.01). There was relatively little demand on the shoulder musculature for the prayer and quadruped positions (2%-10% MVIC). Muscular activation was greater for the infraspinatus than for other shoulder muscles throughout most of the exercise positions tested. CONCLUSION: These results indicate that alterations of weight-bearing exercises, by varying the amount of arm support and force, resulted in very different demands on the shoulder musculature. Specifically, the infraspinatus was particularly active during the weight-bearing exercises used in this study.

Adult↗
PubMed1986

Shoulder surgery in rheumatoid arthritis.

Surgery was performed on 43 shoulders in 38 rheumatic patients with disabling pain. Fifteen of 22 synovectomized shoulders were available for examination an average of 2 years postoperatively. Twelve patients were satisfied with their operations and had painfree shoulders. Nine shoulders had almost normal mobility but four patients with an advanced shoulder arthropathy had gained little motion. Two patients with severe pain had been re-operated on with arthroplasty. In 15 patients with 18 shoulder replacements, the postoperative gain in motion was limited in all shoulders. Seven out of eleven shoulders had significant pain after hemi-arthroplasty, whereas five out of seven shoulders were painfree after total replacement. It seems that synovectomy can give results which are comparable with total arthroplasty if applied in early stages of rheumatoid disease.

Arthritis, Rheumatoid↗
PubMed1999

[Prognostic factors during rehabilitation after shoulder prostheses for fracture].

PURPOSE: To evaluate the role, the difficulties of rehabilitation and to diagnose the eventual surgical complications after shoulder prosthesis for 4-part fractures. MATERIAL AND METHODS: Forty three patients (46 shoulders) who underwent shoulder arthroplasty after fracture of the proximal humerus underwent rehabilitation and follow-up at a special reeducation center for an average of 3 months (1 to 6). There were 42 four-part fractures (with 22 fracture-dislocation) and 4 three-part fractures. The patients were send by five different hospitals and have all been operated by senior surgeons. Three types of implants were used: the Modular Shoulder prosthesis (27 cases), the Global prosthesis (2 cases), and the Aequalis prosthesis (17 cases). The rehabilitation followed the protocol recommended by Neer (recovery of passive joint movements, muscular strengthening and stretching) to which were added hydrotherapy, physiotherapy and occupational therapy. Forty patients (43 épaules) were reviewed and radiographed with an average follow-up of 29 months (18 to 72 months). RESULTS: The functional results were disappointing with a normalised Constant score of only 60.2 per cent and an average active elevation of only 96 degrees. There appeared to be two factors which explained these poor results. Firstly, the advanced age of the population (52 per cent older than 70) who was often poorly or non-motivated (22 per cent) and debilitated (21 per cent chronic alcoholics) and who had significant medical and neuro-psychiatric histories. Secondly, incompletely resolved anatomical and surgical problems: damage to the circumflex nerve (6.5 per cent), early migration of the greater tuberosity (6.5 per cent), secondary migration with malunion (15 per cent) and/or nonunion (11 per cent) of the greater tuberosity. Migration of the greater tuberosity should be suspected clinically in three circumstances: 1) in patients who have an abnormally painful shoulder in the immediate post-operative period (16 cases in our series); 2) when there is no progression (24 per cent) or regression (9 per cent) of active shoulder mobility after three months of correct supervised rehabilitation; 3) later, if there is a dissociation between active anterior elevation (deficient) and passive anterior elevation (preserved). DISCUSSION AND CONCLUSION: The age and poor general condition of the patients as well as the difficulty of the surgical technique more than the rehabilitation, explain the disappointing results observed after shoulder prosthesis for four-part fractures. The discrepancy between active and passive elevation suggests that limited motion is not caused by a stiff shoulder because of glenohumeral scarring but instead by weakness of the deltoid (because of axillary lesion) and/or of the external rotators (because of greater tuberosity migration). There is some discordance between the necessity to early mobilise the shoulder and the high rate of tuberosity migration.

Adult↗
PubMed2001

Shoulder range of motion characteristics in collegiate baseball players.

BACKGROUND: To determine range of motion and capsular characteristics of dominant and nondominant shoulders in baseball players. Our hypothesis was that there is a significant difference between dominant and nondominant range of motion in collegiate baseball players with unoperated and without shoulder pain. METHODS DESIGN: prospective, range of motion measurements during regular season. SETTING: two collegiate baseball teams in Houston. PARTICIPANTS: 15 pitchers and 23 position players. MAIN OUTCOME MEASURES: shoulder range of motion was evaluated by goniometric technique in all baseball players. Horizontal adduction (cross body reach test) and active internal rotation (reach behind back) in standing position and external rotation and internal rotation in supine lying position were measured for each player. RESULTS: Average external rotation with the arm in 90 degrees of abduction was significantly greater and average internal rotation was less in the dominant shoulder than in the nondominant shoulders, both in pitchers and position players. There was no statistical difference in shoulder horizontal adduction. Both dominant and nondominant shoulders of pitchers had greater average range of motion in horizontal adduction and external rotation at 90 degrees of abduction and less average internal rotation than those of position players. Although there was a significant difference in active internal rotation as cm between dominant and nondominant shoulders both in both groups, no difference was found between pitchers and position players. CONCLUSIONS: Differences in the range of motion in the throwing shoulder of baseball players exist involved in overhead throwing motions and should be considered in rehabilitation of the upper extremity after injury and in the prevention of injury for pitchers and position players.

Adolescent↗
PubMed2001

Association of occupational physical demands and psychosocial working environment with disabling shoulder pain.

OBJECTIVE: To estimate the individual and combined associations of physical and psychosocial working environment with disabling shoulder pain and to identify groups at "high risk" for shoulder pain. METHODS: A cross sectional survey was conducted at five manual occupational settings in south Manchester, United Kingdom (n=775, 83%). RESULTS: Both the duration of occupational physical demands (working postures, manual handling activities, and repetitive arm movements) and psychosocial working environment (psychological demands and lack of opportunity to learn new skills) were found to be significantly associated with shoulder pain. Three occupational factors identified a high risk group for shoulder pain: duration of lifting with one hand (prevalence rate ratio (PRR) (highest third) 2.0, 95% confidence interval (CI) 1.4 to 2.8), duration of working above shoulder level (PRR (highest third) 2.2, 95% CI 1.5 to 3.3), and whether employees found their work stressful (PRR (highest third) 1.4, 95% CI 1.0 to 2.1). In addition, a measure of psychological distress (General Health Questionnaire (GHQ) score) was found to identify a group at high risk for shoulder pain (PRR (highest third) 1.9, 95% CI 1.3 to 2.9). In employees exposed to three or more of these factors, 79% (23/29) reported shoulder pain compared with only 16% (56/353) of those not exposed to any. CONCLUSION: This study has identified a variety of occupational physical demands and psychosocial factors associated with shoulder pain. It has also identified groups of employees at a "high risk" for shoulder pain by their exposure to both physical and psychosocial factors.

Adolescent↗
PubMed2002

Fetal shoulder dystocia.

Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%. An increase in the incidence of shoulder dystocia has been recorded over the last 20 years, probably just because it has now been regularly registered at maternity wards as an obstetric complication. The risk factors for shoulder dystocia include fetal macrosomia, fetal malformations and tumors, maternal adiposity, excessive weight gain during pregnancy, diabetes mellitus, pathologic pelvis, multiparity, short maternal stature, advanced maternal age, postterm pregnancy, so-called midforceps delivery or vacuum extraction, prolonged delivery stage II, oxytocin labor induction, premature fetal expression according to Kristeller, and previous shoulder dystocia in macrosomatic children. The sequels of shoulder dystocia and obstetric maneuvers for incarcerated shoulder release include clavicular fracture, brachial plexus lesions, sternocleidomastoid muscle distension with or without hematoma, diaphragmatic paralysis, Horner's syndrome, peripartal asphyxia and consequential cerebral lesions (cerebral palsy), and peripartal death. Maternal complications due to shoulder dystocia are postpartal hemorrhage, cervical and vaginal lacerations, frequent infections during the puerperium, symphysiolysis and rupture of the uterus, and secondary cesarean section with related complications due to unsuccessful obstetric procedures or as continuation of Zavanelli's maneuver. McRoberts' maneuver (or Gaskin maneuver) is recommended as the initial procedure for shoulder release in case of shoulder dystocia. If it fails, other obstetric procedures such as Resnik's suprapubic pressure and Woods' grip with posteriorly placed arm release should be used, always with gross lateral episiotomy. The performance of all these obstetric procedures requires skilfull and highly experienced obstetrician and obstetric team as a whole.

Delivery, Obstetric↗
PubMed2004

Incidence of shoulder pain in repetitive work.

AIMS: To determine the predictiveness of personal and occupational factors for the onset of shoulder pain in occupations requiring repetitive work. METHODS: A sample of 598 workers in five activity sectors completed a self administered questionnaire in 1993-94 and again three years later. Both questionnaires included questions about shoulder pain. The associations between various factors at baseline and subsequent shoulder pain were studied among subjects free from shoulder pain at baseline. RESULTS: The incidence of shoulder pain was associated with several independent risk factors: depressive symptoms, low level of job control, and biomechanical constraints. After adjustment for other risk factors, the presence of depressive symptoms predicted occurrence of shoulder pain. A low level of job control was also associated with the onset of shoulder pain in both sexes. For men, repetitive use of a tool was a strong predictor, while the two most important biomechanical risk factors for women were use of vibrating tools and working with arms above shoulder level. CONCLUSION: This study used a longitudinal approach to examine different sets of risk factors for shoulder pain simultaneously. The results confirm the role of several biomechanical constraints. Psychological symptoms and a low level of job control also play a role.

Adult↗
PubMed2004

[Shoulder dystocia--risk factors and fetal outcome].

The purpose of this retrospective study is to evaluate the perinatal outcome in cases with birth injuries, suggesting shoulder dystocia. This survey involves 92 cases of live newborns (gestational age between 37 and 42 weeks) with shoulder injuries. Another control group of 120 cases of live mature newborns without any shoulder injuries is studied for comparison. There are no significant differentialities between those two groups, regarding age, parity, weight and height of the parturients. Shoulder dystocia is most frequently found in newborns of 3500-4000 g birthweight. Antepartum, risk factors for shoulder dystocia are: diabetes, obesity of the mother and chronological postterm pregnancy. Intrapartum, the evaluated risk factors prove to be unreliable because the same were found in as many as one half of the non-traumatic vaginal deliveries. In 27% of the cases, shoulder dystocia occurs most probably after the passage of the shoulder through the pelvic inlet. The most frequent type of shoulder injury is fracture of the clavicle (90.2%), followed by paresis of the brachial plexus (7.6%). Severe shoulder dystocia both from obstetrical and neonatological point of view is found in 2-3% of the cases.

Adult↗