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Flexibility of the shoulder joint measured as range of abduction in a large representative sample of men and women over 65 years of age.

In a representative survey of 1000 elderly men and women aged over 65 years living in their own homes, assessments have been made of flexibility measured as range of shoulder abduction in addition to health status, psychological well-being and reported customary activity. The results for shoulder abduction were approximately normally distributed and the mean values (+/- 1 standard deviation) were as follows: - in men aged 65-74 years, 129 (+/- 14) degrees and aged over 74 years, 121 (+/- 19) degrees; in women aged 65-74 years, 124 (+/- 19) degrees and aged over 74 years, 114 (+/- 22) degrees. These mean values are about 30 degrees less than those accepted for younger subjects. Nearly half the distribution falls below the accepted threshold level of 120 degrees for adequate function. There were significant effects of sex and age (P less than 0.001); women had poorer flexibility and the reduction with age amounted to 10 degrees per decade. Multiple regression analysis showed that the effect of age was accounted for in part by health, strength and customary use. The effects of use were most marked in those with some disability. This suggests that maintained or increased use could offset some of the age-related loss of the range of shoulder movement.

Aged↗

Assessment of the superior labrum of the shoulder joint with CT-arthrography and MR-arthrography: correlation with anatomical dissection.

The ability to detect and categorize SLAP (Superior Labrum Anterior to Posterior) lesions of the scapular labrum is of practical importance to the orthopedic surgeon and the radiologist. The aim of this study, performed on cadaveric shoulders, was to determine whether CT arthrography or MR arthrography is able to show normal anatomical variation of the glenoid labrum and detect labral abnormalities. CT arthrography, MR arthrography followed by anatomical dissection were performed on twenty three fresh frozen cadaveric shoulders and analysed by a radiologist and two orthopaedic surgeons. As Gadolinium intra-articular injection is not allowed in France, we used an iodinated contrast media for both MR arthrography and CT arthrography. In this study, the sensitivity of MR arthrography seemed higher than CT arthrography (respectively 4 and 3 labral lesions diagnosed out of five), although no significant statistical conclusions can be made due to the small number of cases. In conclusion, under such specific conditions, MR arthrography seems to be the method of choice for the detection and classification of labral lesions.

Aged↗

Periarticular neural elements in the shoulder joint.

Due to its unconstrained nature, the glenohumeral joint must necessarily have several mechanisms to regulate its position in space. The neural mechanisms associated with this positioning have not been fully evaluated anatomically. In this study, three fresh-frozen human cadaveric adult shoulders were dissected. Specimens were excised from the proximal biceps insertion, the superior, middle, and inferior glenohumeral ligaments, and the capsule superior to the glenohumeral ligaments. In two specimens, a portion of glenoid labrum was analyzed using a modified gold chloride staining method and light microscopy. A portion of mid-biceps tendon was used as a control. In the superior glenohumeral ligament, 45% of sections contained neural elements consisting of Golgi's, Ruffini's, and Pacini's corpuscles as well as free nerve endings. The predominant types were Ruffini's and Golgi's. The middle glenohumeral ligament sections revealed all four receptor types in 42%, with the most common elements being Pacini's and Ruffini's receptors. The inferior glenohumeral ligament specimens contained the four receptor types in 48% of sections, with Ruffini's, Pacini's, and Golgi's types equally distributed. The shoulder capsule specimens revealed Ruffini's and Pacini's receptors in 47.5% of sections. Only free nerve endings were identified in the biceps tendon and glenoid labral tissue. These findings suggest that the pattern of neural elements does not appear to be random in nature and may have some correlation with the specific functions of some of the glenohumeral ligaments.

Adult↗

Outcomes of acute arthroscopic repair and conservative treatment following first traumatic dislocation of the shoulder joint in young patients.

INTRODUCTION: The aim of this study was to compare patients who had arthroscopic repair done following the first traumatic dislocation with patients who were treated conservatively, in terms of stability and function. MATERIALS AND METHODS: Acute arthroscopic Bankart repair with absorbable tack was used in 30 shoulders after the first dislocation, while 32 patients who sustained traumatic anterior dislocation were treated conservatively at Gülhane Military Medical Academy, Department of Orthopaedics and Traumatology between March 1997 and April 2001. Preoperative and postoperative range of motion of the shoulder and Constant score of all patients were recorded. RESULTS: In the conservative group, the average pretreatment Constant score was 46.8 (range, 30 to 70) and the average post-treatment Constant score was 71.4 (range, 30 to 95). In the surgical group, the average preoperative Constant score in cases with Bankart lesion was 44.7 (range, 30 to 60) and the average postoperative Constant score was 92.3 (range, 65 to 100), (P = 0.0001). CONCLUSION: Our results support the use of acute arthroscopic repair of traumatic anterior shoulder dislocations with absorbable tacks. Arthroscopic repair is the treatment of choice in young and active patients who are having their first traumatic dislocation.

Adolescent↗

MR and MR arthrography to identify degenerative and posttraumatic diseases in the shoulder joint.

MR imaging provides a comprehensive evaluation of a wide spectrum of both intraarticular and extraarticular pathology of the shoulder. MR imaging enables the detection or exclusion of degenerative and posttraumatic diseases of the shoulder with a reasonable accuracy. MR arthrography is useful in the visualization of subtle anatomic details and further improves the differentiation. In this article, findings of MR imaging and MR arthrography of degenerative and posttraumatic shoulder diseases (impingement syndrome, rotator cuff tears, and glenohumeral instability) has been reviewed.

Humans↗

Effects of the glenoid labrum and glenohumeral abduction on stability of the shoulder joint through concavity-compression : an in vitro study.

BACKGROUND: Although the glenohumeral joint is the most mobile articulation of the human body, it is known to exhibit ball-and-socket kinematics. Compression into the glenoid labral concavity keeps the humeral head centered. The purpose of the present study was to determine the effects of joint position on glenohumeral stability through concavity-compression. METHODS: Ten cadaveric shoulders were tested. The glenoid was mounted horizontally onto a six-component load-cell while the humerus was clamped to a vertically unconstrained slide. An x-y stage translated the load-cell with the glenoid underneath the humeral head in eight different directions. Compressive loads of 20, 40, and 60 N were applied. The tests were repeated in 0 degrees, 30 degrees, 60 degrees, and 90 degrees of glenohumeral abduction with and without the labrum. Relative translations between the glenoid and the humeral head and the forces resisting translation were recorded. Then the stability ratio, defined as the peak translational force divided by the applied compressive force, was calculated. RESULTS: The average stability ratio was higher in the hanging-arm position than it was in glenohumeral abduction. The highest stability ratio was detected in the inferior direction (59.8% 7.7%) when the labrum was intact and in the superior direction (53.3% 7.9%) when the labrum had been resected. Under both conditions, the anterior direction was associated with the lowest stability ratio (32.0% 4.4% with the labrum and 30.4% 4.1% without the labrum). Resection of the glenoid labrum resulted in an average decrease in the stability ratio of 9.6% 1.7%. With increasing compressive load, the average stability ratio slightly decreased. CONCLUSIONS: Glenohumeral stability through concavity-compression was greater in the hanging-arm position than it was in glenohumeral abduction. The average contribution of the labrum to glenohumeral stability through concavity-compression was approximately 10%, about one-half of the value previously reported. With the labrum intact, the glenohumeral joint was most stable in the inferior direction. Without the labrum, it was most stable in the superior direction. Under both conditions, it was least stable in the anterior direction. Glenohumeral joint stability through concavity-compression decreases with higher compressive loads.

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