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PubMed1994

Shoulder proprioception. Effect of joint laxity, joint position, and direction of motion.

Recently, considerable importance has been ascribed to that portion of shoulder stability which may be provided by active muscle forces. Joint proprioception likely has a considerable role in muscular stabilization of the shoulder by providing information to the central nervous system for the management of muscular activity. Normal human shoulder proprioception has not yet been thoroughly characterized. We have measured shoulder joint proprioception in a population of subjects without known shoulder abnormalities by quantifying the subjects' ability to correctly detect passive shoulder rotation in the abducted shoulder. We have found absolute angular proprioception to range from an average "best" of 0.78 degrees to a "worst" of 1.08 degrees. Individuals who have clinically determined generalized joint laxity are significantly less sensitive in proprioception (P < .002). Detection of external rotation is significantly more sensitive than detection of internal rotation (P < .001). Detection of external rotation becomes significantly more sensitive as the limit of external rotation is approached. We have concluded that these findings suggest capsular tightening as one possible mechanism for shoulder proprioception.

Adult↗
PubMed1993

Grip strength: relationship to shoulder position in normal subjects.

The objective of this study was to evaluate the effect of shoulder position on grip strength. A Jamar dynamometer was used to measure the grip strength of 160 subjects (80 males and 80 females), stratified on both sex and age, in the four testing positions. For each of the tests of grip strength, the subject stood with the shoulder adducted and neutrally rotated while the forearm and wrist were held in the neutral position. The four hand strength tests consisted of three positions in which the elbow was maintained in full extension combined with varying degrees of shoulder flexion (i.e., 0 degree, 90 degrees, and 180 degrees) and of one position in which the elbow was flexed at 90 degrees with the shoulder in 0 degree of flexion. Only the dominant hand was tested. The results showed that the highest mean grip strength measurement was recorded when the shoulder was positioned at 180 degrees of flexion with elbow in full extension; whereas the position of 90 degrees elbow flexion with shoulder in 0 degree of flexion had the lowest grip strength score. In addition, the grip strength measured with the elbow in extension, regardless of shoulder position (i.e., 0 degree, 90 degrees, and 180 degrees of flexion), was significantly higher than when the elbow was flexed at 90 degrees with the shoulder positioned at 0 degree of flexion. Finally, grip strength differed significantly for both sexes and for each age group. The findings are valuable in the evaluation and rehabilitation training of hand injured patients.

Adult↗
PubMed1997

Prospective analysis of total shoulder arthroplasty biomechanics.

A prospective clinical trial was undertaken to evaluate preoperative and postoperative shoulder motion clinically and roentgenographically in 9 patients with severe arthritis who underwent a total shoulder arthroplasty. The relative contributions of glenohumeral and scapulothoracic motion to scapular plane abduction were determined by obtaining roentgenograms of the shoulder region with the arm in five positions before surgery and at follow-up. Before surgery, the ratio of glenohumeral to scapulothoracic motion was 0.32:0.68, or 1:2, compared with a normal ratio of 2:1, meaning that for every degree of glenohumeral movement there were 2 degrees of scapulothoracic motion. At follow-up, statistically significant improvements in pain, motion, and function were found. However, regression analysis determined the ratio of glenohumeral to scapulothoracic motion to be 1:1.3. An abnormal ratio before surgery was associated with significant pain and decreased motion in the shoulder and represented the patients' attempt to immobilize the glenohumeral joint for pain relief and maximize shoulder movement with scapulothoracic motion. The abnormal glenohumeral-to-scapulothoracic ratio after total shoulder arthroplasty indicates that for a given amount of arm abduction, less motion occurs between the prosthetic components than in a normal glenohumeral joint. Abnormal shoulder biomechanics appear to be a function of the underlying disease process and were not restored after total shoulder arthroplasty.

Adult↗
PubMed1998

[Shoulder complaints in family practice; a simple approach].

In two patients with shoulder complaints, a man aged 56 years and a woman aged 43, the function of the shoulder girdle (structures of the cervical spine, the upper thoracic spine and the upper ribs) played an important role. A simple classification of shoulder complaints is presented in which the influence of the shoulder girdle is recognized: (a) synovial disorder: complaints originating from the structures of the glenohumeral joint, the subacromial space, the acromioclavicular joint or combinations of these, (b) shoulder girdle disorder: the complaints are caused by functional problems in the structures of the shoulder girdle, (c) combination disorder: both a synovial disorder and a functional disorder of the structures of the shoulder girdle are causing the complaints, making it impossible to determine which structure is the primary cause. Considering the limited therapeutic choices (at first nonsteroidal antiinflammatory drugs, followed in case of persistent complaints by injections of analgesics and corticosteroids for synovial complaints, or manipulative therapy for shoulder girdle complaints), a more detailed classification is not needed to determine a successful therapeutic strategy.

Acromioclavicular Joint↗
PubMed2001

Infant shoulder sonography: technique, anatomy, and pathology.

BACKGROUND: In the infant, shoulder injury due to birth trauma and infection in joint and bone may be difficult to detect radiographically. Shoulder ultrasound provides a dynamic, noninvasive method of evaluation. OBJECTIVE: To develop a technique to evaluate the infant shoulder and to successfully demonstrate pathology. MATERIALS AND METHODS: Using a multiplanar, dynamic technique, 24 normal and 12 symptomatic infants (age range, 3 days to 9 months) were examined (49 shoulders). RESULTS: Sonographic findings were normal in 41 shoulders and abnormal in 8 shoulders. Abnormalities included subluxation, fracture, abnormal cartilage, soft-tissue mass, and inflammatory collections, including effusion. CONCLUSION: Ultrasound can be used successfully to evaluate the infant shoulder for instability, fracture, and infection.

Birth Injuries↗
PubMedDate not supplied

Kinematic MRI of the shoulder.

OBJECTIVE: Clinical evaluation of shoulder pain can be difficult. Pain in the shoulder is often dynamic/positional, and it can often be elicited only during specific activity or function. Soft tissue deforms or changes in shape through motion. These complex interrelationships at the glenoid humeral joint require dynamic studies to accurately evaluate normal anatomy and abnormal pathology. The objective of our study was to evaluate the use of a dynamic cyclic cine imaging to evaluate the glenoid humeral joint. MATERIALS AND METHODS: Kinematic MRI was performed using axial 5 mm sections of the gradient echo and dedicated shoulder surface coil. The patient's arm was placed in the Bonutti cine shoulder system and allowed fixed incremental rotational movement of the shoulder at 10 degrees intervals. Images were reformatted onto a dynamic cine motion by oscillating from internal to external rotation then back to internal rotation. A total of 24 asymptomatic shoulders and 35 symptomatic painful shoulders were studied. RESULTS: Normal variations in the glenoid labrum were readily identified. The glenoid labrum in external rotation is taunt and triangular with well-identified capsular attachments. In neutral rotation the labrum often has increased signal and the middle glenoid humeral ligament occasionally blends with the labrum, making identification difficult. In maximum internal rotation the labrum is rounded and occasionally infolded. Variations in signal through the labrum are not indicative of tears. Capsular attachment must be followed from maximum internal to external rotation to identify stripping. The middle and inferior glenoid humeral ligaments often blend with labrum and internal rotation; however, in external rotation they can be identified as distinct and separate structures. Subcoracoid impingement can be identified in maximum internal rotation with a narrowing of the subcoracoid space to < 11 mm and buckling of the subscapularis and lesser tuberosity against the coracoid process. CONCLUSION: Accurate evaluation of the capsular/labral complex requires cine studies for accurate diagnosis. Signal changes alone or labral morphology alone varies through rotation, and static MRI does not accurately assess these morphologic changes, which vary with extremity position. Capsular attachments can be identified with cine studies accurately and reproducibly. Subcoracoid impingement can be identified with a narrowing of the coracohumeral distance to < 11 mm in internal rotation, which is suggestive of pathology.

Humans↗
PubMedDate not supplied

Shoulder injuries during alpine skiing.

We retrospectively reviewed alpine skiing injuries at a destination ski resort during three seasons to characterize the incidence and types of shoulder injuries. A total of 3451 injuries in 3247 patients were reviewed. The overall injury rate was 4.44 injuries per 1000 skier-days. Injuries to the upper extremity represented 29.1% (N = 1004) of all alpine ski injuries. Injuries involving the shoulder complex (393 injuries in 350 patients) accounted for 39.1% of upper extremity injuries and 11.4% of all alpine skiing injuries. The rate of shoulder injury was 0.51 injuries per 1000 skier-days. Patients with shoulder injuries had a mean age of 35.4 years, and the male-to-female ratio of these patients was 3:1. Falls represented the most common mechanism of shoulder injury (93.9%) in addition to collisions with skiers (2.8%), pole planning (2.3%), and collisions with trees (1%). The most common shoulder injuries were rotator cuff strains (24.2%), anterior glenohumeral dislocations or subluxations (21.6%), acromioclavicular separations (19.6%), and clavicle fractures (10.9%). Less common shoulder injuries included greater tuberosity fractures (6.9%), trapezius muscle strains (6.4%), proximal humeral fractures (3.3%), biceps tendon strains (2.3%), glenoid fractures (1.5%), scapular fractures (1%), humeral head fractures (1%), sternoclavicular separations (0.5%), an acromial fracture (0.3%), a posterior glenohumeral dislocation (0.3%), and a biceps tendon dislocation (0.3%).

Accidental Falls↗
PubMed2000

Shoulder muscle activation during aquatic and dry land exercises in nonimpaired subjects.

STUDY DESIGN: Randomized, single blind experimental design using electromyography to measure shoulder muscle activation in nonimpaired subjects. OBJECTIVES: To compare the muscle activation of rotator cuff and shoulder synergists during rehabilitation exercises performed in water or on dry land. BACKGROUND: Early motion is critical to restoration of normal shoulder function. Aquatic therapy has been promoted as a method for increasing range of motion while minimizing stress on the shoulder. METHODS AND MEASURES: The integrated electromyography amplitude of 6 muscles of the shoulder girdle was examined on the nondominant shoulders of 6 subjects (supraspinatus, infraspinatus, and subscapularis, anterior, middle, and posterior deltoids). Each subject performed elevation (0 degree to 90 degrees) in the scapular plane with neutral rotation on land and in water at 3 different speeds of elevation (30 degrees/s, 45 degrees/s, and 90 degrees/s). The mean percentage of the maximal voluntary contraction was determined for each of the 3 test speeds on land and in water. Comparisons between water and dry land were made with a repeated measures analysis of variance. RESULTS: For all 6 muscles tested, muscle activation during the 30 degrees/s test speed and all muscles tested at the 45 degrees/s test speed was significantly less when performed in water versus when performed on land. For example, electromyography activation of the supraspinatus muscle was 16.68% of a maximal voluntary contraction when elevation at was performed at 30 degrees/s on dry land versus 3.93% when performed in water. CONCLUSION: These data suggest that shoulder elevation in the water at slower speeds resulted in a significantly lower activation of the rotator cuff and synergistic muscles. This decreased muscle activation during aquatic physical therapy allows for earlier active motion in the postoperative period without compromising patient safety.

Adult↗
PubMed1996

[Assessment of shoulder pain in athletes].

The shoulder joint, the most movable joint in our body, is exposed to a considerable load during many sporting activities. The shoulder can be injured and limited in its function not only by direct and indirect trauma but also by repetitive load. Sports with body contact may cause bruises, glenohumeral and acromio-clavicular dislocations or strains of the rotator cuff. Any repetitive microtrauma, particularly those involving sporting activities requiring repetitive overhead use of the arm, may develop lesions of tendons, glenohumeral instabilities or impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim and may be frequently the cause of shoulder pain in athletes. After an introduction to the anatomy of the shoulder and an illustration of the biomechanics of throwing, we explain shoulder pains in the athlete caused by tendon lesions, joint instability and by neurovascular shoulder problems with the typical patient history, the clinical signs, physical and imaging studies in detail. Among the typical lesion of tendons we are describing the impingement syndrome of the supraspinatus tendon, the lesions of the biceps tendon and the impingement of the lower surface of the cuff on the postero-superior glenoid labrum. As glenohumeral instability we describe the anterior, posterior, and inferior instability and the multidirectional instability as well. As neurovascular shoulder problems we describe anatomy, function, patient history, etiology, clinical signs, physical examination, differential diagnosis, therapy, and prognosis of lesions of the nervi suprascapularis, axillaris, thoracicus longus, musculocutaneus, and accessorius as well as lesions of the plexus brachialis and in the thoracic outlet syndrome.

Acromioclavicular Joint↗
PubMed2000

Effectiveness of automatic shoulder belt systems in motor vehicle crashes.

CONTEXT: Approximately 10 million cars with automatic shoulder belt systems are currently in use in the United States. However, reports on the effectiveness of such restraints have yielded conflicting results. OBJECTIVE: To determine the effectiveness of automatic shoulder belt systems in reducing the risk of injury and death among front-seat passenger vehicle occupants. DESIGN, SETTING, AND SUBJECTS: Analysis of data collected from the 1993-1996 National Highway Traffic Safety Administration Crashworthiness Data System on front-seat occupants involved in 25,811 tow-away crashes of passenger cars, light trucks, vans, and sport utility vehicles. MAIN OUTCOME MEASURES: Death and serious injury to specific body areas by use of manual lap and shoulder belts, automatic shoulder belts with manual lap belts, or automatic shoulder belts without lap belts, compared with no restraint use. RESULTS: Use of automatic shoulder belts without lap belts was associated with a decrease in the risk of death vs no restraint use but was not statistically significant for all crashes (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.42-1.06) or for frontal crashes (OR, 0.71; 95% CI, 0.38-1.35) after adjustment for occupant age, sex, vehicle year, air-bag deployment, estimated change in vehicle speed during the crash, and principal direction of force. This association was significantly weaker than the 86% lower risk observed for use of automatic shoulder belts with lap belts (OR, 0.14; 95% CI, 0.07-0.26 vs no restraint; P<.05). Use of automatic shoulder belts without lap belts was associated with an increased risk of serious chest (OR, 2.66; 95% CI, 1.11-6.35) and abdominal (OR, 2.06; 95% CI, 1.004-4.22) injuries for all crashes. CONCLUSIONS: These data indicate that improperly used automatic restraint systems may be less effective than properly used systems and are associated with an increased risk of serious chest and abdominal injuries. Given the continued widespread use of these automatic systems, educational programs may be warranted. JAMA. 2000;283:2826-2828

Abdominal Injuries↗
PubMed1994

The shoulder-hand syndrome after stroke: a prospective clinical trial.

Shoulder-hand syndrome developed in 36 (27%) of 132 hemiplegic patients in a prospective study. Subluxation, paresis of the shoulder girdle, moderate spasticity, and deficits in confrontation visual field testing were the major risk factors. In a placebo-controlled, nonblinded trial, 31 of the 36 patients became almost symptom free within 10 days' treatment with low doses of oral corticosteroids. Shoulder joint capsules taken at autopsy of 7 patients showed signs of previous trauma of the affected shoulder. In the second part of this study on another 86 patients, early awareness of potential injuries to shoulder joint structures reduced the frequency of shoulder-hand syndrome from 27 to 8%. These clinical findings suggest that shoulder-hand syndrome in hemiplegia is initiated by peripheral lesions. A self-perpetuating vicious cycle may be established, followed by the clinical picture of a "reflex sympathetic dystrophy." In the majority of stroke patients, this clinical phenomenon seems to be preventable by avoiding shoulder trauma.

Adrenal Cortex Hormones↗
PubMed2006

Combined low pressure pneumoperitoneum and intraperitoneal infusion of normal saline for reducing shoulder tip pain following laparoscopic cholecystectomy.

INTRODUCTION: Intraabdominal CO(2) gas after laparoscopic cholecystectomy causes postoperative shoulder-tip pain. Many methods of analgesia have been used to reduce this pain, including analgesic drugs, intraperitoneal local anesthetic, intraperitoneal saline, a gas drain, heated gas, low-pressure gas, and nitrous oxide pneumoperitoneum. The aim of this study was to evaluate the efficacy of combined low-pressure CO(2) pneumoperitoneum and intraperitoneal infusion of normal saline in reducing the incidence of postoperative shoulder-tip pain. METHODS: Altogether, 109 patients undergoing elective laparoscopic cholecystectomy were randomized prospectively into three groups. Patients in group A (n = 34) underwent laparoscopic cholecystectomy with 14 mmHg CO(2) pneumoperitoneum; patients in group B (n = 37) underwent laparoscopic cholecystectomy with 10 mmHg CO(2) pneumoperitoneum; and those in group C (n = 38) underwent laparoscopic cholecystectomy with 10 mmHg CO(2) pneumoperitoneum in addition to intraperitoneal normal saline infusion in the right hemidiaphragmatic area. Shoulder-tip pain was recorded on a verbal rating scale 2, 6, 12, 24, and 48 hours after operation. RESULTS: Twelve patients in group A (35.2 percent), six in group B (16.2 percent), and seven in group C (18.4 percent) complained of shoulder-tip pain. Hence, there was a significant decrease in the frequency of shoulder-tip pain in groups B and C in relation to group A, but there was no significant difference between groups B and C. The postoperative shoulder-tip pain scores were significantly reduced in group C at 6, 12, and 24 hours. The number of patients who required additional analgesics was also reduced in group C. CONCLUSIONS: Low-pressure CO(2) pneumoperitoneum reduces the number of patients complaining of shoulder-tip pain and the intensity of the pain after laparoscopic cholecystectomy. The addition of intraperitoneal normal saline infusion to low-pressure CO(2) pneumoperitoneum seems to reduce the intensity but not the frequency of shoulder-tip pain after laparoscopic cholecystectomy.

Adult↗
PubMed2006

An evaluation of a lane support system for bus rapid transit on narrow shoulders and the relation to bus driver mental workload.

The use of dedicated bus shoulders is a key method for implementing bus rapid transit (BRT) in areas that do not have the space for additional infrastructure. However, the narrow width of the bus shoulder and the need to anticipate traffic hazards in the adjacent lane can both be significant stressors for bus drivers. Bus driver mental workload and stress in response to these conditions should be a significant concern both for operational safety and driver health. This pilot study evaluated the potential stressors of traffic density and shoulder width in the context of an express BRT service in a large US metropolitan area. In addition, the study considered the potential role of a prototype lane support system (LSS) to support vehicle control within the narrow shoulder boundaries. Ten experienced bus drivers drove an actual route with an instrumented bus equipped with and without LSS. Self-reported effort was recorded along with performance measures of speed and position control relevant to mobility and safety objectives. Bus drivers did note stressors in the BRT environment and the prototype LSS. However, the use of the shoulder during high-density traffic conditions did improve mobility. Moreover, the LSS did enhance safety on the shoulder when there was high-density traffic in the adjacent lane. However, there was no evidence that the LSS reduced bus driver workload while operating in the narrow shoulder. Future research should consider the impact of BRT operations and support systems on bus driver mental workload and stress, and support the deployment of such devices for bus operations on shoulders during high traffic volumes.

Accidents, Traffic↗
PubMed1998

Cervical spine alignment in immobilized hockey players: radiographic analysis with and without helmets and shoulder pads.

OBJECTIVE: To establish the appropriate technique for cervical immobilization of the hockey player with an acute neck injury, we analyzed the alignment of the cervical spine in healthy volunteers with combinations of applied hockey equipment and assessed the amount of cervical spine motion possible in a secured hockey helmet. Our hypothesis was that there is a significant difference among various positions of the cervical spine with and without equipment and with active motion in a secured helmet. DESIGN: We analyzed lateral cervical spine radiographs of eight healthy male volunteers immobilized on a backboard with the following combinations of hockey equipment: shoulder pads and helmet, shoulder pads only, helmet only, no equipment, and neck flexion and extension with helmet and shoulder pads on and helmet secured to the backboard. SETTING: Large university hospital, tertiary care center. RESULTS: Cervical lordosis without equipment (control) was not significantly different than cervical lordosis with shoulder pads and helmet applied (p=0.31). Subjects with shoulder pads averaged 8.9 degrees more lordosis than did controls (p= 0.0002) and 6.6 degrees more lordosis than did subjects with shoulder pads and helmets (p=0.027). Subjects with shoulder pads and a helmet secured to the backboard were able to flex and extend the cervical spine 12.9 degrees compared with the control position (p =0.009). CONCLUSIONS: In an acute cervical spine injury involving an ice hockey player, we recommend immobilization in both the helmet and the shoulder pads, with removal of both pieces of equipment in a controlled hospital setting and only after initial radiographic examination. We also recommend securing the player's chin to prevent as much head and neck motion as possible during transport and transfers.

Adult↗
PubMed1996

Risk factors and fetal outcome in cases of shoulder dystocia compared with normal deliveries of a similar birthweight.

OBJECTIVES: To compare risk factors and fetal morbidity in deliveries complicated by shoulder dystocia with deliveries of similar infant birthweights but not complicated by shoulder dystocia. DESIGN: A retrospective case-controlled study. SETTING: Kuwait Maternity Hospital. PARTICIPANTS: Sixty-nine cases of true shoulder dystocia and 138 controls matched for exact infant's birthweight. METHODS: Demographic data and data regarding history of previous shoulder dystocia, diabetes mellitus, labour course, method of delivery and newborns' condition were collected from patients and case notes following delivery. The mothers' height and weight were measured. Oral glucose tolerance test were performed on patients who were not known as diabetics. The infants' head and chest circumferences and bisacromial diameter were measured. RESULTS: There were no significant differences between cases and controls when mean age, parity, height, weight and gestational ages were compared. The cases demonstrated a higher incidence of previous shoulder dystocia (P < 0.01), diabetes mellitus (P < 0.001), use of oxytocin for acceleration of labour (P < 0.01) and operative vaginal deliveries (P < 0.01). Differences between cases and controls in their newborn infants' head and chest circumferences were not significant, but the newborns of cases have a longer mean bisacromial diameter and a shorter head circumference:bisacromial diameter ratio (P < 0.001 and P < 0.001, respectively). Thirty-seven infants (53.6%) from cases and two from controls (1.4%) sustained birth injuries. There were two stillbirths among the cases. CONCLUSIONS: Although fetal macrosomia is the principal risk factor for shoulder dystocia, other important risk factors include diabetes mellitus, previous history of shoulder dystocia, prolonged labour, delay in the second stage of labour and fetal shoulder width which appear to be independent of fetal weight.

Adult↗
PubMed2006

Rotator cuff contusions of the shoulder in professional football players: epidemiology and magnetic resonance imaging findings.

BACKGROUND: No published reports have studied the epidemiology and magnetic resonance imaging findings associated with rotator cuff contusions of the shoulder in professional football players. PURPOSE: To determine a single professional football team's incidence, treatment, and magnetic resonance imaging appearance of players sustaining rotator cuff contusions of the shoulder. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: From 1999 to 2005, a North American professional football team's injury records were retrospectively reviewed for athletes who had sustained a rotator cuff contusion of the shoulder during in-season participation. Those patients who had magnetic resonance imaging of the shoulder with a 1.5-Tesla magnet were reviewed by a musculoskeletal radiologist and graded according to the appearance and severity of clinical injury. RESULTS: Twenty-six players had a rotator cuff contusion. There was an average of 5.5 rotator cuff contusions per season (47% of all shoulder injuries). The predominant mechanism of injury was a direct blow in 70.3%. Magnetic resonance imaging findings included peritendon edema at the myotendinous junction, critical zone tendon edema, and subentheseal bone bruises. Treatment consisted of a protocol involving modalities and cuff rehabilitation in all patients. Six patients had persistent pain and weakness for a minimum of 3 days and were given a subacromial corticosteroid injection. Overall, 3 patients (11.4%) required later surgical treatment on the shoulder. CONCLUSION: Rotator cuff contusions accounted for nearly half of all shoulder injuries in the football players in this study. Magnetic resonance imaging is an extremely useful tool in determining severity of injury and integrity of the rotator cuff. The majority of athletes are able to return to sports with conservative treatment; a minority of shoulders might progress to more severe injuries such as rotator cuff tears.

Adult↗
PubMed2007

Trapezius transfer to treat flail shoulder after brachial plexus palsy.

BACKGROUND: After severe brachial palsy involving the shoulder, many different muscle transfers have been advocated to restore movement and stability of the shoulder. Paralysis of the deltoid and supraspinatus muscles can be treated by transfer of the trapezius. METHODS: We treated 10 patients, 8 males and 2 females, by transfer of the trapezius to the proximal humerus. In 6 patients the C5 and C6 roots had been injured; in one C5, C6 and C7 roots; and 3 there were complete brachial plexus injuries. Eight of the 10 had had neurosurgical repairs before muscle transfer. Their average age was 28.3 years (range 17 to 41), the mean delay between injury and transfer was 3.1 years (range 14 months to 6.3 years) and the average follow-up was 17.5 months (range 6 to 52), reporting the clinical and radiological results. Evaluation included physical and radiographic examinations. A modification of Mayer's transfer of the trapezius muscle was performed. The principal goal of this work was to evaluate the results of the trapezius transfer for flail shoulder after brachial plexus injury. RESULTS: All 10 patients had improved function with a decrease in instability of the shoulder. The average gain in shoulder abduction was 46.2 degrees; the gain in shoulder flexion average 37.4 degrees. All patients had stable shoulder (no subluxation of the humeral head on radiographs). CONCLUSION: Trapezius transfer for a flail shoulder after brachial plexus palsy can provide satisfactory function and stability.

Journal Article↗
PubMed2006

Registry of shoulder arthroplasty - the Scottish experience.

INTRODUCTION: Recognising that timely dissemination of information in the orthopaedic community was important and in the absence of any national guidelines for shoulder arthroplasty, the Scottish shoulder arthroplasty registry, a voluntary registry, was started in 1996. The goals of the registry were to assess contemporary practice, provide a benchmark against which surgeons could compare their practice, identify risk factors for a poor outcome, and to improve outcomes through continuous feedback to the participating surgeons. PATIENTS AND METHODS: A standardised proforma was used to collect information on the diagnostic and demographic data, type of procedure performed, type of implant used, any associated procedures performed in conjunction with the arthroplasty, and peri-operative complications. Postoperative pain, activity and patient satisfaction were assessed annually using another standardised proforma. RESULTS: Twenty surgeons have contributed to the register and 451 shoulder arthroplasties were registered over a 5-year period. Of patients, 23.2% were male and 76.8% female. The mean age was 65 years (range, 37-90 years). Shoulder arthroplasty was commonly performed for rheumatoid arthritis followed by trauma, osteoarthritis and avascular necrosis of the humeral head. Overall, 397 (88%) patients had a hemi-arthroplasty and 54 (12%) had a total shoulder replacement. Of the 54 cases that had a glenoid replacement, 28 were performed for inflammatory arthritis, 21 for osteoarthritis and 5 were for revisions. The humeral component was cemented in 204 (45%) cases, 160 of whom had a shoulder replacement for trauma. The glenoid component was cemented in 48 (89%) cases. Cross referencing our data with the figures of the actual number of shoulder arthroplasties performed, however, indicated that our registry at best collected only 53% of all the shoulder arthroplasties performed in Scotland annually. CONCLUSIONS: The value of a joint registry is dependent on the accuracy and completeness of the data entered. Our registry, therefore, fails as an implant registry. We believe that compliance for data registration can only be ensured if dedicated data collection staff are employed to co-ordinate the data collection and collation process.

Adult↗