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[Rehabilitation treatment of injuries of the shoulder joint].

The authors share their experience with treatment of injuries of the humeral articulation and their consequences. Main diseases of the articulation such as scapulohumeral periarthritis, habitual dislocation of the shoulder, fractures of the proximal end of the humeral bone are described. Original methods of conservative and operative treatment are proposed.

Fracture Fixation, Internal↗

Electromyographic study of shoulder joint.

The abduction in the scapular plane and forward flexion of the arm were studied in ten subjects by electromyography combined with goniometry permitting simultaneous measurement of arm and glenohumeral angles. The "integrated" electromyograms from six should girdle muscles plotted against the arm angle were submitted to variance analysis for pattern discrimination. The progression of electromyographic activities in these muscles was discriminable with errors ranging from 0.0 to 26.3 percent and could be classified in several categories. Their relationship with functional mechanism to the abduction movement was not necessarily constant, but accelerated just before the maximum elevation.

Action Potentials↗

New aspects on the topography of the tendon of the long head of the biceps brachii muscle. One more stabilizer factor of the shoulder joint.

There are little variations in descriptions on the origin of the tendon of the long head of the biceps brachii muscle, in the classical text books of Anatomy. Most authors define as the main origin of the tendon of the long head of the biceps brachii muscle, the supraglenoid tubercle and adjoining part of the glenoid labrum of the scapula. In the present study we found that the origin of the tendon of the long head of the biceps brachii muscle extended towards almost the whole periphery of the glenoid cavity on the glenoid labrum except from a small area near to the supraglenoid tubercle.

Humans↗

[Macroscopic and microscopic anatomy of the shoulder joint and the limbus glenoidalis].

Macroscopical and histological examinations were carried out in order to investigate the anatomy of the limbus glenoidalis, with respect to its surrounding structures such as tendons and ligaments. Basically the crosscut limbus glenoidalis has a triangular shape, however, especially in its anterior part, it has a meniscoid or labiate form. Histologically the limbus glenoidalis consists exclusively of connective tissue, rich in cells and fibers. It originates from the fibrocartilaginous rim of the glenoid surface, which merges into the hyalin cartilage. The bundles of fibers have a circular arrangement with radially and reticularly interwoven structures near the tendons of the biceps and triceps muscle.

Cartilage, Articular↗

Function of the upper extremity and ability to perform housework following reconstructive surgery of the shoulder joint using a free vascularized fibula bone graft: a case report.

The cases of two female patients who underwent reconstructive surgery using free vascularized fibular bone grafting of the proximal humerus are reported. Both patients were evaluated 1 year postoperatively for active range of motion; an Enneking evaluation and activities-of-daily-living (housework) assessment were also done. Patient 1 regained flexion and abduction to 110 degrees, and patient 2 regained flexion and abduction to 90 degrees. On the Enneking test, the patients achieved scores of 23 and 25 points, respectively. On the activities-of-daily-living housework assessment, patient 1 performed at 91.0% and patient 2 at 60.6%. In both cases, neither active range of motion nor the Enneking scores accurately reflected the functional abilities of the reconstructed limbs. It is important that upper extremity therapists evaluate and consider functional abilities in activities of daily living, such as housework, in the early phases of rehabilitation.

Activities of Daily Living↗

Macroscopical anatomy of the so-called "rotator interval". A cadaver study on 19 shoulder joints.

The triangular capsular space between the insertion tendons of the Mm. supraspinatus and subscapularis--the "rotator interval", can be divided into lateral, medio-superior and medio-inferior parts. The lateral part of the capsule is strengthened by the "Lig. semicirculare humeri" and the anterior fibres of the M. supraspinatus tendon. The Ligg. coracohumerale and "coracoglenoidale" are the macroscopical elements of the medio-superior part. The medio-inferior part of the "rotator interval" is reinforced by the Ligg. glenohumeralia superius et medium. The key ligament of the "rotator interval" is the "Lig. semicirculare humeri". Laterally it ensures the insertion of the anterior fibres of the M. supraspinatus tendon above the Lig. transversum humeri and on the Tubercula majus et minus. Medially it is the place of attachment of the Lig. coracohumerale and oblique fibres of the Lig. glenohumerale superius. The "rotator interval" is not a weak capsular region but a complex network of macroscopically recognizable tendinous and ligamentous structures.

Cadaver↗

Arthroscopic surgical approaches and intraarticular anatomy of the equine shoulder joint.

Arthroscopic approaches to the scapulohumeral joint were developed in four clinically normal, live horses (5 limbs) to determine their usefulness for evaluation and potential surgical treatment of intraarticular lesions. The articular surface of the entire glenoid, cranial humeral head (medial and lateral) and caudolateral humeral head, as well as the synovial membrane, could be closely examined from an arthroscopic portal cranial to the infraspinatus tendon. The caudomedial humeral head could be examined partially. Cranial and caudal instrument portals allowed good surgical access to the entire glenoid and the majority of the humeral head (except caudomedial in adult, heavily muscled horses). The described arthroscopic and instrument portals allowed access to the areas frequently affected with osteochondritis dissecans (OCD). Potential difficulties with this technique include problems establishing triangulation, extravasation of fluids, and inability to reach potential lesions on the caudomedial humeral head with conventional equipment in heavily muscled horses.

Animals↗

Artificial shoulder joint by Péan (1893): the facts of an exceptional intervention and the prosthetic method.

In 1893, the famous French surgeon E. J. Péan substituted the proximal end of a humerus with a total shoulder arthroplasty made of platinum and rubber. After 2 years, the prosthesis was removed and nothing more was heard about it. After more than 80 years from that historic operation, the author has found Péan's original prosthesis in the Smithsonian Institution of Washington, D.C. This exceptional medical document was designed by a Parisian dentist, J. Porter Michaels and was brought to the United States by Edward A. Bogue, an American dentist who worked in Paris. Bogue donated it in 1916 to the Armed Forces Institute of Pathology in Washington. At the present time the prosthesis is being kept in the Smithsonian Institution. The intervention was not a complete success since Péan had to remove the artificial joint due to a persistent tubercular infection. Nevertheless this prosthesis represents a milestone in the history of medicine, an event justly deserving of our note.

Adult↗

[Post-traumatic chronic instability of the shoulder joint. Therapy and results].

If posttraumatic chronic instability of the AC-joint causes subjective complaints, this is an indication for operative therapy. In our unit 38 patients were treated at all. In most cases previous treatment had been conservative. Syndesmoplasty was done with local tissue. 33 patients were examined radiological and clinical after a minimum time of twelve months after operative treatment. The AC-joints of 25 patients were stable, in five cases there was a slight instability, in three cases there was a severe instability. Only with four patients the diminuation of mobility was of consequence.

Bone Wires↗