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At least 739 records · Page 41Linked to original sources
PubMed2005

Effect of fore-aft seat position on shoulder demands during wheelchair propulsion: part 1. A kinetic analysis.

BACKGROUND/OBJECTIVE: The highly repetitive and weight-bearing nature of wheelchair (WC) propulsion has been associated with shoulder pain among persons with spinal cord injury (SCI). Manipulation of WC seat position is believed to reduce the overall demand of WC propulsion. The objective of this investigation was to document the effect of fore-aft seat position on shoulder joint kinetics. METHODS: Thirteen men with complete motor paraplegia propelled a test WC in 2 fore-aft seat positions during free, fast, and graded conditions. The seat-anterior position aligned the glenohumeral joint with the wheel axle and the seat-posterior position moved the glenohumeral joint 8 cm posteriorly. The right wheel of the test chair was instrumented to measure forces applied to the pushrim. An inverse dynamics algorithm was applied to calculate shoulder joint forces, external moments, and powers. RESULTS: For all test conditions, the superior component of the shoulder joint resultant force was significantly lower in the seat-posterior position. During graded propulsion, the posterior component of the shoulder joint force was significantly higher with the seat posterior. Peak shoulder joint moments and power were similar during free and fast propulsion. During graded propulsion, the seat-posterior position displayed increased internal rotation moment, decreased sagittal plane power absorption, and increased transverse plane power generation. CONCLUSIONS: This investigation provides objective support that a posterior seat position reduces the superior component of the shoulder joint resultant force. Consequently, this intervention potentially diminishes the risk for impingement of subacromial structures.

Acceleration↗
PubMed2005

Effect of fore-aft seat position on shoulder demands during wheelchair propulsion: part 2. An electromyographic analysis.

BACKGROUND/OBJECTIVES: Shoulder pain is common in persons with complete spinal cord injury. Adjustment of the wheelchair-user interface has been thought to reduce shoulder demands. The purpose of this study was to quantify the effect of seat fore-aft position on shoulder muscle activity during wheelchair propulsion. METHODS: Shoulder electromyography (EMG) was recorded while 13 men with paraplegia propelled a wheelchair in the following 2 seat positions: (a) shoulder joint center aligned with the wheel axle (anterior) and (b) shoulder joint center 8 cm posterior to the wheel axle (posterior) in 3 test conditions (free, fast, and graded). Duration of EMG activity and median and peak intensities were compared. RESULTS: During free propulsion, the median EMG intensity of all muscles was similar between anterior and posterior seat positions. The major propulsive muscles (pectoralis major and anterior deltoid) demonstrated significant reductions in their median and peak intensities in the posterior seat position. Pectoralis major median intensity was significantly reduced in the posterior position during fast (52% vs 66% maximal muscle test [MMT]) and graded (41 % vs 49% MMT) conditions, and peak intensity was significantly reduced in the free condition (29% vs 52% MMT) and the fast condition (103% vs 150% MMT). Anterior deltoid intensity was significantly reduced in the posterior position during fast propulsion only (26% vs 31% MMT). For all muscles, EMG duration was similar between positions in all test conditions. CONCLUSIONS: Reduction in the intensity of the primary push phase muscles (pectoralis major and anterior deltoid) during high-demand activities of fast and graded propulsion may reduce the potential for shoulder muscle fatigue and injuries.

Acceleration↗
PubMed2001

Measurement of scapular asymetry and assessment of shoulder dysfunction using the Lateral Scapular Slide Test: a reliability and validity study.

BACKGROUND AND PURPOSE: The Lateral Scapular Slide Test (LSST) is used to determine scapular position with the arm abducted 0, 45, and 90 degrees in the coronal plane. Assessment of scapular position is based on the derived difference measurement of bilateral scapular distances. The purpose of this study was to assess the reliability of measurements obtained using the LSST and whether they could be used to identify people with and without shoulder impairments. Subjects. Forty-six subjects ranging in age from 18 to 65 years (X=30.0, SD=11.1) participated in this study. One group consisted of 20 subjects being treated for shoulder impairments, and one group consisted of 26 subjects without shoulder impairments. METHODS: Two measurements in each test position were obtained bilaterally. From the bilateral measurements, we derived the difference measurement. Intraclass correlation coefficients (ICC [1,1]) and the standard error of measurement (SEM) were calculated for intrarater and interrater reliability of the difference in side-to-side measures of scapular distance. Sensitivity and specificity of the LSST for classifying subjects with and without shoulder impairments were also determined. RESULTS: The ICCs for intrarater reliability were .75, .77, and .80 and .52, .66, and .62, respectively, for subjects without and with shoulder impairments in 0, 45, and 90 degrees of abduction. The ICCs for interrater reliability were .67, .43, and .74 and .79, .45, and .57, respectively, for subjects without and with shoulder impairments in 0,45 and 90 degrees of abduction. The SEMs ranged from 0.57 to 0.86 cm for intrarater reliability and from 0.79 to 1.20 cm for interrater reliability. Using the criterion of greater than 1.0 cm difference, sensitivity and specificity were 35% and 48%, 41% and 54%, and 43% and 56%, respectively, for 0, 45, and 90 degrees of abduction. Sensitivity and specificity based on the criterion of greater than 1.5 cm difference were 28% and 53%, 50% and 58%, and 34% and 52%, respectively, for the 3 scapular positions. CONCLUSION AND DISCUSSION: Our results suggest that measurements of scapular positioning based on the difference in side-to-side scapular distance measures are not reliable. Furthermore, the results suggest that sensitivity and specificity of the LSST measurements are poor and that the LSST should not be used to identify people with and without shoulder dysfunction.

Adult↗
PubMed2002

Shoulder biomechanics and muscle plasticity: implications in spinal cord injury.

After spinal cord injury, excessive burden falls on the upper extremity, especially the shoulder. Overall, 51% of persons with spinal cord injury have shoulder problems. Common shoulder problems in persons with spinal cord injury begin with muscle imbalance that can lead to glenohumeral instability, impingement disease, rotator cuff tears, and subsequent degenerative joint disease. These problems can be attributed to the functional demands placed on the shoulder that are specific to patients with spinal cord injury, including overhead activities, wheelchair use, and transfers. Despite preventive exercises, shoulder problems in persons with spinal cord injury remain a significant problem, causing pain and functional limitations. The biomechanics of the shoulder for persons with spinal cord injury resulting from changes in muscle plasticity will be elucidated. Specifically, the effects of scapular protraction that can result from muscle imbalance, the age-dependent properties of the anterior band of the inferior glenohumeral ligament, and the influence of the dynamic restraints around the shoulder will be addressed.

Biomechanical Phenomena↗
PubMed2004

Outcome expectancies, functional outcomes, and expectancy fulfillment for patients with shoulder problems.

OBJECTIVES: This study was conducted to evaluate the relationship among patient outcome expectancies, perceived shoulder function changes, and perceptions of expectancy fulfillment. METHODS: Patients (n = 199) treated for shoulder problems at one orthopedic surgeon's office completed a baseline survey comprised of measures of outcome expectancies, shoulder function, health status, and demographics. At 1 month, 2 months, and 3 months, patients completed a mailed follow-up survey comprised of all baseline measures except demographic variables. At 3 months, a measure of expectancy fulfillment was added. A general linear modeling approach was used to assess the significance and effect size of 1) outcome expectancies on changes in shoulder function; and (2) outcome expectancies, shoulder function changes, and their interaction on perceptions of expectancy fulfillment. RESULTS: Outcome expectancies significantly predicted changes in shoulder function and accounted for 10% of the variance in functional improvement. The improvement difference between patients with high expectancies compared with those with low expectancies was clinically relevant (4.57 points), as it was greater than the minimal clinically important difference (3.02 points). Outcome expectancies and shoulder function changes significantly predicted patients' perceptions of fulfilled expectancies, but their interaction was not statistically significant. CONCLUSIONS: Results highlight the importance of patient expectancy in medical encounters. The findings suggest the need for interventions targeting patient expectancies such as including discussions about expectancy in patient-physician negotiations of therapeutic plans. Results also underscore the need for the development of better measures of outcome expectancies and expectancy fulfillment.

Adolescent↗
PubMed2002

How reliably do rheumatologists measure shoulder movement?

OBJECTIVE: To assess the intrarater and interrater reliability among rheumatologists of a standardised protocol for measurement of shoulder movements using a gravity inclinometer. METHODS: After instruction, six rheumatologists independently assessed eight movements of the shoulder, including total and glenohumeral flexion, total and glenohumeral abduction, external rotation in neutral and in abduction, internal rotation in abduction and hand behind back, in random order in six patients with shoulder pain and stiffness according to a 6x6 Latin square design using a standardised protocol. These assessments were then repeated. Analysis of variance was used to partition total variability into components of variance in order to calculate intraclass correlation coefficients (ICCs). RESULTS: The intrarater and interrater reliability of different shoulder movements varied widely. The movement of hand behind back and total shoulder flexion yielded the highest ICC scores for both intrarater reliability (0.91 and 0.83, respectively) and interrater reliability (0.80 and 0.72, respectively). Low ICC scores were found for the movements of glenohumeral abduction, external rotation in abduction, and internal rotation in abduction (intrarater ICCs 0.35, 0.43, and 0.32, respectively), and external rotation in neutral, external rotation in abduction, and internal rotation in abduction (interrater ICCs 0.29, 0.11, and 0.06, respectively). CONCLUSIONS: The measurement of shoulder movements using a standardised protocol by rheumatologists produced variable intrarater and interrater reliability. Reasonable reliability was obtained only for the movement of hand behind back and total shoulder flexion.

Aged↗
PubMed2005

Correlation between clinical diagnosis and arthroscopic findings of the shoulder.

OBJECTIVE: To assess the accuracy of clinical examination by non-specialist orthopaedic surgeons of patients presenting to a diagnostic and treatment centre (DTC) for arthroscopic shoulder surgery. METHODS: A retrospective review of notes of 130 consecutive shoulder arthroscopies performed at a DTC over a 10 month period. Preoperative clinical diagnosis was compared with operative arthroscopic findings. Additional information from preoperative imaging was compared with clinical examination and arthroscopic findings. Preoperative clinical examinations and consent were undertaken by clinical fellows, (SpR level) and non-upper limb consultant orthopaedic surgeons. Consultants specialising in upper limb surgery performed the operations. RESULTS: Six main groups were identified on the basis of clinical examination: impingement 76 cases (58%), instability 22 cases (17%), frozen shoulder 11 cases (8%), rotator cuff tear four cases (3%), non-specific pain eight cases (6%), and normal clinical examination nine cases (7%). Impingement and instability diagnosed clinically strongly correlated with the arthroscopic findings. Clinical diagnosis of frozen shoulder and rotator cuff tears had a weaker correlation with the arthroscopic findings. Of the nine cases of normal clinical examination, abnormality was found at arthroscopy in all cases. CONCLUSION: There have been very few studies comparing clinical examination of the shoulder with arthroscopic findings. This study emphasises the importance of good clinical examination skills in diagnosing common shoulder abnormalities. The addition of imaging, particularly ultrasound and magnetic resonance imaging further increases the likelihood of an accurate diagnosis. Shoulder examination should be taught with as much emphasis at both undergraduate and postgraduate level as other orthopaedic clinical examinations.

Adult↗
PubMed1995

Anterior shoulder instability: diagnostic criteria determined from prospective analysis of 121 MR arthrograms.

PURPOSE: To determine magnetic resonance (MR) arthrographic criteria in the diagnosis of anterior glenohumeral instability. MATERIALS AND METHODS: In 121 patients with diagnoses proved surgically, the labrum, glenohumeral ligaments, and capsular insertion types were assessed prospectively with gadolinium-enhanced MR arthrography. Findings were compared in stable and unstable shoulders. RESULTS: Operative results showed 59 normal, 57 torn, and five deficient labra. In 37 unstable shoulders, 31 had discrete inferior labral-ligamentous lesions and six had capsular laxity. MR arthrograms showed labral abnormalities with 92% sensitivity, 92% specificity. Inferior labral-ligamentous lesions enabled prediction of anterior instability with 76% sensitivity (capsular laxity was missed in all shoulders), 98% specificity. Inferior labral-ligamentous abnormalities were strongly associated with unstable shoulders (P << .0001), whereas noninferior labral-ligamentous abnormalities were related to stable shoulders (P = .01). Capsular insertion types showed no significant differences between stable and unstable shoulders (P > .8). CONCLUSION: On MR arthrograms, inferior labral-ligamentous abnormalities were most closely correlated with anterior glenohumeral instability. Capsular insertion sites had no role in the prediction of shoulder instability.

Adolescent↗
PubMedDate not supplied

The stabilizing function of passive shoulder restraints.

UNLABELLED: The static restraints of the scapulohumeral joint provide stability for the humeral head in the glenoid cavity, limit extremes of motion of the glenohumeral joint, and guide positioning of the humerus during normal shoulder movement. Eleven fresh-frozen cadaver shoulders of unknown age were attached to a shoulder motion device that allowed measurement of motion in three planes with an accuracy to 0.5 degrees. Four shoulders underwent motion analysis and seven were used for strain gauge analysis of the static scapulohumeral ligamentous restraints. The results of the motion analysis demonstrated that any attempt at simple motion (flexion, extension, abduction, internal or external rotation) resulted in coupled motion in two additional planes. The strain gauge data, expressed as a percent of total tension for each ligament tested, demonstrated a reciprocal tension-sharing relationship among all ligament components and a transference of tension among these components when original and new joint positions were compared. These data provide an in vitro model of shoulder restraint function to explain primary restraint, tension sharing, and transference of tension functions in the in vivo scapulohumeral joint. CLINICAL RELEVANCE: These principles of shoulder function have application in the treatment of instability and frozen shoulder syndrome, and provide an in vitro model to better understand static restraint function in the throwing mechanism.

Biomechanical Phenomena↗
PubMedDate not supplied

Anterior shoulder instability in weight lifters.

Occult instability is recognized as a major cause of shoulder dysfunction in throwing athletes. Few studies have characterized the findings of occult instability in nonthrowers. The purpose of this study was to examine shoulder instability in a group of weight lifters. The symptoms, physical findings, and results of treatment for 23 shoulders in 20 athletes are presented. All athletes presented with a complaint of progressive inability to perform exercises with the upper extremity in the abducted, externally rotated position (the "at-risk" position) because of pain. One hundred percent of the athletes experienced posterior shoulder pain when the shoulder was placed in forced abduction and external rotation. Thirteen shoulders in 10 patients responded to conservative management including aggressive rehabilitation and modification of technique to avoid the at-risk position. The other 10 shoulders, which did not respond to conservative treatment, required surgical treatment to alleviate the symptoms. All 20 patients have successfully returned to their previous weight lifting activities.

Adolescent↗
PubMedDate not supplied

Posterior shoulder laxity in asymptomatic athletes.

We evaluated the frequency of posterior subluxations on physical examination of athletes who had no symptoms of shoulder injuries and correlated the findings with other measures of joint laxity. During routine sports physical examinations, 356 shoulders in 178 athletes were examined for posterior subluxation and graded as either positive or negative for subluxation. Sulcus signs were performed and graded as I (< 1.0 cm), II (1.0 to 1.5 cm), or III (> 1.5 cm). Standard hyperlaxity tests of other joints were used to measure general ligamentous laxity. Statistical analysis included the Student's t-test and chi-square analysis (P < 0.05). Overall, 55% of the shoulders could be subluxated posteriorly. More female shoulders (65%) than male shoulders (51%) could be subluxated posteriorly. Ten percent of the athletes had asymmetrical posterior shoulder laxity. Men had statistically significant less inferior translation (sulcus signs of grade I, 49%; grade II, 46%; grade III, 3%) than women (grade I, 36%; grade II, 54%; grade III, 9%). Five percent of the shoulders had posterior subluxation and a grade III sulcus sign. Asymptomatic posterior subluxation present at physical examination may represent normal laxity and may not indicate pathologic instability.

Adolescent↗
PubMedDate not supplied

Shoulder motion and laxity in the professional baseball player.

We studied 148 professional baseball players with no history of shoulder problems to assess range of motion and laxity of their dominant and nondominant shoulders. There were 72 pitchers and 76 position players. Average external rotation with the arm in 90 degrees of abduction was statistically greater and average internal rotation was statistically less in the dominant shoulders than in the nondominant shoulders, both in pitchers and position players. There was no statistical difference in forward elevation of external rotation with the arm at the side of the body in either group. Both dominant and nondominant shoulders of pitchers had greater average range of motion in forward elevation and external rotation (both at the side and at 90 degrees of abduction) and less average internal rotation than those of position players. Regarding laxity testing, 61% of dominant shoulders in pitchers had a sulcus sign, as compared with 47% in position players. Also, this degree of inferior laxity was significantly greater in pitchers than in position players. Differences in range of motion and laxity exist in the throwing shoulder of athletes involved in overhead throwing motions and should be considered in rehabilitation protocols and surgical repair.

Adolescent↗
PubMed2004

Diagnosis and current treatment options of shoulder impingement.

A comprehensive review of shoulder impingement reveals numerous causes, contributing factors, and therapeutic options for the resolution of symptoms and return to optimal shoulder function. The clinical diagnosis of shoulder impingement is rather straightforward, but the challenge arises in identifying causative factors and directing treatment options to alleviate symptoms and restore normal function. Shoulder impingement occurs when the space between the proximal humerus and the coracoacromial arch is narrowed such that the transversing tendons, primarily the supraspinatus and to a lesser degree, the infraspinatus, are injured. As the most diagnosed shoulder ailment an understanding of shoulder anatomy, supporting musculature and function, inciting factors, and individual demands are critical in directing the appropriate treatment plan. Medications, therapeutic exercise and surgical interventions all have their place in the treatment of shoulder impingement.

Acromion↗
PubMed1997

Postoperative eccentric and concentric isokinetic strength for the shoulder rotators in the scapular and neutral planes.

Considerable variability exists for isokinetic testing of the shoulder rotators, leaving the clinician in a quandry concerning the most appropriate method for patient evaluation. The purpose of this study was to evaluate concentric and eccentric rotational strength in the scapular and neutral planes for the surgical and nonsurgical shoulders. Fifteen males consented to be tested during a 90-minute isokinetic session. Both shoulders for each patient were tested concentrically (240 degrees/sec) and eccentrically (120 degrees/sec) in the scapular and neutral planes. Patient positioning was maintained through the use of a goniometer, plumb line, and floor grid system. Following a warmup, five maximal effort reciprocal internal and external rotation concentric and eccentric contractions were evaluated using multiple two-way analyses of variance (shoulder x plane) with repeated measures. Results indicated no statistically significant differences between the surgical or nonsurgical shoulders for either concentric (p = .063-.247) or eccentric (p = .460-.840) modes, regardless of test plane. No statistically significant differences were observed eccentrically between test planes (p = .06-.470), but the scapular plane produced significantly higher (p = .005) peak torques concentrically. Generally, the external rotators were 53.0% (concentrically) and 63.0% (eccentrically) of the internal rotator strength for either shoulder. Clinically, concentric and eccentric testing of the postoperative shoulder patient can occur in either the scapular or the neutral plane. However, the scapular plane may be preferred since it is more functionally relevant and less injurious to the rotator cuff. A full, functional recovery may be expected for the rotator cuff repair patient.

Adult↗
PubMed2002

Translations of the humerus in persons with shoulder impingement symptoms.

STUDY DESIGN: Two-group mixed-model analysis of covariance and correlation analysis. OBJECTIVES: To determine whether differences in humeral translations exist between patients with shoulder impingement symptoms and an asymptomatic comparison group, and if so, to determine if shoulder range-of-motion (ROM) measures are associated with abnormal translations. BACKGROUND: Abnormal translations of the humeral head are believed to reduce the available subacromial space and to contribute to the development or progression of shoulder impingement symptoms. These abnormal translations have also been theorized to be related to tightness of the posterior capsule and decreased shoulder ROM. METHODS AND MEASURES: Three-dimensional humeral translations were tracked in symptomatic construction workers and an asymptomatic comparison group while elevating the arm in the scapular plane under no-load, 2.3-kg, and 4.6-kg hand-load conditions. Between-group comparisons were made across 3 phases of motion (30 degrees-60 degrees, 60 degrees-90 degrees, and 90 degrees-120 degrees) and the association between humeral translations and cross-body adduction and shoulder internal rotation ROM measures were determined by Pearson correlation analysis. RESULTS: Persons with shoulder symptoms demonstrated small but significant changes in anterior-posterior translations of the humerus. These changes for the 90 degrees-120 degrees phase of humeral elevation were moderately negatively associated with available cross-body adduction ROM. CONCLUSIONS: The identified kinematic deviations are consistent with possible reductions of the subacromial space. Further study of relationships between posterior capsule tightness, rotator cuff function, and abnormal humeral translations is warranted to better delineate underlying kinematic mechanisms that may contribute to shoulder impingement symptoms and to refine rehabilitation techniques.

Adult↗
PubMed1977

Resection of the acromion in the treatment of persistent rotator cuff syndrome of the shoulder.

Partial or complete excision of the acromion was performed in 25 patients (29 shoulders) with long-standing pain in the shoulder typical of rotator cuff syndrome. There was no verified history of trauma in nine cases (13 shoulders), while injury was the cause of pain in 16 patients (16 shoulders). In nine shoulders there was a small and in two a large rupture of the rotator cuff. Twelve of the 13 non-traumatic shoulders became painless postoperatively and the pain was relieved in one. In the 16 traumatic shoulders the relief of pain was complete in six, partial in nine, and one remained unchanged. The condition was not aggravated in any of the cases. Mobility increased postoperatively in four cases and was in no case decreased by the operation. In this series the results were as favourable after partial as after complete excision of the acromion alone or excision in combination with other procedures appears to be a promising method of treatment of patients with long-standing rotator cuff syndrome.

Acromion↗
PubMed1999

[Paralytic shoulder secondary to post-traumatic peripheral nerve lesions in the adult].

A critical review is presented of the indications for nerve repair or transfer and for palliative operations in the management of paralytic shoulder following traumatic neurological injuries in the adult. Different situations are considered: paralytic shoulder following supraclavicular lesions of the brachial plexus, following retro- and infraclavicular lesions and following lesions to the terminal branches of the plexus (axillary, suprascapular and musculocutaneous nerves) and finally problems related to lesions of the accessory nerve and the long thoracic nerve. I. Supraclavicular lesions of the brachial plexus. In complete (C5 to T1) lesions, the possibilities for nerve repair or transfer are at best limited, and the aim is to restore active flexion of the elbow. Palliative operations may be associated in order to stabilize the shoulder. In case of a complete C5 to T1 root avulsion, amputation at the distal humerus may be considered but is rarely performed combined with shoulder arthrodesis if the trapezius and serratus anterior muscles are functioning. The shoulder may also be stabilized by a ligament plasty using the coracoacromial ligament. In cases where the supraspinatus and long head of the biceps have recovered, but where active external rotation is absent, function may be improved by derotation osteotomy of the humerus. In partial C5,6 or C5,6,7 lesions, the indications for nerve repair and transfer are wider, as well as the indications for muscle transfers. In C5,6 lesions, a neurotization from the accessory nerve to the suprascapular nerve gives 60% satisfactory results; this is also true following treatment of C5,6,7 lesions, whereas restoration of active elbow flexion is obtained in 100% of cases in C5,6 lesions but only in 86% in C5,6,7 lesions. In cases where shoulder function has not been restored, palliative operations may be considered: arthrodesis or, more often, derotation osteotomy of the humerus which can be combined with transfer of the teres major and latissimus dorsi. II. Retro- and infraclavicular lesions of the brachial plexus. Twenty-five percent of the lesions of the brachial plexus occur in the retro- or infraclavicular region and involve the secondary trunks, most commonly the posterior trunk. Nerve repair should be performed early. The shoulder may be affected owing to involvement of the axillary nerve in cases of lesions of the posterior trunk, often associated with a lesion of the suprascapular nerve. Regarding the terminal branches (axillary, suprascapular and musculocutaneous nerves), spontaneous recovery may be expected in a significant proportion of cases but is often delayed (6-9 months), and the problem is to avoid unnecessary operations while not unduly delaying surgical repair in cases where it is indicated. MRI may be useful to delineate those cases where surgery is indicated: repair is usually performed around 6 months following trauma. Isolated lesions of the axillary nerve may be repaired with good results using a nerve graft. The lesion may occur in combination with a lesion of the suprascapular nerve; the latter may be interrupted at several levels. Proximal repair may be performed using a nerve graft; distal lesions are more difficult to repair and may require intramuscular neurotization. Lesions of the musculocutaneous nerve may be repaired with good results using a nerve graft. Lesions of the axillary nerve may be seen associated with lesions of the rotator cuff. The treatment varies according to the age and condition of the patient and according to the condition of the cuff muscles and tendons: in a young patient with avulsion of the tendons from bone, cuff reinsertion is indicated; in an older patient, the cuff must be evaluated by MRI or arthroscan, and repair is indicated unless the cuff tear is not amenable to surgery or there is fatty degeneration of the muscles. Palliative surgery may be indicated in cases seen late or after failed attempts at nerve repair. (ABSTRACT

Accessory Nerve↗
PubMed2004

Shoulder stiffness: diagnosis.

BACKGROUND: Pain and stiffness of the shoulder is a common complaint, particularly in the 40-80 years age group. There are several causes of painful, stiff shoulders, but the most common cause in the fifth decade of life is idiopathic capsulitis ('frozen shoulder'). OBJECTIVE: This article summarises the functional anatomy of the shoulder joint, the pathology of the conditions that lead to shoulder stiffness, and methods to differentiate them. DISCUSSION: Clinical history and examination is effective in differentiating rotator cuff tears, impingement and frozen shoulder. Restriction of glenohumeral joint motion, particularly in external rotation, with no abnormality on X-ray is strongly suggestive of the diagnosis of frozen shoulder. Plain true anteroposterior X-rays are important to identify glenohumeral joint arthritis. Ultrasound is often helpful for confirming or denying rotator cuff tears when there is doubt on the clinical examination.

Humans↗