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At least 757 records · Page 42Linked to original sources
PubMed1992

Functional evaluation of the shoulder after transfer of the vascularized latissimus dorsi muscle.

The function of the shoulder after removal of the vascularized latissimus dorsi muscle in seventeen patients was compared with the function of the shoulder in seventeen control subjects. Physical examination of the extremity and instrumented muscle-testing were used to evaluate both the patients and the control subjects, and the patients also completed a questionnaire. Thirteen patients rated the appearance of the donor extremity as good, and sixteen patients perceived no functional impairment of the donor extremity. The range of motion of both shoulders was symmetrical in eleven patients and fourteen control subjects. Manual muscle-testing showed normal strength of the latissimus dorsi bilaterally in seven patients and in thirteen control subjects. Nineteen instrumented isometric, isotonic, and isokinetic tests were performed to assess the strength of each shoulder of all of the patients and control subjects, and the results in these two groups were then compared. there was no statistically significant difference in the strength of the two shoulders between the patients and the control subjects, with the exception that the patients exhibited weakness in the amount of isokinetic torque during extension of the shoulder with the limb in a position of 60 degrees of flexion and at a speed of 60 degrees per second. On the basis of these findings, and because of the inherent inaccuracy of manual muscle-testing, we concluded that transfer of the vascularized latissimus dorsi muscle had little effect on the range of motion, muscular strength, and function of the donor shoulder in our patients.

Adult↗
PubMed2006

The frozen shoulder syndrome. Description of a new technique and five case reports using the subscapular nerve block and subscapularis trigger point infiltration.

BACKGROUND AND OBJECTIVES: A frozen shoulder is considered by some authors to be a common stage of many disorders affecting the shoulder, while others regard it as an independent idiopatic condition. A consistent finding is that subscapularis muscle trigger points play a key role in the development of the frozen shoulder syndrome. Apart from the conventional treatment, a selective subscapularis fossa nerve block combined with subscapularis trigger points infiltration, may be an effective treatment in preventing chronic pain. METHODS: In this manuscript the posterior injection technique of the subscapularis fossa nerve block is described. RESULTS: Five patients with typical symptoms of frozen shoulder, who did not respond to conventional treatment, but obtained pain relief after a combination of a subscapularis nerve block with the infiltration of trigger points, are presented. CONCLUSION: The results of this block in various painful situations of the shoulder region suggest the importance of subscapularis muscle in the etiology of the frozen shoulder. Using this technique, we could demonstrate that a subscapular nerve block and subscapularis trigger points infiltration have both a diagnostic and therapeutic value for the treatment of the frozen shoulder.

Adult↗
PubMed1991

[Assessment of shoulder function].

In 1980, a major study began on the recovery of shoulder function following injuries of various kinds. In order to try and assess shoulder function and it's recovery following injury, it became apparent that diagnostic assessments of the shoulder were of little value, and the Author worked on designing a method of shoulder functional assessment what would allow easy and repeated assessment of shoulder function at various intervals following injury. This method of shoulder functional assessment is now used as a standard practice in many centres, throughout the world, and this paper aims to present the clinical method of functional assessment, as used by the Author, in plotting progress following injury over a number of years. The method has been extensively used by the author and others over the past ten years, in studying the recovery of shoulder function in different disease processes, after injuries and after various treatments, including surgery.

Activities of Daily Living↗
PubMed1988

[Post-traumatic pain syndromes of the shoulder joint--differentiation and treatment].

The main symptom of posttraumatic trouble in the shoulder-joint is the painful immobility. We had to differentiate between genuine shoulder pain originating in shoulder alternation and shoulder pain in consequence of other diseases. Significant causes of posttraumatic shoulder pain are the impingement syndrome with tendon alteration or lesion or, due to fractures, the instable shoulder joint as well as shoulder rigidity. An exact diagnosis and, in consequence an exact treatment can only be accomplished basing on accurate history and specific clinical examination.

Humans↗
PubMed1984

[Significance of the limbus glenoidalis for the stability of the shoulder joint].

Besides the osseous structures and the muscular elements, the capsular and ligamentous apparatus, including the limbus genoidalis, is of utmost importance for the stability of the shoulder-joint. In the literature the limbus glenoidalis (L.G.) is generally described as a fibrocartilagineous structure comparable to the menisci of the knee-joint. Basically, the cause of a primary foreful shoulder-dislocation may be either a direct or an indirect trauma. The lesions during luxation concern the joint's capsula, the L.G. and the head of the humerus. However, in the literature one finds many different explanations as to which of those lesions is responsible for the subsequent development of recurring shoulder dislocation. The variability of concepts is reflected by the large number of operative procedures that are advised as treatment of a recurring dislocation. Assuming that the L.G. substantially contributes to the stability of the shoulder joint, we have investigated structure, blood-perfusion and anatomical connections of the L.G. The mechanism of the primary shoulder dislocation was simulated in mechanical strain-experiments, carried out on human corpse specimens. The occurring lesions were analysed. The following investigations were undertaken in alltogether 182 fresh specimens of human shoulder joints: measurement and calculation of the joint-surfaces of scapula and humeral head, dye-injection of the arteria axillaris, in order to demonstrate the vascular supply of the limbus glenoidalis, histological examination of the structure of the limbus glenoidalis, mechanical strain-experiments, that simulate the dislocation mechanism of the shoulder-joint. The calculations of joint-surfaces showed a relative decrease of the scapular joint-surface with growing age. The relation of the scapular joint-surface (always plus limbus glenoidalis) to the joint-surface of the humeral head is 1: 2.25 +/- 0.38 in men and 1: 2.20 +/- 0.11 in women (age-group: 20 to 49 years). In the age-group of 70 to 89 years the respective numbers are 1: 2.90 +/- 0.35 and 1: 2.99 +/- 1.04. The differences in the relations of surfaces between the different age-groups are statistically significant for both sexes (p less than 0.01; Student-t-test). The dye-injection showed that the main artery supplying the limbus glenoidalis is a branch of the arteria circumflexa scapulae. This branch is connected by several anastomoses with the arteriae circumflexa humeri anterior and posterior. These macroscopical observations were confirmed by histological and microangiographic examinations.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1982

Chronic unreduced dislocations of the shoulder.

We evaluated the results of treatment in twenty-three patients with twenty-four shoulder dislocations that had gone unreduced for at least three weeks. Fourteen dislocations were posterior, eight were anterior, and one each was superior and inferior. Seventy-nine per cent of the posterior dislocations had not been recognized by the initial treating physician. Fourteen shoulders (58 per cent) were operated on. Of seven that were treated by open reduction with preservation of the humeral head, the results in two were graded as excellent; in three, as good; and in two, as fair. A Neer total shoulder-replacement prosthesis was used in one patient with an excellent result, and a Neer humeral-head prosthesis was used in two patients with a good and a fair result. In four patients, the humeral head was removed and a Jones procedure was performed, with one good and three fair results. There were no poor results after surgical treatment and it was not necessary to arthrodese any shoulder. We did not find it necessary to transfix the shoulder joint by screws or pins, or to use plaster spica casts to maintain stability of the shoulder following open reduction. Supporting the arm at the side in a position posterior to the coronal plane for a posterior dislocation, and anterior to the coronal plane for an anterior dislocation, proved to be comfortable and effective. There were no postoperative dislocations using this simple method. These results show that the over-all prognosis for surgical treatment of the chronic unreduced dislocation shoulder is more favorable than has previously been reported. A rating system based on 100 units was used to evaluate our final results, and is recommended as a standard system for future comparative studies.

Adult↗
PubMed1993

Diagnosis of shoulder instability by examination under anesthesia.

A systematic method of examining the shoulder in anesthetized patients was developed. Humeral translocation on the glenoid was assessed in five directions and in three positions of arm rotation for four of these directions. Fifty-five patients thought to have shoulder instability were evaluated by history taking, physical examination, standard and special roentgenograms, examination under anesthesia, and either shoulder arthroscopy or operation. The findings at examination under anesthesia were compared with the pathologic conditions identified at arthroscopy or operation. Twenty-five shoulders had pathologic evidence of continuing instability: Bankart lesions in 19 and clearly excessive capsular laxity in six. All 25 had abnormal results on examination under anesthesia (no false-negative results). Thirty shoulders had no demonstrable pathologic condition. The results of examination under anesthesia were normal for 28 shoulders and abnormal for two (two false-positive results). The sensitivity of examination under anesthesia in these patients was 100%. The specificity and predictive value were 93%. Examination under anesthesia has proven to be reasonably precise in assessing shoulder stability. If the results of the examination are normal, more complex and invasive diagnostic testing may not be necessary.

Adolescent↗
PubMed1997

A self-administered questionnaire for assessment of symptoms and function of the shoulder.

A self-administered questionnaire was designed to assess the severity of symptoms related to and the functional status of the shoulder. It includes domains of global assessment, pain, daily activities, recreational and athletic activities, work, satisfaction, and areas for improvement. Each domain is graded separately and is weighted to arrive at the total score. The over-all scale and each domain were prospectively tested for validity, reliability, and responsiveness to clinical change. One hundred patients who were seen for evaluation of the shoulder were enrolled in the study. The validity of the scale was demonstrated by moderate-to-high correlation of the domains and individual questions of the Shoulder Rating Questionnaire with those of the Arthritis Impact Measurement Scales 2. Validity was supported further by significant correlation of the scores in each domain with the level of satisfaction in that domain and by significantly lower scores in domains that patients selected as areas important for improvement. The over-all scale and each domain were internally consistent (Cronbach alpha, 0.71 to 0.90). Reproducibility was evaluated by repeated administration of the questionnaire after a mean of three days to forty patients whose condition was clinically stable. Reproducibility of the over-all questionnaire and individual domains was excellent (Spearman-Brown index, 0.94 to 0.98). Individual questions were reproducible, with a weighted kappa value of more than 0.7 for each. Responsiveness was evaluated by comparison of the preoperative and postoperative scores of thirty patients who had a satisfactory result one year after an operation on the shoulder. The over-all Shoulder Rating Questionnaire and each domain were responsive to clinical change as demonstrated by favorable standardized response means (range, 1.1 to 1.9) and indices of responsiveness (range, 1.1 to 2.0). Similar analysis performed for individual diagnostic groups supported the validity, reliability, and responsiveness of the questionnaire in each group. The self-administered shoulder questionnaire was found to be valid, reliable, and responsive to clinical change. These qualities should make it a useful instrument for the prospective assessment of the outcome of treatment of disorders related to the shoulder.

Activities of Daily Living↗
PubMed1997

A biomechanical study of fast throwing movements of the shoulder in baseball pitching.

OBJECTIVE: To define the biomechanic function of the shoulder in fast throwing movements in baseball pitching. METHODS: Using NAC high-speed video and PIAS LA-555 computer system, overhand pitching movements carried out by 12 healthy Japanese professional baseball pitchers were analyzed in three dimensions. The pitching motion was displayed as stick to sick figures dynamically. RESULTS: Pitching motion was a combination of translational and rotational movements. Acceleration and deceleration, being two typical motion patterns, worked sequentially through the anatomic link system from the pivot leg to the pitching hand. During the acceleration phase, the shoulder joint acted as a junction point and a fulcrum, supporting the rotational acceleration motion, shoulder forward flexion and elbow extension. According to the changing glenohumeral angles of the pitching shoulder, shearing force turned into tension force which worked on the anterior shoulder structures and then shifted to the posterior part of the joint. CONCLUSIONS: In fast throwing motion, the shoulder functions as an important fulcrum to support the pitching arm during the acceleration phase. Avoiding excessive stress and shearing force on the joint components and enhancing coordination of muscle action are important to a successful throwing motion and the prevention of shoulder injury.

Athletic Injuries↗
PubMed1998

[Shoulder joint instability after primary arthroplasty].

Instability is one of the most common complications after shoulder arthroplasty. The literature cites subluxation or luxation to occur between 0% and 38% in various studies. Instabilities may present either as subluxation or frank dislocation, and may be directed in an anterior, posterior, inferior or, depending on the state of the rotator cuff, cranial direction. The stability of any shoulder joint is given by the balance of the muscles directing the forces around the shoulder joint in association with the passive stabilizers of the shoulder joint capsule as well as the bony contours between glenoid and humeral head. Any disturbance of this delicate balance will lead the shoulder into instability, particular so if bony erosion patterns such as posterior glenoid wear in osteoarthritics will develop subluxation early on. Therefore implantation of any prosthesis is required to be done in the appropriate version as to avoid secondary instability through the prosthetic components. In the study undertaken here instability was found to be the most common complication in 44 shoulder revision surgeries. The result with an average Score of 41.9 recorded after Constant demonstrates that the excellent and good results obtained with primary arthroplasties can not be expected in revision surgery. Posterior instability may be present just as well as the more easily observed anterior instability. Separate to frank luxation or instability is the late cranialisation of the rotator cuff deficient shoulder which, although resulting in many cases in superior anterior subluxation, will mostly be seen as a late complication after arthroplasty.

Arthroplasty, Replacement↗
PubMed1976

[Effect of muscular dysfunction on the development of shoulder joint in children with Erb's paralysis].

In order to evaluate the disturbances of development of the shoulder joint in children with Erb's paralysis the authors conducted an X-ray examination of the shoulder girdle and the shoulder in the anterior-posterior projection. The assessment of the functional state of the muscles of the shoulder girdle was made with the aid of clinical EMG. It was established that there was a retardation of growth and ossification of the radial head of the humerus on the affected side, a decrease in the longitudinal and cross-sectional sizes of the humerus, a retardation in the development of the joint scopular cavity, disorders in spacial interrelationship in the components of the shoulder joint and internal rotation of the shoulder joint. The structural and anatomical changes in the components of the shoulder joint are associated with disorders of the neurotrophic processes in the bone tissue and the muscular dysbalance.

Adolescent↗
PubMed2001

Advances in the management of traumatic anterior and atraumatic multidirectional shoulder instability.

Dislocation of the shoulder is a common and often disabling injury to an athlete. Most shoulder dislocations are traumatic in origin, occur in the anterior direction and result in stretching and detachment of the anterior capsule and labrum. The most frequent adverse sequel of shoulder dislocation is recurrence--an event that occurs most commonly in active individuals and less frequently with age. In the past, many operative procedures failed to address the anatomical disruptions of shoulder instability. Recently, an enhanced understanding of shoulder instability pathoanatomy and significant technological advances have resulted in surgical procedures for shoulder instability that are less interventional and have focused on restoring disrupted static constraints.

Humans↗
PubMed2006

Conservative management following closed reduction of traumatic anterior dislocation of the shoulder.

BACKGROUND: Acute anterior dislocation is the commonest type of shoulder dislocation and usually results from an injury. Subsequently, the shoulder is less stable and more susceptible to redislocation, especially in active young adults. OBJECTIVES: To compare methods of conservative (non-surgical) management versus no treatment or different methods of conservative management after closed reduction of traumatic anterior dislocation of the shoulder. Interventions include methods of postreduction immobilisation and rehabilitation. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE, EMBASE, the National Research Register (UK), conference proceedings and reference lists of articles. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing various conservative interventions versus control (no or sham treatment) or other conservative interventions applied after closed reduction of traumatic anterior dislocation of the shoulder. DATA COLLECTION AND ANALYSIS: All authors selected trials, assessed methodological quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: One flawed quasi-randomised trial was included. A "preliminary report" gave the results for 40 adults with primary traumatic anterior dislocation of the shoulder treated by post-reduction immobilisation with the arm in either external or internal rotation. There was no statistically significant difference between the two groups in the failure to return to pre-injury sports by previously active athletes, in redislocation or shoulder instability. Similar numbers of participants of the two groups removed their immobiliser before one week had passed. AUTHORS' CONCLUSIONS: There is a lack of evidence from randomised controlled trials to inform the choices for conservative management following closed reduction of traumatic anterior dislocation of the shoulder. Sufficiently powered, good quality, well reported randomised controlled trials with long-term surveillance of conservative management are required. In particular, trials examining the type and duration of immobilisation would be useful.

Humans↗
PubMed1986

Clinical experience with total arthroplasty and hemiarthroplasty of the shoulder using the Neer prosthesis.

A consecutive series of 28 shoulders in 26 patients, treated since 1982 by either total arthroplasty (11 shoulders) or hemiarthroplasty (17 shoulders), are reviewed. A glenoid osteotomy was also performed in five of the shoulders with a hemiarthroplasty. Overall 16 shoulders were completely satisfactory with little pain and satisfactory movement. Nine had a total arthroplasty. The average range of shoulder elevation after total arthroplasty (121 degrees +/- 29 degrees) was significantly better than after hemiarthroplasty (91 degrees +/- 39 degrees). Pain was still present in seven shoulders with a hemiarthroplasty but in only one with a total joint replacement.

Adult↗
PubMed1992

The frozen shoulder: diagnosis and treatment. Prospective study of 50 cases of adhesive capsulitis.

A prospective study of randomized analysis treatment of 50 cases of frozen shoulder was carried out in 3 Swiss medical centres. Three separate aetiological groups were studied: post-traumatic (40%), neurological (14%) and idiopathic (46%). An increased radioisotope bone scan (99 mTc diphosphonate) was found in 96% of cases, regardless of aetiology. The so-called idiopathic frozen shoulder showed a scapulo-humeral increase in radioisotope uptake in several areas (in 82% of cases) without involvement of the ipsilateral carpus. Clinically, the neurological type was associated with a shoulder-hand syndrome with positive bone scan of the shoulder and the wrist in all cases. The post-traumatic type showed a diffuse (in 50% of the cases) or at several circumscribed areas (also in 50%) increase in radioisotope uptake in the shoulder. In 45% of the post-traumatic type, there was also a shoulder-hand syndrome with uptake in the wrist also. A physical treatment and early mobilization, associated with the administration of subcutaneous salmon calcitonin for 21 days (100 U Calcitonin Sandoz) had a statistically significant increased effect on pain compared to treatment with physiotherapy alone by patients with post-traumatic frozen shoulders (p < 0.02). There was no significant difference, however, in the speed of recovery of function between the two treatment groups. These observations strengthen the hypothesis that adhesive capsulitis behave like an algoneurodystrophic process.

Adult↗
PubMed1992

Thermography of frozen shoulder and rotator cuff tendinitis.

The role of thermography in the diagnosis of soft tissue lesions of the shoulder was evaluated by screening 28 patients with unilateral frozen shoulder and 86 patients with unilateral rotator cuff lesions. Index shoulders were then compared with the normal side. Differences in skin temperature distribution were found in 82% of subjects with frozen shoulder, nearly three-quarters of whom had reduced skin temperature. There was no consistent pattern of shoulder skin temperature found in rotator cuff tendinitis patients (49% normal, 28% reduced, 23% increased). Thermography can be helpful in the diagnosis of frozen shoulder but further studies are required to determine whether it is useful in other soft tissue shoulder lesions.

Adult↗
PubMed2002

[Shoulder metastasis as the initial manifestation of hepatocellular carcinoma (HCC)].

BACKGROUND: Primary diagnosis of hepatocellular carcinoma (HCC) by a shoulder metastasis is a rare event. HISTORY AND CLINICAL FINDINGS: A 68-year-old man was admitted with swelling of his left shoulder. No further clinical symptoms. Alcohol consumption: 1 l beer/day. On ultrasound, the clinically impressing tumor of the left shoulder showed calcifications. INVESTIGATIONS: Histologic examination of the tumor of the shoulder showed a well-differentiated, trabecular carcinoma consistent with the metastasis of an HCC. Subsequent ultrasound of the abdomen gave evidence of liver cirrhosis. In addition, an infiltrating mass was found, which encompassed 75% of the right liver lobe and was subsequently shown by histology to be a well-differentiated HCC with identical features of the tumor of the shoulder. Further metastases with pathologic rib fractures were found on CT scan of the thorax. DIAGNOSIS: Based on clinical findings, laboratory investigations and imaging studies, the patient suffered from an HCC owing to ethyl-toxic liver cirrhosis stage Child C, and initially presented with a shoulder metastasis. THERAPY: Due to the advanced tumor stage, no curative or palliative therapy was administered. CONCLUSION: This is an interesting case of an atypical primary diagnosis of HCC. The most important information was given by the pathologists who raised the suspicion of a metastasizing HCC by examining the tumor of the shoulder.

Aged↗
PubMed2004

[Evaluation of shoulder arthroplasty in treatment of four-fragment fractures of the proximal humerus].

The dislocated four-fragment fracture of the proximal humerus is a problematic fracture. In this study we evaluated shoulder function after implantation of a shoulder hemiprosthesis of the anatomical generation. The evaluation was based on a case-control study in which the following information was gathered: epidemiology, Constant-Murley score, compliance score, radiological results, and a summary of complications. Twenty shoulder prostheses were implanted between September 2000 and August 2002. After an average follow-up time of 14 months, the average Constant score was 52. The score for the opposite shoulder was 91 points. The function found to be most limited was shoulder movement. The subjective estimation of shoulder function had a mean value of 49% and correlated with the Constant score. Fourteen of the patients exhibited a postoperative defect in the tuberculum majus. Implantation of shoulder hemiprostheses allows treatment of four-fragment fractures of the humerus head in older patients, whereby limitations of mobility and function are to be expected.

Aged↗