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PubMed1991

Clinical reliability of shoulder function assessment in patients with rheumatoid arthritis.

A model for functional assessment and a dynamic test of the shoulder joint were designed and tested for normal variation and clinical inter- and intra-rater reliability. The functional assessments, which covered four common shoulder functions, were compared with assessments of pain, recordings of active motion range and the results of a Health Assessment Questionnaire, in eight patients with rheumatoid arthritis according to the ARA criteria. Intra-rater reliability was satisfactory for all four functions and inter-rater reliability was satisfactory for the hand-raising and hand-to-opposite-shoulder functions but less so for hand-behind-back and hand-to-neck. A second test-retest study in 15 patients, with a slight modification of one of the functional tests, confirmed the results and improved the reliability of the modified test. The reliability of the dynamic test and of the active motion range measurement was less satisfactory or not satisfactory. No significant correlation was found between shoulder functional assessment and the Fries index, but there were positive significant correlations between active motion range and shoulder functions. It is concluded that the method presented for evaluating shoulder functions has satisfactory reliability and in the first test-retest study was more reliable than conventional motion range measurement of the shoulder joint.

Adult↗

PubMed1980

Immobilization after primary dislocation of the shoulder.

A total of 226 patients with primary shoulder dislocation were followed up for 1 year, the primary object being to observe the effect of immobilization on the incidence of redislocation. The shoulders were immobilized in a mitella for 1 week in all the 127 patients older than 50 years of age, and in 53 of the patients under 50 years of age. The shoulders of the remaining 46 patients (under 50 years) were completely immobilized with a stockinette-Gilchrist bandage for a period of 3 weeks. Thirteen per cent (30/226) suffered from one to four redislocations each during the follow-up period. Because most recurrences occurred in the patients under 30 years of age, these patients were compared with the older ones in the analysis. The frequency of redislocation was higher in the group of 53 patients under 30 years than in the older subgroup (P less than 0.001). Twenty-six of these 53 patients (under 30 years), who had been immobilized for 1 week, presented a higher frequency of redislocation than the remaining 27 patients subjected to 3 weeks' immobilization (P less than 0.05). Manual labourers experienced more numerous redislocations than office workers (P less than 0.01). The greater the initial trauma to the shoulder, the lower was the incidence of recurrence. There were only two among the 57 patients with early complications of the primary shoulder dislocation who had a redislocation (P less than 0.001). Residual stiffness was encountered more often in the patients over 30 years than in the younger ones (P less than 0.001). Following primary shoulder dislocation, 1 week's immobilization in a sling is sufficient in patients over 30 years, while in the case of most of the younger patients 3 weeks' complete immobilization of the shoulder is recommended.

Adolescent↗

PubMed2004

Work-related risk factors for the incidence and recurrence of shoulder and neck complaints among nursing-home and elderly-care workers.

OBJECTIVES: This study assessed the differences and similarities in the incidence and recurrence of shoulder and neck complaints with respect to work-related physical, psychosocial, and personal risk factors. METHODS: A prospective cohort study was carried out among 769 workers of nursing homes and homes for the elderly. At baseline, a questionnaire was used to collect data on personal characteristics, physical workload, psychosocial workload, and the presence of shoulder and neck complaints. After 1 and 2 years, follow-up data were collected on shoulder and neck complaints. Generalized estimation equations were used for analyzing risk factors for the participants with at least one follow-up measurement available (N=556, 72%). RESULTS: In the multivariate model, adjusted for age and gender, obesity [odds ratio (OR) 2.12, 95% confidence interval (95%CI) 1.23-3.65] was related to the incidence of shoulder complaints. The incidence of neck complaints was increased for obesity (OR 1.81, 95% CI 1.07-3.05), work in awkward postures (OR 1.76, 95% CI 1.11-2.78), and poor or fair general health (OR 1.53, 95% CI 1.02-2.31). The recurrence of both shoulder and neck complaints was associated with chronic complaints at baseline (shoulder: OR 1.91, 95% 1.36-2.67; neck: OR 1.71, 95% 1.14-2.55) but not with work-related risk factors. CONCLUSIONS: The results suggest that there are differences in risk factors for the incidence and recurrence of shoulder and neck complaints.

Adult↗

PubMed2004

Neck and shoulder symptoms and disorders among Danish computer workers.

OBJECTIVES: Neck and shoulder pain and disorders were studied among frequent computer users, and the associated effect of mouse and keyboard use was evaluated. METHODS: Technical assistants and machine technicians were followed for 1 year. Questionnaires were sent to 9480 persons (initial response 73%, follow-up response 82%). Computer use information was obtained from the questionnaires. Symptom cases at baseline and follow-up were clinically examined using a standardized clinical protocol. The main outcomes were self-reported pain symptoms in the neck and right shoulder and clinical cases of rotator cuff syndrome, tension neck syndrome, and neck-shoulder pain with pressure tenderness. RESULTS: The prevalence of moderate-to-severe pain in the neck and right shoulder was 4.1% and 3.4%, respectively, and the 1-year incidence for no or minor baseline symptoms was 1.5% and 1.9%, respectively. At baseline, the prevalence rate ratio (PRR) for neck pain was 1.7 [95% confidence interval (95% CI) 1.1-2.6] for mouse use >25 hours/week, that for right shoulder pain increased from 1.6 (95% CI 1.1-2.4) for 15-19 hours/ week to 2.5 (95% CI 1.4-4.3) for >30 hours/week of mouse use, and that for tension neck syndrome increased from 3.5 (95% CI 1.0-12) for 25-29 hours/week to 4.7 (95% CI 1.2-18) for >30 hours/week of mouse use. The relative risk (RR) for new neck pain was 1.8 (95% CI 0.8-3.9) for keyboard use > or = 15 hours/week and increased to 2.4 (95% CI 0.8-6.8) for > or = 30 hours/week. New right-shoulder pain symptoms were associated with mouse use >20 hours/week (RR 1.9, 95% Cl 1.0-3.5, and RR 3.3, 95% CI 1.2-8.9) and with keyboard use >15 hours/week (RR 2.2, 95% CI 1.0-4.9). CONCLUSIONS: Mouse use is associated with an increased risk of moderate-to-severe pain in the neck and right shoulder, and an association with tension neck syndrome is possible.

Cohort Studies↗

PubMedDate not supplied

Diagnosis of shoulder instability in dogs and cats: a retrospective study.

The glenohumeral joint is a remarkable articulation providing the greatest range of motion of any joint in the body. Glenohumeral stability results from several mechanisms, including those that do not require expenditure of energy by muscle ("passive mechanisms") and those that do ("active mechanisms"). Glenohumeral instability has been recognized in 47 shoulders of 45 dogs and one cat. Cases are presented because of chronic foreleg lameness. Shoulder joint pain is obviated by the orthopedic examination. Only 57% of the involved shoulders presented with degenerative joint disease. Signs of instability are recognized under anesthesia using a craniocaudal or mediolateral drawer sign or both. This report describes the radiographic and arthroscopic findings of shoulder instability. Arthroscopy of the shoulder joint allows identification of all intra-articular pathologies. Shoulder instability, not fully recognized in the past, appears to be the most common cause of shoulder lameness in the dog.

Animals↗

PubMed1995

Rotator cuff insufficiency in the arthritic shoulder: treatment alternatives.

Shoulder arthroplasty can relieve the pain and improve the functional status of an arthritic shoulder. Because of the unique anatomic characteristics of the glenohumeral joint, the rotator cuff provides stability and control of shoulder motion. Thus, an intact, functioning rotator cuff is necessary for successful shoulder arthroplasty. There are clinical situations where the rotator cuff is torn, absent, or incompetent and an arthritic condition affects the shoulder. The patient must understand that, when confronted with rotator cuff insufficiency and shoulder arthritis, the goal of surgical treatment is limited to pain relief, with shoulder function often limited by the condition of the rotator cuff. We will discuss the incidence of rotator cuff disease associated with differing arthritic conditions, the treatment options available, and expected outcomes in these difficult and challenging clinical situations.

Arthritis↗

PubMed1999

[Arthroplasty with a mobile cup for shoulder arthrosis with irreparable rotator cuff rupture: preliminary results and cineradiographic study].

PURPOSE OF THE STUDY: Management of patients with massive irreparable rotator cuff tears associated with severe glenohumeral joint degeneration presents a difficult clinical challenge. The present study reports on 24 patients with disabling shoulder pain due to rotator cuff arthropathy treated using a bipolar arthroplasty. MATERIAL AND METHODS: Between 1995 and 1997, a bipolar shoulder arthroplasty (Biomet, Warsaw, In) was used in 24 patients (25 shoulders) with rotator cuff arthropathy. Patients were monitored for an average of 14.5 months (range 12 to 24 months). The coracoacromial ligament was maintained in all patients to provide anterosuperior stability. The rotator cuff was irreparable and no attempt was made to cover the superior defect. Postoperative results were reviewed with the Constant score and the Swanson score. In order to verify the head-shell motion and to analyze the dynamic comportement of bipolar arthroplasties, we recorded anterior active elevation and active rotations with video-fluoroscopy. RESULTS: At final the follow-up, 21 shoulders had no or slight pain. Average active flexion improved to 84.8 degrees after operation from 62.4 degrees beforehand. 13 patients achieved more than 90 degrees of active flexion after operation. Active external rotation improved from a mean 3 to 28.8 degrees. Before surgery the average Constant score was 17.62. Postoperatively, the average Constant score was 46.97 and the average Swanson score was 23.13. Complications requiring reoperation occurred in 2 cases: 1 component dislocation (Head-shell), 1 subluxation of the long head of the biceps. Radiographic evaluation at follow up demonstrated no humeral stem loosening or component migration and no bony erosion of the coracoacromial arch. Rupture of the infraspinatus tendon (absolute Constant score: p = 0.04, adjusted Constant score: p = 0.02, Swanson score: p = 0.03, Functional score: p = 0.04), preoperative anterior subluxation of the humeral head (absolute Constant score: p = 0.03, adjusted Constant score: p = 0.05, anterior elevation: p = 0.01, functional score: p = 0.04), preoperative narrowing of the acromio-humeral interval (adjusted Constant score: p = 0.02, overall mobility: p = 0.02, anterior elevation: p = 0.03) may jeopardize the subsequent success of bipolar shoulder arthroplasty. The results of this study suggest that the radius curvature of the shell must match that of the bony surface of the glenoid and the coracoacromial arch (absolute Constant score: p = 0.003, adjusted Constant score: p = 0.005, overall mobility: p = 0.002, anterior elevation: p = 0.0008, functional score: p = 0.002). Recording of anterior active elevation with video-fluoroscopy allowed to identify 3 different types of movements after bipolar shoulder arthroplasty. Recording of internal and external rotation allowed to distinguish 2 differents types of movements. Motion appeared to occur between the bipolar shell and the head. The amount of motion was variable and depended on the biomechanics. DISCUSSION AND CONCLUSION: Bipolar shoulder arthroplasty is an effective surgical option for patients with massive irreparable tears of the rotator cuff with concomitant glenohumeral arthritis. Satisfactory pain relief and modest gains in motion result in significant functional improvement in this "low functional demand" population. Predictive factors have been identified and should be discussed before surgery.

Activities of Daily Living↗

PubMed2000

Improving the selective use of plain radiographs in the initial evaluation of shoulder pain.

OBJECTIVE: In a previous retrospective study, we had found that shoulder radiographs were overused in the initial evaluation of patients presenting to the emergency department with shoulder pain. Our objective was to prospectively define clinical criteria that identify patients who have a low risk of radiographic findings that influence the management of the initial evaluation of shoulder pain in the emergency department. METHODS: All adult patients presenting to the emergency department of a university teaching hospital with shoulder pain were eligible to participate. Patients with deformities, penetrating wounds, referred pain, and those presenting for followup were excluded. Data were recorded prospectively using a standardized form. All radiographs were classified as therapeutically uninformative (TU) except fracture, acromioclavicular joint separation (> or =Grade 3), infection, or malignancy. A classification tree was used for analysis. RESULTS: Two hundred six patients had shoulder radiographs, of which 88% were TU. The model yielded 3 sets of low risk patients with a high percentage of TU radiographs: (1) no fall, no swelling (99% TU: 106 TU, 1 radiograph with lytic lesions in a cancer patient); (2) a fall, but no swelling, and no pain at rest (100% TU, n = 18); (3) a fall and pain at rest, but no swelling and normal range of motion (100% TU, n = 10). Not performing radiographs on these low risk patients would have decreased radiograph utilization from 52 to 18% of all shoulder patients seen. CONCLUSION: Our findings suggest that specific clinical criteria are able to identify patients who do not need radiographs as part of the initial management of shoulder pain. Prospective validation of these criteria are needed to confirm that these low risk patients can be safely evaluated without radiographs.

Adult↗

PubMedDate not supplied

Shoulder pathology associated with symptomatic acromioclavicular joint degeneration.

We report the incidence and nature of shoulder disease found in association with symptomatic degenerative change in the acromioclavicular joint in 218 shoulders. Coexisting pathologic conditions were present in 213 shoulders: rotator cuff degeneration in 176 shoulders (79 with complete thickness tears), labral tears in 72, glenohumeral degeneration in 31, and biceps tendon disease in 49. In 59 shoulders findings were unexpected. We looked specifically at 2 age groups: <50 years and > or =50 years. In the <50 years group labral tears were seen in 42% (30 of 71) and rotator cuff disease in 65% (46 of 71). Cuff tears tended to be incomplete. In the older age group only 14% (21 of 147) had an intact cuff, with 72 shoulders having a full-thickness tear. Labral tears were seen in 29% (42 of 147). We recommend that all patients undergo shoulder arthroscopy at the time of acromioclavicular surgery.

Acromioclavicular Joint↗

PubMed2001

[Acute anterior instability of the shoulder: short- and mid-term outcome after conservative treatment].

PURPOSE OF THE STUDY: We assessed short and mid-term outcome after emergency care for acute anterior instability of the shoulder. MATERIALS AND METHOD: Between October 1990 and May 1996, 233 shoulders (206 anteromedial dislocations, 21 dislocations with spontaneous reduction, and 6 painful shoulders with unknown instability) were treated, mainly orthopedically. The series included 165 men and 68 women, mean age 42 years (range 13-95 years). One hundred fifty-eight practiced sports more or less regularly (73% of the 216 patients) and a sports accident was involved in 121 cases (52.8%). Besides the usual lesions secondary to bone displacement, there were 51 fracture-avulsions of the greater tuberosity, 7 major fractures of the anteroinferior border of the glenoid cavity, 2 fractures of the coracoid process, 10 nerve lesions (6 axillary nerve palsies and 4 partial palsies of the brachial plexus) and 10 rotator cuff tears. Orthopedic reduction was performed in the emergency room in all patients with a dislocated shoulder (82%). Immobilization, elbow to body, was prescribed for 8 to 15 days. Sixteen patients (6.8%) underwent surgery during the days following reduction, 8 for displaced fracture of the greater tuberosity, 7 for important fracture of the glenoid cavity and 1 for avulsion of the rotator cuff. RESULTS: Patient files (n=210) or phone interviews (n=185) were used to assess outcome. Mean follow-up was 38 months (12 - 72 months). All nerve lesions regressed within a few weeks without sequelae. We had 6 cases of retractile capsulitis and 4 cases of reflex dystrophy that regressed totally in 3 to 6 months. Recurrent dislocation was observed in 52 cases (24.7% recurrence rate) with 29 occurring within one year (55.8%). Among the 145 other shoulders, 84 recovered completely (58%), 52 were occasionally bothersome (36%), 8 exhibited repeated subdislocation (5.5%) and one remained pseudoparalytic. Among the factors favoring recurrence, we found patient age (higher risk in younger subjects) and lack of rehabilitation (p<0.05). DISCUSSION: Acute anterior dislocation of the shoulder is frequent, but emergency surgical repair is rarely needed (15 cases in our series, 6.9%). Mid-term recurrence is not as frequent as is often thought, warranting the choice of first intention orthopedic care. Our findings demonstrated that emergency surgery is not indicated in most cases of anterior shoulder instability, even with the arthroscopic approach, especially since the results of this method remain unclear.

Accidents↗

PubMed2001

Features of shoulder dystocia in a busy obstetric unit.

OBJECTIVE: To assess the incidence and complications of shoulder dystocia and whether those complications could be avoided. STUDY DESIGN: Retrospective analysis of shoulder dystocia between 1996 and 1999 to determine whether macrosomia, diabetes, height of head at full dilatation, length of second stage or instrumental delivery could predict shoulder dystocia. Fetal asphyxia, brachial plexus injury, maneuvers used to free the shoulders and experience of the attendant were also assessed. RESULTS: There were 56 cases of shoulder dystocia in 24,000 births, 59% after spontaneous delivery. McRoberts maneuver was used in 48 deliveries but sufficed as a solitary procedure in nine cases. The addition of suprapubic pressure was sufficient for 25 patients and 27 when bilateral episiotomy was also used. Corkscrew procedures were required in 12 patients. Midwives were involved in 35 cases and required assistance in 27. Macrosomia > 4,000 g was a feature in 20 infants and diabetes in 6. Neither the height of the head nor the length of the second stage was helpful. There were 13 cases of Erb's palsy, seven after vacuum delivery and six after spontaneous delivery. Eight of these cases were associated with McRoberts procedure and suprapubic pressure, two with no procedure and three with the corkscrew procedure. CONCLUSION: If all infants > 4,000 g had been delivered by cesarean section, there still would have been 36 cases of shoulder dystocia. If the ultrasonically estimated weight were used to select patients for cesarean section, seven cases would have been diagnosed. To lessen the degree and incidence of fetal injury, labor ward staff are urged to become as familiar as possible with the techniques of freeing the shoulders.

Asphyxia Neonatorum↗

PubMed2001

Shoulder instability. Diagnosis and management.

BACKGROUND: The shoulder is the most commonly dislocated joint in the body. The most frequent complication of shoulder dislocation is recurrence, occurring most often in young athletes. OBJECTIVE: To summarise the functional anatomy of the shoulder joint, the structures damaged following shoulder dislocation and the methods to evaluate and treat shoulder instability. DISCUSSION: Clinical history is effective for diagnosing obvious shoulder instability. The O'Brien's sign (for superior labral lesions), the sulcus sign (for capsular laxity) and the apprehension sign (for anterior instability) are helpful clinical tests for more subtle instabilities. Labral disruptions and capsular laxity can often be restored by minimally invasive (arthroscopic) methods. Rehabilitation aims to enhance the dynamic muscular and proprioceptive restraints to shoulder instability.

Exercise Therapy↗

PubMed1998

[Clinical study on traumatic anterior instability of shoulder].

OBJECTIVE: To study the clinical diagnosis, conservative and surgical treatment of traumatic anterior instability of the shoulder. METHOD: Based on the experience in diagnosis and treatment of 41 patients, we put forward criteria for diagnosis and treatment of traumatic anterior instability of the shoulder. RESULT: Diagnostic criteria: (1) history of injury to the shoulder; (2) sharp pain in the anterior aspect of the shoulder and weakness and limitation of range of motion of the shoulder; (3) the positive apprehension sign and or anterior drawer test; (4) a Hill-Sachs bony lesion on roentgenogram and abnormal double contrast CT. TREATMENT: (1) rehabilitation program for the patients having symptoms less than 3 months and without anterior capsular rupture; (2) capsular repair and imbrication procedure for the patients having symptoms more than 3 months, or not satisfied to the rehabilitation treatment, or severe anterior capsular rupture on double contrast CT. The results of the treatment were satisfactory with average 16-month follow-up. CONCLUSION: The diagnostic criteria and the treatment principles help improve the results of treatment of shoulder injuries, further clinical study is needed for traumatic anterior instability of the shoulder.

Adult↗

PubMed2001

[Shoulder pain after laparoscopic cholecystectomy].

OBJECTIVE: To detect the mechanism of shoulder pain after laparoscopic cholecystectomy(LC). METHODS: Ninety patients who had receive LC were randomly divided into three groups (each 30 patients): group A, no management after LC; group B, absorption of residual CO2 after LC; group C, O2 insufflation for three times followed by complete absorption of CO2 after LC. PO2 and PCO2 before and after LC were recorded. Postoperative shoulder pain was assessed with shoulder pain's rate and level. RESULTS: The PO2 difference of group C between before and after LC was significant as compared to groups A and B(P < 0.05). Postoperative shoulder pain developed in 13 patients (43.33%) of group A, in 8 (26.67%) of group B, and 21 (70%) of group C (P > 0.05 A vs B; P < 0.05 A vs C; and P < 0.01 B vs C). The shoulder pain's level was higher in group C than in groups A and B. CONCLUSIONS: Direct irritation to the diaphragm due to the residual CO2 pneumoperitoneum is not the main cause of shoulder pain. The excessive traction of the triangular ligament and over-stretching of the diaphragmatic fibers due to insufflation are the main cause of shoulder pain.

Carbon Dioxide↗

PubMed2002

A method for estimating torque-vector directions of shoulder muscles using surface EMGs.

In this study, a new method is proposed to estimate the torque-vector directions of each shoulder muscle. The method is based on a multiple regression model that reconstructs shoulder torque, which is calculated from the hand force and posture, from the surface EMG of many muscles recorded simultaneously. The torque-vector directions of eleven shoulder muscles of four subjects were obtained at up to 30 different arm postures with this method. The mean confidence interval (p < 0.05) of the estimated torque-vector direction of each subject was 7.7-10.6 degrees. The correlation coefficient between the measured shoulder torque and reconstructed shoulder torque was between 0.76-0.84. The results for majority of the muscles were in accordance with previous studies, and reasonable from the viewpoint of anatomy. The torque-vector directions of a muscle, which are estimated with this method, have more of a functional meaning than a pure anatomical or mechanical one. These indicate the direction of the shoulder torque accompanying the muscle activation for a normal shoulder action that involves the cooperative contraction of many muscles.

Adult↗

PubMed2002

[Painful or unstable shoulder after coracoid transfer: result of surgical treatment].

INTRODUCTION: The purpose of this study was to investigate the results of revision surgery for complications related to previous coracoïd transfer for recurrent anterior instability of the shoulder. MATERIALS AND METHODS: Seventeen patients with previous surgery for anterior shoulder instability underwent a new surgical procedure, because of recurrent instability in 10, and painful shoulder with limitation of motion in 7. A soft tissue procedure (Bankart and/or capsuloplasty) was performed in the 10 unstable shoulders, and a joint debridement with removal of the coracoid transfer in the 7 painful shoulders. The subscapularis was found to be normal in only 2 cases, fibrotic in 11, thin in 3, and teared in 1. The interval between the initial procedure and the revision surgery was eleven years on average. RESULTS: At an average of 21 months follow-up, the patients were evaluated according to the Duplay scoring system. A radiographic analysis was also performed for all the patients, and a CT-examination for fourteen. The results were good or excellent for 11 patients (70% in the soft tissue procedure group, and 57% in the debridement group with removal of the coracoid transfer), fair for 4, and poor for 2. Clinical evaluation of the subscapularis showed a lag of muscle function in 10 patients. Strength in internal rotation was 3.3 kg lesser in the operated shoulder compared to the opposite side. CT-examination showed that 4 patients presented a significantly fatty degeneration of the subscapularis. Finally on radiographic examination, osteoarthritis was present in 9 patients.The most important preoperative factor that affected the final results was the number of previous surgical procedures. DISCUSSION: Recurrent instability, problems related to the bone graft or ostheosynthesis material, osteoarthritis, and neurological damage can complicate a coracoid transfer procedure. Our study shows that this procedure can also induce irreversible damage to the subscapularis muscle. CONCLUSION: Revision surgery for complications related to coracoid transfer for anterior shoulder instability is a challenging procedure. Only 2/3 of patients achieved excellent or satisfactory results. Patients with recurrent instability had better results than those with painful impingement and or osteoarthritis. The high rate of late osteoarthritis and irreversible damage of the subscapularis muscle remain sources of concern.

Debridement↗

PubMed2003

[Chronic anterior shoulder dislocation treated by open reduction sparing the humeral head].

PURPOSE OF THE STUDY: Treatment options for unreduced anterior dislocation of the shoulder have varied from nonoperative treatment to different surgical options. Little has been written in the literature on the management of unreduced anterior dislocation or on the results of the different procedures. We report our experience and present the outcome after an open reduction joint-saving procedure used in five patients. MATERIAL AND METHODS: Five patients, mean age 39 years (range 17-69 years) underwent the joint-saving procedure for chronic anterior shoulder dislocation. Pain was predominant for two patients and functional impairment for three. The shoulder had been anteriorly dislocated for six weeks to up to 36 months (average 14 months). Open reduction was performed in all cases with reinsertion of the capsulo-labral complex onto the anterior glenoid rim. A bone graft was used in one patient to reconstruct an anterior glenoid bone defect involving more than half of the joint surface. No graft was used to fill the humeral head defect. RESULTS: At an average follow-up of 25 months (range 12-36 months), outcome was excellent in one patient, good in three, and poor in one (Rowe and Zarins score). Postoperatively, the overall score averaged 75 points (range 40-90). Pain score improved from 12 to 27 points. Three shoulders were totally pain free and two had mild to moderate pain. Motion improved from 12 to 28 points. Anterior active elevation averaged 126 degrees, external active rotation 17 degrees, and internal active rotation to the level of the first lumbar vertebral body. Functional score improved from 9 to 20 points. All the patients were able to perform daily living activities. The radiographic evaluation showed anterior subluxation of one shoulder one year after surgery. Osteoarthritis was also noted in one patient. No peroperative or postoperative complication was seen. DISCUSSION: Unreduced anterior shoulder dislocation should be treated with an open reduction and reconstruction of the specific lesions, unless the patient is old or debilitated. This operation can however be difficult and requires extensive soft tissue release, and occasionally use of a bone graft to reconstruct the anterior defect of the glenoid. The long-term results remain modest. When the humeral head cannot be saved because of extensive osteochondral lesions, shoulder arthroplasty must be the treatment of choice.

Accidental Falls↗

PubMed1992

Surgical treatment of hemodialysis-related shoulder arthropathy.

Thirteen patients with hemodialysis-related shoulder arthropathy were treated either with arthroscopic synovectomy or with open surgery. Arthroscopic synovectomy was performed in eight patients who had shoulder pain, shoulder immobility or both but did not have cystic bone lesions. The therapy was effective for pain relief and improvement of shoulder function for six months but in 12 months the shoulder pain reappeared in most of the patients. Open surgery was done in 5 patients who, in addition to shoulder pain and immobility, had humeral head bone cysts. Resection of the deposited mass on the biceps tendon sheath, of hypertrophied synovium and bursa as well as curettage of cysts and calcium hydroxyapatite ceramic implantation were performed. The therapy was effective for pain relief throughout the follow-up period (12 months). No adverse effects were noted for either procedure. Resected specimens of the synovia contained amyloid as indicated by a positive Congo-red stain by light microscopy and the presence of amyloid fibrils by electron microscopy. Deposition of amyloid in the biceps tendon sheath, synovium and bursa and invasion of the humeral head by amyloid were observed upon open surgery. The results suggest that the resection of deposited material induces the improvement of the shoulder arthropathy.

Amyloidosis↗