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PubMedDate not supplied

A prospective study of shoulder disability resulting from radical and modified neck dissections.

A prospective longitudinal study of shoulder function after 103 neck dissections involving either preservation or sacrifice of the spinal accessory nerve is presented. The postoperative evolution and course of trapezius muscle denervation and resultant shoulder dysfunction were objectively determined for both radical and modified nerve sparing neck dissections. All patients were enrolled in a program of physical therapy aimed at maintaining range of motion at the shoulder joint. Shoulder function was examined preoperatively and for 12 months postoperatively with manual muscle strength testing, range of motion measurements, and electrodiagnostic testing. Results indicate that modified nerve sparing dissections are followed on the average by a significant, but temporary and reversible phase of shoulder dysfunction. By comparison, radical neck dissection is followed by profound and permanent trapezius muscle weakness and denervation.

Accessory Nerve↗
PubMed1985

Alignment of the human body in standing.

Alignment of the body in typical symmetrical standing was studied by photographing fifteen subjects in profile on a reaction board. Two aspects of alignment were studied: (1) the anteroposterior position of the body landmarks of knee joint, hip joint, shoulder joint, and ear, compared to the ankle joint; and (2) the positions of the partial centers of gravity above the knee and hip, as a measure of how the body is balanced above these joints. The knee, hip, shoulder, and ear were forward of the ankle in all subjects. On average, the knee was 3.8 (+/- 2.0), the hip 6.2 (+/- 1.3) the shoulder 3.8 (+/- 1.9), and the ear 5.9 (+/- 1.6) cm (+/-S.D.) anterior to the ankle. The positions of landmarks were positively correlated with one another but not highly. The position of the center of gravity could be predicted well from the positions of the landmarks within individual subjects' data, but not across subjects. The centers of gravity above the knee and hip were calculated by subtracting the mass and position of the segments below the joint from the whole-body center of gravity. The center of gravity above the knee was located on average 1.4 (+/- 1.1) cm in front of the joint, and that of the hip 1.0 (+/- 1.6) cm behind the trochanter. Thus, at both knee and hip in typical standing, there exist slight gravitational torques tending to extend the joints.

Adolescent↗
PubMed2003

Localization and diagnosis of septic endoprosthesis infection by using 99mTc-HMPAO labelled leucocytes.

The aim of this study was to evaluate, retrospectively, the diagnostic value of Tc hexamethylpropylene amine oxime (99mTc-HMPAO) labelled autologous leucocytes for the preferred septic localizations of the infection of the endoprosthesis. We retrospectively reviewed 67 patients with implanted endoprostheses. Diagnosis was found in 42/67 patients. In 25/67 patients we were able to negate an acute pathological process of infection of the endoprosthesis. Our patients were divided into three groups according to the type of endoprosthesis (hip joint, knee joint, shoulder joint). The localizations of the endoprosthesis disorders are shown. The preferred localizations of the acute infection of the hip endoprosthesis are the regio intertrochanterica and the middle part of the shaft of the prosthesis. The preferred localization of the acute infection of the knee endoprosthesis is the proximal shaft of the tibia. The preferred localization of the acute infection of the shoulder endoprosthesis is the distal end of the prosthesis in the proximal humerus. It is hoped that the knowledge of these preferred localizations of infection of endoprosthesis will help patients and doctors in diagnosis and treatment in the future.

Acute Disease↗
PubMed1987

Primary degenerative joint disease of the shoulder in a colony of beagles.

Shoulder joints of 149 Beagles over 8 years old at the time of death (mean age, 13.8 years +/- 3.21), were examined radiographically throughout their life-times for the frequency of degenerative joint disease (DJD). Clinical histories revealed no underlying cause for DJD. The shoulder joints of a subgroup of 18 dogs were examined at necropsy, and thin sections of the joints were evaluated radiographically and histologically. Serial clinical radiographic studies indicated that normal shoulder joint development during the first year of life was followed by the appearance of subchondral bone sclerosis and bony remodeling of normal joint contour, and by the formation of periarticular osteophytes and enthesiophytes. All changes were progressive with age and typical for DJD in dogs. Bilateral involvement was common. Evaluation of specimens obtained at necropsy revealed: articular cartilage change with roughening of the surface layer, degeneration and death of superficial chondrocytes, exposure of deeper layers of chondrocytes that had proliferated with fissuring of the damaged cartilage, total cartilage loss with polishing of the exposed subchondral bone, mixed patterns of subchondral bone sclerosis and osteoporosis, change in contour of the articular surfaces, and formation of periarticular osteophytes and enthesiophytes. Joint capsule thickening, synovitis, pannus formation, and synovial chondroma formation were observed. Because of the available clinical information, in addition to the typical changes of DJD, it was thought that the changes were primary. Instability appeared to play a role in the pathogenesis of the joint disease described; however, it was not clear whether the instability caused abnormal forces on healthy cartilage or whether the primary cartilage wear caused the instability.

Aging↗
PubMedDate not supplied

[Biomechanical principles in diarthroses and synarthroses. II: The humerus articulation as a ball-and-socket joint].

The shoulder joint does not represent a simple ball-and-socket joint with three degrees of freedom unlike widely believed. Series of X-ray pictures show that in abduction the momentary rotational axis does not meet the center of the humerus. Morphological measurements yield the result that the radius of curvature of the cavitas is slightly greater (2 mm) than the humeral one. This physiological incongruity of the articulating surfaces is functionally necessary. Thus, the shoulder joint represents a force-locked dimeric ball-and-socket joint. In abduction e.g. the humerus simultaneously rotates around the humeral center and around the cavitas center in opposite direction. The resultant momentary rotational axis is therefore shifted towards the scapula as in vivo measurements confirm. Fundamental kinematical and statical properties of the joint are derived which explain substantial experimental finding in literature.

Biomechanical Phenomena↗
PubMed1984

Acute effects of shock-type vibration transmitted to the hand-arm system.

The aim of the project was to find out whether shock-type vibration of hand-tools compared to non-impulsive vibration has stronger acute effects on the hand-arm system and therefore needs a stricter evaluation from the occupational health point of view in comparison with the requirements of the Draft International Standard ISO-DIS 5349. Under laboratory conditions, subjects were exposed to simulated vibration of hand-tools (grinder, chain saw, hammer-drill, pneumatic hammer, rivet hammer and nailer). The following evaluation criteria were used: biomechanical transmissibility of the hand-arm system (wrist, elbow joint, shoulder joint); muscle-activity (m. flexor carpi ulnaris, m. biceps, m. triceps); peripheral circulation (skin temperature) and subjective perception (comparison of intensity of standard and test vibrations). The results show no significant difference in acute effects on the hand-arm system between impulsive and non-impulsive type vibrations of the hand-tools tested with respect to the chosen vibration level, short-time exposure (up to 8 min) and evaluation criteria. In summary, therefore, it may be concluded that for the evaluation of shock-type vibration of the hand-tools tested, it is justified to use the existing Draft International Standard ISO-DIS 5349.

Adult↗
PubMed1990

[Staphylococcal septicemia in a newborn infant with multiple organ involvement].

The clinical course and therapeutic problems are presented in a case of staphylococcal septicaemia in a newborn. Generalized infection was associated with multiorgan location of pathological changes, among them, acute haematogenous osteitis and arthritis (of the temporomandibular joint, shoulder joint, hip, elbow joint, knee joint and wrist joint) and rarely occurring parotitis.

Arm↗
PubMed1966

Little league shoulder: osteochondrosis of the proximal humeral epiphysis in boy baseball pitchers.

Roentgenographic changes consistent with osteochondrosis of the proximal humeral epiphysis were observed in five young baseball pitchers complaining of shoulder pain in the throwing arm. The symptoms and findings were quite similar to the previously reported involvement of the medial epicondylar epiphysis or "Little Leaguer's elbow."The act of throwing a baseball hard is an abnormal whip-like action which places a forceful repetitious traction strain on the shoulder joint. Shoulder pain in youngsters engaged in organized competitive swimming programs can also be explained in this way. Since these entities became evident with the establishment of organized baseball programs for boys in this age group, better medical supervision and rule changes to limit the amount of pitching until the epiphyses close, are urgently needed.

Adolescent↗
PubMed2006

[Forensic identification of floating shoulder injury].

OBJECTIVE: To discuss forensic identification of floating shoulder injury (FSI). METHODS: To analyze fifteen cases of FSI which were accepted from Jan. 1993 to Jan. 2006, including 15 shoulder neck fracture, 13 clavide stem fracture and 2 distal end clavide fracture, the function of shoulder joint was evaluated six months after injure considering the following three aspects: result of forensic examination such as X-ray photograph, CT and MRI, the injurers' symptom, objective sign and joint function, shoulder joint territory, degree of pain and local muscle power. RESULTS: Basing on the curative effect standard of Herscovic, all cases were divided into good. Modest, worst, which included 2, 4, 9 cases respectively; referring the standard of GA35-92, GB18667-2002, all cases were divided into six, seven, eight, nine and ten degree, which included 2,9,2,1,1 cases respectively. CONCLUSION: As a special powerful injure, FSI always companied with concurrent and multiple injure, and characterized by missed, incorrect and delayed diagnosis and infelicitous treatment, which lead to the high frequency and degree of injure. To prevent missed and incorrect forensic identification, we should have a full realization of the particularity of FSI, and evaluate the function of shoulder all-sidely, objectively and synseticaly.

Accidents, Traffic↗
PubMed2006

[An improved operation approach for bipedal rat model construction].

OBJECTIVE: To explore an improved operation approach to make up the ethical deficiency of classical bipedal rat model. METHODS: 20 SD rats were randomly divided into an improved group and a traditional group averagely. Improved group were operated with plexus brachialis nerve amputation, while traditional group with forelimbs amputation close to shoulder joint. Forelimb and shoulder joint movements were observed and electromyography of the peripheral muscles around shoulder joint were recorded to make certain the paralytic scope. Operation duration and axillary artery hurt probability of both the improved and traditional operation were compared to evaluate the operation risk of improved approach. Mean total upright time on 2 d, 1 w, 2 w, 4 w and 6 w post-operation and upright posture on 6 w post-operation were recorded to evaluate the human-upright-posture-simulating effect of bipedal rats operated with improved approach. RESULTS: Compared with classical amputation approach, improved approach exhibited simpler operation procedure, shorter operation duration and lower axillary artery hurt probability. Electromyography revealed that all forelimb muscles and most shoulder-peripheral muscles were denervated, forelimbs of the improved bipedal rats were absolutely paralyzed and shoulder joint reserved only slight abduction function. The mean total upright time of improved bipedal rats was longer than the classical ones after 2 w post-operation, while upright posture showed no difference with classical bipedal rats. CONCLUSIONS: The improved operation approach not only simplified operation procedures, but also achieved even better effect than classical amputation operation and exempted bipedal rat model from the ethical shadow.

Animals↗
PubMed2003

Arthrographic and clinical findings in patients with hemiplegic shoulder pain.

OBJECTIVES: To identify the etiology of hemiplegic shoulder pain by arthrographic and clinical examinations and to determine the correlation between arthrographic measurements and clinical findings in patients with hemiplegic shoulder pain. DESIGN: Case series. SETTING: Medical center of a 1582-bed teaching institution in Taiwan. PARTICIPANTS: Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical examinations included Brunnstrom stage, muscle spasticity distribution, presence or absence of subluxation and shoulder-hand syndrome, and passive range of motion (PROM) of the shoulder joint. Arthrographic measurements included shoulder joint volume and capsular morphology. RESULTS: Most patients had onset of hemiplegic shoulder pain less than 2 months after stroke. Adhesive capsulitis was the main cause of shoulder pain, with 50% of patients having adhesive capsulitis, 44% having shoulder subluxation, 22% having rotator cuff tears, and 16% having shoulder-hand syndrome. Patients with adhesive capsulitis showed significant restriction of passive shoulder external rotation and abduction and a higher incidence of shoulder-hand syndrome (P=.017). Those with irregular capsular margins had significantly longer shoulder pain duration and more restricted passive shoulder flexion (P=.017) and abduction (P=.020). Patients with shoulder subluxation had significantly larger PROM (flexion, P=.007; external rotation, P<.001; abduction, P=.001; internal rotation, P=.027), lower muscle tone (P=.001), and lower Brunnstrom stages of the proximal upper extremity (P=.025) and of the distal upper extremity (P=.001). Muscle spasticity of the upper extremity was slightly negatively correlated with shoulder PROM. Shoulder joint volume was moderately positively correlated with shoulder PROM. CONCLUSIONS: After investigating the hemiplegic shoulder joint through clinical and arthrographic examinations, we found that the causes of hemiplegic shoulder pain are complicated. Adhesive capsulitis was the leading cause of shoulder pain, followed by shoulder subluxation. Greater PROM of the shoulder joint, associated with larger joint volume, decreased the occurrence of adhesive capsulitis. Proper physical therapy and cautious handling of stroke patients to preserve shoulder mobility and function during early rehabilitation are important for a good outcome.

Adult↗
PubMed2000

The effect of motor learning in facioscapulohumeral muscular dystrophy patients.

Two models of motor learning (ML) practice (complex and simple) were used to investigate upper limb function in individuals with facioscapulohumeral dystrophy (FSHD). The effect of ML practice was studied by examining changes in the ability to undertake a simulated drinking task. In the complex model, seven FSHD patients and seven age- and gender-matched healthy volunteers were studied. Performance was assessed by measurement of the electromyographic (EMG) activity of the biceps brachii and brachioradialis, elbow joint flexion, shoulder joint flexion and abduction, maximum acceleration at the onset of movement, movement time and reaction time, both before and after a 30-min complex ML task. In the simple model, a second group of six FSHD patients and six age- and gender-matched healthy subjects were studied. The same parameters were measured as for the complex ML task, except that the EMG activity of the triceps and deltoid muscles (anterior part) were measured instead of that of the brachioradialis. In both studies, the FSHD patients showed significantly larger values for all parameters except the flexion of shoulder joint and reaction time, compared with controls before the ML task. In the FSHD group, while the complex ML resulted in decreases in the brachioradialis EMG activity (P<0.005) and reaction time (P<0.0001), the simple ML model resulted in significant changes towards the normal value in all parameters measured except shoulder flexion. The change in the measured variables towards normal values indicates that ML may help to improve performance in FSHD.

Adult↗