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Soft tissue xeroradiography of the shoulder joint has been compared with a film technique arrived at previously. The xerox plates gave a lower radiation dose to the patient without loss of information. The film technique requires a tungsten target tube with an extra thin glass window (=0.5 mm Al), while the xerox technique may be used with standard tubes.
The objective of this study was to evaluate the effect of negative intra-articular pressure on shoulder joint stability in canine cadavers. Cadaver forelimbs from 12 mature dogs were used. The forelimbs were placed in a testing frame and axially preloaded with 4 kg of weight. Shoulder joint stability was tested in flexion, extension, and neutral position before and after venting of the joint capsule. Humeral translation relative to the glenoid was induced by applying a 3 kg load in three different directions (cranial, lateral, and medial) and quantitatively measured by use of an electromagnetic motion tracking system. Peak translational data were compared in each joint position before and after venting of the joint capsule. After venting the shoulder joint capsule, a significant increase in translation was observed in the cranial direction with the joint in neutral position and in the medial direction with the joint in extension. The horizontal translations measured after venting of the joint capsule were likely not clinically relevant. Negative intra-articular pressure is not a major contributor to shoulder stability in dogs during weight-bearing.
The shoulder joint is a free joint which enables the free forelimb to describe curves in space, in order to perform movements and for locomotion. The movements can be measured in three planes: flexion-extension, abduction-adduction and rotation. The extent of movement in the cat, the German Shepherd and the Dachshund are described and the efficacy for these species and breeds is discussed.
In order to analyze shoulder joint movements, the authors use a ZEBRIS CMS-HS ultrasound-based movement analysis system. In essence, the measurement involves the determination of the spatial position of the 16 anatomical points, which are specified on the basis of the coordinates of ultrasound-based triplets positioned on the upper limb, the scapula, and the thorax; their spatial position is measured in the course of motion. Kinematic characteristics of 74 shoulder joints of 50 healthy persons were identified during elevation in the plane of the scapula. Kinematic characteristics of motion were identified by scapulothoracic, glenohumeral, and humeral elevation angles; range of angles; scapulothoracis and glenohumeral rhythm; scapulothoracic, glenohumeral, and scapuloglenoid ratios; and the relative displacement between the rotation centers of the humerus and the scapula. Motion of the humerus and the scapula relative to each other was characterized by their rotation as well as the relative displacement between the rotation centers of scapula and humerus. The biomechanical model of the shoulder joint during elevation can be described by analyzing the results of the measurements performed.
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A laboratory evaluation was undertaken to assess the shoulder range of motion and distal strength after oncologic resection and reconstruction involving the shoulder joint and to compare these functional parameters based on potentially important variables. Inclusion in the study was limited to 32 patients with bone tumors of the proximal humerus or scapula treated surgically by resection of the shoulder joint including the proximal humerus from 1976 through 1992. Active shoulder range of motion and isometric elbow extension and forearm supination strength are significantly less after surgery in patients with greater amounts of bony resection and with resection of the deltoid. Patients who had a modified Tikhoff-Linberg resection were able to achieve 10 degrees to 15 degrees greater shoulder motion in each direction than were patients who had the classic procedure including complete scapulectomy. However, elbow flexion and extension strength and forearm pronation strength were greater for the patients with the classic resection. Osteoarticular allografts as a reconstructive alternative provide as a group the best shoulder motion and overall distal upper extremity strength, but these reconstructions were performed only when the rotator cuff muscles and deltoid were able to be reconstructed. Diminishing elbow strength was seen with longer followup in the patients with osteoarticular reconstructions, corresponding temporally to subchondral collapse observed on radiographs. Range of shoulder motion except rotation was just as good for allograft vascularized fibular arthrodeses as for the osteoarticular allografts, but strength was significantly less with the arthrodeses.
In the present work, morphological changes in the interior structures of the developing human shoulder joint were studied at different prenatal ages (9, 12, 16, 23 and 40 weeks) and were compared with the same structures in the adult joint. It was found that the shoulder joint had gone through important developmental changes during the 12th week of the prenatal life and it is assumed that genetic factors operative during this stage of development were more important than mechanical factors. A subsequent development of the intracapsular glenohumeral ligaments was present at the 16th week. The glenoid labrum, the biceps tendon and the three glenohumeral ligaments formed a complete ring around the glenoid fossa which constituted a functional unit, which seemed to have a role in stabilizing the joint. In the present work, histological prenatal studies were done on sagittal and radial sections from the glenoid fossa and its associated structures and the results were compared with the same structures in adults. At a crown-rump length of 30 mm (9 weeks), intermingling of the collagen fibres of the superior labrum and the biceps tendon was observed and the superior labrum could be considered as an extension of the biceps tendon. While the superior and inferior parts of the labrum appeared fibrous, the posterior labrum appeared as a primitive cellular condensation. At the 12th week, it became a fibrocellular structure and changed to a fibrocartilaginous structure at the 16th week. But until full term, no definitive fibrocartilage was found due to its hypercellularity compared to the adult. It was found that at all ages, the capsule was formed of cellular and fibrous elements, its collagenous content was progressively increased with age and at full term, it became generally fibrous but was still different compared to adults. In all stages of development, the synovial tissue of different regions of the same joint exhibited marked variations in thickness, vascularity, cellular density and collagenous content. It lined the capsule, surrounded the biceps tendon and reflected on the labrum. Its cell density as well as their vascular and collagenous contents were progressively increased with age. At full term, the synovial tissue was thickest at its inferior reflection and forming large folds. The synovial tissue lining the capsule was thinner than the synovial tissue at its reflection from the labrum, many villi and processes arising from it and projecting into the joint cavity.
Characteristic degeneration of the nerves in shoulder joints was recognized in 26 of 35 capsules (74.3%) from 20 cadavers. No left or right or gender differences were found. Histologic features of the nerves were (1) thickening of the perineurium, (2) myxoid degeneration in the endoneurium, and (3) hyaline globular structures with a whorled, oligocellular appearance regarded as Renaut bodies. The results of histochemical and electron microscopic studies showed prominent degenerated collagen fibers in the globular areas. These features resembled those found in the fusiform swelling in the axillary nerve branch to the teres minor muscle, believed to be caused by chronic nerve compression. Sixty percent of the degenerated nerves occurred in the anteroinferior and posteroinferior portions of the capsule, an area that is considered to be innervated by the axillary nerve. No correlation between age and severity of these degenerative nerve changes was noted. Compression of the axillary nerve and inferior joint capsule caused by repetitive shoulder movement such as forward flexion, abduction, and external rotation of the humerus might result in this form of nerve degeneration found histologically over a lifetime without necessarily causing clinical symptoms.
OBJECTIVE: To objectively evaluate the effect of transecting the tendon of the biceps brachii muscle (BBT), tendon of the infraspinatus muscle (IFS), or medial glenohumeral ligament (MGHL) on shoulder joint stability in canine cadavers. SAMPLE POPULATION: 81 forelimbs from mature dogs. PROCEDURE: Cadaver forelimbs were placed in a testing frame and axially preloaded with 4 kg of weight. Shoulder joint stability was tested in neutral joint position, flexion, and extension before and after transection of the BBT (n = 37), IFS (37), or MGHL (7). Humeral translation relative to the glenoid was induced by applying a 3-kg load in each of 3 directions (cranial, lateral, and medial) and quantitatively measured by use of an electromagnetic motion tracking system. Peak translational data were compared in each joint position before and after transection of the BBT, IFS, or MGHL. RESULTS: When tested in neutral position, the cranial, lateral, and medial translation of the humerus was significantly increased after BBT transection. In the flexed position, translation of the humerus in the cranial and lateral directions was significantly increased after BBT transection. In the extended position, the medial translation of the humerus was significantly increased after BBT transection. Complete medial luxation of all humeral heads occurred following transection of the MGHL. CONCLUSIONS AND CLINICAL RELEVANCE: The BBT contributes to passive shoulder joint stability in dogs, particularly in the neutral and flexed positions. It also provides medial stability during shoulder joint extension. Complete luxation of the joint occurs when the MGHL is transected.
The study was an open randomized controlled trial to compare the outcome at 8 weeks with two different modalities in the treatment of 'Frozen shoulder'. Clinical cases with painful limitation of movement of shoulder were randomized to receive physical therapies alone versus physical therapies and shoulder arthrography with intra-articular steroid in a sequential randomization process. Cases suspected of having a concomitant illness and has potential to cause secondary frozen shoulder were excluded, such as, history of trauma to shoulder over the last 6 months, symptomatic clinical cervical degenerative diseases, and causes in and around the shoulder (infective and non-infective). Physical Therapies provided to all patients were therapeutic exercises, transcutaneous electrical nerve stimulation (TENS) and infra-red radiation (IRR). Outcome measures were improvement of pain on a Visual Analogue Scale (VAS) score and range of motion measured by Goniometer at 8 weeks. Patients were followed weekly for 8 weeks and outcome parameters were recorded on every evaluation. The baseline range of motion in the two groups was comparable. At 8 weeks a statistically significant difference in outcome were observed in the two groups. The chi-square means difference of improvement in range of motion for abduction was p <0.00 and for external rotation was p <0. 00. The pain reduction on VAS score was not significant in the two groups (p <0. 40). In the present small series, the distension arthrography with intra-articular (IA) steroid plus physical therapy was superior over physical therapy alone in the functional improvement of the frozen shoulder. Further studies with larger sample size are required to confirm the observations.
Alterations of shoulder motion have been suggested to be associated with shoulder disorders. The objective of this study was to perform a 3D motion analysis (kinematic and electromyographical) of skeletal elements and muscles of shoulder joint in patients with multidirectional instability. Fifteen patients with multidirectional instability and 15 normal controls were investigated during continuous elevation in the scapular plane. The spatial coordinates of 16 anatomical points of the shoulder to determine kinematical parameters were quantified by an ultrasound-based motion analyzer. The activities of 12 muscles were measured by surface electromyography. Kinematic characteristics of motion were identified by scapulothoracic, glenohumeral, and humeral elevation angles; range of angles; scapulothoracic and glenohumeral rhythm; scapulothoracis, glenohumeral, and scapuloglenoid ratios; and the relative displacement between the rotation centers of the humerus and the scapula. The electromyographical characteristics of motion were modeled by the on-off pattern of muscle activity. Significant alterations in kinematical parameters were observed between patients and asymptomatic volunteers. The anterior, posterior, and inferior dislocations of shoulders with multidirectional instability could be properly modeled by the relative displacement between the rotation centers of the scapula and humerus. The shorter activity by m. pectoralis maior and all three parts of m. deltoideus and longer activity by m. supraspinatus, m. biceps brachii, and m. infraspinatus assure the centralization of the glenuhumeral head of a shoulder with multidirectional instability.
Anatomic dissection of 220 cadaver shoulders was performed to find out more about the static stabilizers of the shoulder joint. The static stabilizers, i.e. the glenohumeral ligaments, were always found to be present and strong in healthy shoulders. It was revealed that in anatomic preparations with all the organs removal except the synovial capsule, the capsule ligaments completely stabilized the joint. Anterior dislocation at 45 degrees of abduction was prevented by the superior and medial glenohumeral ligaments, while at 90 degrees of abduction the inferior glenohumeral ligament prevented dislocation. When anterior dislocation has occurred even the coracohumeral ligament must be ruptured. A new finding recorded is that the glenoid labrum is the origin of the inferior glenohumeral ligament and not a triangular static organ enlarging the socket and having a similar function to the menisci in the knee. This ligament is the most important ventral stabilizer of the humeral joint. With the conventional arthrotomy technique the medial and inferior ligaments are immediately cut through and therefore cannot be seen. The inferior glenohumeral ligament must be reconstructed in cases of anterior recurrent dislocation.
In 6 dogs the hip joint was experimentally replaced using a ceramic stepped-stem prosthetic device implanted in the thigh bone. In six other dogs V4A steel stepped-stem prosthetic devices inserted in the arm bone was used for replacing shoulder joint. The six devices replacing the shoulder joint healed up without complications and proved to be mechanically stable. From six devices replacing the hip joint only one was successful; the remaining five implants did not heal up due to fractures of the stem, loosening in the thigh bone and osteomyelitis. We suggest that these different results are based not on the different material, but on the different conditions characteristic for each implantation sites. The devices implanted in the arm bone of the dog, corresponding to the conditions in man, were stressed mainly by pressure and pull. In such conditions the newly formed bone tissue anchoring in the steps on the stem stabilized the device. On the other hand, the biomechanical load on the hip joint replacing device in the dog is represented mainly by rotation at stress, for which the devices are not conceived. The stepped profile of the stem can not work; it twists in the thigh bone and remains unstable causing consequences such as fractures, osteomyelitis and loosening. For experimental testing of bone and joint replacing prosthetic devices of cementless anchoring systems replacing human hip joint and thigh bone we recommend the shoulder joint of the dog instead of hip joint, because of the comparable biomechanics.
Two cases of complete infraclavicular brachial plexus palsy after anterior dislocation of the shoulder joint are reported. Both patients had transient motor brachial plexus paralysis and extensive anesthesia of the whole upper limb. Additionally, one of them had occlusion of the axillary vessels. Vascular recovery occurred immediately after manipulation and reduction of the affected shoulder joint. Neurological recovery occurred 9 to 12 months later in both cases without surgery, other than closed reductions. Such neurological and vascular complications after anterior dislocation of the shoulder joint are unique.
OBJECTIVE: To examine the effects of positioning and sleeve type bracing on passive position sense of shoulder joints of healthy untrained subjects. METHOD: A cross over study was carried out on 26 subjects (13 male, 13 female) with a proprioception measurement device. The selected method of testing was passive reproduction of a target angle. Both shoulder joints of all the subjects were evaluated with and without a compressive neoprene sleeve type of brace at two different start positions (45 degrees internal rotation, 75 degrees external rotation) with an angular rotational movement at a constant speed of 0.5 degrees /s. The angular displacements from the target angles at the end of the reproduction tests were recorded as position sense deficit scores. RESULTS: The overall mean (SD) deficit score (0.99 (0.06)) was significantly (p<0.001) lower with the brace than without, and the overall mean deficit score was significantly (p<0.001) higher at the 45 degrees internal rotation start position than at the 75 degrees external rotation start position. However, there was no significant (p>0.05) interaction between brace application and start position. CONCLUSION: Terminal limits of range of motion facilitate the position sense of shoulder joints. Compressive brace application improves the passive positioning sense possibly by stimulating cutaneous mechanoreceptors.
The freedom of movement of the feline shoulder joint corresponds to that of a ball-and-socket joint, although the humeral head is not ball-shaped. The profiles of the humeral head and glenoid fossa were analysed with respect to their lines of movement in three planes of motion. The incongruity of the joint surfaces allows the variety of movements. Of clinical relevance are the description of a shoulder joint injection site and of the extent of joint movement in degrees.
The paper provides the results of MRI studies in 100 patients having complaints of pain and impaired movements in the shoulder joint in order to establish a diagnosis. Sixty-three patients were found to have MRI signs of shoulder joint instability (SJI). The paper presents and states the found MRI symptoms of SJI. The authors concludes that MRI of the shoulder joint in its instability should be used appropriately as it may early reveal changes in the articular osseous, cartilaginous, and soft tissues, which is useful in diagnosing and choosing a treatment.
The paper provides the results of MRI studies in 100 patients having complaints of pain and impaired movements in the shoulder joint in order to establish a diagnosis. Sixty-three patients were found to have MRI signs of shoulder joint instability (SJI). The paper presents and states the found MRI symptoms of SJI. The author concludes that MRI of the shoulder joint in its instability should be used appropriately as it may early reveal changes in the articular osseous, cartilaginous, and soft tissues, which is useful in diagnosing and choosing a treatment.