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PubMed1981

Osteochondrosis of the shoulder joint of the horse.

Osteochondrosis of the shoulder joint in the horse was diagnosed radiographically in 54 shoulders of 38 horses. Clinical signs were those of an intermittent lameness characterized as a swinging leg shoulder lameness with pain elicited by extension, flexion or abduction of the limb. Diagnosis of shoulder lameness was supported by blocking the shoulder joint with local anesthetics. Radiographic changes consisted of: (1) alteration in the contour of the humeral head and glenoid cavity, (2) periarticular osteophyte formation, (3) sclerosis of the subchondral bone, and (4) bone cyst formation. The primary bony lesion in the shoulder of the horse is similar to that described in the dog, pig, bull, turkey and broiler chicken. Secondary joint disease is a prominent finding with osteochondrosis of the shoulder in the horse. A follow-up study of 17 horses indicated that many of the affected horses had been sold and were being used for pleasure riding and breeding purposes. Those horses still in use usually had less severe radiographic changes at the time of diagnosis.

Animals↗
PubMed1995

Emergent management of shoulder dystocia.

It is clear that in the vast majority of cases, shoulder dystocia cannot be predicted by the physician. Although macrosomia is strongly associated with shoulder dystocia in retrospective analyses, there are no clinical or sonographic parameters that can reliably and prospectively identify the individual macrosomic fetus. Furthermore, more than 98% of patients with macrosomic fetuses who deliver vaginally do not have shoulder dystocia. Some investigators have advocated the use of cesarean delivery for suspected macrosomic fetuses to avoid potential birth trauma during vaginal delivery; however, this strategy has not been shown to be beneficial in the majority of cases. Boyd and colleagues report that an increase in the cesarean delivery rate for suspected macrosomia from 8% in the 1960s to 21% in 1980 did not improve overall perinatal outcome among macrosomic infants. Since 50% to 90% of cases of shoulder dystocia occur in normally grown fetuses, cesarean delivery for all suspected macrosomic fetuses would not be expected to prevent the vast majority of cases of shoulder dystocia and would expose many mothers to a substantially increased risk for morbidity and mortality. Management of this complex problem requires clinical judgment by the well-trained physician and individualized care for each patient. Because shoulder dystocia remains unpredictable in almost all cases, when it does occur it must be managed expeditiously but carefully with one or more of the maneuvers described. The sequence of manipulations reported herein represents one way of managing shoulder dystocia (Fig. 11). As noted before, however, there are no data to support improved efficacy of one particular sequence over another. The sequence of maneuvers chosen by the clinician should be based on the algorithm with which he or she is most familiar and which has proven successful in their hands. Permanent injury to the fetus fortunately is rare but does occur even in the well-managed case.

Delivery, Obstetric↗
PubMed1995

Chiropractic treatment of frozen shoulder syndrome (adhesive capsulitis) utilizing mechanical force, manually assisted short lever adjusting procedures.

OBJECTIVE: To describe treatment of frozen shoulder syndrome (adhesive capsulitis) via conservative chiropractic treatment to the shoulder joint, utilizing specific contact, low force, instrumental adjusting procedures. A case report, providing an illustrative example of the same, is presented along with a review of the relevant literature. CLINICAL FEATURES: A 53-yr-old woman suffered severe shoulder pain of over 6 months' duration. The patient had been diagnosed as having adhesive capsulitis and had undergone a variety of different treatment regimens without obtaining relief, including various NSAIDs, analgesics and physical therapy. At the time of her presentation, her condition had progressed to the point of near total immobility of the shoulder joint, accompanied by severe pain with resulting marked restriction in her normal activities of daily living. INTERVENTION AND OUTCOME: The patient's shoulder was conservatively managed with chiropractic adjustments to the affected shoulder joint, as well as to the cervicothoracic spine. Treatment consisted of mechanical force, manually assisted short lever chiropractic adjustments, delivered via an Activator Adjusting Instrument. Successful resolution of the presenting symptomatology was achieved. CONCLUSION: Chiropractic care may be able to provide an effective mode of therapeutic treatment for certain types of these difficult cases. Low force instrumental adjustments, in particular, may present certain benefits in these cases that the more forceful manipulations and/or mobilizations cannot. As such, further formal investigation of this type of therapeutic intervention for treatment of frozen shoulder may be warranted on a larger scale.

Activities of Daily Living↗
PubMed1994

[A comparison between the pain relief effect of electroacupuncture, regional never block and electroacupuncture plus regional never block in frozen shoulder].

BACKGROUND: Frozen shoulder is a kind of spontaneous, progressive peri-arthritis over the shoulder joint. The etiology is not yet clear. Traditional treatments for frozen shoulder included conservative medical therapy, physical therapy, nerve block and acupuncture and so on. The purpose of our study is to determine the pain relief effect of electroacupuncture (EAP), regional nerve block (RNB) and the combination of EAP + RNB for frozen shoulder. MATERIALS & METHODS: One hundred and fifty patients with fresh frozen shoulder were, randomly divided into 3 groups. Group I patients (n = 50) had RNB with stellate ganglion block and suprascapular nerve block by 1% xylocaine 10 ml. Group II patients (n = 50) had EAP with local acupoint--Chien-Yu, Chien-Ching, Chien-Nei-Ling, Ah-Shih Hsueh treatment and Group III (n = 50) patients had RNB+EAP performed with acupuncture first, then followed by the regional nerve block. Six vectors of movements were checked in all methods. Four graded Bromage score was used for pain assessment, Grade 1 means complete painless; Grade 2 means slight pain (i.e. pain on motion); Grade 3 means moderate pain (i.e. pain on silence); Grade 4 means severe pain (i.e. need analgesics). The range of shoulder joint was also recorded. Patients were requested for second treatment if pain recurred. The onset (time from injection to maximal pain relief), duration (time from injection to grade 3) Bromage score and side effects were recorded. RESULTS: The results showed that the combined EAP and RNB method had significant high pain control quality, longer duration, and better range of movement of the shoulder joint than that of EAP or RNB performed alone.

Analgesia↗
PubMed1994

Grip strength in different positions of elbow and shoulder.

This study investigated the effect of shoulder position on grip strength in 80 men and 80 women. A Jamar dynamometer was used to measure the grip strength in the four testing positions. The four hand strength tests consisted of three positions in which the elbow was maintained in full extension combined with varying degrees of shoulder flexion (ie, 0 degrees, 90 degrees, and 180 degrees) and of one position in which the elbow was flexed at 90 degrees with the shoulder in 0 degrees of flexion. Only the dominant hand was tested. The highest mean grip strength measurement was recorded when the shoulder was positioned at 180 degrees of flexion with elbow in full extension; whereas the position of 90 degrees elbow flexion with shoulder in 0 degrees of flexion had the lowest grip strength score. In addition, the grip strength measured with the elbow in extension, regardless of shoulder position (ie, 0 degrees, 90 degrees, and 180 degrees of flexion), was significantly higher than when the elbow was flexed at 90 degrees with the shoulder positioned at 0 degrees of flexion. Finally, grip strength differed significantly for both sexes and for each age group. The grip values of the standardized 90 degrees elbow flexed position were further analyzed to determine the average performances in the study population. For men, grip strength peaked within the 20 to 39 years age group and gradually declined thereafter. For women, the highest mean grip strength measurement was recorded in the 40- to 49-year-old age group and then deteriorated with age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

The use of the Varney brace for subluxating shoulders in stroke and upper motor neuron injuries.

Applying the Varney shoulder brace for painful subluxating shoulders in stroke and head injury patients with or without spasticity has proved to be an extremely effective means of reducing the subluxed shoulder. Other causes for painful shoulders in these patients must be ruled out. Not every shoulder which subluxes with or without spasticity is painful. Correct diagnosis of the etiology of the pain is essential to help the patient. Rotator cuff tendinitis, reflex sympathetic dystrophy, glenohumeral arthritis, shoulder contracture, pain due to central nervous system origin (thalmic pain) and other intrinsic causes of referred pain must be ruled out. Once the subluxed shoulder is proven to be the cause of pain, the Varney brace is an excellent orthosis for the reduction and maintenance of position. Pain usually subsides completely within 5 to 7 days.

Braces↗
PubMed1993

Electromyographic analysis and its role in the athletic shoulder.

In 1944, Inman made some conclusions regarding shoulder function that have become the foundation of a classic model. Clinical observations of the athletic shoulder and its associated common injuries have demonstrated selective weakness of specific rotator cuff muscles rather than generalized muscle impairment. Shoulder mechanics during athletic activities have been evaluated dynamically with electromyography (EMG), which has helped to formulate a base for optimal rehabilitation. Dynamic EMG and high-speed film analysis have been used to evaluate the shoulder during throwing, swimming, tennis, and golf. Evaluation of shoulder function in these various sports revealed that although rotator cuff function is important in all, the emphasis and role of individual muscles varied. The importance of serratus anterior muscle activity to stabilization and protraction of the scapula has been consistently reported. The muscles about the shoulder act according to their mechanical qualities and are function- or sport-specific. A thorough understanding of the mechanics of the normal and pathologic shoulder constitutes the foundation for training and rehabilitation strategies.

Baseball↗
PubMed1995

[Involvement of the shoulder in rheumatoid arthritis].

The course of rheumatoid arthritis (R.A.) in the shoulder is evaluated in 100 patients in a retrospective study and in 73 patients in a prospective study. The involvement of the shoulder may occur at an early stage of the disease. However, usually it causes a significant handicap at a later stage. The retrospective study shows that 62% of the patients hospitalized between 1976 and 1992 for R.A. complained of pain, reduction in range of motion and functional disability of one or both shoulders. However, these historic cases cannot be used for a radiological study because the shoulders have been radiographed in 17% of cases only, probably because of the poor possibilities of surgical therapies available at this time. The survey of 72 patients received at the out- patient clinic between september 1992 and december 1993 who had a radiograph of the shoulder is the basis for the description of the progress of the disease. The erosions appear at the border of the cartilage where the synovium is attached and refers mainly to the cephalic articular cartilage. Narrowing of the subacromial space is often present with early appearance of subluxation in the cranial direction. The destruction often prevails in the area of humeral head but cases with predominant global joint space narrowing or with destruction of glenoid labrum and fossa exist as well. Secondary osteoarthritis was often observed. The involvement of the shoulders is not always symmetric. Unilateral involvement has been observed. The different evolutive processes will be illustrated and their frequency evaluated. The forms with predominant cephalic destruction constitute the best indications for total shoulder arthroplasty.

Acromioclavicular Joint↗
PubMed1996

Atraumatic loose shoulder: the treatment by pectoralis major muscle transfer.

From 1975, 40 shoulders of 34 patients with a loose shoulder were operated on by pectoralis major transfer. The insertions of the clavicular and sternal portions were transferred to the inferior angle of the scapula to bring the glenoid cavity upwards. The follow-up period was 5.3 years on average, and complaints of dullness of the shoulder, feeling of subluxation and dullness of the arm had decreased. However, complaints of dullness of the shoulder girdle had increased at follow-up. The inferior instability had improved in all but four shoulders because this method brings the glenoid cavity upwards and the changes of the upward rotating angle of the scapula were confirmed by roentgenographic investigations. The study of the tracking movement pointed out that this method did not affect the motion of the shoulder, and the high activity of the transferred pectoralis major muscle during the movement was thought to play an important role in reducing inferior instability. This method is most recommended for a patient who has multidirectional instability and can subluxate the head antero-inferiorly by the pectoralis major muscle, but it is not recommended for athletes as the power of the shoulder adductor is reduced to some extent after surgery.

Adult↗
PubMed1995

An analysis of risk factors for the prediction of shoulder dystocia in 16,471 consecutive births.

This paper is a univariate analysis of the demographic, antepartum and intrapartum risk factors in a series of 16,471 consecutive deliveries in a tertiary obstetric and gynaecological unit in Singapore. In total, 12,229 term vaginal cephalic deliveries with 77 cases of shoulder dystocia were entered into the study for analysis. The incidence of shoulder dystocia was found to be 0.63% of all term vaginal cephalic deliveries. There is a direct relationship between increasing infant birthweight and incidence of shoulder dystocia. The critical birthweight for the prediction of shoulder dystocia is 3600 g. In order of decreasing relative risks, the factors which appear to be predictive of shoulder dystocia are a birthweight in excess of 3600 g, diabetes in pregnancy, lower social class, of Indian origin, maternal weight in excess of 70 kg, parity more than 4, and the use of oxytocics during labour. The local birthweight distribution is very different from the West. A policy for elective caesarean section for birthweights in excess of 4000 g (97% tile) would prevent 44% of shoulder dystocias, increase the caesarean section rate by 2% and half the perinatal mortality among births with shoulder dystocia.

Adult↗
PubMed1996

The influence of the mobility in the cervicothoracic spine and the upper ribs (shoulder girdle) on the mobility of the scapulohumeral joint.

OBJECTIVE: To examine the influence of the cervicothoracic spine and upper ribs (shoulder girdle) on glenohumeral mobility and the development of shoulder complaints. DATA COLLECTION AND SYNTHESIS: Literature was collected by a search in Medline and Embase for English, German and Dutch publications, by further checking references in the articles found and by perusal of already collected literature regarding shoulder research. Articles referring directly or indirectly to a mutually influencing anatomical connection between the cervicothoracic spine, upper ribs (shoulder girdle) and scapulohumeral joint were selected during a consensus meeting of all reviewers. RESULTS: Eight relevant articles, differing strongly in supposition and objective, were found and subsequently classified and presented according to the anatomical relations indicated in the articles. Indications were found that suggested anatomical relations between the mobility in the shoulder girdle and the scapulohumeral joint, between the mobility in the spinal column and the first rib (shoulder girdle) and between the spinal column and the scapulohumeral joint. No relevant indications regarding the development of shoulder complaints were found. CONCLUSIONS: Although no direct evidence was found, a comparison of the results of this study with theories postulated by other researchers on this subject suggests that a certain relation does exist.

Cervical Vertebrae↗
PubMed1996

[Arthrodesis of the shoulder for post-traumatic palsy of the brachial plexus. Analysis of a series of 18 cases].

PURPOSE OF THE STUDY: In case of severe traction injuries of the supraclavicular brachial plexus in adult, the functional results of direct shoulder nerve repair are less predictable than those of the elbow. Furthermore, the surgical management of the remaining flail shoulder is still controversial. The post-operative results and the indication for shoulder arthrodesis are evaluated in this study. MATERIAL AND METHODS: Between October 1978 and January 1994, 18 gleno-humeral arthrodesis were performed on 18 patients for paralytic shoulder following brachial plexus injury. The average age at the time of operation was 25 years. A C5C6 lesion was present in 2 patients, a C5C6C7 lesion in 8 patients and a C5 to T1 lesion in the remaining 8 patients. Seven patients had a suprascapular nerve reinnervation failure. All these 18 patients recovered an active elbow flexion spontaneously or following direct nerve repair, tendon or free muscle transfer. The average delay between nerve repair and arthrodesis was 2 years and 4 months. For fixation, we always used internal fixation by screws, combined to an external fixator device in 10 cases. RESULTS: 16 patients were reviewed with an average follow-up of 6 years and 10 months (min. 6 months, max. 15 years and 8 months). Two types of complications occurred: 2 cases of gleno-humeral non-union requiring revision with bone-grafting, and 3 humeral fractures in the first 6 months after arthrodesis. The study of the arthrodesis position showed an average abduction of 25 degrees, an average flexion of 18 degrees, an average internal rotation of 22 degrees. The average motion values are 60 degrees of abduction and flexion, 14 degrees of extension, 0 degree of external rotation and 48 degrees of internal rotation. The range of motion depends closely on scapulo-thoracic muscles strength, especially the serratus anterior muscle. A flail hand primarily influences the subjective result. 14 of the 16 patients could easily reach their mouth. The average muscle shoulder strength, evaluated with the Isobex device, is 11 kg for flexion and abduction, 9 kg for adduction, 8 kg for internal rotation and 4 kg for external rotation. DISCUSSION AND CONCLUSION: Gleno-humeral arthrodesis is a reliable method for restoring shoulder function in case of brachial plexus sequellae lesion, giving more strength, but less external rotation than shoulder nerve repair.

Adolescent↗
PubMed1998

Functional laboratory assessment after oncologic shoulder joint resections.

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.

Adolescent↗
PubMed1998

Can shoulder dystocia be predicted? Preconceptive and prenatal factors.

OBJECTIVE: To evaluate the predictability of shoulder dystocia using preconceptive and prenatal risk factors. STUDY DESIGN: Data from 1,622 term patients with prenatal care prior to 20 weeks who delivered single, vertex fetuses during a consecutive 12-month period were analyzed. Two groups were chosen. The first group was patients whose fetuses experienced shoulder dystocia during delivery (cases). The second group (controls) consisted of the remaining patients, whose fetuses had not experienced shoulder dystocia. The two groups were compared with regard to demographics and pregnancy characteristics. RESULTS: Factors not significantly different between the two groups included were obesity, multiparity, history of diabetes, short maternal stature, postdatism and advanced maternal age. The incidence of macrosomia was significantly higher (P < .001) in cases (35.4%) than in controls (4.8%). Other factors associated with shoulder dystocia were previous shoulder dystocia, concurrent diabetes, prior delivery of a fetus > 4,000 g and excessive weight gain during pregnancy. Many factors previously associated with shoulder dystocia were found to be nonsignificant in our study. CONCLUSION: Macrosomia appears to be the single important factor associated with shoulder dystocia which, even in the presence of significant risk factors, remains largely unpredictable.

Adolescent↗
PubMedDate not supplied

The injured shoulder. Primary care assessment.

Shoulder problems are the second most common orthopedic complaint in primary care medicine. The range of motion, ligamentous and muscular support, and central location of the shoulder are key factors for the successful performance of persons at work or on the playing field. These special attributes also contribute to injury and to difficulty in assessing the painful shoulder. An understanding of the pertinent anatomic structures, the differential diagnosis of shoulder pain (intrinsic and referred pains), and a systematic approach to the evaluation including a complete history and physical examination are necessary in this assessment. Adequate examination consists of inspection, muscle strength and range-of-motion testing, palpation, and neurologic testing of the shoulder, neck, and elbow followed by special tests to detect impingement, instability, or tendinosis. This basic assessment is augmented by the proper use of radiographs, arthrography, computed tomography, ultrasonography, and magnetic resonance imaging. An adequate database and proper assessment of the injured shoulder allow the primary care physician to make a pathoanatomic diagnosis and formulate an appropriate treatment plan and make appropriate use of orthopedic consultants.

Acute Disease↗
PubMed2004

[Conservative treatment and rehabilitation of shoulder problems].

The shoulder joint has an important influence on arm- and hand function. Therefore, activities of daily living, working and leisure time can be negatively influenced by diseases of the shoulder joint. Problems of the shoulder joint can be induced by muscular dysbalance and poor body posture. There is a strong relationship between shoulder function and body posture. Conservative treatment and rehabilitation of the shoulder joint aims at improving the local dysfunction of the shoulder joint as well as at improving function and social participation. Antiinflammatory and pain medication, exercise, occupational, electro-, ultrasound and shock wave therapy, massage, thermotherapy and pulsed electromagnetic fields are used as conservative treatments. Exercise therapy aims at improving muscular performance, joint mobility and body posture. Occupational therapy aims at improving functional movements for daily living and work. Electrotherapy is primarily used to relieve pain. Shock wave and ultrasound therapy proved to be an effective treatment for patients with calcific tendinitis. The subacromial impingement syndrome can be effectively treated by conservative therapy.

Biomechanical Phenomena↗
PubMed2003

[Biomechanical tests for type II SLAP lesions of the shoulder joint before and after arthroscopic repair].

Superior labral anterior-to-posterior (SLAP) lesions can cause shoulder pain partly by causing glenohumeral instability. The purpose of this study was to examine the effect of a simulated type II SLAP lesion and subsequent repair on glenohumeral translation of the vented shoulder. In eight cadaver joints, a robotic/UFS testing system was used to measure joint translation by applying an anterior, posterior, or inferior load of 50 N to each shoulder. The "apprehension tests" for anterior and posterior instability were simulated by applying an anterior load of 50 N with an external rotation torque of 3 Nm or a posterior load of 50 N with an internal rotation torque of 3 Nm. Each loading condition was applied at 30 degrees and 60 degrees of glenohumeral abduction with a constant joint compressive load (44 N) to the intact, simulated SLAP lesion, and repaired shoulder. Repair of the type II SLAP was then performed by placing a Suretac through the labrum both anterior and posterior to the biceps anchor and testing was repeated. ANOVA was used to compare translation of the intact joint, the joint after the type II SLAP lesion had been simulated, and after repair. At 30 degrees of abduction, anterior translation of the intact vented shoulder joint from anterior loading was 18.7+/-8.5 mm and increased to 26.2+/-6.5 mm after simulation of the type II SLAP lesion ( p< or =0.05). The arthroscopic repair did not restore anterior translation (23.9+/-8.6 mm) to the same degree as the intact joint ( p> or =0.05). At 60 degrees of abduction, anterior translation of 16.6+/-9.6mm in the intact joint was not significantly increased at 19.4+/-10.1 after simulation of the type II SLAP lesion ( p=0.0527). AP loading also resulted in inferior translation. At 30 degrees of abduction it was 3.8+/-4.0 mm in the intact joint and increased to 8.5+/-5.4 mm after the type II SLAP lesion ( p< or =0.05. After repair the inferior translation decreased significantly to 6.7+/-5.3 mm ( p< or =0.05). Although inferior translations were less at 60 degrees of abduction, results were similar to those at 30 degrees after repair. There were no significant increases in translation after SI/AP combined external rotation torque or posterior-anterior combined internal rotation torque loading. In this study the repair of a type II SLAP lesion only partially restored translations to the same degree as an intact vented shoulder joint. Therefore, improved repair techniques or an anteroinferior capsulolabral procedure in addition to the type II SLAP lesion repair might be needed to restore normal joint function.

Arthroscopy↗
PubMed2000

Ultrasonography of the shoulder.

Musculoskeletal ultrasound (MSUS) is an important modality in evaluating shoulder disease. Following a baseline shoulder conventional radiographic examination, MSUS can be used to screen the painful shoulder. It is accurate in diagnosing full- and partial-thickness tears of the rotator cuff. Both types of tears can be further characterized by size, location, and extension. Postoperatively, the rotator cuff can also be evaluated for recurrent full-thickness tears. MSUS is the only modality that can visualize and characterize synovial disease, without radiographic contrast, and when necessary, US-guided aspiration and biopsy can be performed. Real-time scanning shows the actual motion of the shoulder and its parts. Multiple attempts can be made to achieve optimal images for accurate documentation. Accessibility to MSUS facilitates the rapid turnaround of patients. US imagers and bone radiologists would do well to use MSUS to help their referring physicians establish a quick and accurate diagnosis of shoulder disorders. This article presents a comprehensive, pictorial review of the technical aspects of shoulder sonography as well as major types of pathology that can be diagnosed with US.

Arthrography↗