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PubMed1995

Bilateral isokinetic variables of the shoulder: a prediction model for young men.

Clinicians frequently want to know the pre-injury strength of an uninjured limb. The purpose of this study was to delineate the differences in bilateral isokinetic peak torque (PT) at 60 degrees and 240 degrees, and torque acceleration energy (TAE), average power (AP) and total work (TW) at 240 degrees during shoulder extension and flexion movements, and to develop a method to determine the expected maximal isokinetic variables of the dominant shoulder based upon isokinetic measurements from the non-dominant shoulder. Shoulder isokinetic measurements were obtained from 30 normal young male adults. While bilateral correlation was significant (P < 0.01), results also suggest significant bilateral differences P < 0.01). Thus, it is inappropriate to use the uninjured extremity to predict the pre-injured strength of the injured side without adjustment. In this investigation models were developed relating the expected maximal isokinetic measurement of the dominant shoulder to the non-dominant shoulder measurements.

Acceleration↗
PubMed2003

Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder.

BACKGROUND: The purpose of this study was to evaluate the results of arthroscopic treatment of traumatic unidirectional recurrent posterior subluxation of the shoulder. METHODS: We treated twenty-seven patients who had traumatic unidirectional recurrent posterior subluxation of the shoulder with arthroscopic labral repair and posterior capsular shift, and we evaluated them at a mean of thirty-nine months postoperatively. Patients who had posteroinferior instability, multidirectional instability, or an atraumatic onset or who were undergoing revision were excluded. There were twenty-five male and two female patients with a mean age of twenty-one years (range, fourteen to thirty-three years). All patients were involved in sports activity, and all had had a substantial injury prior to the onset of the instability. Results were assessed on the basis of stability, motion, and UCLA (University of California at Los Angeles), ASES (American Shoulder and Elbow Surgeons), and Rowe scores. Pain and function were also evaluated with visual analog scales. RESULTS: All patients had one or more lesions in the posteroinferior aspect of the labrum and capsule. The most common finding was incomplete stripping of the posteroinferior aspect of the labrum (eighteen patients). At the arthroscopy, the posteroinferior aspect of the capsule appeared to be stretched in twenty-two patients. At the time of follow-up, all patients had improved shoulder function and scores (p < 0.01). All patients also had a stable shoulder according to subjective and objective measurements, except for one patient who had recurrent subluxation. Except for that patient, all patients were able to return to their prior sports activity with little or no limitation. Shoulder function was graded as >90% of the preinjury level in twenty-four patients. There were twenty-one excellent UCLA scores, five good scores, and one fair score. The average pain score improved from 4.5 points preoperatively to 0.2 point at the time of follow-up (p < 0.0001). The mean loss of internal rotation was one vertebral level. There were no operative complications. CONCLUSIONS: Arthroscopic posterior labral repair and capsular shift to treat traumatic unidirectional recurrent posterior subluxation is a reliable procedure with respect to providing stability, pain relief, and functional restoration.

Adolescent↗
PubMed1965

NON-TUBERCULOUS SHOULDER DISABILITIES IN SANATORIUM PATIENTS.

Limitation of shoulder movement and/or shoulder pain occurs among patients chronically ill with conditions not related to bones and joints. Thirty patients with 45 disabled shoulders among persons with pulmonary tuberculosis were studied. The condition occurred most frequently in men beyond the age of 38 years. The shoulder involvement was not related to the location or severity of the underlying lung disease. Before the onset of their illness, most of these patients were very active and had well-developed shoulder muscles. The relative inactivity of hospital life may be a causative factor. The condition is reversible with physiotherapy and corticosteroids; 58% in this series recovered completely and 33% improved. Four progressed to a shoulderhand syndrome. Prophylactic shoulder exercises may be effective.

Adrenal Cortex Hormones↗
PubMed2005

Accuracy of estimated fetal weight in shoulder dystocia and neonatal birth injury.

OBJECTIVE: This study was undertaken to determine whether there is any difference in the rate of error of estimated fetal weight (EFW) in cases of shoulder dystocia compared with controls. STUDY DESIGN: Women whose delivery was complicated by shoulder dystocia were studied and compared with a control group matched for parity, race, labor type (spontaneous or induced), and birth weight (BW). Accuracy (%) was defined as [(EFW-BW)/BW] x 100. The primary outcome of the study was rate of EFW underestimation error 20% or greater. RESULTS: During the 5-year study period, there were 206 cases of shoulder dystocia that met all study criteria. There was no difference in the number of patients that had EFW underestimation error 20% or greater (shoulder dystocia 9.8% vs control 12.8%; P = .38). There was also no difference in the number of patients that had EFW underestimation error 20% or greater between shoulder dystocia with and without injury (injury 8.3% vs no injury 7.1%; P = .79). CONCLUSION: EFW underestimation error in cases of shoulder dystocia is an infrequent event and does not occur more often than in deliveries without shoulder dystocia.

Adolescent↗
PubMed2005

Shoulder dystocia: are historic risk factors reliable predictors?

OBJECTIVE: Our purpose was to determine the rate of associated risk factors for shoulder dystocia from a large cohort of patients delivered within our Southern California perinatal program. STUDY DESIGN: A retrospective analysis was performed of patients delivered from January 1991 to June 2001. Patients with and without shoulder dystocia were identified from our computer-stored perinatal database and compared. Statistical methods used included: chi 2 test, t test, calculation of odds ratios, and Fisher exact test, as indicated. RESULTS: Among the 267,228 vaginal births during the study period, there were 1,686 cases of shoulder dystocia (rate 0.6%). Rates for operative vaginal delivery, diabetes, epidural use, multiparity, and postdatism were similar among cases with and without shoulder dystocia. The clinical triad of oxytocin use, labor induction, and birth weight greater than 4,500 g yielded a cumulative odds ratio of 23.2 (95% CI 17.3-31.0) for shoulder dystocia, but its sensitivity and positive predictive value were only 12.4% and 3.4%, respectively. CONCLUSION: Historic obstetric risk factors for shoulder dystocia are not useful predictors for the event. Furthermore, although shoulder dystocia was observed more frequently with increasing birth weight, current limitations in estimating birth weight antenatally with accuracy preclude its practical use as a reliable predictor.

Adult↗
PubMed2006

Arthroscopic shoulder synovectomy in patients with rheumatoid arthritis.

PURPOSE: Currently, there is little information available concerning the results of shoulder synovectomy in patients with rheumatoid arthritis. Furthermore, it remains difficult to assess the success of shoulder synovectomy because of a high association of rotator cuff tears in rheumatoid patients. We hypothesized that synovectomy in patients with a functionally intact rotator cuff would provide durable pain relief. TYPE OF STUDY: Case series. METHODS: Sixteen shoulders in 13 patients with rheumatoid arthritis were treated with arthroscopic shoulder synovectomy from 1988 to 2002 with a mean follow-up of 5.5 years. Patients with full-thickness rotator cuff tears or partial tears that required repair were excluded. Two of the 13 patients had been diagnosed with juvenile rheumatoid arthritis and 11 had adult-onset disease. The medical records of the patients were reviewed and patients were assessed clinically and by questionnaire to assess pain, satisfaction, range of motion, radiographic outcomes, and occurrence of complications. RESULTS: There was an improvement in pain at long-term follow-up in 13 of 16 patients (P < .001). Active shoulder elevation improved from a median of 145 degrees to 160 degrees but was not significant (P = .14). External rotation improved significantly (P = .01) from a median of 45 degrees (range, 0 degrees to 90 degrees) to 60 degrees (range, 0 degrees to 100 degrees). According to the Neer rating system, there were 5 excellent, 8 satisfactory, and 3 unsatisfactory results. Seven of 8 shoulders followed-up radiographically for more than 1 year showed radiographic progression of disease. All 3 patients reporting pain that was no better or worse than before surgery had radiographic arthrosis at last follow-up with advancing periarticular erosions and reduction of glenoid articular space. CONCLUSIONS: Arthroscopic synovectomy of the shoulder in patients with rheumatoid arthritis with an intact rotator cuff offers a reliable decrease in pain with less predictable improvements in range of motion. Limitations in predicting final results based on preoperative radiographs should be discussed with patients; those with more advanced radiographic changes may not benefit from the procedure. LEVEL OF EVIDENCE: Level IV, therapeutic study, case series, no control group.

Arthritis, Rheumatoid↗
PubMed2005

Maternal morbidity associated with obstetrical maneuvers in shoulder dystocia.

OBJECTIVES: To determine whether shoulder dystocia and obstetrical maneuvers used for its relief have detrimental effects on perineum or immediate postpartum outcome. DESIGN: Case-control study. SETTING: Tertiary maternity ward in Marseille, France. POPULATION: A total 140 cases with shoulder dystocia and 280 controls without shoulder dystocia were enrolled by reviewing charts for the period between January 1999 and December 2004. METHODS: Demographic data including obstetrical history, age, height, weight before pregnancy and at the time of delivery, and respective body mass index (BMI) and obstetrical data including analgesic technique, duration of first and second stage of labor were compared in function of outcome and of the type and number of maneuvers used to relieve shoulder dystocia. RESULTS: Resolving shoulder dystocia required one obstetrical maneuver in 41 cases (29.3%) and two obstetrical maneuvers in 48 cases (34.3%). Third-degree tears occurred in one patient in the case group versus five in the control group. No correlation was found between the number of obstetrical maneuvers needed to relieve shoulder dystocia and risk for third-degree tear (OR: 0.8; 95% CI: 0.1-7.6). Mean hemoglobin values were 96.1 g/l in the case group and 96.0 g/l in the control group (p=0.95). There was no difference between the two groups regarding duration of postpartum hospitalization. The incidence of urinary incontinence was similar in the group that underwent obstetrical maneuvers: 4.7% (6/127) and in the control group: 3.7% (13/352). Only two patients reported de novo anal symptoms, both in the control group. CONCLUSION: Shoulder dystocia and obstetrical techniques used for its relief did not result in adverse maternal outcome.

Adult↗
PubMed1997

The effects of paved shoulders on accidents on rural highways.

This paper presents the results of a project that sought to determine the safety effect of paving shoulders in rural roads Victoria, Australia. Data were obtained on the location, condition and cost of recent shoulder-paving projects on two-lane two-way roads (i.e. one lane in each direction). Accident data were obtained for these sites, and a before-and-after comparison, using control sites, was undertaken. Most shoulder-paving programs examined involved a low-cost paving of an existing shoulder, typically involving an interim bituminous sealing treatment, followed a year or so later with a reseal in conjunction with a pavement reseal. The shoulder width is typically between 600 and 1200 mm, with 600 or 800 mm being the most common. The results for this type of treatment indicate that shoulder paving was associated with a statistically-significant reduction in casualty accident frequencies at sites where it was installed on two-lane two-way rural highways in Victoria. Overall, casualty accidents were reduced by 41 per cent on a per vehicle kilometre basis at such sites, which is equivalent to a reduction of 0.071 casualty accidents per million vehicle kilometres. The break-even point (the point at which it is economically worthwhile to pave shoulders) is at a traffic flow of about 360 vehicles per day. The main accident reductions are for accidents involving rear end, overtaking--out of control, off carriageway to left, and off carriageway to right into fixed object. A relationship between measures of economic worth (net present value and benefit/cost ratio) and traffic flow is developed.

Accidents, Traffic↗
PubMed1998

A biomechanical study of occupational loads in the shoulder and elbow in dentistry.

OBJECTIVE: The aim was to demonstrate that when electromyographic (EMG) recordings are supplemented by biomechanical calculations more detailed information on shoulder loads are produced. DESIGN: Shoulder and elbow moments were calculated for three work situations of arm abduction (> 30 degrees, < 30 degrees and < 30 degrees with force on the hand) and were related to EMG. BACKGROUND: Prolonged arm elevation may result in shoulder pain and information on shoulder loads is needed to avoid development of musculoskeletal disorders. METHODS: Three-dimensional coordinates from video recordings of eight working dentists were used in a static link segment model based on orthopaedic axes. Moments and EMG (trapezius muscle) were related. Results: Working with the upper arm abducted more than 30 degrees produced 1.7 Nm (440%) higher moments of shoulder abduction, 0.5 Nm (100%) higher moments of outward upper arm twisting and 0.3 Nm (18%) smaller moments of elbow flexion than working with the upper arm abducted less than 30 degrees. Trapezius muscle activity did not increase with increased arm abduction. Force on the hand (20 N) recorded during cavity filling altered moments of the shoulder and elbow but not the activity level of the trapezius muscle. CONCLUSION: Supplementing EMG with biomechanical calculations of moments results in more detailed information on shoulder loads. This is important for over-all risk identification.

Journal Article↗
PubMed2003

Diagnosis and management of the painful shoulder. Part 2: examination, interpretation, and management.

Diagnosis, interpretation and subsequent management of shoulder pathology can be challenging to clinicians. Because of its proximal location in the schlerotome and the extensive convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns can be broadly distributed to the deltoid, trapezius, and or the posterior scapular regions. This pain behavior can make diagnosis difficult in the shoulder region, as the location of symptoms may or may not correspond to the proximity of the pain generator. Therefore, a thorough history and reliable physical examination should rest at the center of the diagnostic process. Effective management of the painful shoulder is closely linked to a tissue-specific clinical examination. Painful shoulder conditions can present with or without limitations in passive and or active motion. Limits in passive motion can be classified as either capsular or noncapsular patterns. Conversely, patients can present with shoulder pain that demonstrates no limitation of motion. Bursitis, tendopathy and rotator cuff tears can produce shoulder pain that is challenging to diagnose, especially when they are the consequence of impingement and or instability. Numerous nonsurgical measures can be implemented in treating the painful shoulder, reserving surgical interventions for those patients who are resistant to conservative care.

Journal Article↗
PubMed2001

Shoulder girdle elevation during neurodynamic testing: an assessable sign?

One of the signs advocated for monitoring during neurodynamic testing in the assessment of patients with upper quadrant disorders, is the response of the shoulder girdle. It is stated that a protective rising of the shoulder girdle is present when patients with neurogenic disorders are assessed and that the elevation is absent in asymptomatic subjects. As sensory responses are elicited in the majority of asymptomatic subjects and as the range of motion (ROM) is often limited during neurodynamic testing, it is questionable whether the elevation of the shoulder girdle would be absent in asymptomatic subjects. The aim of this study was to measure the shoulder girdle elevation force during five variants of the neural tissue provocation test for the median nerve. Thirty-five asymptomatic male subjects were assessed. A load cell was used to measure the amount of shoulder girdle elevation force and two electrogoniometers were used to measure the ROM at the elbow and wrist. When the ROM at the end of the test was restricted, a gradual increase in shoulder girdle elevation force could be observed throughout the test. Compared to the initial force at the start of the test, all variants resulted in a significant increase in force. It is concluded that a gradual increase in shoulder girdle elevation force should not be regarded as an abnormal sign in the interpretation of neurodynamic tests.

Adult↗
PubMed1995

Shoulder dystocia: could it be deduced from the labor partogram?

The study was undertaken to test the hypothesis that shoulder dystocia might be suspected and reliably identified from the labor partogram. A retrospective analysis of 52 consecutive patients with shoulder dystocia was performed. The 52 controls were the next consecutive parturient matched for maternal age, gestational age at delivery, parity, presentation, and infants weight at delivery. The mean dilation rate was 2.1 +/- 1.9 cm/hr in shoulder dystocia group compared to 2.4 +/- 1.5 cm/hr in the control group. The incidence of protracted rate of less than 1 cm/hr was 14.3% in shoulder dystocia group and 13.5% in the control group. The mean duration of second stage was 38.3 +/- 30.7 minutes in the shoulder dystocia group compared to 35.5 +/- 32.5 minutes in the control group. Only 1.9% have had a prolonged second stage (more than 2 hours) in the shoulder dystocia group compared to 1.9% in the control group. The difference between the groups regarding the length of labor was not statistically significant. We conclude that protracted labor does not seem to be a risk factor for shoulder dystocia.

Adult↗
PubMed2005

Trends in the rate of shoulder dystocia over two decades.

OBJECTIVE: To describe the trend in the rate of shoulder dystocia over twenty-four years and identify the risk factors related to the occurrence of dystocia. METHODS: Data was obtained from Maryland State regarding all vaginal deliveries that occurred during six different time periods at five-year intervals since 1979. Trends in the rate of shoulder dystocia, episiotomy, forceps and vacuum delivery were examined. RESULTS: There were a total of 277 974 vaginal deliveries. The overall rate of shoulder dystocia was 1.29% (n = 3590). Induction of labor (adjusted OR 1.2, 1.1-1.3), presence of diabetes (gestational (OR 1.9, 1.7-2.3) or pre-gestational (OR 3.8, 2.7-5.4)), fetal macrosomia (OR 5.1, 4.1-6.3) use of episiotomy (OR 1.6, 1.5-1.8), forceps (OR 1.3, 1.0-1.8) or vacuum (OR 2.3, 2.0-3.9) at delivery were associated with a higher rate of shoulder dystocia. TREND: There was an increase in the rate of shoulder dystocia from 0.2% in 1979 to 2.11% in 2003. In addition there was a drop in the overall episiotomy rate from 73.67% to 23.94% and increase in the use of vacuum from 0.1% to 8.36%. CONCLUSION: The rate of shoulder dystocia has increased by 10 fold during the study period. The use of episiotomy either at spontaneous delivery or instrumental delivery does not appear to decrease the occurrence of shoulder dystocia.

Adolescent↗
PubMed2004

Shoulder scoring scales for the evaluation of rotator cuff repair.

Various assessment tools have been proposed for evaluation of shoulder function. Analyses of comparability, validity, and reliability among shoulder assessment tools are lacking. The purpose of our investigation was to compare the results of three commonly used shoulder assessment tools in the evaluation of a specific shoulder condition. Seventy-two full-thickness rotator cuff tears were treated with an open rotator cuff repair from 1986-1993. The average age of the patients at surgery was 58 years (range, 24-92 years). The median duration of followup at the time of evaluation for this study was 55 months (range, 24-102 months; standard deviation, 22 months). Correlation among the results of the UCLA, Constant-Murley, and the Simple Shoulder Test scales was fair (range, 0.66-0.76). More importantly, the three systems were evaluated for their ability to accurately predict improved motion, strength, and patient satisfaction. The Simple Shoulder Test and the Constant-Murley scales showed the highest positive predictive values. The Simple Shoulder Test is a patient-based self-assessment device that easily can be incorporated into a busy clinical practice, providing outcome data comparable with complex evaluation systems when evaluating the results of rotator cuff repair.

Adult↗
PubMed2006

A multi-centre randomized controlled trial comparing electrothermal arthroscopic capsulorrhaphy versus open inferior capsular shift for patients with shoulder instability: protocol implementation and interim performance: lessons learned from conducting a multi-centre RCT [ISRCTN68224911; NCT00251160].

BACKGROUND: The shoulder is the most frequently dislocated joint in the body. Multiple causes and pathologies account for the various types of shoulder instability. Multi-directional instability (MDI) and multi-directional laxity with antero-inferior instability (MDL-AII) are similar in pathology, less common and more difficult to treat. These instabilities are caused by ligamentous capsular redundancy. When non-operative management fails for these patients, quality of life is significantly impaired and surgical treatment is required to tighten the ligaments and joint capsule. The current reference (gold) standard treatment for MDI/MDL-AII is an open inferior capsular shift (ICS) surgical procedure. An alternative treatment involves arthroscopic thermal shrinkage of redundant capsular tissue to tighten the joint. However, there is a lack of scientific evidence to support the use of this technique called, electrothermal arthroscopic capsulorrhaphy (ETAC). This trial will compare the effectiveness of ETAC to open ICS in patients with MDI and MDL-AII, using patient-based quality of life outcome assessments. METHODS: This study is a multi-centre randomized clinical trial with a calculated sample size of 58 patients (p = 0.05, 80% power). Eligible patients are clinically diagnosed with MDI or MDL-AII and have failed standardized non-operative management. A diagnostic shoulder arthroscopy is performed to confirm eligibility, followed by intra-operative randomization to the ETAC or ICS surgical procedure. The primary outcome is the disease-specific quality of life questionnaire (Western Ontario Shoulder Instability Index), measured at baseline, 3, 6, 12 and 24 months. Secondary outcomes include shoulder-specific measures (American Shoulder and Elbow Surgeons Score and Constant Score). Other outcomes include recurrent instability, complications and operative time. The outcome measurements will be compared on an intention-to-treat basis, using two-sample independent t-tests to assess statistical significance. A Generalized Estimated Equations (GEE) analysis will determine whether there is an effect over time. DISCUSSION: This ongoing trial has encountered unexpected operational and practical issues, including slow patient enrollment due to high intra-operative exclusion rates. However, the authors have a greater understanding of multi-directional laxity in the shoulder and anticipate the results of this trial will provide the medical community with the best scientific clinical evidence on the efficacy of ETAC compared to open ICS.

Journal Article↗
PubMed2006

Comparison of visual and objective quantification of elbow and shoulder movement in children with obstetric brachial plexus palsy.

BACKGROUND: The Active Movement Scale is a frequently used outcome measure for children with obstetric brachial plexus palsy (OBPP). Clinicians observe upper limb movements while the child is playing and quantify them on an 8 point scale. This scale has acceptable reliability however it is not known whether it accurately depicts the movements observed. In this study, therapist-rated Active Movement Scale grades were compared with objectively-quantified range of elbow flexion and extension and shoulder abduction and flexion in children with OBPP. These movements were chosen as they primarily assess the C5, C6 and C7 nerve roots, the most frequently involved in OBPP. Objective quantification of elbow and shoulder movements was undertaken by two-dimensional motion analysis, using the v-scope. METHODS: Young children diagnosed with OBPP were recruited from the Royal Children's Hospital (Melbourne, Australia) Brachial Plexus registry. They participated in one measurement session where an experienced paediatric physiotherapist facilitated maximal elbow flexion and extension, shoulder abduction and extension through play, and quantified them on the Active Movement Scale. Two-dimensional motion analysis captured the same movements in degrees, which were then converted into Active Movement Score grades using normative reference data. The agreement between the objectively-quantified and therapist-rated grades was determined using percentage agreement and Kappa statistics. RESULTS: Thirty children with OBPP participated in the study. All were able to perform elbow and shoulder movements against gravity. Active Movement Score grades ranged from 5 to 7. Two-dimensional motion analysis revealed that full range of movement at the elbow and shoulder was rarely achieved. There was moderate percentage agreement between the objectively-quantified and therapist-rated methods of movement assessment however the therapist frequently over-estimated the range of movement, particularly at the elbow. When adjusted for chance, agreement was equal to chance. CONCLUSION: Visual estimates of elbow and shoulder movement in children with OBPP may not provide true estimates of motion. Future work is required to develop accurate, clinically-acceptable methods of quantifying upper limb active movements. Since few children attained full range of motion, elbow and shoulder movement should be monitored and maintained over time to reduce disability later in life.

Journal Article↗
PubMedDate not supplied

[Shoulder-hand syndrome in patients after stroke].

Basing on the literature, the information on the shoulder-hand syndrome in stroke patients is presented. The syndrome is believed to be a clinical form of algodystrophy of the upper extremity. The main signs and symptoms include pain and considerable reduction of movement in shoulder joint, wrist and hand. The condition usually develops 1-6 months after stroke with pain and loss of range of motion in the shoulder at the beginning; then the distal part of the extremity is involved. The syndrome is considered to develop in three consecutive phases: I--acute, II--dystrophic and III--atrophic. Besides classical clinical form, affecting distal and proximal part of extremity, the incomplete forms confined only to one of this parts may exist. The prevalence of the condition is rated at 12.5-27% in stroke patients. It is believed that the development of the syndrome is related to altered biomechanics of the hemiplegic shoulder. Stability of the joint is considerably affected due to paresis or palsy of shoulder girdle muscles what results in partial subluxation of humeral head. Repeated microtraumas of shoulder joint may cause chronic pain and may initiate development of abnormal, regional sensory-sympathetic reflex arch, or--according to the other concept--it results in "sensitization" of neurons in the dorsal horn; this state may alter dorsal horn central mechanisms processing sensory and painful stimuli. The diagnosis of the syndrome is based on clinical ground. Three-phase bone scintigraphy is believed to be the most useful additional diagnostic test. The diagnostic and predictive value of this technique is presented. For all advantages of scintigraphic examination, it does not need to be performed in the majority of stroke patients since the presence of typical signs and symptoms is usually sufficient to make a diagnosis. The treatment of shoulder-hand syndrome included administration of steroids with satisfactory response. The role of proper physical therapy in improving of the results of treatment as well as in prophylactics of the syndrome is emphasised. Considering the fact that many of stroke patients may have contraindications to steroid therapy, other methods of effective treatment are proposed.

Cerebrovascular Disorders↗
PubMed2000

Unconstrained shoulder arthroplasty.

OBJECTIVE: To evaluate the results of 36 unconstrained shoulder arthroplasties. METHODS: In the series, 24 total and 12 hemi-arthroplasties of the shoulders were performed with unconstrained shoulder prostheses in 29 patients who suffered from glenohumeral degenerative arthritis, rheumatoid arthritis, avascular necrosis and proximal fracture of humerus, respectively. Follow-up averaged 6.2 years. All patients were evaluated pre- and post-operatively using the rating system of the Society of American Shoulder and Elbow Surgeons which assesses the severity of pain, strength of muscles around shoulder, stability, range of motion and functional activities of daily living. Radiolucent line and migration of prostheses were observed postoperatively on X-rays. RESULTS: Postoperatively, the rate of pain relief was 91.3%, and active range of motion increased by 47 in forward flexion, 43 in abduction, 30 in external rotation, and 4 segments in internal rotation. Preoperatively the average points of 6 functional activities patients could perform was 0.8, and postoperatively 3.1. On postoperative X-ray, proximal migration of the humerus was seen in 8 shoulders, 6 of which had either a torn or absent rotator cuff. Radiolucent lines were seen around 1 humeral component and 9 glenoid components. One humeral and 2 glenoid components loosened. CONCLUSIONS: These results suggest that unconstrained shoulder arthroplasty is a satisfactory and safe technique.

Journal Article↗