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PubMed2004

Human involuntary postural aftercontractions are strongly modulated by limb position.

Involuntary muscle activations called aftercontractions occur in skeletal muscles following sustained voluntary contractions. They are strongest following high-force voluntary contractions in proximal muscles. Their mechanism is unknown. Some authors have hypothesised that they are dependent on proprioceptive feedback; others believe that they are independent of such influences. These experiments tested this hypothesis by examining the effect of shoulder joint excursion magnitude and direction on aftercontraction amplitude. A 1-min maximal isometric voluntary abduction of the shoulder joint was used to evoke a postural involuntary aftercontraction in the deltoid muscle. During the 20-s aftercontraction which followed the arm was allowed to abduct in the coronal plane and active muscle shortening took place. The maximum amplitude of EMG activity during the aftercontraction of the deltoid muscle was equal to 20-50% of the EMG amplitude of the maximal voluntary contraction. The aftercontraction EMG amplitude grew as the angle of shoulder joint abduction increased. This growth ceased and the activity levelled off if arm movement was blocked. The results showed that the final EMG amplitude reached depended linearly on the final shoulder angle allowed-it did not grow purely as a function of time. Forcible adduction of the arm by the experimenter and consequent lengthening of the muscle caused the EMG of the aftercontraction to fall with decreasing shoulder joint angle. It is concluded that the neural centres controlling the involuntary aftercontraction are strongly modulated by proprioceptive feedback. Results are given as mean (SD) unless otherwise stated.

Adaptation, Physiological↗
PubMed1998

Multijoint arm movements in cerebellar ataxia: abnormal control of movement dynamics.

In cerebellar ataxia, kinematic aberrations of multijoint movements are thought to originate from deficiencies in generating muscular torques that are adequate to control the mechanical consequences of dynamic interaction forces. At this point the exact mechanisms that lead to an abnormal control of interaction torques are not known. In principle, the generation of inadequate muscular torques may result from an impairment in generating sufficient levels of torques or from an inaccurate assessment and prediction of the mechanical consequences of movements of one limb segment on adjacent joints. We sought to differentiate the relative contribution of these two mechanisms and, therefore, analyzed intersegmental dynamics of multijoint pointing movements in healthy subjects and in patients with cerebellar degeneration. Unrestrained vertical arm movements were performed at three different target movement velocities and recorded using an optoelectronic tracking system. An inverse dynamics approach was employed to compute net joint torques, muscular torques, dynamic interaction torques and gravitational torques acting at the elbow and shoulder joint. In both groups, peak dynamic interaction forces and peak muscular forces were largest during fast movements. In contrast to normal subjects, patients produced hypermetric movements when executing fast movements. Hypermetric movements were associated with smaller peak muscular torques and smaller rates of torque change at elbow and shoulder joints. The patients' deficit in generating appropriate levels of muscular force were prominent during two different phases of the pointing movement. Peak muscular forces at the elbow were reduced during the initial phase of the movement when simultaneous shoulder joint flexion generated an extensor influence upon the elbow joint. When attempting to terminate the movement, gravitational and dynamic interaction forces caused overshooting extension at the elbow joint. In normal subjects, muscular torque patterns at shoulder and elbow joint were synchronized in that peak flexor and extensor muscular torques occurred simultaneously at both joints. This temporal pattern of muscular torque generation at shoulder and elbow joint was preserved in patients. Our data suggest that an impairment in generating sufficient levels of phasic muscular torques significantly contributes to the patients' difficulties in controlling the mechanical consequences of dynamic interaction forces during multijoint movements.

Adult↗
PubMed1991

Multi-joint reaching movements and eye-hand tracking in cerebellar incoordination: investigation of a patient with complete loss of Purkinje cells.

Performance on an eye-hand tracking task and a multi-joint reaching movement to a visual target was studied in a patient with stable cerebellar ataxia and in control subjects. The patient subsequently died and a full neuropathological examination was performed. The neuropathological findings were similar to those seen in patients with paraneoplastic cerebellar degeneration, but no tumor was found at autopsy eight years after onset of the patient's cerebellar syndrome. A severe cerebellar cortical degeneration with complete Purkinje cell loss was demonstrated, whereas cerebellar nuclei and brainstem structures showed no neuronal loss. Tracking performance by the patient was characterized by abnormally large numbers of high velocity movements and hand direction reversals, and by excessive lagging of the hand behind the target in time. In the multi-joint reaching movement, the patient showed a delay in movement onset at the elbow joint compared to movement onset at the shoulder joint. The velocity profile of the movement at the shoulder joint was abnormal. The duration of the acceleration phase was poorly correlated with both peak angular velocity and the duration of the deceleration phase. One of the most striking findings was the inability of the patient to consistently produce the same movement direction from trial to trial while reaching to the same target. Our data suggests that the cerebellar cortex is involved in multiple aspects of motor control including visuomotor integration mechanisms.

Adult↗
PubMedDate not supplied

[Results of radiosynoviorthesis with yttrium 90 in chronic synovitis: a long-term prospective study. I. Total results and effect of local factors].

The purpose of the presented study was to investigate, whether the results of radiosynovectomy were dependent on different characteristics of the chronic synovitis. In our unit, from October 1978 to April 1981 193 joints--174 knee joints and 19 shoulder joints--of 107 patients underwent radiosynoviorthesis. 93 patients (169 joints) suffered from rheumatoid arthritis of different ARA-stages (I = 16, II = 31, III = 27, IV = 19; 67 seropositive, 26 seronegative), 14 patients with 24 treated joints had chronic synovitis other than rheumatoid arthritis. Only joints with chronic synovitis in the local stages I and II were treated if they did not respond to medical therapy and intraarticular applications of corticosteroids, respectively. Joints with local stage III and IV, respectively, with instability or with a secondary osteoarthrosis were excluded from radiosynovectomy. Every six months the patients were reinvestigated, and pain, swelling, mobility, stability of the joint, frequency of effusions and intraarticular steroid applications were assessed as well as the overall activity of the disease, SR, hemoglobin and effectivity of medical treatment. The overall result was good in 60% of cases after 6 and 12 months, respectively, in 54% of cases after 2 years and in 50% of cases after 3 years, it was fair in about 35% of cases. The results of 20 repeated radiosynovectomies were comparable. The frequency of joint effusions and of necessary intraarticular corticosteroid injections was significantly reduced even in patients showing a "poor" result of synoviorthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Results of radiosynoviorthesis with yttrium 90 in chronic synovitis: a long-term prospective study. II. Effect of general disease parameters].

The results of 193 Yttrium-90 synovectomies in 174 knee joints and 19 shoulder joints, mostly in patients with rheumatoid arthritis, were analysed statistically on the basis of 6 monthly reinvestigations up to a follow up of three years. The results were significantly better in stage I than in stages II-IV of rheumatoid arthritis, which did not differ between each other; they were better in patients with low than in those with high disease activity; the effectivity was better in patients who responded well to medical treatment than in those who responded badly. In the group with "good" results of Y-90 synovectomy a significant fall in sedimentation rate and significant rise of hemoglobin could be registered. On the other hand, there was no difference between seropositive and seronegative patients. In a number of joints the good result of radiation synovectomy was preserved even in patients with overall progression of the disease. Our results show that the results of radiation synovectomy as of all local treatments have to be regarded in relation to the general development of the disease.

Adult↗
PubMed2006

Changes in corticomotor excitability of forearm muscles in relation to static shoulder positions.

We examined whether the recruitment properties of the corticospinal pathway to forearm muscles are influenced by variations of the shoulder joint angle. Flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles motor evoked potentials (MEPs) in response to transcranial magnetic stimulation were examined during different static positions of shoulder joint in the horizontal plane: from 30 degrees abduction to 30 degrees adduction. We found that at 30 degrees shoulder adduction, maximum slope and plateau phase of the ECR and FCR input-output relationship (i.e., relation between MEP size and stimulus intensity) were significantly higher and lower than at 30 degrees abduction of the shoulder joint, respectively. Intracortical inhibition (ICI) and intracortical facilitation (ICF) of the FCR were assessed using a paired-magnetic pulse paradigm. A significant decrease in ICF was observed after changing shoulder position from 30 degrees abduction to 30 degrees adduction. On the contrary, no variation in the amount of ICI occurred in relation to the same changes in shoulder position. FCR H-reflex to electrical stimulation of median nerve at elbow did not differ significantly between the two shoulder positions. We conclude that shoulder position influences the recruitment efficiency (gain) of the corticospinal volleys to motoneurones of forearm muscles. It is proposed that activity of peripheral receptors signaling static shoulder position influences corticomotor excitability of forearm muscles mainly at cortical level, although C3-C4 propriospinal system could be also involved. It is proposed that the above changes in corticomotoneuronal excitability to forearm muscles as function of shoulder joint position are part of a global proximal-distal synergy operating throughout reaching movements.

Adult↗
PubMed1993

[The carpal tunnel syndrome, its diagnosis and therapy].

Secondary amyloidosis is a complication typical for patients on long-term haemodialysis (HD). The first clinical signs are usually shoulder joint pain and CTS. We have questioned 74 patients who were on regular HD treatment and divided them into 3 groups according to the length of HD. Group I--on HD for 1-4 years: there were 35 patients in this group, 15 of them (i.e. 43%) had shoulder joint pain and/or CTS. None of these patients had such symptoms, which would require surgical treatment. Group II--on HD for 5-9 years: there were 22 patients in this group, 15 of them (i.e. 68%) had shoulder joint pain and/or CTS. 3 patients from this group had severe night pain and were therefore indicated for surgical treatment for CTS, each of them on 1 hand only. In 2 cases there was amyloid present in the histological examination. Group III--on HD for over 10 years: there were 17 patients in this group, 13 of them (i.e. 76%) had shoulder joint pain and/or CTS. 5 patients from this group were operated on both hands for severe night pain due to carpal tunnel syndrome. Only 1 patient had positive amyloid on both hands in the histological examination. All the 8 patients (i.e. 13 hands) were examined by EMG before the operation, showing reduction of motor conduction on n. medianus by 30.7 +/- 15.1%. After the operation the EMG control was done in 4 patients (7 hands), showing no improvement in 2 cases and in 5 cases the conduction on the n. medianus was found to be in the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Amyloidosis↗
PubMed1990

Retroversion of the humeral head in the normal shoulder and its relationship to the normal range of motion.

Retroversion of the humeral head and the range of motion of the shoulder joint in both the frontal and the scapular plane have been studied in 100 shoulder joints in 50 healthy subjects, 25 men and 25 women. The average angle for humeral head retroversion was 33 degrees on the dominant side and 29 degrees for the nondominant side. There was no difference between genders. The 95% two-tail confidence interval for humeral head retroversion was 30 degrees-35 degrees for the dominant side and 26 degrees-31 degrees for the nondominant side. A larger retroversion angle was consistent with an increased range of external rotation. Mean external rotation in 90 degrees abduction was 105 degrees in the frontal plane and 120 degrees in the scapular plane. External rotation in 90 degrees abduction was greater in women than in men, but there was no difference between dominant and nondominant shoulder joints. The range of motion of rotation was found to be greater than the accepted normal values.

Adult↗
PubMed2005

[Efficacy of pulsed mode radiofrequency lesioning of the suprascapular nerve in chronic shoulder pain secondary to rotator cuff rupture].

Suprascapular nerve blockade can be performed in chronic shoulder pain secondary to rotator cuff lesions, shoulder joint osteoarthritis, and adhesive capsulitis. Local anesthetics and steroids are commonly combined for the blockade. In this report, we present pulsed mode radiofrequency lesioning of suprascapular nerve for persistent shoulder pain in 8 patients. 8 patients with no response to six weeks physical or medical treatment were hospitalized in our Algology Clinic for suprascapular nerve pulsed mode radiofrequency lesioning. All blocks were performed in sitting position with a 22-Gauge, 100 mm "SMK" needle with 5 mm active tip and "Radionics" radiofrequency generator. Sensory stimulation at 50 Hz, 0.2 millisecond pulse width was performed and paresthesias in the shoulder joint occurred at 0.3 V. Motor stimulation at 2 Hz, 0.2 millisecond pulse width showed the contractions of the infraspinatus and supraspinatus muscles occurred at 0.4-0.5 V. Pulsed mode radiofrequency lesioning was then carried out two times for 120 seconds at 2 Hz frequency and pulse width of 20 milliseconds at 42 degrees C. Patients were evaluated for pain scores and shoulder joint movements at 1, 2, 4, 8, and 12 weeks after the procedure. Pulsed mode radiofrequency lesioning of suprascapular nerve block provided pain control for at least twelve weeks and improved shoulder joint movements.

Humans↗
PubMed1990

Stabilizing mechanism of the glenohumeral ligaments.

By using the electromagnetic tracking system, the kinematics of the glenohumeral joint in the shoulder complex was studied. With the location of the glenohumeral ligament insertions digitized, the change of ligament length and direction could then be calculated throughout a given movement. This technique provided a useful method for in vitro assessment of the capsuloligamentous constraints of the shoulder joint.

Biomechanical Phenomena↗
PubMed2005

Effect of fore-aft seat position on shoulder demands during wheelchair propulsion: part 2. An electromyographic analysis.

BACKGROUND/OBJECTIVES: Shoulder pain is common in persons with complete spinal cord injury. Adjustment of the wheelchair-user interface has been thought to reduce shoulder demands. The purpose of this study was to quantify the effect of seat fore-aft position on shoulder muscle activity during wheelchair propulsion. METHODS: Shoulder electromyography (EMG) was recorded while 13 men with paraplegia propelled a wheelchair in the following 2 seat positions: (a) shoulder joint center aligned with the wheel axle (anterior) and (b) shoulder joint center 8 cm posterior to the wheel axle (posterior) in 3 test conditions (free, fast, and graded). Duration of EMG activity and median and peak intensities were compared. RESULTS: During free propulsion, the median EMG intensity of all muscles was similar between anterior and posterior seat positions. The major propulsive muscles (pectoralis major and anterior deltoid) demonstrated significant reductions in their median and peak intensities in the posterior seat position. Pectoralis major median intensity was significantly reduced in the posterior position during fast (52% vs 66% maximal muscle test [MMT]) and graded (41 % vs 49% MMT) conditions, and peak intensity was significantly reduced in the free condition (29% vs 52% MMT) and the fast condition (103% vs 150% MMT). Anterior deltoid intensity was significantly reduced in the posterior position during fast propulsion only (26% vs 31% MMT). For all muscles, EMG duration was similar between positions in all test conditions. CONCLUSIONS: Reduction in the intensity of the primary push phase muscles (pectoralis major and anterior deltoid) during high-demand activities of fast and graded propulsion may reduce the potential for shoulder muscle fatigue and injuries.

Acceleration↗
PubMed1992

Anatomy and function of the bursa subacromialis.

The ligamentum coracohumerale, as the anterior limit of the bursa subacromialis, runs into the shoulder joint capsule, connecting--broadly based--above the sulcus intertubercularis. It does not, however, originate--as described previously--from the base of the processus coracoideus (viewed frontally), but rather medially from the base, i.e. on the side of the fossa supraspinatus. The sliding mechanism starting at 50 degrees affects the parietal sheet of the bursa subacromialis, whereby the laterally situated section slides under the medially situated section. With an abduction of up to 50 degrees, the lateral section congests in front of the corner of the acromion, sliding from there under the acromion, so that the--hitherto--medial section is located above the section now sliding away beneath it. This sliding mechanism continues on up to 100 degrees. At this point the parietal sheet of the bursa subacromialis lies as follows: The section that had been situated laterally at the beginning of the sliding mechanism now lies caudally to the section that had lain medially at the outset. The bursa subacromialis does not slide fully into the fossa supraspinatus, as in all of the cases observed, it is firmly connected, together with the fascia subdeltoidea, to the corner of the acromion. The visceral sheet does not change in the course of the sliding mechanism as described, as it is connected to the fascia of the supraspinatus muscle--with the exception of a medial stretch of 16 mm. A further finding deals with the course of the muscles of the caput breve of the biceps brachii. Individual muscle fibre components do not connect to the processus coracoideus, but rather run before the tip of the processus coracoideus into the ligamentum coracoacromiale, radiating not only into the ligamentum coracoacromiale, but also--certain components--into the shoulder joint capsule. Through this, the 'aponeurosis tendinis brachii' forms a tendon roof in front of the processus coracoideus that extends to the structures running along the head of the humerus. The muscle fibre components of the caput breve of the m. biceps brachii radiating into the shoulder joint capsule, together with the muscles of the rotator cuff and the ligamentum coracohumerale, keep the shoulder joint capsule tense, thus preventing constriction symptoms.

Bursa, Synovial↗
PubMedDate not supplied

Holmium:YAG laser-assisted capsular shift in a canine model: intraarticular pressure and histologic observations.

The purpose of this study was to determine the initial effects of Holmium:YAG laser energy on the shoulder joint capsule. A new surgical procedure to correct shoulder joint instability uses Holmium:YAG laser energy to cause "shrinkage" of joint capsular tissues. To date there has been no information concerning an intraoperative measurable end point for the application of laser energy at surgery or the resultant depth and degree of tissue alteration. Seven greyhound dogs were used in this study. Preoperative intraarticular pressures (IAP) were measured on entry and after injection of 10 ml of solution. Laser energy was applied to the cranial medial glenohumeral ligament and joint capsule of all right shoulders with arthroscopic visualization. The unoperated left shoulders served as the control group. Six weeks after surgery pressure measurements were performed on both shoulders. A "second look" arthroscopy was performed on the shoulders. After euthanasia was performed, the anterior capsular tissues were harvested from both shoulders for histologic examination. The specimens were inspected by three blinded examiners. After 6 weeks the postoperative laser-treated IAP were higher than the same joint preoperative IAP in four of six dogs for both static nondistension and 10 ml distension measurements. At this same interval the marked tissue damage of the treated capsule was easily discerned by blinded observers. On histologic evaluation the laser-treated capsule showed synovitis and pericapsular tissue reactivity. The depth of the injury was beyond the joint capsule into the pericapsular tissue. It was not possible to determine the end point of the capsular "shrinkage" operation by combined pressure/volume intraoperative measurements. There was no uniform joint capsule compliance at 6 weeks. The histologic changes were extensive in both magnitude and depth. Future studies in this animal should include decreased laser energy plus other means of monitoring the intraoperative effects of laser use.

Animals↗
PubMed1998

Prospective evaluation of shoulder-related problems in patients with pectoral cardioverter-defibrillator implantation.

BACKGROUND: The pectoral approach to implantation of cardioverter defibrillators (ICDs) has become a standard in defibrillator therapy because of reduced generator size, weight, and volume. But the size of these devices is still comparable to the size of the early conventional antibradycardia pacemakers that were associated with a number of significant pocket- and shoulder-related problems after implantation in the pectoral region. In a prospective, single-center study of 50 patients with subpectoral implantation of a fourth-generation ICD, the ipsilateral shoulder joint was evaluated regarding active shoulder motility, shoulder-related pain, shoulder function, shoulder elevation, insertion tendinitis, and morphologic alterations of the shoulder. METHODS AND RESULTS: The shoulder was evaluated before implantation and at 3, 6, and 12 months after implantation. Shoulder motility was documented by evaluating active abduction, forward flexion, and external rotation. Shoulder-related pain and function were documented by the "Basic Shoulder Evaluation Form," insertion tendinitis was diagnosed by standardized palpation and the impingement test, and morphologic alterations were documented by ultrasound and radiograph of the shoulder. Three months after implantation, 20 (40%) patients had a reduced active abduction, 30 (60%) patients had an impaired active forward flexion, and eight (16%) patients had a reduced external rotation. Thirty-one (62%) patients reported shoulder-related pain or impaired shoulder function according to the "Basic Shoulder Evaluation Form." Twenty-four (48%) patients showed a shoulder elevation and 21 (42%) patients demonstrated clinical signs of insertion tendinitis. After 12 months the number of patients with reduced active abduction, forward flexion, and external rotation dropped to four (8%). Shoulder-related pain and reduced function were documented in seven (13%) patients, four (8%) patients still had shoulder elevation, and five (10%) patients still had signs of insertion tendinitis. None of the postoperatively performed ultrasounds or radiographs showed any pathologic shoulder alterations. No predictors for the occurrence of shoulder-associated problems could be found. CONCLUSIONS: (1) Decreased active shoulder motility, shoulder-related pain, reduced function, shoulder elevation, and insertion tendinitis of the ipsilateral shoulder joint are diagnosed in many patients 3 months after subpectoral ICD implantation. (2) After 12 months the number of patients with impaired shoulder motility, function, shoulder-related pain, shoulder elevation, and insertion tendinitis decreased significantly. (3) Ultrasound and radiographs of the ipsilateral shoulder showed no evidence of pathologic morphologic alterations after subpectoral ICD implantation. (4) No shoulder-associated problems required an operative revision of the subpectoral generator pocket.

Defibrillators, Implantable↗
PubMed1989

[Complete rotator cuff lesions in athletes].

The causal etiologies of complete rotator cuff lesions are described. Handball, volleyball, rugby, throwing and putting disciplins, but also tennis, swimming, golf and artistic gymnastics are regarded as sports especially straining the periarticular structures of the shoulder joints. In the period from November 1980 to April 1986, 72 shoulder joints with complete rotator cuff lesions were treated surgically (bilaterally in three cases). The 69 patients comprised 16 recreational and 11 competitive sportsmen. An average of 2.4 years after the operation, 66 shoulder joints (91.6%) could followed up clinically and sonographically with simultaneous use of a 100-point-score. Good and very good results were shown in 70% of the cases.

Adult↗
PubMed2003

A randomised study of two training programmes for general practitioners in the techniques of shoulder injection.

OBJECTIVES: To evaluate the impact of two different modes of shoulder injection training on the level of confidence and number of injections performed by general practitioners (GPs) METHODS: Demographic details, and information on referrals for shoulder problems, shoulder joint injection activity, and confidence in the six months before training were obtained for 40 GP principals at baseline. Standardised training in the techniques of shoulder joint injection using rubber mannequins was given to all GPs. Twenty of these GPs were randomly allocated to receive additional training on patients in hospital joint injection clinics. Six months after both forms of training the shoulder injection and referral activities of all GPs were reassessed. RESULTS: Both training groups had comparable demographic characteristics and baseline clinical activity. GPs who had additional training with patients reported a marked increase in their level of confidence in performing shoulder injections and the number performed. The number of shoulder referrals did not differ between the groups CONCLUSION: Training on patients in addition to conventional training on mannequins increased GPs' shoulder injection activity and their level of confidence. Hospital injection clinics may provide a suitable setting in which to train GPs interested in developing their shoulder joint injection skills.

Clinical Competence↗
PubMed1980

[Shoulder mechanism - study based on cineradiography and radiography with the arm elevated (author's transl)].

In order to better understand the shoulder mechanism and make a clinical assessment of the "zero-position", a study by means of cineradiography and radiography was performed on normal and disordered shoulders with arm elevated. The conception of the "scapular plane" has been widely accepted as the reference plane for the mechanism at the shoulder joint, but practically this plane is not easily defined. Thus, a cineradiographic study of 50 normal joints has been carried out in 7 planes between the frontal and the sagittal plane, during upward and downward movement of the arm. As a result, it was determined that the "scapular plane" should be inclined forward at an angle of 30 degrees to the frontal plane. In evaluating the anatomical relationship between the humeral head and the glenoid during upward and downward movement of the arm, 50 normal shoulders and 22 disordered shoulders composed of 12 loose shoulders and 10 rotator cuff injuries were analyzed in the "scapular plane" using devised method of measurement. Concerning the "zero-position", information was gained mostly from radiographies of 600 normal and 32 disordered shoulder joints. Especially o the disordered joints, a radiographic study of the shoulder with arm elevated was made pre- and postoperatively with the arm elevated. The results obtained are as follows, 1. In the "zero-position", the humerus must be elevated to 150 degrees in the "scapular plane", with individual variations. 2. Regularization of the glenohumeral rhythm of the normal shoulder joints was observed between the end of the "setting phase" and the "zero-position". 3. Glenohumeral mechanism of the normal and disordered shoulders was different between upward and downward movement of the arm, especially more remarkable at the disordered joints. 4. Lateral deviation of the humeral head toward the glenoid was found in the loose shoulder during upward and downward movement of the arm, especially during maximum elevation of the arm. 5. Glenoid osteotomy was determined to be the reasonable procedure for stabilizing loose shoulders, from the aspect of radiographic study with the arm elevated. 6. In rotator cuff injuries, the glenohumeral rhythm was disturbed, and in some patients instability at the glenohumeral joint was observed. From postoperative radiographic evaluation with the arm elevated, it has been observed that the anatomical situations at the glenohumeral joint have recovered to nearly norma conditions. 7. In conclusion the author emphasizes the mechanism of normal and disordered glenohumeral joints, using radiography of the shoulder with the arm elevated.

Adolescent↗