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PubMed1998

Muscles within muscles: the neuromotor control of intra-muscular segments.

The aim of this investigation was to anatomically identify, and then determine the function of, individual segments within the human deltoid muscle. The anatomical structure of the deltoid was determined through dissection and/or observation of the shoulder girdles of 11 male cadavers (aged 65-84 years). These results indicate that the deltoid consists of seven anatomical segments (D1-D7) based upon the distinctive arrangement of each segment's origin and insertion. Radiographic analysis of a cadaveric shoulder joint suggested that only the postero-medial segment D7 has a line of action directed below the shoulder joint's axis of rotation. The functional role of each individual segment was then determined utilising an electromyographic (EMG) technique. Seven miniature (1 mm active plate; 7 mm interelectrode distance) bipolar surface electrodes were positioned over the proximal portion of each segment's muscle belly in 18 male and female subjects (18-30 years). EMG waveforms were then recorded during the production of rapid isometric shoulder abduction and adduction force impulses with the shoulder joint in 40 degrees of abduction in the plane of the scapula. Each subject randomly performed 15 abduction and 15 adduction isometric force impulses following a short familiarisation period. All subjects received visual feed back on the duration and amplitude of each isometric force impulse produced via a visual force-time display which compared subject performance to a criterion force-time curve. Movement time was 400 ms (time-to-peak isometric force) at an intensity level of 50% maximal voluntary contraction. Temporal and intensity analyses of the EMG waveforms, as well as temporal analysis of the isometric force impulses, revealed the neuromotor control strategies utilised by the CNS to control the activity of each muscle segment. The results showed that segmental neuromotor control strategies differ across the breadth of the muscle and that individual segments of the deltoid can be identified as having either "prime mover", "synergist", "stabiliser" or "antagonist" functions; functional classifications normally associated with whole muscle function. Therefore, it was concluded that the CNS can "fine tune" the activity of at least six discrete segments within the human deltoid muscle to efficiently meet the demands of the imposed motor task.

Adult↗
PubMed1993

Diagnosis and treatment of carpal tunnel syndrome.

Secondary amyloidosis is a complication typical for patients on long-term hemodialysis. The first clinical signs are usually shoulder joint pain and carpal tunnel syndrome (CTS). We have questioned 74 patients who were on regular hemodialysis (HD) treatment and divided them into 3 groups according to the length of HD. Group 1--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 symptoms that 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. Three 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 amyloid was 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. Five 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)

Amyloid Neuropathies↗
PubMed2005

Factors influencing performance in the Hecht vault and implications for modelling.

This paper investigated the factors that influence Hecht vault performance and assessed the level of model complexity required to give an adequate representation of vaulting. A five-segment planar simulation model with a visco-elastic shoulder joint and a torque generator at the shoulder joint was used to simulate the contact phase in vaulting. The model was customized to an elite gymnast by determining subject-specific segmental inertia and joint torque parameters. The simulation model was matched to a performance of the Hecht vault by varying the visco-elastic characteristics of the shoulders and the arm-horse interface and the activation time history of the shoulder torque generator until the best match was found. Perturbing the matching simulation demonstrated that appropriate initial kinematics are necessary for a successful performance. Fixing the hip and knee angles at their initial values had a small effect with 3 degrees less rotation. Applying shoulder torque during the contact phase also had a small effect with only a 7 degrees range in landing angles. Excluding the hand segment from the model was found to have a moderate effect with 15 degrees less rotation and the time of contact reduced by 38%. Removing shoulder elasticity resulted in 50 degrees less rotation. The use of a five-segment simulation model confirmed that the use of shoulder torque plays a minor role in vaulting performance and that having appropriate initial kinematics at touchdown is essential. However, factors such as shoulder elasticity and the hands which have previously been ignored also have a substantial influence on performance.

Biomechanical Phenomena↗
PubMed1998

Adaptive multimode lubrication in natural synovial joints and artificial joints.

To examine the lubrication mechanisms in both natural synovial joints and artificial joints with artificial cartilages, pendulum tests of pig shoulder joints and simulator tests of sliding pairs of a stainless steel spherical component and natural articular cartilage or artificial cartilage have been conducted. Firstly, it was shown in pendulum tests of pig shoulder joints that both concentration of hyaluronic acid or viscosity and adsorbed film formation of proteins and phospholipids exerted a significant effect on frictional behaviour in swinging motion immediately after a loading of 100 N. Under a high load of 1 kN, low friction was observed under wide-ranging viscosity conditions, since a high load similar to body weight probably enhanced the squeeze film effect due to improved congruity. Next, frictional behaviour of sliding pairs in knee joint models, consisting of a stainless steel spherical surface and either specimens of pig tibial cartilage or polyvinylalcohol (PVA) hydrogel, was examined during walking in simulator tests. In these tests, the influences of lubricant viscosity and addition of protein on frictional behaviour were evaluated. For both compliant materials, the appropriate addition of gamma-globulin to sodium hyaluronate (HA) solution maintained low friction and protected rubbing surfaces under thin film conditions. These phenomena are discussed from the viewpoint of adaptive multimode lubrication.

Animals↗
PubMed2006

[Clinical outcomes of treatment of glenohumeral osteoarthritis with new generation shoulder prosthesis].

OBJECTIVE: To investigate the clinical effects of arthroplasty with UNIVERS 3-D prosthesis, the representative of fourth generation of shoulder joint prosthesis proved to be more suitable to shoulder anatomy, in treatment of glenohumeral osteoarthritis. METHODS: Seventy-four patients with glenohumeral osteoarthritis, aged 67.07 (47 - 84), received shoulder arthroplasty with UNIVERS 3-D prosthesis and were followed up for 31.9 months (12 - 74 months). Roentgenography was conducted to observe the acromion, and acromion-humeral distance (AHD), glenohumeral distance (GHD), humerus height (HH), and humerus width (HW). Constant scoring and normalized Constant scoring were used to evaluate the function of the shoulder joint. RESULTS: The Constant score at the last follow-up was 68.40 +/- 16.91 points, significantly higher than that at beginning (34.094 +/- 15.00, P < 0.05), The normalized Constant score at the last follow-up was 92.27 +/- 22.53%, significantly higher than that at the beginning (45.29 +/- 19.87%, P < 0.05). The post-operative pain, daily life, activity score, and myodynamia scores were all significantly higher than those evaluated pre-operatively (all P < 0.05). Pre-operative roentgenography showed 93.47% of the cases with humeral head periarticular osteophytes located at the inferior side; 36.96% with humeral head necrosis; 8.69% with humeral head cyst; and 39.13% with periarticular osteophytes of glenoid, and showed that AHD was shortened (1.83 +/- 1.64 mm), and GHD, HH, and HW were all narrowed (10.91 +/- 3.03 mm; 5.71 +/- 4.32 mm, and 3.34 +/- 4.82 mm respectively). After the operation, the AHD, GHD, and HH were all significantly increased, and HW did not significantly changed. The humeral inclination angle was changed postoperatively from 126 degrees to 142 degrees. The incidence of radiolucent lines around the prosthesis of humeral shaft was 5.41%, most in the zones d, c, and e, all with the radiolucent index of less than 1. The overall complication rate was 12.2%. CONCLUSION: Treatment of glenohumeral osteoarthritis with UNIVERS 3-D prosthesis effectively reconstructs the anatomy of glenohumeral joint, and shows excellent clinical results with low incidence of radiolucency and postoperative complications.

Aged↗
PubMed1999

[Reconstruction of elbow flexion and shoulder abduction with transfer of pectoralis major].

OBJECTIVE: To evaluate the clinical application of primary transfer of pectoralis major to reconstruct the elbow flexion and shoulder abduction. METHODS: 12 cases of old injury of branchial plexus with dysfunction of both elbow and shoulder joints were received surgical operation to reconstruct the palsy joints by primary transfer of pectoralis major, shoulder abduction was reconstructed by clavicular head and elbow flexion by sternal head respectively. All cases were followed up for 5 to 18 months. RESULTS: The function of both joints recovered obviously, the total superior rate is 91.7%. CONCLUSION: Only if the palsy joints, shoulder or elbow, remained normal or almost normal passive motion, and the muscle power of pectoralis major over 4 degrees, the primary transfer of pectoralis major should be a simple, reliable and convenient technique to reconstruct the palsy joints.

Adolescent↗
PubMed2003

The role of capsular distention in adhesive capsulitis.

OBJECTIVE: To explore the efficacy of capsular distension in the treatment of adhesive capsulitis of the shoulder joint. DESIGN: Prospective study. SETTING: Musculoskeletal clinic. PARTICIPANTS: Twenty-two patients (18 women, 4 men; mean age, 41.3y; range, 29-54y) with adhesive capsulitis of shoulder joint. Nineteen patients had Hannafin stage II and 3 patients had Hannafin stage III adhesive capsulitis. All patients had continuous pain and significant range of motion (ROM) limitations of the shoulder joint despite a minimum of 3 months of physical therapy (PT). INTERVENTION: Capsular distension with saline under fluoroscopic control, followed by a PT program. MAIN OUTCOME MEASURES: L'Insalata Shoulder Rating Questionnaire (LSRQ) score and Hannafin ROM assessment protocol. RESULTS: In the 19 patients with stage II adhesive capsulitis, the mean LSRQ score and range of abduction improved from predistention values of 49.8 degrees and 87.2 degrees to postdistension mean values of 88.1 degrees and 117.6 degrees at minimum of 1 year postdistention, respectively (P<.05). However, in the 3 patients with stage III adhesive capsulitis, the mean LSRQ score and range of abduction changed from predistention values of 41.2 degrees and 84.1 degrees to postdistension mean values of 57.8 degrees and 90.4 degrees at minimum of 1 year postdistention, respectively (P>.05). CONCLUSIONS: The treatment modality should be individualized on the basis of the stage of the adhesive capsulitis, and the distension procedure should be reserved for patients in stage II who do not progress despite participating in a PT program.

Adult↗
PubMed2007

Transverse humeral ligament: does it exist?

The insertion of the tendon of subscapularis is accepted as being on the lesser tubercle of the humerus. The transverse humeral ligament (THL) is described as a distinct entity in most textbooks, overlying the long tendon of biceps as it emerges from the capsule of the shoulder joint. In this study, we dissected 85 embalmed shoulders to clarify the anatomy of the THL and variation in the insertion of the tendon of subscapularis. In all specimens no distinct THL could be identified, but in every shoulder a fibrous expansion arose from the posterior lamina of the tendon of pectoralis major overlying the long tendon of biceps. In 86% of shoulders, fibres from the tendon of subscapularis passed over the long tendon of biceps within this fibrous expansion and inserted on to the greater tubercle of the humerus where one would expect to find the THL. In 33% of dissections, fibres from the tendon of subscapularis lay deep to the long tendon of biceps, inserting either into the bicipital groove or on to the greater tubercle. In only 8% of cases did the tendon of subscapularis insert exclusively on to the lesser tubercle. We conclude that the THL does not exist as a separate entity. We suggest that in the majority of cases, the structure overlying the long tendon of biceps as it emerges from the capsule of the shoulder joint consists of tendinous fibres from subscapularis, contained within a fibrous expansion derived from the posterior lamina of the tendon of pectoralis major. In the minority of shoulders, where the tendon of subscapularis inserts exclusively on to the lesser tubercle, we hypothesise that this fibrous expansion acts as a retinaculum preventing the long tendon of biceps from "bowstringing."

Aged↗
PubMed1991

[Surgical treatment of habitual dislocation of the shoulder].

In the article is presented the analysis of treatment of 32 patients with shoulder joint instability. There have been studied the outcomes of treatment after the arm "suspension" operations, interventions at the anterior region of an articulation, derotational osteotomies of an arm. There have been considered the problems of etiopathogenesis of shoulder joint instability. There have been analyzed the peculiarities of the tactical approach to the treatment of patients with shoulder joint instability. There is presented the principled position of the authors' approach to the selection of pathogenetically substantiated method of the habitual shoulder slip operative treatment.

Adolescent↗
PubMed2006

Cartilage lesions of the glenohumeral joint: diagnostic effectiveness of multidetector spiral CT arthrography and comparison with arthroscopy.

This study assessed the diagnostic effectiveness of multidetector spiral CT arthrography (MDCTa) in detecting hyaline cartilage abnormalities of the shoulder joint, with correlation to arthroscopy. Shoulder MDCTa images prospectively obtained in 22 consecutive patients (mean age, 50 years; age range, 23-74 years; 12 female, 10 male) were evaluated for glenohumeral cartilage lesions. Two musculoskeletal radiologists independently analysed the cartilage surfaces of the humeral head and of the glenoid fossa in nine anatomical surface areas. Observations of MDCTa were compared to arthroscopic findings. The sensitivity and specificity of MDCTa for grade 2 (substance loss <50%) or higher and grade 3 (substance loss >or=50%) or higher cartilage lesions, the Spearman correlation coefficient between arthrographic and arthroscopic grading, and K statistics for assessing Intra and Interobserver reproducibility were determined. At MDCTa, sensitivities and specificities ranged between 80% and 94% for the detection of grade 2 or higher cartilage lesions, and between 88% and 98% for the detection of grade 3 or higher cartilage lesions. Spearman correlation coefficients between MDCTa and arthroscopic grading of articular surfaces ranged between 0.532 and 0.651. Interobserver agreement was moderate for grading all articular surfaces (kappa = 0.457), but substantial to almost perfect for detecting lesions with substance loss (kappa, 0.618-0.876). In conclusion, MDCTa is accurate for the study of cartilage surface in the entire shoulder joint. This technique may beneficially impact patient's management by means of selecting the proper treatment approach.

Adult↗
PubMed1977

[Vascular injury associated with shoulder luxation].

The author reports on the rupture of subscapular artery that followed the reduction of an anterior dislocation of the shoulder joint. On this occasion, vascular injuries associated with shoulder joint dislocation, their diagnosis and treatment is discussed in the article. The aim of the author was to remind the reader to a complication of our everyday activity. He wants to call attention to the importance of gentle manipulation and the careful observation of the circulation after reduction.

Accidents, Traffic↗
PubMed2006

Relationships between throwing mechanics and shoulder distraction in collegiate baseball pitchers.

A distraction force occurs at the shoulder joint in all throwing motions. At the professional level, the relationship between this force and pitching mechanics has been explained. Three-dimensional, high-speed (240 Hz) video data were collected on fastballs from 48 collegiate baseball pitchers. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing arm elbow and shoulder joints were calculated. Multiple linear regression analysis was used to investigate the relationships between shoulder distraction and pitching mechanics. Shoulder distraction stress averaged 81% body weight for the collegiate pitchers. The mean ball velocity was 81 mph. Ten parameters of pitching mechanics accounted for 89% of the variance in shoulder distraction. Two of the variables (maximum shoulder abduction torque and elbow angle at release) previously shown to affect shoulder distraction in professional baseball pitchers appear to be important for collegiate pitchers as well. These data provide a scientific basis for clinicians, athletes, and coaches to establish methods to reduce distraction force at the shoulder joint through modification of pitching mechanics.

Adult↗
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↗
PubMed1992

The humeroscapular bone of the great horned owl (Bubo virginianus) and other raptors.

A small, separate, bony density dorsal to the shoulder joint is radiographically visible in several species of large hawks and owls. Gross dissection and histological examination show the bone to lie on the deep surface of the major deltoid muscle in intimate association with the dorsal coracohumeral ligament of the shoulder joint. The tendon of the supracoracoideus muscle passes immediately cranial to the humeroscapular bone. Two ligaments distinct from the shoulder joint capsule attach the humeroscapular bone to the proximal humerus: one passes to the proximal edge of the pectoral crest of the humerus, and the other passes to the ventral tubercle of the humerus. The bone was described as the humeroscapular bone in reference to a similar fibrocartilaginous structure possessed by some birds. The humeroscapular bone is present in the great horned owl (Bubo virginianus), the screech owl (Otus asio), the barred owl (Strix varia), the red-tailed hawk (Buteo jamaicencis), the Cooper's hawk (Accipiter cooperii), and the sharp-shinned hawk (Accipiter striatus). The bone is absent in the barn owl (Tyto alba), the osprey (Pandion haliaetus), the golden eagle (Aquila chysaetos), and the turkey vulture (Cathartes aura), though some of these species possessed a similar fibrocartilaginous structure. Whether the humeroscapular structure develops as bone or cartilage in a given species may be related to other morphological features of the wing, and/or to characteristics of the predatory behavior of the species. Clinicians and anatomists dealing with birds of prey must be aware of the presence of the humeroscapular bone to avoid misinterpreting it as a fracture fragment.

Animals↗
PubMed1999

Pigmented villonodular synovitis of the shoulder: review and case report.

Pigmented villonodular synovitis (PVNS) as reviewed in detail elsewhere most frequently involves the knee and finger synovial structures; shoulder involvement is rare: A search through the English literature yielded 18 publications describing 25 cases of PVNS affecting the shoulder joint. Analyzing these reports we found the clinical and radiological findings generally to be nonspecific, often mimicking a malignancy, as in the case presented here of a 16-year-old boy with painful swelling in the area of the left proximal humerus. Magnetic resonance imaging showed a suspected malignant soft tissue mass involving the shoulder capsule and measuring 7.5 x 6 x 4 cm. Preoperatively the patient could recall no trauma; however, postoperatively he did report a distortion trauma of the affected shoulder following a bicycle accident. Intraoperatively, two tumors were found infiltrating the axillary vessels and nerve and tendon structures originating in the capsule of the shoulder joint. Rapid sections of the tissue revealed no signs of malignancy; further pathohistological examination revealed localized PVNS. Preoperatively, the shoulder joint was not suspected as the primary site of origin of the tumor because the patient had no complaints or functional deficits of the shoulder. The clinical presentation of such a PVNS lesion over the proximal humerus is unusual and to date has only twice been described in the literature.

Adolescent↗
PubMed1981

"Milwaukee shoulder"--association of microspheroids containing hydroxyapatite crystals, active collagenase, ad neutral protease with rotator cuff defects. III. Morphologic and biochemical studies of an excised synovium showing chondromatosis.

Synovial tissue excised from the unstable right shoulder joint of a patient with an absent rotator cuff, severe glenohumeral joint degeneration, and hydroxyapatite-containing microspherules, collagen types I, II, and III, active collagenase, and neutral protease in the joint fluid showed extensive osteochondromatosis histologically. Electronmicroscopy revealed calcific foci in microvilli which could easily escape into the adjacent joint space through areas denuded of synovial cells. Fibrocytes demonstrated intensive pinocytotic activity of unknown significance. Energy dispersive analysis showed elemental ratios consistent with hydroxyapatite. A literature review suggested some relationships between the various pathologic lesions present in this joint. Whether similar synovial changes exist in the opposite shoulder joint of this patient and in 3 other subjects with nearly identical clinical, radiographic, and joint fluid findings is not known.

Aged↗
PubMed2004

Stress perception and social indicators for low back, shoulder and joint pains in Japan: national surveys in 1995 and 2001.

This study aims to clarify the effects of stress perception and related social indicators on three major musculoskeletal symptoms: low back, shoulder, and joint pains in a Japanese population. Twenty health-related variables (stress perception and 19 social indicators) and the three symptoms were obtained from the following Japanese national surveys: the Comprehensive Survey of Living Condition of the People on Health and Welfare, the System of Social and Demographic Statistics of Japan, and the Statistical Report on Health Administration Services. The results were compared among 46 Japanese prefectures in 1995 and 2001. By factor analysis, the 19 indicators were classified into three factors of urbanization, aging and life-regularity, and individualization. The prevalence of stress perception was significantly correlated to the 8 indicators of urbanization factor. Although simple correlation analysis revealed a significant relationship of stress perception only to shoulder pain (in both years) and low back pain (in 2001), the results of multiple regression analysis showed that stress perception and some urbanization factors were significantly associated with all the three symptoms in both years exclusive of joint pain in 1995. Taking the effects of urbanization into consideration, stress perception seems to be closely related to the complaints of musculoskeletal symptoms in Japan.

Arthralgia↗
PubMed2001

Topography of muscle spindles and Golgi tendon organs in shoulder muscles of "Monodelphis domestica".

The topography of muscle spindles and Golgi tendon organs in the rotator cuff and surrounding shoulder muscles of a small laboratory marsupial (monodelphis domestica) were studied using light microscopy of serial sections. The shoulder joint of monodelphis has a large degree of freedom of movement allowing this animal to use the upper extremities for a wide range of activities like climbing and manipulating food. Thus, similar to the situation in man the shoulder joint is mainly secured by muscles. Silver stained serial paraffin sections were examined under the light microscope and the distribution of muscle spindles and Golgi tendon organs was reconstructed using three-dimensional image processing. In the two animals examined 113 and 131 muscle spindles respectively were found within the 4 rotator cuff muscles. In addition, 76 and 40 Golgi tendon organs respectively were seen at the musculo-tendinous junctions of these muscles preferentially close to the insertion at the humerus head. Also the surrounding shoulder muscles contain both muscle spindles and Golgi tendon organs in large numbers, but the ratio of Golgi tendon organs per muscle spindle appears to be lower. Number and localization of muscle spindles and Golgi tendon organs suggest, that these receptors are important for both reflex control of shoulder muscle tone as well as monitoring of static position and movement in the shoulder joint.

Animals↗