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At least 955 records · Page 53Linked to original sources
PubMed1998

Impingement syndrome following total shoulder arthroplasty and humeral hemiarthroplasty: treatment with arthroscopic acromioplasty.

Pain following total shoulder arthroplasty or humeral hemiarthroplasty is uncommon. Impingement syndrome can be an infrequent source of pain following shoulder arthroplasty. We retrospectively reviewed six patients with refractory impingement syndrome treated with arthroscopic acromioplasty following either total shoulder arthroplasty (four patients) or humeral hemiarthroplasty (two patients). Chronic impingement syndrome requiring acromioplasty affected 3% of all patients who underwent total shoulder arthroplasty or humeral hemiarthroplasty during the study period. A thorough history, physical examination, and radiographic findings made the clinical diagnosis of impingement syndrome. All six patients had positive impingement signs and a positive impingement test with subacromial lidocaine injection. Preoperative radiographs revealed a type II or III acromion and subacromial outlet narrowing in five of six patients. Other sources of shoulder pain including prosthesis loosening, infection, and rotator cuff tear were ruled out preoperatively by physical examination and radiographic findings, and were confirmed by arthroscopic examination. The results of arthroscopic acromioplasty were a reduction in pain from 7.5 preoperatively to 1.6 postoperatively, on a scale from 0 to 10. Five of six patients were completely satisfied with the results of their arthroscopic surgery. Overall, according to the University of California at Los Angeles end-result score, the results were rated as excellent or good in five patients, and unsatisfactory in one patient. Arthroscopic acromioplasty can be a successful technique for the treatment of chronic impingement syndrome following total shoulder arthroplasty or hemiarthroplasty in appropriate patients.

Acromion↗
PubMedDate not supplied

The mechanism of creation of superior labrum, anterior, and posterior lesions in a dynamic biomechanical model of the shoulder: the role of inferior subluxation.

Lesions of the superior glenoid labrum are a source of shoulder disease. However, the mechanisms of injury to this region are unknown, and controversy exists regarding the role of shoulder instability in creation of this lesion. With a cadaver model that simulates physiologic rotator cuff forces and produces traction on the biceps tendon, the creation of type II superior labrum, anterior, and posterior (SLAP) lesions and the role of glenohumeral subluxation were investigated: Left and right shoulders from each of 8 paired cadavers (age 62 +/- 7.2 years, 5 male and 3 female) were randomized to be tested in either a 20 mm inferiorly subluxed position or in a reduced position. The long head of the biceps tendon was held near the musculotendinous junction with a novel cryogenic clamp. Traction on the long head of the biceps tendon was applied at a fast rate of 12.7 cm/sec with a servohydraulic testing machine. A load cell was used to monitor the biceps tendon load. After testing to failure, the presence or absence of a type II SLAP lesion was determined by 2 experienced shoulder surgeons masked to the test group. The production of type II SLAP lesions differed significantly (P = .03) between reduced shoulders (2 SLAP lesions out of 8 tests) and the shoulders with inferior subluxation (7 SLAP lesions out of 8 tests). This experiment has shown that traction on the biceps tendon in this biomechanical model can reproducibly create type II SLAP lesions, and inferior subluxation facilitates the generation of such lesions.

Aged↗
PubMedDate not supplied

Bipolar shoulder arthroplasty in patients with osteoarthritis: short-term clinical results and evaluation of birotational head motion.

To determine the clinical outcome and evaluate the biomechanical properties (persisting birotational head motion) of the bipolar shoulder system in patients with primary osteoarthritis, a prospective study of 48 shoulders in 43 patients was undertaken. Patients were monitored for a mean of 3. 1 years (range 2 to 6 years). Pain relief was achieved in 92% of cases. Forty-one (96%) patients were satisfied with the result of the surgery, and satisfactory results were obtained in 92% of shoulders (with The University of California at Los Angeles rating system). Prosthetic birotational motion (head-shell and shell-glenoid motion) persisted in all shoulders. Bipolar shoulder arthroplasty is a low-friction device with persisting birotational head motion that offers excellent pain relief, eliminates glenoid component loosening concerns, and represents an adequate alternative to shoulder arthroplasty. Early results have been promising.

Aged↗
PubMed2002

A comparison of the effects of exercise and lifestyle modification on the resolution of overuse symptoms of the shoulder in polio survivors: a preliminary study.

OBJECTIVE: To compare the effectiveness of exercise and lifestyle modification therapy in treating shoulder symptoms in polio survivors with lower-extremity weakness. DESIGN: A randomized parallel group study. SETTING: Research laboratory. PARTICIPANTS: Twenty-three subjects recruited from a cohort of 194 polio survivors who had participated in a previous study had bilateral hip-extensor and knee-extensor weakness and reported experiencing shoulder pain on a regular basis with daily activity. INTERVENTIONS: Subjects were randomly assigned to 1 of 3 treatment groups. Members of group 1 were placed on a home exercise program that focused on strengthening their hip and knee extensors. Members of group 2 were instructed in lifestyle modification techniques designed to avoid shoulder overuse. Members of group 3 received both interventions. MAIN OUTCOME MEASURES: Shoulder symptoms were quantified in terms of number and severity. Isometric strength of bilateral hip and knee extensors was measured with a hand-held dynamometer. RESULTS: Symptoms improved in all 3 groups. However, members of the exercise-only group (group 1) were the only ones to show a significant difference in both number and severity of symptoms when pre- and posttreatment values were compared. CONCLUSIONS: Both exercise and lifestyle modification therapies that focus on reducing the stress related to lower-extremity weakness are effective in treating shoulder overuse symptoms in polio survivors. A trend toward greater improvement in shoulder symptoms in subjects who participated in the exercise program and who also showed a trend toward increased knee-extensor strength supports muscle strength and/or endurance as a key factor.

Aged↗
PubMed2002

Complications associated with arthroscopic shoulder surgery.

We review the literature on complication of arthroscopic shoulder surgery and their management. Computer data based searches were used to identify articles regarding complications of shoulder arthroscopy, as well as hand searches of Arthroscopy and Journal of Shoulder and Elbow Surgery over the last decade. Arthroscopic shoulder surgery has become a popular therapeutic and diagnostic procedure during the past two decades. As with all interventions complications can occur which require recognition and management by the orthopedic surgeon. While the literature is helpful with identifying types of complications, establishing the rate of these complications remains elusive. These complications can be divided into general complications, complications generic to all shoulder procedures, and complications specific to the type of procedure performed. General complications such as infection and anesthesia problems continue to show low incidences. Shoulder arthroscopy presents increased risk of complications over knee arthroscopy in regard to vascular and neurologic injury, fluid extravasation, stiffness, iatrogenic tendon injury, and equipment failure. New techniques of increased complexity for subacromial surgery, rotator cuff repair, and arthroscopic instability present new problems related to implant failure, nerve injury, iatrogenic fracture, and capsular necrosis. While the rate of complications especially with newer procedures remain elusive, most studies suggest that the rate is low, 5.8-9.5% in all recent review studies published. Underreporting complications makes assessment of incidence rates of complication difficult. Proper patient selection, attention to operative detail, and careful post-operative monitoring can minimize the morbidity associated with these complications.

Arthroscopy↗
PubMedDate not supplied

[MRI-based 3-D analysis of the glenohumeral translation in patients with shoulder instability].

AIM: Until now, pathological translation of the glenohumeral joint could not be assessed three-dimensionally and in functionally important arm positions in the living. The objektive of this study was therefore to develop an MR-based technique for determining the three-dimensional glenohumeral translation in functionally relevant positions in vivo. METHOD: In an open MR scanner both shoulder joints of 5 volunteers with an unilateral traumatic instability were examined in different positions of abduction and rotation. After semiautomatic segmentation, 3D reconstruction of the bony structures of the shoulder girdle was performed and the center of mass of the glenoid cavity was determined and used as reference point. In a virtual reality, the midpoint of the humeral head was assessed and its position relative to the center of mass of the glenoid cavity was calculated. RESULTS: At 30 degrees of abduction, in both shoulders, the humeral head was positioned inferior and posterior relative to the glenoid cavity (healthy: 0.42 +/- 1.1 inf., 0.75 +/- 1.0 mm post.; unstable: 1.31 +/- 0.87 mm inf., 0.51 +/- 1.28 mm post.) The maximal translation (to anterior and inferior) was observed both on the healthy side (mean 1.0 mm, max. 1.8 mm) and in the unstable shoulders (mean 2.5 mm, max. 4.6 mm) with the arm in 90 degrees of abduction and external rotation, thus being 1.7 to 2.5 times higher in the pathological shoulders. CONCLUSIONS: With this technique the glenohumeral translation can be quantified three-dimensionally in functionally important positions and without projectional artefacts. In the future, this method can be applied to patients with different entities of shoulder instability.

Adolescent↗
PubMedDate not supplied

[Rope pulley isokinetic system in shoulder rehabilitation--initial results].

AIM: Of this study was to evaluate the results of a shoulder rehabilitation program of different shoulder diseases, based on an isokinetie pulley system ("Moflex", Recotec/Bernina, Swiss). METHOD: In this prospective study 70 patients participated in a standardized rehabilitation program (instability: n = 19; rotator cuff disorders: n = 23; impingement syndrome without lesion: n = 16; others: n = 12; operative therapy: n = 47). The major aspect of the program was an isokinetic pulley system. RESULTS: Isokinetic training with the used device affords strict monitor-feedback to avoid critical torque values. Strength which was attained without relevant pain was almost linearly increased by a mean of 31% until the 20th day of rehabilitation, workload by 79%. At the end of the rehabilitation program the strength of the affected (mostly dominant) shoulder was 15% higher than in the unaffected shoulder; the respective workload values were almost equal. CONCLUSION: These first results demonstrate the value of the isokinetic pulley system in the rehabilitation of the investigated shoulder diseases. The equipment may be used already in an early postoperative state. First results of strength increases using an isokinetic pulley system in shoulder rehabilitation are presented.

Adult↗
PubMed2003

[Total shoulder arthroplasty vs. hemiarthroplasty].

Shoulder arthroplasty remains problematic despite the dramatic development of the new implant systems, due to the anatomical characteristics of the shoulder joint. The development of the modern third and fourth generation of shoulder prostheses enables the surgeon by its the three dimensional modularity to adjust the inclination and dorsomedial offset and to reconstruct the anatomic center of rotation. The fixation of the glenoid component is one of the most complicated aspects in the total shoulder arthroplasty. The main criteria regarding hemi- or total arthroplasty are based on morphological changes in the glenoid, the condition of the rotator cuff muscles, disorder etiology, age and activity level of the patient. The cup arthroplasty has proven itself as an alternative to standard humeral shaft arthroplasty. The main advantages of this new system are the elimination of the obligatory humeral head resection and the possibility of converting to the classical humeral shaft prosthesis method. First experiences with the cup system have been evaluated in the department of accident and reconstructive surgery of the UKBF in Berlin as part of a clinical trial. Between March 1998 and June 1999 15 shoulder prostheses in 14 patients were implanted in this hospital. The implants were inserted 8 times in a rheumatic shoulder, 4 times in posttraumatic arthrosis and in 3 humeral head necroses. 13 patients with 14 prostheses were available for follow up. An improvement from 23 to 55 average score points (Constant-Score) was attained by implantation of the cup system within a mean postoperative observation period of 6.1 months.

Arthritis, Rheumatoid↗
PubMed2004

Shoulder imaging in athletes.

Shoulder pain and injuries are common in athletes. Overhead athletes, in particular, place great demands on the shoulder and supporting structures. Magnetic resonance (MR) imaging is well suited to evaluation of the osseous structures and soft tissues of the shoulder and plays an important role in evaluation of shoulder pain in athletes. Primary extrinsic impingement is well evaluated on MR imaging as are the less common posterior superior glenoid impingement and subcoracoid impingement. Rotator cuff tendinosis as well as partial- and full-thickness tears are frequently encountered in the athletic shoulder. The biceps tendon and rotator interval capsular structures are important sources of shoulder pain. Glenohumeral instability that results from a traumatic event or atraumatic multidirectional recurrent instability is assessed. The biceps labral complex is a source of considerable anatomic variability and pathology.

Athletic Injuries↗
PubMedDate not supplied

Intraoperative measurement of shoulder translation.

Assessing laxity of the shoulder joint in patients who are under anesthesia is a standard procedure before arthroscopy. The aim of this study was to evaluate a novel instrument for quick and reliable intraoperative measurement of glenohumeral translation. Previous testing of various designs has resulted in a device secured by 1 pin in the acromion and 1 pin in the proximal humerus. These pins are interconnected by a sliding ruler that gives translation values in millimeter increments as the laxity tests are performed. Comparison between manual arbitrary approximation of laxity and instrumented translation measurements showed that manual testing is reasonably good for assessment of anterior and posterior translation, without, however, providing values of translation in millimeter increments. The low correlation between manual assessment and instrumented inferior translation measurements indicates that inferior translation is more difficult to approximate manually. The shoulder translation tester was used in 102 patients. The mean values for clinically stable shoulders (n = 58) were 5 mm for anterior translation, 5 mm for posterior translation, and 4 mm for inferior translation. The corresponding values in unstable shoulders were significantly higher than in the stable shoulders, especially in patients with multidirectional instability. We conclude that the shoulder translation tester is easy and quick to use. It provides quantitative values of translation and will thus contribute information for correct diagnosis, therapy, and documentation.

Adult↗
PubMed1996

Neuroarthropathy: an overuse injury of the shoulder in quadriplegia.

The shoulder joint of the spinal cord injured patient is the primary joint used for transfer and wheelchair propulsion. In addition to ordinary use, the shoulder is subject to overuse injury with resultant functional impairment. Frequent overuse injuries of the shoulder include subdeltoid bursitis, bicipital tendonitis, rotator cuff tear and secondary degenerative arthritis. Neuroarthropathy of the shoulder, an overuse injury of an insensate shoulder girdle, has been rarely described in the literature. The case presented is that of an active 47 year old, right hand dominant, C7 complete quadriplegic male with a one week history of painless right shoulder girdle swelling. Radiologic evaluation documented right proximal humerus destruction. Magnetic Resonance Imaging (MRI) confirmed syringomyelia. The pathophysiology of neuroarthropathy is presented here and limited treatment options are discussed.

Arthropathy, Neurogenic↗
PubMed2003

Shoulder pain in hemiplegia revisited: contribution of functional electrical stimulation and other therapies.

OBJECTIVES: Post-stroke shoulder pain is probably the most frequent complication in hemiplegia and has repercussions on motor rehabilitation and the psychological equilibrium of the patient. The strategies for prevention and treatment are presented. AETIOLOGY: Among the various factors contributing to the occurrence of shoulder pain in hemiplegia, some are related to the joint, such as lesion of the rotator cuff tendons, reflex sympathetic dystrophy, inferior-anterior subluxation of the head of the humerus, whereas others are related to the neurologic lesion such as central post-stroke pain, lack of sensibility, unilateral neglect and spasticity. PREVENTION: Efforts should be made from the start to keep the shoulder in an ideal position at all times and movement of the shoulder and upper limb should be carried out with care. TREATMENT: Will be aimed to the cause of pain and passive or active range of motion exercises will be encouraged. Physical, medical and surgical treatments have improved over the last few decades. Functional electrical stimulation in patients with shoulder pain and subluxation, applied early after onset of the stroke, has shown beneficial positive effects on subluxation, pain and mobility. Efforts should therefore be made to better understand the post-stroke shoulder pain in order to provide better outcomes of rehabilitation and thus improve quality of life for patients.

Electric Stimulation Therapy↗
PubMed1986

Neuromuscular electrical stimulation of the muscles surrounding the shoulder.

Neuromuscular electrical stimulation (NMES) can be used to augment range-of-motion, strengthening, and facilitation treatment programs of the muscles surrounding the shoulder. The purposes of this article are 1) to describe the uses of NMES around the shoulder joint as developed through our clinical use and 2) to detail the effects of an NMES program on chronic shoulder subluxation as determined by a clinical study. Because of the complexities of this multiarticular joint, NMES is most useful in the initial phase of the ROM, and stimulated contractions are compromised, relatively, as the humerus moves above the 90-degree horizontal plane. The use of NMES to provide scapular stabilization often entails unwanted alteration of the pressures on the spinal column, occasionally making the treatment program unusable. Electrical stimulation to prevent or correct shoulder subluxation, especially in the neurologically involved patient, provides the therapist with a powerful new treatment technique. In a group of stroke patients, shoulder subluxation was reduced significantly (p less than .05) at the completion of a six-week NMES program. Some of the problems, and possible solutions, unique to the development of electrical stimulation programs for the shoulder muscles are discussed.

Adult↗
PubMed2005

Diagnosis and relation to general health of shoulder disorders presenting to primary care.

OBJECTIVES: To prospectively evaluate the incidence, spectrum of disease and relation to general health of shoulder disorders in primary care. METHODS: Patients presenting with shoulder pain to two large general practices in the Cambridge area over a 1-month period were invited to participate. After consulting their general practitioner, patients were administered a demographic information questionnaire, a shoulder pain and disability index (SPADI) and a short form 36 (SF-36) health survey. Subsequent review in a clinic held by a rheumatology registrar every 2 weeks was undertaken. RESULTS: The sex- and age-standardized incidence of shoulder pain was 9.5 per 1000 (95% confidence interval 7.9 to 11.2 per 1000). Rotator cuff tendinopathy was found in 85%, signs of impingement in 74%, acromioclavicular joint disease in 24%, adhesive capsulitis in 15% and referred pain in 7%. On the SPADI the mean disability subscale score was 45 (95% confidence interval 41 to 50) and the mean pain score was 58 (95% confidence interval 53 to 62) (range 0 to 100). Evaluation of general health status using the SF-36 showed the difference between population norms and those with shoulder pain was significant in six of the eight domains, being especially marked (greater than 20 point reduction) for emotional role, physical function and physical role. CONCLUSION: Shoulder pain, most commonly due to rotator cuff tendinopathy, is associated with significantly reduced health when measured by both specific and generic means. Effort towards prevention and early intervention in these complaints is warranted.

Acromioclavicular Joint↗
PubMed2006

Cross-cultural adaptation, reliability and validity of the German Shoulder Pain and Disability Index (SPADI).

OBJECTIVE: To cross-culturally adapt the Shoulder Pain and Disability Index (SPADI) from English into German, and to test the reliability and validity of the German version. METHODS: Cross-cultural adaptation of the SPADI was performed according to international guidelines. One hundred and eighteen patients who had undergone shoulder arthroplasty, on average 4 yr previously, completed a questionnaire booklet containing the German SPADI, the Short Form 36 (SF-36), the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, and the American Shoulder and Elbow Surgeons (ASES) questionnaire for the shoulder to assess SPADI's construct validity. One week later, they completed the SPADI again to assess test-retest reliability. RESULTS: The six-step cross-cultural adaptation procedure revealed no major problems with the content or language. The intraclass correlation coefficients for the individual items of the SPADI were between 0.68 and 0.89, and that for the SPADI total score was 0.94. The SPADI total score showed a correlation of 0.61-0.69 with the SF-36 physical scales, of 0.88 with the DASH and of 0.92 with the ASES. CONCLUSIONS: The German SPADI is a practicable, reliable and valid instrument, and can be recommended for the self-assessment of shoulder pain and function.

Activities of Daily Living↗
PubMed2001

Arthroscopic treatment of shoulder stiffness.

The optimal treatment of shoulder stiffness remains controversial. The current authors reviewed the results of arthroscopic capsular release of 45 stiff shoulders in 45 patients that was done after the patients did not respond to conservative treatment. There were nine idiopathic frozen shoulders, 21 that had postoperative stiffness, and 15 shoulders with stiffness after trauma. At a mean followup of 26 months (minimum, 12 months), arthroscopic capsular release improved the subjective shoulder value from 25% to 68% and the age- and gender-adjusted Constant-Murley score from 41% to 75%. Pain improved from 4.7 to 10.9 of 15 points. Active, pain-free anterior elevation increased from 90 degrees to 128 degrees and external rotation increased from 14 degrees to 31 degrees. The quality of sleep improved from 0.5 to 1.6 on a two-point scale. The only improvement that did not reach statistical significance was the improvement in the ability to work. A retrospective analysis of the results stratified according to the etiology of stiffness showed that the outcome after treatment of idiopathic stiffness was better than after postoperative stiffness and that the results of treatment for posttraumatic stiffness were least favorable. The difference between preoperative state and followup, however, was not statistically significantly different from one group to another. All groups improved significantly and to a similar degree but the final outcome was related to the initial degree of disability. Arthroscopic release is an effective method for treatment of shoulder stiffness; however, the ultimate outcome is related directly to the severity of stiffness regardless of the etiology.

Adult↗
PubMed1998

Shoulder rehabilitation: principles and practice.

The goal of shoulder rehabilitation is to restore the function of the shoulder. Function can be described in many different ways, but the framework for restoration of function should include restoration of the anatomy plus normalization of physiology and biomechanics. Without the normalization of physiology and biomechanics, the shoulder will not function in a normal fashion. Most of the methods and practice of shoulder rehabilitation are involved in strategies to normalize physiology and biomechanics of the shoulder motion. This study will review the physiology and biomechanics of normal shoulder function and then describe basic principles and clinical practices to restore those functions.

Biomechanical Phenomena↗
PubMed1979

Arthrography in acute shoulder dislocations.

Arthrography of the shoulder was performed on 50 patients with acute traumatic shoulder dislocations. The mean interval between injury and arthrogram was 2.3 days, with a median interval of one day. Anterior dislocations occurred in 96% of patients, and posterior dislocations in 4%. Initial dislocations were present in 74%, and recurrent dislocations in 26%. The most frequent abnormality identified or arthrograms was an enlarged but intact shoulder capsule (58%), most commonly seen in shoulders subject to recurrent dislocations (77%). Shoulder joint capsular tears or disruptions were seen in 48% of the patients. The next most common lesion was fracture (52%), identified on standard roentgenograms. These included Hill-Sachs lesions (28%), greater tuberosity fractures (22%), and coracoid fractures (2%). Ruptures of the rotator cuff, present in 28% of the cases (14 patients), occurred more frequently in initial dislocations (62%) than in recurrent ones (36%). The high frequency of enlarged intact shoulder capsules, even after an acute initial joint dislocation (58%), suggests that the humeral head does not routinely rupture the capsule during dislocation, but rather tears the glenoid labrum at its bony attachment and dislocates subperiosteally, dissecting a false pouch below the periosteum and under the subscapularis.

Acute Disease↗