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PubMedDate not supplied

Techniques for reduction of anteroinferior shoulder dislocation.

Dislocation of the shoulder joint is common. The shoulder is affected in up to 60% of all major joint dislocations, one study citing an incidence of 1.7% in the general population. The most common form is anteroinferior dislocation. A variety of techniques to reduce shoulder dislocation has been described. The key to successful relocation is a thorough understanding of the anatomy of both the enlocated and the dislocated shoulder joint.

Adult↗
PubMed1995

Biomechanics of total shoulder arthroplasty: a preoperative and postoperative analysis.

To successfully perform a total shoulder arthroplasty, it is essential to understand the normal anatomy and biomechanics of the shoulder joint. Currently, nonconstrained prostheses offer the most consistent and durable long-term results, allowing for the restoration of normal anatomy and motion close to that of the normal shoulder joint. To determine the effects of the disease process, surgical technique, and postoperative rehabilitation on glenohumeral biomechanics after nonconstrained total shoulder arthroplasty, a prospective clinical trial was undertaken to evaluate preoperative and postoperative shoulder motion clinically and roentgenographically in nine patients with severe arthritis. Preoperatively, the ratio of glenohumeral to scapulothoracic motion was 1:2; for every degree of glenohumeral movement there were two degrees of scapulothoracic motion. This was associated with significant pain and decreased motion in the shoulder and represented the patient's attempt to immobilize the glenohumeral joint for pain relief and maximize shoulder movement with scapulothoracic motion. After total shoulder arthroplasty, significant improvements were observed in pain relief, motion, and function; however, the ratio of glenohumeral to scapulothoracic motion was not significantly different. The abnormal ratio indicates that less motion occurs between the prosthetic components compared with a normal joint, whereas scapulothoracic motion is unchanged. Abnormal shoulder biomechanics seem to be a function of the underlying disease process and were not restored after total shoulder arthroplasty. Despite the successes to date, improvements on the current state of the art are still needed, and will occur with better understanding of the complex biomechanics of the shoulder joint.

Biomechanical Phenomena↗
PubMedDate not supplied

Arthroscopic release of the glenohumeral joint in shoulder stiffness: a review of 26 cases. French Society for Arthroscopy.

The purpose of this multicenter retrospective study of arthroscopic release of the glenohumeral joint was to evaluate the technical feasibility, the results, and the potential correlations between results and cause of the stiffness. Twenty-six shoulders in 25 patients (19 women and six men) were re-evaluated 3 to 72 months (mean, 21 months) after arthroscopic release of the glenohumeral joint. Diagnoses were primary frozen shoulder in 13 cases, bipolar stiffness (rotator cuff tear plus capsular contraction) in 3 cases, and postinjury or postsurgery stiffness in 10 cases. Results were evaluated on passive range of motion, Constant's score, and subjective assessment. Anterior or anterior inferior capsular release was done at the anterior rim of the glenoid fossa. Posterior capsule release was not performed in this series. There were no intraoperative complications. Mean range of motion gains were 86 degrees for forward elevation, 72 degrees for abduction, 34 degrees for external rotation, and 6 spinal processes for internal rotation. Constant's range of motion score increased from 12.9 out of 40 to 32 out of 40 points. Thirteen patients were very satisfied, 5 satisfied, 5 improved, and 3 unchanged. Range of motion gains were independent from the cause of shoulder stiffness, but global results were better in the primary frozen shoulder group in terms of pain and strength. Arthroscopic release of the glenohumeral joint is feasible and safe. For primary frozen shoulders, in case of failure of the functional treatment, arthroscopic release is a less traumatic alternative to manipulation under general anesthesia. For bipolar stiffness, arthroscopy provides the opportunity for treating concomitant lesions. For postsurgical stiffness, arthroscopic release improves range of motion, but the shoulder often remains painful.

Adult↗
PubMed2005

[Clinical observation on acupuncture at pain point combined with moxibustion at Zusanli (ST 36) for treatment of periarthritis of shoulder].

OBJECTIVE: To find an effective therapy for periarthritis of shoulder. METHODS: Sixty cases were divided into two groups, 30 cases in each group. They were treated by acupuncture at pain point combined with moxibustion at Zusanli (ST 36) and routine acupuncture, respectively. Pain of the shoulder and movement functions of shoulder joints were used as indexes of therapeutic effects and their therapeutic effects were compared. RESULTS: The total effective rate was 96.7% in the treatment group and 90.0% in the routine group with no significant difference between the two groups (P > 0.05); the cured rate in the two groups were 46.7% and 20.0% respectively with a significant difference between the two groups (P < 0.05). There were statistically significant differences between the two groups in improvement of movement function of shoulder joints and alleviation of pain (both P < 0.01). CONCLUSION: Acupuncture at pain points combined with moxibustion at Zusanli (ST 36) in increase of the cured rate and alleviation of pain, and improvement of movement function of shoulder joints is better than the routine acupuncture and moxibustion for treatment of periarthritis of shoulder.

Acupuncture Therapy↗
PubMed1987

[Study of the tracking movement in dislocation of the acromioclavicular joint].

Tracking movement in the scapular plane and electromyograms from the upper trapezius, rhomboideus, middle deltoideus, and pectoralis major muscles were analyzed during the movement in ten subjects who had grade II dislocation of the acromioclavicular joint. The purpose of this study was to clarify whether or not the dislocation of the acromioclavicular joint affects the rhythmic movement of the shoulder joint, and to evaluate objectively fatigue on the shoulder girdle of the dislocated side. The dislocation of acromioclavicular joint affects the fast rhythmic movement of the shoulder joint from 90 degrees elevation, but does not affect the movement from hanging position. The amplitude of electromyograms of some muscles on the dislocated side is greater than that on the sound side in the same movement of the shoulder joint. This increase of action potential on the dislocated side is thought to produce fatigue.

Acromioclavicular Joint↗
PubMed1994

Operative treatment of the rheumatoid shoulder.

Rheumatoid arthritis can affect almost any joint. Shoulder involvement typically occurs late in the disease process and usually after other joints have manifested arthritic change. Any of the four shoulder articulations can be involved: scapulothoracic, acromioclavicular, sternoclavicular, and glenohumeral. In addition to bony involvement, many of the soft tissues of the shoulder joint can be affected. Early operative treatment includes synovectomy with or without bursectomy, which is indicated prior to radiographic evidence of arthritis. Early synovectomy provides for a slowing of the progression of the disease process. Patients who have incapacitating pain with loss of range of motion can benefit from total shoulder replacement. Most patients experience pain relief and some restoration of motion. The restoration of normal range of motion is dependent on anatomic reconstruction of the glenohumeral joint. Factors that can affect the range of motion include rotator cuff tears and the general health status and motivation of the patient. Although there is a 30% to 80% incidence of radiographic lucencies with nonconstrained prostheses, their presence does not indicate the need for revision surgery. Occasionally, there is medialization of the glenohumeral joint with central bony losses of the glenoid. The surgeon should try to bone graft the defect and lateralize the components. If there is massive medialization of the glenoid that is not reconstructable, then a hemiarthroplasty is the procedure of choice.

Arthritis, Rheumatoid↗
PubMed2006

Efficacy of comprehensive group rehabilitation for women with early breast cancer in South Korea.

The purpose of this study was to evaluate the effects of a comprehensive group rehabilitation program on the range of motion of the shoulder joint, psychosocial adjustment, and the quality of life for early breast cancer patients. Fifty-five women with early breast cancer were assigned to an intervention group or a control group. Intervention was provided three times per week for 10 weeks. The results showed an increased range of motion of the shoulder joint, and psychosocial adjustment and quality of life were shown to be significantly higher in the intervention group than in the control group. The rehabilitation program comprised psychology-based education, exercise, and peer support group activity to promote recovery of the affected shoulder joint range of motion, alleviate physical symptoms, and improve psychosocial adjustment and quality of life for early breast cancer patients in South Korea.

Adaptation, Psychological↗
PubMed2005

The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury.

OBJECTIVE: To determine the influence of contractures and different stretching velocities on the reliability of the Modified Ashworth Scale (MAS) in patients with severe brain injury and impaired consciousness. DESIGN: Cross-section observational study. SETTING: A rehabilitation centre for adult persons with neurological disorders. SUBJECTS: Fifty patients with impaired consciousness due to severe cerebral damage of various aetiologies. MEASUREMENT PROTOCOL: Three experienced and trained medical professionals rated each patient in a randomized order once daily for two consecutive days. Shoulder, elbow, wrist, knee and ankle spasticity were assessed by the use of the MAS with different stretching velocities. The presence of contractures was assessed by a goniometer. MAIN OUTCOME MEASURES: Retest and inter-rater reliability (k(w) = weighted kappa) of the MAS. RESULTS: The retest reliability of the MAS was good (shoulder joints (k(w) 0.74), elbow joints (k(w) 0.74), wrist joints (k(w) 0.72), knee joints (k(w) 0.72), ankle joints (k(w) 0.77)) and the inter-rater reliability was moderate (shoulder joints (k(w) 0.49), elbow joints (k(w) 0.52), wrist joints (k(w) 0.51), knee joints (k(w) 0.54) ankle joints (k(w) 0.49)). The presence of contractures significantly influenced the reliability of MAS in shoulder and wrist joints. No influence of stretching velocity on the reliability of the MAS was found. CONCLUSION: In patients with impaired consciousness due to severe brain injury the MAS has good retest, but only limited inter-rater, reliability. The presence of contractures may influence reliability of the MAS, but stretching velocity does not.

Brain Injuries↗
PubMed1998

Net joint moments and powers in the equine forelimb during the stance phase of the trot.

The objective of this study was to provide normative data describing the net joint moments and joint powers for the stance phase of the forelimb in trotting horses. Kinematic and force plate data, synchronised in time and space, were collected for the right forelimb of 6 Warmblood horses moving at a trot. The 3-D kinematic data were collapsed onto a sagittal plane, and were combined with the vertical and longitudinal ground reaction forces and with segment morphometric data to calculate net joint moments in the sagittal plane across the distal interphalangeal (coffin), metacarpophalangeal (fetlock), carpal, elbow and shoulder joints. The joint mechanical power was calculated as the product of the joint moment and the joint's angular velocity. Major peaks on the moment and power curves were identified. Each joint showed consistent and repeatable patterns in the net joint moments and joint powers. During most of stance the net joint moment was on the caudal/palmar side of all joints except the shoulder. At the coffin joint the power profile indicated an energy absorbing function that peaked at 74% stance, which coincided with the maximal longitudinal propulsive force. The fetlock joint behaved as an elastic spring; energy was absorbed in the first half of stance as the flexor tendons and SL stored elastic energy, which was released in the second half of stance as a result of elastic recoil. The carpus did not appear to play an important role in energy absorption or propulsion. Both the elbow and shoulder joints showed what appeared to be phases of elastic energy storage and release in the middle part of the stance phase, followed by a propulsive function at the shoulder in the later part of stance. The fetlock, carpus and elbow showed virtually no net generation or absorption of energy. The net energy generation at the shoulder joint was approximately equal to the energy absorption at the coffin joint. In human subjects specific gait pathologies produce characteristic alterations in the shape of the power profile as well as changes in the amount of energy absorbed and generated at the joints. In horses evaluation of net joint moments and joint powers will further our understanding of the mechanics and energetics of lameness, and may prove to be a useful diagnostic tool. An understanding of the function and dysfunction of different anatomical structures will facilitate the interpretation of clinical findings in terms of mechanical deficits.

Animals↗
PubMed2004

Complaint-severity and cervical spine problems successfully classified patients with shoulder complaints.

OBJECTIVE: To construct a classification of patients with shoulder complaints based on their physical examination. To investigate (1) the interobserver reliability, (2) to what extent the setting in which the patients were recruited, and demographic and clinical characteristics are related to the classification. STUDY DESIGN AND SETTING: Data from 132 patients with shoulder complaints recruited in various health care settings in The Netherlands were examined. Two observers independently performed a physical examination of the cervical spine and shoulder joint. A nonmetric multidimensional scaling procedure was performed for each observer separately. The interobserver reliability of both observers was computed. Differences between setting, demographic and clinical characteristics, and the resulting dimensions were investigated. RESULTS: For both observers two dimensions (severity of complaints of the shoulder joint, and severity of problems of the cervical spine) were sufficient to classify all patients. Agreement between the two observers was good (r=0.84) to moderate (r=0.69). Patients with neck pain in history taking showed higher scores on both dimensions. CONCLUSION: Despite moderate interobserver agreement for each variable from physical examination found in previous studies, observers agree on the scores of the patients on the relevant dimensions. Given the limited number of effective treatments available to the general practitioner, a more sophisticated classification system seems unnecessary.

Adolescent↗
PubMed1994

Case report: rapidly progressive neuropathic arthropathy in syringohydromyelia--radiographic and magnetic resonance imaging findings.

A rapidly progressive neuropathic shoulder joint in a patient with syringohydromyelia is presented. He developed marked destruction of the shoulder joint over 5 weeks. The MRI findings in the pre- and post-resorptive phases of the arthropathy are presented for the first time. Low signal intensity areas are observed in the medullary cavity of the bone on both T1- and T2-weighted spin-echo images even before the actual resorptive process starts. Additional major findings are the joint effusion and synovial thickening.

Adult↗
PubMed2003

Isolated ruptures of the supraspinatus muscle.

We rarely encounter isolated ruptures of the supraspinatus muscle. At the Clinic of Orthopedics at the Faculty Hospital in Olomouc, we encountered only 21 cases out of 385 arthroscopic operation cases from October 1998 to October 2003. The patients were examined by USG, 5 patients were examined arthrographically and 3 patients underwent MRI examination. Of these 21 patients, only 3 were operated for acute post-injury haemarthrosis of the shoulder joint. During arthroscopic operation, an isolated rupture of the supraspinatus muscle was discovered in all these patients. The remaining 40 patients were only treated at our clinic for problems associated with impingement syndrome after an interval of 3-11 months and were indicated for operational therapy for the rupture of the supraspinatus muscle, verified sonographically and by MRI. Surgically we performed end to end sutures in 12 patients, in 9 cases we performed refixation using 1-2 titanium MITEK anchors. We supplemented the work by a detailed anatomical study of the supraspinatus muscle on 27 cadaverous anatomical preparations. It was noted that the supraspinatus muscle may be divided into three parts, with a superficial and deep layer of muscle fascicles. An aponeurotic insertion tendon runs through the center, to which part of the superficial muscle fascicles are attached. The muscle fascicles, including the central attachment tendon, run across the superior margin of the shoulder joint and by broad tendon are attached to the superior surface of the greater tubercle of the humerus. Together with the long head of the biceps muscle, they act as a significant shoulder stabiliser. The authors believe that due to the course of the muscle fascicles, this muscle acts as a significant shoulder stabiliser and a powerful abductor and elevator in the shoulder joint. The inferior portion of the muscle fascicles acts as an external rotator of the shoulder.

Adult↗
PubMed2006

A penetration-based finite element method for hyperelastic 3D biphasic tissues in contact. Part II: finite element simulations.

The penetration method allows for the efficient finite element simulation of contact between soft hydrated biphasic tissues in diarthrodial joints. Efficiency of the method is achieved by separating the intrinsically nonlinear contact problem into a pair of linked biphasic finite element analyses, in which an approximate, spatially and temporally varying contact traction is applied to each of the contacting tissues. In Part I of this study, we extended the penetration method to contact involving nonlinear biphasic tissue layers, and demonstrated how to derive the approximate contact traction boundary conditions. The traction derivation involves time and space dependent natural boundary conditions, and requires special numerical treatment. This paper (Part II) describes how we obtain an efficient nonlinear finite element procedure to solve for the biphasic response of the individual contacting layers. In particular, alternate linearization of the nonlinear weak form, as well as both velocity-pressure, v-p, and displacement-pressure, u-p, mixed formulations are considered. We conclude that the u-p approach, with linearization of both the material law and the deformation gradients, performs best for the problem at hand. The nonlinear biphasic contact solution will be demonstrated for the motion of the glenohumeral joint of the human shoulder joint.

Anisotropy↗
PubMed2003

Efficacy of NovoSeven during surgery on a haemophiliac with previous history of inhibitors.

Management of bleeding in haemophiliacs with a history of inhibitor remains problematic. With infusion of factor VIII (FVIII), development of an anamnestic response and possible appearance of high-titre inhibitor remains a valid concern. We report a case of a haemophiliac with a history of moderately high-titre FVIII inhibitor that had become undetectable. He had not received FVIII since 1997, when he became inhibitor negative. He had been managed during his bleeding episodes with prothrombin complex factor concentrates, which became less effective in controlling his bleeding. The patient had a history of recurrent, spontaneous shoulder joint dislocations with bleeding, pain and significant disability. Shoulder joint replacement surgery was suggested. Replacement therapy was discussed with the patient, who refused treatment with human FVIII because of his concern for possible anamnestic response and inhibitor rebound. Porcine FVIII was not acceptable due to his poor response when used once in the past, and his history of moderate allergic reaction. Therefore, recombinant factor VIIa (NovoSeven, Novo Nordisk, Princeton, NJ) was considered to be an acceptable option for the contemplated shoulder surgery. The patient underwent 2.5 h of surgery with NovoSeven infusion. The surgeons were impressed with the lack of bleeding in this traumatic surgery. Despite the continuously prolonged activated partial thromboplastin time and low FVIII levels, the patient maintained a remarkably dry surgical field. Effective haemostasis was achieved during and after this procedure. This case illustrates the usage of NovoSeven as an effective treatment modality in a haemophilia A patient with past history of inhibitor undergoing joint surgery.

Adult↗
PubMed1995

Use of a pattern recognition technique to control a multifunctional prosthesis.

Various kinds of command source can be used to control an above-elbow prosthesis. But none of them can be used to perform a specified task easily. The research is devoted to investigation of the potential effectiveness of applying the kinematic data of the shoulder joint to control an upper-limb prosthesis. Using these data as input signals, an appropriate signal processing technique, pattern recognition, is utilised to derive control commands. The purpose of the investigation is to use these commands to control a multifunctional prosthesis so that an amputee can perform a few tasks. For testing performance accuracy, a goniometer is worn by a subject with intact arm. It is also interfaced to a digital computer. Next, he is asked to do one of the predefined tasks for which the joint angle trajectories have already been derived and stored. Almost as soon as the shoulder joint angles are sampled and sent to the computer, the program calculates the elbow and wrist angles. These values are compared with actual elbow and wrist angles, which are monitored by the goniometer.

Arm↗
PubMed1985

Prosthesis position in shoulder arthroplasty. A cadaver study of the humeral component.

In six cadaver shoulder joints, the external rotation was measured applying a constant external torque to the humerus before and after insertion of a non-constrained shoulder joint prosthesis at different degrees of retroversion. At 35-45 degrees of retroversion there was no difference between the external rotation of the inserted prosthesis and the external rotation of the joint before arthroplasty.

Biomechanical Phenomena↗
PubMed2005

Evaluation of general joint laxity, shoulder laxity and mobility in competitive swimmers during growth and in normal controls.

The aim of the study was to evaluate differences between competitive swimmers and a reference group of school children concerning general joint laxity, laxity of the glenohumeral joint and range of motion in the shoulder. Materials and methods. Competitive swimmers (n = 120) were compared with references consisting of age and gender matched school children (n = 1277). General joint laxity was evaluated with the Beighton score. Anterior glenohumeral laxity was assessed according to the drawer test, and inferior glenohumeral laxity according to the sulcus test. Shoulder rotation was measured with a goniometer. RESULTS: Male swimmers of both age groups showed a higher degree of general joint laxity compared with the reference group while 9-year-old female swimmers alone had a lower degree of general joint laxity compared with references. No significant difference concerning shoulder laxity was noticed between groups. There was a decreased internal rotation in male and female swimmers as compared with the reference group. External rotation was reduced in female swimmers as compared with the female references. The same result was observed in male swimmers, but only at the age of 12 years. CLINICAL CONSEQUENCE: Competitive swimming in children seems to lead to a decreased range of motion with regard to shoulder rotation. However, the reason for this is still unclear and further investigations are needed.

Child↗