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At least 991 records · Page 55Linked to original sources
PubMed2003

Decision making in glenohumeral arthroplasty.

Prosthetic replacement arthroplasty for glenohumeral arthritis is a well-developed and well-described technique with good and excellent results. The surgeon is faced with many decisions to make, however, regarding choice of implant, implant fixation, soft tissue management, and options for glenoid resurfacing. In general, when the precise cause of the arthritic condition is identified, the choices become more straightforward. For advanced osteoarthritis of the shoulder joint in an older patient with asymmetric posterior erosion of the glenoid, a total shoulder arthroplasty renders the best relief of pain and improvement in motion. Similarly, for advanced rheumatoid arthritis in patients with an intact rotator cuff, a total shoulder arthroplasty results in the best pain relief. If the rotator cuff is deficient and irreparable, an anatomically sized humeral head replacement is appropriate, taking care to preserve the coracoacromial arch. Acute, nonreducible fractures of the proximal humerus are treated best with a humeral head replacement. Post-traumatic arthropathy of the shoulder joint is treated with arthroplasty, and the decision to resurface the glenoid should take into account the age of the patient and the wear and concentricity of the glenoid. Many options exist for the choice of an implant; biomechanical and anatomic studies suggest that a better technical result can be achieved with a third-generation implant design that has the ability to recreate accurately the proximal anatomy of the humerus.

Arthritis, Rheumatoid↗
PubMed2002

Abnormal sonographic findings in the asymptomatic arthritic shoulder.

OBJECTIVE: To assess the diagnostic value of ultrasonography (US) in the evaluation of arthritic shoulder joints, especially in painless shoulders. METHODS: US examinations were performed in 57 consecutive patients with rheumatoid arthritis (114 shoulders) and in 32 controls (32 shoulders), using a 7.5 MHz linear probe and a standardized study protocol. US findings were compared with clinical, laboratory, and radiological data to find any relationship. RESULTS: Abnormal sonographic findings were found in 80 shoulders (70%); the most common were lesions in the supraspinatus tendon (38%), subacromial-subdeltoid bursitis (29%), bone erosions of the humeral head (20%), glenohumeral joint ellusion (19%), and biceps tendinitis (13%). Although US abnormalities were most frequent in patients with painful shoulders or abnormal findings on physical examination or radiography, a high rate of alterations was found in asymptomatic shoulders (51%), in normal shoulders on physical examination (44%) and in normal shoulders on radiographic assessment (61%). Differences of US findings in relation to time of evolution of rheumatoid arthritis, patient's age, and radiographic stage in hand and/or wrist joints were not found. CONCLUSION: US abnormalities in the shoulder joint are frequent in rheumatoid arthritis, both in patients with and without shoulder complaints as well as in patients with normal findings on physical examination.

Adult↗
PubMed2001

The effect of overhead drilling position on shoulder moment and electromyography.

The effect of overhead drilling tasks on electromyographic (EMG) activity and shoulder joint moment was examined in this study. Twenty subjects simulated an overhead drilling task using a close, middle and far reach position while standing on either a lower or a higher step of a stepladder. Root mean square amplitude (AMP) of EMG activity from the dominant side anterior deltoid, biceps brachii and triceps brachii muscles was used to determine muscular load. Digital video was used to determine shoulder joint moment using 2-dimensional static link segment modelling in the sagittal plane. The results demonstrated that, compared to the far reach position, using the close reach position significantly decreased anterior deltoid AMP and biceps brachii AMP and moment, but increased triceps brachii AMP. Compared to the lower step, using the higher step significantly decreased anterior deltoid AMP and triceps AMP and moment, while increasing biceps AMP in the close position. There was no significant change noted in EMG median frequency indicating that fatigue was minimized. Moment increased monotonically with AMP. The findings indicated that workers performing overhead tasks should work close to their body in order to minimize shoulder forces. The implications of this recommendation are discussed.

Adult↗
PubMed2000

Differences between experts and trainees in the motion pattern of the dominant upper limb during intracorporeal endoscopic knotting.

BACKGROUND: Very little research has been carried out on the ergonomics of surgeon-instrument interface. The aim of this study is to investigate the effect of experience on the motion pattern of the dominant upper limb during endoscopic intracorporeal knot tying. METHODS: Two groups of 5 surgeons (expert consultants and higher surgical trainees) tied 360 surgeon's knots inside an endoscopic trainer in a random sequence. Motion analysis at the elbow and shoulder joints of the dominant upper limb was carried out using 3-dimensional kinemetrix system. Each knot was distracted using a tensiometer. The endpoints were the execution time, knot quality score, angular velocity and range of movement. Kruskal-Wallis one-way analysis of variance and Mann-Whitney U test were used for analysis. RESULTS: The expert group had a better knot quality score (p < 0.005) and shorter execution time (p < 0.0001) than beginners. Motion analysis at the shoulder joint showed that experts had a higher angular velocity (p < 0.05) and a wider range of movement with more adduction (p < 0.01) compared to beginners. No significant differences were found at the elbow. CONCLUSION: The better task performance by expert surgeons is associated with controlled rapid manipulations and a wider range of movement at the shoulder joint of the dominant upper limb.

Adult↗
PubMed1999

Nonsurgical treatment of suprascapular nerve injury in horses: 8 cases (1988-1998).

OBJECTIVE: To determine the outcome of horses with suprascapular nerve injury treated with stall rest alone. DESIGN: Retrospective case series. ANIMALS: 8 horses. PROCEDURE: Information on signalment, history, limbs affected, severity of lameness, degree of muscle atrophy, gait abnormalities, and results of radiography and electromyography was obtained from medical records. All horses were treated with stall rest. Follow-up information on severity of lameness, gait abnormalities, degree of muscle atrophy, time between injury and resolution of gait abnormalities, and outcome was obtained during reexamination at the hospital or through telephone conversations with owners. RESULTS: In 4 horses, the injury was a result of trauma; in the other 4, the injury was suspected to be a result of trauma. All horses had pronounced instability of the shoulder joint during the weight-bearing phase. Follow-up information was available for 7 horses. Shoulder joint instability resolved in all 7 horses within 3 to 12 months (mean, 7.4 months) after the original injury. Two horses had complete return of the supraspinatus and infraspinatus muscle mass 15 and 18 months after the injury. Two horses used as broodmares before the injury and 4 of 5 horses used for riding or in race training before the injury were able to return to preinjury activities. CLINICAL IMPLICATIONS: Horses with suprascapular nerve injury treated with stall rest alone have a good prognosis for recovery of normal gait and return to performance; however, the recovery period may be prolonged.

Animals↗
PubMed1997

Diagnosis of rotator cuff lesions: comparison of US and MRI on 38 joint specimens.

An experimental study was performed on cadaveric joint specimens of the shoulder to determine the accuracy of US and MRI in diagnosis of abnormalities of the rotator cuff. The value of different morphological criteria was evaluated for discrimination of degeneration as well as partial and complete disruption. A total of 38 surgically exposed specimens of the shoulder joint were examined by US, MRI and pathological methods visualising the tendons of the rotator cuff in same axial and longitudinal orientations. The three imaging modalities were reviewed separately by experienced examiners, respectively, who were blind to other results. Evaluation criteria consisted of signs of shape (thinning, thickening, discontinuity and absence of rotator cuff) and structure (changes in echogenicity in US, increased signal intensity in MRI, tissue changes in pathology). Findings in US and MRI were finally compared with pathology to assess sensitivity and specificity. Pathology demonstrated 4 full-thickness tears, 6 partial-thickness tears, 16 cases with degeneration and 12 normal rotator cuffs. Ultrasound showed pathological signs in all abnormal cuffs, and one MRI report was false negative. Specificity was 67 % in US (4 of 12 cases were false positive) and 100 % in MRI (no abnormal findings in healthy tendons). Discrimination of different pathological disorders of the rotator cuff was reduced in both methods. Using US only 10 of 16 cases of degeneration, 2 of 6 partial tears and 3 of 4 complete tears were correctly defined. Using MRI 13 of 16 degenerations, 3 of 6 partial tears and 3 of 4 complete tears were detected. The MRI technique failed to visualise intratendinous calcifications in all 3 cases. We conclude that MRI and US are both sensitive in detection of abnormalities of the rotator cuff. Ultrasound should be the primary diagnostic method in screening of shoulder pain because it is economic and fast. The MRI technique should be used secondary because it provides more information about extent of tendons and has lower risk of artefacts.

Adult↗
PubMed2003

[Anatomy of the superior labrum complex of the shoulder].

The outstanding progress achieved in MRI and arthroscopic techniques has forced orthopedic surgeons to consider the anatomy of the shoulder joint in detail. The superior labrum complex shows a broad range of variations, which is the reason for some difficulties regarding diagnostic conclusions as well as therapeutic considerations. In particular, the differentiation between the normal and pathological adherence of the labrum is a serious clinical problem. The glenoid labrum consists of circularly arranged collagenous fibers attached to the osseous margin of the glenoid by a fibrocartilaginous transitional zone. The cranial part of the labrum is more compact than the caudal one. It is also connected to the joint capsule and the integrated ligaments. Most of the fibers of the long head of the biceps tendon insert at the supraglenoid tubercle, only some of them continue in the fibrous ring. So-called SLAP lesions have to be differentiated from variations. In up to 18% of the patients normal clefts can be seen, e. g., sublabral holes, and in less than 6% other rare variations, e. g., the so-called Buford complex.

Arthroscopy↗
PubMed2006

Volume analysis of arthroscopic capsular shift.

PURPOSE: To determine how much volume reduction can be obtained with varying amounts of arthroscopic capsular plication. METHODS: Six fresh-frozen, cadaveric specimens were used. Specimens were rejected if a rotator cuff tear was present. The volume of each shoulder joint was measured under 3 conditions: no capsular shift, 5-mm capsular shift, and 10-mm capsular shift. For each shift, 4 sutures were placed arthroscopically, 2 anteriorly and 2 posteriorly. Repeated measures were used to confirm the validity of the measurements. Data were analyzed with parametric and nonparametric tests. RESULTS: The average percentage of volume reduction at 5 mm of capsular plication from control was 16.2% (range, 9.7% to 21.5%). The percentage of volume reduction from control to 10 mm of capsular plication averaged 33.7% (range, 25.3% to 44.6%). Statistical significance was found with both parametric (P < .0001) and nonparametric tests (P < .0313). CONCLUSIONS: The current study found that capsular volume reduction was related to the amount of capsular plication with reproducible results. Capsular plication can produce volume reduction comparable to other techniques. CLINICAL RELEVANCE: The data could be used to determine the potential number of sutures and amount of tissue plication needed for the amount of laxity found at surgery.

Anthropometry↗
PubMed1988

[Computed tomography of the soft tissues of the shoulder. 3. Periarthropathia calcificans humeroscapularis].

Computed tomography of the soft tissues of the shoulder in cases of calcifying tendinitis of the rotator cuff provides the following information: 1. Localisation of the calcium deposits within the rotator cuff. 2. Contours and density of the calcium deposits correlated with the clinical findings as described by Uhthoff et al. Ill-defined contours and non-homogeneous deposits are associated with more severe clinical features. 3. Computed tomography shows that apatite particles, which are not visible radiologically, may penetrate into the shoulder joint and produce synovitis with an effusion. This is of importance in local therapy.

Calcinosis↗
PubMed1985

[Inflammatory changes in shoulder arthrography].

Arthrography of the shoulder joint in so-called periarthritis humeroscapularis often shows nodular contrast defects, irregular defects in the bursa and contrast-filling of irregular lymphatics; these are characteristic signs of a synovitis. Arthrography can provide an exact diagnosis, not only in suspected post-traumatic rotator cuff, tears, but also in other painful conditions that limit movement. It is superior to CT in demonstrating inflammatory changes.

Arthrography↗
PubMed1989

Peripheral arthritis in the elderly: a hospital study.

One hundred consecutive patients admitted to an acute geriatric unit were examined for evidence of peripheral arthritis with recognised criteria used to define osteoarthritis, rheumatoid arthritis, pyrophosphate arthropathy, gout, and disorders of the shoulder joint. The presence of arthritis and its severity were related both to functional independence and to a recognition by the patient that joint problems were impairing independence. Seventy six patients had clinical peripheral arthritis; 48 had arthritis contributing to loss of function, and 19 of these did not volunteer evidence of their joint disease. The common occurrence of arthritic conditions in the elderly, with consequential disability and dependency, suggests that increased medical awareness may be required to prevent unnecessary morbidity. Our findings need confirmation in community based studies.

Aged↗
PubMed2002

Clinical and pathologic analyses of bicipital tenosynovitis in dogs.

OBJECTIVE: To determine the clinical and pathologic findings in dogs with primary bicipital tenosynovitis. ANIMALS: 19 dogs with 20 shoulder joints treated surgically for bicipital tenosynovitis and 8 shoulder joints from 4 clinically normal dogs. PROCEDURE: Histologic abnormalities of tendon sheaths of the biceps brachii in affected dogs were determined by use of comparison with findings in clinically normal dogs. Specimens were graded for inflammation, fibrosis, villous hypertrophy, vascular prominence, and synovial cell proliferation. Histopathologic results were statistically evaluated for relationship with clinical findings and treatment before surgery. RESULTS: Synovial villous hypertrophy and vascular prominence were the most consistent histologic findings in 16 and 14 of 20 affected joints, respectively. Evidence of inflammation was lacking in 6 joints. Ten joints had inflammatory cell infiltration of the tendon sheath. Plasma cells and lymphocytes were the most common infiltrates; however, the type and amount of inflammatory cell infiltrate were variable. Fibrosis of the tendon sheath was seen in 8 joints, and synovial cell proliferation was seen in 11 joints. Other changes included accumulation of hemosiderin, focal calcification, osseous metaplasia, lysis of collagen, and fibrocartilaginous metaplasia. No significant relationship was detected between histopathologic findings and clinical findings or treatment before surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Inflammation was more variable than hypothesized and may not be a consistent pathophysiologic feature of bicipital tenosynovitis. In some dogs, this disease may be the result of a degenerative process rather than an inflammatory process.

Adrenal Cortex Hormones↗
PubMed2005

[Evaluation of shoulder instability under general anesthesia and arthroscopic diagnosis].

Instability of the shoulder joint is evaluated with the use of history, physical examination, radiography, computed tomography or CT-arthrography, fluoroscopy, and examination under general anesthesia. The degree of glenohumeral translation in every direction under general anesthesia is of great value in determining the direction and severity of the instability. Arthroscopy provides a great advantage to inspect the joint clearly and to plan the most appropriate treatment, enabling to draw diagnoses of bone lesions of the humerus and glenoid, labral-ligamentous lesions, increased capsular volume, biceps pathologies, and rotator cuff tears.

Anesthesia, General↗
PubMed1980

Recent advances in research in prosthetics for children.

New prosthetic components are being designed and developed specifically to meet needs of children. Some are primarily new power systems for operating components which are already in general use, and some are entirely new components such as those developed at the Child Amputee Prosthetics Project at UCLA. These include the CAPP Terminal Device, the CAPP Multi-Position Post, CAPP Wrist Units, the CAPP Modular Elbow, the CAPP Two-Way Shoulder Joint, the CAPP Frame Shoulder Socket, and the CAPP Prosthetic Foot for Above-Knee Amputees. At present, there is great interest in externally powered components, and these are being developed at many centers around the world. A new electric elbow, is the Motor-Lock Elbow, was developed at New York University; a Swedish Electric Hand extends the application of the Otto Bock Myoelectric System to the very young child; the 3-state myoelectric system developed in New Brunswick, Canada, allows the amputee to control 2 functions from a single muscle site, and the INAIL System from Italy is based on a procedure for evaluation and fitting with externally powered along with body powered components. The pneumatically powered Simpson Arm and Kenworthy Hand from Scotland are based on the concept of extended physiologic proprioception. All of the components selected for this review are now being developed or tested so that clinical application can be anticipated.

Amputees↗
PubMedDate not supplied

[Mobilization of the partially stiff shoulder under anesthesia (ankylosing humeroscapular periarthritis)].

"Humeroscapular periarthritis" (HPA) was first described by Duplay in 1872 and is to be understood as a syndrome whose typical symptoms are pain and partial or total stiffness of the shoulder ("ankylosing" HPA). This term includes all regressive and reactive affections occurring in the region of the shoulder joint proper (Refish and van Laack, 1985), and has meanwhile become a synonym for painful shoulder stiffness, a term which covers many different processes which are not covered in detail here. Today, however, thanks to refined clinical and radiological examination methods, it is often possible to detect objectively at least some of the changes and to gain insights into the pathophysiological processes. The goal of treatment of HPA is to restore the function of the shoulder joint and eliminate the pain. To this end, various forms of treatment are fundamentally available: 1) conservative treatment, with medication and physiotherapy; 2) surgical treatment; and 3) mobilization under anesthetic, with which, comparatively speaking, results have been best.

Adult↗
PubMed1986

The painful diabetic shoulder.

Different types of shoulder affection were studied in 62 diabetic patients with shoulder pain. Three groups of shoulder joint disorder were found: painful shoulder with restricted mobility (62%), tendinitis without mobility restriction (27%), and a small group with mixed diagnoses. Sixty per cent had hand symptoms and 38% had restricted mobility of their hip joints. High frequencies of retinopathy and neuropathy were found. Affection of the shoulder joint was seen with almost the same frequency in insulin-dependent as in non-insulin-dependent patients, but after a shorter duration of diabetes in the latter. A group of patients with the triad shoulder pain, hand symptoms and restricted mobility of the hip joints had a significantly higher frequency of proliferative retinopathy than patients with shoulder pain only. The long duration of diabetes, the high frequency of insulin treatment and classical late complications indicate that diabetic patients with painful shoulder and restricted mobility are suffering from clinically advanced diabetes mellitus.

Adult↗
PubMed1997

Diagnosis of tears in rotator-cuff-injuries.

Pathology of the rotator cuff is the cause of most common problems at the shoulder joint. Acute injuries are not as frequent as chronic cuff disease, but often they aggravate inflammatory or degenerative tendon alterations, even if they are of minor severity. Traumatic rotator cuff tears predominantly affect the supraspinatus tendon or the rotator interval. The subscapularis tendon is involved in anterior dislocations of the glenohumeral joint or in direct trauma. Plain film radiography still remains the base of all further imaging studies. If only full-thickness tears must be ruled out, double-contrast arthrography and ultrasound are acceptable imaging modalities. However, the former has a drawback in being invasive and does not detect partial tears at the bursal site of the cuff or rotator cuff tendinopathy, whereas the latter heavily depends on the experience of the radiologist and is restricted to the rotator cuff. Nowadays the most comprehensive imaging method is magnetic resonance (MR) imaging. MR imaging enables the detection or exclusion of complete rotator cuff tears with a reasonable accuracy and is also suitable to diagnose further pathologies of the shoulder joint. MR arthrography is valuable in the detection of subtle anatomic details and further improves the differentiation of rotator cuff diseases. Although in comparison MR imaging is still the most expensive imaging method, its high negative predictive value for the diagnosis of complete rotator cuff tears and its reliability evaluating different shoulder joint pathologies make it the preferred imaging modality.

Humans↗
PubMedDate not supplied

Comparison of the ultrasonographic appearance of osteochondrosislesions in the canine shoulder with radiography, arthrography, and arthroscopy.

Osteochondrosis lesions in 29 shoulder joints (from 20 dogs) were evaluated with ultrasound (US) and the results were compared with survey radiography, arthrography, and arthroscopy. US was performed with a 7-12 MHz linear matrix transducer which was placed in cranio-caudal direction just distally to the acromion while the joint was adducted and maximally endorotated to visualize the caudal aspect of the humeral head. With US, the subchondral defect was completely visible in 21 joints and partially visible in 8 joints. The length of the subchondral defect measured on US was comparable with the length measured on survey radiographs. In two joints, the cartilage flap was mineralized and thus already visible on survey radiographs. The mineralized flap was visible on US as a straight hyperechoic line above the subchondral defect. In the other joints, survey radiographs could not assess the status of the articular cartilage. In 17 joints, the presence of a cartilage flap or cartilage fissuring was suspected based on the presence of a second hyperechoic line at the base of the subchondral defect, and this suspicion was confirmed by arthroscopic examination in 16 joints and also by arthrographic examination in 15 joints. One joint that was suspected of having a cartilage flap on US was normal on arthroscopy and arthrography. When US revealed only focal thickening of the anechoic cartilage layer (5 joints), the joints appeared normal on arthroscopic and arthrographic examination. Of the four joints where the subchondral defect was irregular and covered by heteroechogeneous material on US, arthroseopy revealed the presence of a lesion resembling chondromalacia in two joints, the presence of a small cartilage flap in one joint and the presence of scar tissue underneath the flap at the level of the subchondral defect in one joint. In conclusion, US is a helpful imaging modality in the identification of osteochondritic lesions in the canine shoulder joint. US also appears to be a satisfactory imaging tool for identifying lesions such as joint mice, joint effusion, and distinct new bone formation.

Animals↗