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At least 1,027 records · Page 57Linked to original sources
PubMed2006

Adhesive capsulitis of the shoulder: the rate of manipulation following distension arthrogram.

To determine the rate of manipulation under anaesthesia (MUA) following distension arthrogram for adhesive capsulitis of the shoulder. Thirty-nine patients (42 shoulders) between 1998 and 2004 were treated with distension arthrogram for adhesive capsulitis diagnosed by the clinical picture of progressive pain and stiffness. Capsular disruption into the subscapular bursa was demonstrated in 40 of the 42 shoulders (95%). Thirty-seven of 42 (88%) shoulders were painfree following distension arthrogram. 15 of 42 (36%) shoulders underwent MUA following distension arthrogram for stiffness although 10 of these (67%) were painfree. Prior to distension arthrogram, the range of external rotation (ER) was no different between those that had MUA and those that did not (P = 0.36). The improvement in ER was 33% (P = 0.28) in those that had MUA and 50% (P = 0.001) in those that did not. The only complication was a vasovagal episode during the procedure. Distension arthrogram can be used as a therapeutic procedure for achieving symptomatic pain relief in the majority of adhesive capsulitis and decrease the rate of MUA of the shoulder.

Adult↗
PubMed2004

The German version of the Oxford Shoulder Score--cross-cultural adaptation and validation.

INTRODUCTION: The evaluation of health-related quality of life is an established criterion for the evaluation of therapeutic measurement. Especially in the English language, a great number of different questionnaires have been developed. The original, English-language 12-item Oxford shoulder score (OSS) is a recently developed and validated patient-completed outcome measure specifically designed for the evaluation of patients suffering from shoulder pathology other than instability. Because of the lack of a comparable instrument in German, this questionnaire was translated into German and subsequently tested for validity and reliability in a cross-sectional study. MATERIAL AND METHODS: Translation of the OSS was done according to the guidelines in the literature. One hundred two patients completed the German version of the OSS and the SF-36. Additionally, the Constant shoulder score and the UCLA shoulder score were included into the validation process. The psychometric properties feasibility and patient-burden parameters were also tested. RESULTS: The patients completed all questionnaires. The mean time required for completing the OSS was 3 min, 25 s; the mean time required for evaluation of the questionnaire was 35 s. The internal consistency tested by the Cronbach's alpha (0.94) was high. The reproducibility tested by two different methods showed no significant difference. The construct validity showed a significant correlation between the OSS and the other scores. CONCLUSION: The instrument proved to be valid by demonstrating the same correlations predicted by standard clinical assessments and a generic patient-based instrument. Application and evaluation in clinical trial proved feasible and minimally time consuming. Therefore, the German translation of the Oxford shoulder score is a valid and reliable tool, applicable to outcome studies on shoulder patients.

Adult↗
PubMed2006

Dislocation of the shoulder joint with ipsilateral humeral shaft fracture: two case reports.

INTRODUCTION: A combination of the shaft fracture of the humerus with shoulder dislocation is a rarely documented injury. Moreover, few reports describe a long-term outcome after a follow-up period over 10 years. The present article is the first report of long-term clinical results obtained with this combined injury. MATERIALS AND METHODS: We present two cases of the dislocation of the shoulder joint with ipsilateral humeral shaft fracture. One is an anterior dislocation and the other is posterior. The anterior dislocation was closely reduced on the date of injury, but the posterior dislocation required open reduction 6 weeks after the injury because it was missed at the initial diagnosis and identified 4 weeks after the injury. In the latter case, shoulder pain and limitation of the motion persisting after the first surgery had to be treated by anterior acromioplasty and arthrolysis of the shoulder. In both cases, the humeral fracture was fixed by retrograde intramedullary nailing using a Küntscher nail and successful bone union was achieved. RESULTS: At over 10-year follow-up examination, both patients had no limitation in activities of daily living and no restrictions to their normal occupation. The radiographs of the shoulder joint demonstrated good clinical results, with no degenerative change or osteonecrosis. CONCLUSION: We have experienced two cases of dislocation of the shoulder joint with ipsilateral humeral shaft fracture and reported long-term results over 10 years. Good clinical results were demonstrated in both cases.

Accidents, Traffic↗
PubMed1999

Characteristics of pain drawings in the neck-shoulder region among the working population.

OBJECTIVES: The aim was to study the characteristics of pain drawings in the neck, shoulders, and upper-back regions among the general working population. METHODS: Pain drawings of the rear view of the neck, shoulders, and upper back were made by 125 middle-aged subjects from the general working population suffering from symptoms, mainly ache and pain, in the neck or shoulder regions. The locations of the markings in each pain drawing were coded to computer files using a transparent grid (878 pixels). The total area, the number of separate loci, and the left-right symmetry were recorded. Symptoms and signs were assessed at a medical examination. RESULTS: The most frequently marked locations in the resulting aggregated topographical diagram covered two palm-sized areas in the neck-shoulder angles, with a symmetrical and even distribution occurring between the left and right sides. Subjects with more chronic or severe symptoms made pain drawings with larger areas. The presence of tenderness in the neck-trapezius region was associated with larger areas and more bilateral and multiple loci. Larger areas with multiple bilateral loci and a more symmetric distribution characterized pain drawings made by women as compared with those made by men. No substantial difference was noted in connection with age or educational level. CONCLUSIONS: Pain drawings of neck and shoulder symptoms among the middle-aged general working population most usually focused on the neck-shoulder angles with a symmetrical left-right distribution. The number of separate symptom loci and their total area, left-right distribution, and symmetry were characteristics associated with symptom chronicity and severity or signs of tenderness in the neck-trapezius region.

Adult↗
PubMed1982

Shoulder dystocia: fifteen years' experience in a community hospital.

The profile of the patient most likely to present with shoulder dystocia was determined to be a patient over 41 weeks' gestation with a prolonged decelerative phase of labor (8 to 10 cm) who was receiving epidural anesthesia before adequate descent of the vertex, resulting ina midforceps delivery. The patho-anatomic mechanism involves displacement of the anterior shoulder from a larger, i.e., oblique diameter, to a small (anteroposterior) diameter of the pelvis. The restitution of the shoulders to the oblique diameter is the hallmark of management. Proposed is an algorithm involving abdominal pressure to widening the episiotomy (bilateral if necessary) to displace the shoulders to the oblique diameter by corkscrewing or, if possible, careful delivery of the posterior shoulder. Cleidotomy is downplayed. The constant awareness of the possibility of the rapid development of shoulder dystocia, with its potentially lethal and always dangerous consequences, is espoused.

Birth Weight↗
PubMed1987

Shoulder dystocia: predictors and outcome. A five-year review.

Shoulder dystocia is an uncommon complication of delivery with a high morbidity rate. Ninety-one cases were coded for shoulder dystocia at the Toronto General Hospital from 1980 through 1985. True shoulder dystocia was found in 24 cases, an incidence of 0.23%. There was no significant difference in average weight and percentage of macrosomia between cases of true shoulder dystocia and those merely coded as such. True shoulder dystocia was associated with a neonatal morbidity rate of 42%, consisting of a respiratory arrest and neurological and orthopedic damage. Fundal pressure, in the absence of other maneuvers, resulted in a 77% complication rate and was strongly associated with orthopedic and neurologic damage. Delivery of the posterior shoulder and the corkscrew maneuver were associated with good fetal outcome.

Delivery, Obstetric↗
PubMed1995

Are labor abnormalities more common in shoulder dystocia?

OBJECTIVE: Our objective was to determine the association between labor abnormalities and shoulder dystocia. STUDY DESIGN: All consecutive cases of shoulder dystocia from January 1986 to August 1994 were reviewed (n = 276). For purposes of comparison a control group of vaginally delivered patients was randomly selected in a 2:1 ratio (n = 600). Charts were reviewed for demographic information, labor and delivery events, and neonatal outcome. RESULTS: Labor abnormalities were comparable in the shoulder dystocia and control groups, both in the active phase and in the second stage. When patients with diabetes and those with macrosomic infants were analyzed separately, no significant differences in labor abnormalities were identified. The rate of operative vaginal delivery was significantly higher in the shoulder group, and one third of the operative deliveries were midpelvic. In addition, the induction rate was higher in the shoulder group. CONCLUSIONS: Our data suggest that labor abnormalities may not serve as clinical predictors for subsequent development of shoulder dystocia, thus emphasizing the unpredictability of this condition.

Adult↗
PubMed1985

Shoulder function following the loss of the latissimus dorsi muscle.

A study of shoulder function was carried out in a group of 19 male patients who had their latissimus dorsi muscle removed as a free flap. A control group was examined to obtain data for the normal range of movement and power at the shoulder. Only a few patients had any subjective impairment of shoulder function; 13 of our 19 patients had a complete range of movement at the shoulder. There was no significant difference in power between the patient group and the control group when dominant and non-dominant sides were considered separately (p greater than 0.05). Patients who had surgery carried out more recently and patients with a scar contracture had a significantly higher disability score. The latter group also had a greater deficit in range of movement at the shoulder (p less than 0.05). Most patients encountered no difficulty whatever with their occupational and sporting activities. Our results support the view that the latissimus dorsi muscle is totally expendable and that there is no significant functional loss at the shoulder, either in casual or in forceful activities.

Adolescent↗
PubMed1996

Is macrosomia predictable, and are shoulder dystocia and birth trauma preventable?

OBJECTIVE: To assess our ability to detect macrosomic fetuses, and to examine the relationship between prenatal diagnosis of macrosomia and the incidence of shoulder dystocia and birth trauma. METHODS: We instituted a protocol for routine detection of macrosomic fetuses, defined as weight estimated to be at least 4500 g. Fetal weight was estimated by ultrasonography when there was clinical suspicion of macrosomia. We collected data on these pregnancies as well as on deliveries of macrosomic infants, shoulder dystocia, and birth trauma. RESULTS: During the 14-month study period, there were 4480 deliveries. There were 23 macrosomic newborns (0.5%), of whom 17 were born vaginally. Six of these 17 (35%) vaginal deliveries were complicated by shoulder dystocia, and one infant sustained brachial plexus injury. The overall frequency of shoulder dystocia was 2%, the majority (93%) occurring in infants weighing less than 4500 g. Eleven newborns sustained brachial plexus injury (0.2%), and 39 had isolated clavicular fracture. Six of nine cephalic deliveries that resulted in brachial plexus injury were associated with shoulder dystocia. The sensitivity and predictive value of the study protocol were 17% (four of 23) and 36% (four of 11), respectively. Surprisingly, clinical estimation alone had a sensitivity of 43% (ten of 23) and a positive predictive value of 53% (ten of 19). CONCLUSION: The ability to predict macrosomia is limited. The predictive value of clinical estimation of fetal weight alone may be slightly higher than when it is combined with ultrasonography. Because most cases of shoulder dystocia and birth trauma occur in nonmacrosomic infants, these conditions are practically impossible to prevent.

Birth Injuries↗
PubMed1991

Arthroscopic appearance of frozen shoulder.

Patients (n = 150) were referred to a shoulder clinic with a diagnosis of "frozen shoulder" and the suggestion that they be submitted to manipulation. All patients were further investigated using local anesthetic blocks, routine radiography, and, often, computed tomographic scanning and arthrograms. Subsequently, it appeared that only 37 patients qualified for the diagnosis of "primary" frozen shoulder. The others had a "secondary" frozen shoulder from some other painful cause, such as a rotator cuff tear or impingement. The 37 patients were arthroscoped and then manipulated while under general anesthesia. Patients were told that both irrigation and local injection of the joint would have an additional beneficial therapeutic effect in the recovery phase, and they gave prior consent to the procedures. There were no complications. Pain relief was striking. The arthroscopic appearance was uniform: a patchy vascular reaction around the biceps, and the opening into the subscapularis bursa. The capacity of the joint was reduced. In no patient was the infraglenoid recess obliterated, and no adhesions were seen. Such findings at routine shoulder arthroscopy should alert the surgeon to a diagnosis of frozen shoulder if the clinical presentation has been subtle. The findings raise questions about the previous pathological interpretation of this condition.

Adult↗
PubMed2004

Is abnormal labor associated with shoulder dystocia in nulliparous women?

OBJECTIVE: This study was undertaken to examine the relationship between labor abnormalities and shoulder dystocia in nulliparous women. STUDY DESIGN: Nulliparous women whose delivery was complicated by shoulder dystocia were studied and compared with a control group selected based on the best possible match for race, labor type (spontaneous or induced), and birth weight. The duration of first and second stage of labor, as well as the rates of labor progress, were calculated and compared between groups. RESULTS: During this 4-year study period, there were 8010 nulliparous singleton deliveries of which 65 (0.8%) were complicated by shoulder dystocia. Compared with controls, there was no difference in the rate of cervical dilation in the active phase of the first stage of labor. In the shoulder dystocia group, more patients had a second stage of labor greater than 2 hours (22% vs 3%; P <.05) and had operative vaginal deliveries (26% vs 1.5%; P <.001). In shoulder dystocia cases with birth weight greater than 4000 g, 33% had a second stage of labor greater than 2 hours. CONCLUSION: In our population, the combination of fetal macrosomia, second stage of labor longer than 2 hours and the use of operative vaginal delivery were associated with shoulder dystocia in nulliparous women.

Adult↗
PubMed2005

Comparing McRoberts' and Rubin's maneuvers for initial management of shoulder dystocia: an objective evaluation.

OBJECTIVE: This study was undertaken to objectively compare delivery traction force, fetal neck rotation, and brachial plexus elongation after 3 different initial shoulder dystocia maneuvers: McRoberts', anterior Rubin's, and posterior Rubin's. STUDY DESIGN: We developed a laboratory birthing simulator comprised of a maternal model with a 3-dimensional bony pelvis, an instrumented fetal model, a force-sensing glove, and a computer-based data acquisition system. A single operator performed 30 simulated shoulder dystocia deliveries using standard downward traction after 1 maneuver was performed. Ten deliveries simulated McRoberts' maneuver with fetal shoulders in the anteroposterior diameter. Ten deliveries involved approximately 30-degree oblique rotation of the anterior shoulder with the spine oriented anteriorly (anterior Rubin's maneuver). Ten deliveries involved approximately 30-degree rotation of the posterior shoulder to the opposite oblique pelvic diameter, with the spine oriented posteriorly (posterior Rubin's maneuver). Peak traction force, brachial plexus elongation, and neck rotation were compared between groups using analysis of variance, with P < .05 considered significant. RESULTS: Rubin's maneuvers were found to require less traction force than McRoberts': 16.2 +/- 2.1 lbs for McRoberts' compared with 8.8 +/- 2.2 lbs and 6.5 +/- 1.8 lbs for posterior and anterior Rubin's respectively (P < .0001). Brachial plexus extension was significantly lower after anterior Rubin's maneuver compared with McRoberts' or posterior Rubin's maneuvers. CONCLUSION In a laboratory model of initial maneuvers for shoulder dystocia, anterior Rubin's maneuver requires the least traction for delivery and produces the least amount of brachial plexus tension. Further study is needed to validate these results clinically.

Brachial Plexus↗
PubMed2004

Episiotomy versus fetal manipulation in managing severe shoulder dystocia: a comparison of outcomes.

OBJECTIVE: In severe shoulder dystocia, when initial maneuvers fail, either episiotomy or fetal manipulation (Rubin, Woods' screw, or posterior arm release) is recommended. We sought to compare maternal and neonatal outcomes between severe shoulder dystocia deliveries managed with episiotomy versus fetal manipulation. STUDY DESIGN: We identified severe shoulder dystocia deliveries from three databases: all shoulder dystocia deliveries (1993-2003 and 1994-1997) from two teaching institutions and litigated cases of shoulder dystocia-associated permanent brachial plexus palsy from multiple U.S. institutions. Pair-wise comparisons were made among three groups of deliveries: those managed by fetal manipulation without episiotomy (fetal manipulation-only), those managed by episiotomy without fetal manipulation (episiotomy-only), and those managed with both (episiotomy + fetal manipulation). Rates of brachial plexus palsy, neonatal depression, and anal sphincter trauma were compared among groups using chi 2 , with significance at P < .05. RESULTS: Among episiotomy-only, 13 of 22 (59.1%) sustained brachial plexus palsy, compared with 20 of 57 (35.1%) among fetal manipulation-only (P = .05). Twenty-eight of 48 (58.3%) in episiotomy + fetal manipulation had brachial plexus palsy, which did not differ from episiotomy-only (P = .95) but was higher than fetal manipulation-only (P = .02), suggesting that the addition of episiotomy conferred no benefit in averting neonatal injury. Anal sphincter trauma was significantly more common among episiotomy-only and episiotomy + fetal manipulation, compared with fetal manipulation-only. CONCLUSION: In severe shoulder dystocia, if fetal manipulation can be performed without episiotomy, severe perineal trauma can be averted without incurring greater risk of brachial plexus palsy.

Adult↗
PubMed2004

Accuracy and validity of observational estimates of shoulder and elbow posture.

This study investigated the accuracy of video-based observational posture analysis for the elbow and shoulder. Posture analyses were conducted by 28 ergonomists for four jobs presented on a traditional VHS format video recording. Estimates of posture from the observational-based methods were compared with values measured directly with an optical motion capture system. Ergonomists used categorical posture scales and a continuous visual analog scale to estimate the peak and most frequently occurring or average posture for each job. Use of a three-category scale resulted in misclassifications of peak and most frequently occurring elbow and shoulder posture with a probability averaging 30.1%. With the six-category posture scale this average probability of misclassification increased to 64.9%. Using a continuous visual analog scale peak shoulder elevation was the only posture for which the average error among ergonomists' estimates was significantly different from zero (p<0.05). Correlations between the estimated postures and measured postures were higher and statistically significant (p<0.05) for elbow flexion and shoulder elevation (r2 between 0.45 and 0.66) but were considerably lower and not significant (r2 between 0.03 and 0.18) for the peak and average horizontal shoulder abduction. Ergonomists' estimates of the temporal distribution of shoulder posture, indicating the duration severity of the posture, appeared to be biased such that the percentage of the cycle time in each posture category was estimated as more uniformly distributed than the measured values indicated.

Elbow↗
PubMed2004

Cryotherapy does not impair shoulder joint position sense.

OBJECTIVE: To determine the effects of a cryotherapy treatment on shoulder proprioception. DESIGN: Crossover design with repeated measures. SETTING: University athletic training and sports medicine research laboratory. PARTICIPANTS: Thirty healthy subjects (15 women, 15 men). INTERVENTION: A 30-minute cryotherapy treatment. MAIN OUTCOME MEASURES: Joint position sense was measured in the dominant shoulder by using an inclinometer before and after receiving 30 minutes of either no ice or a 1-kg ice bag application. Skin temperature was measured below the tip of the acromion process and recorded every 5 minutes for the entire 30 minutes and immediately after testing. Three different types of error scores were calculated for data analyses and used to determine proprioception. RESULTS: Separate analyses of absolute, constant, and variable error failed to identify changes in shoulder joint proprioception as a function of the cryotherapy application. CONCLUSIONS: Application of an ice bag to the shoulder does not impair joint position sense. The control of proprioception at the shoulder may be more complex than at other joints in the body. Clinical implications may involve modifying rehabilitation considerations when managing shoulder injuries.

Adult↗
PubMed2005

Thirty minutes of positioning reduces the development of shoulder external rotation contracture after stroke: a randomized controlled trial.

OBJECTIVE: To determine the efficacy of positioning the affected shoulder in flexion and external rotation to prevent contracture shortly after stroke. DESIGN: Prospective, parallel-group, randomized controlled trial. SETTING: Four metropolitan mixed rehabilitation units. PARTICIPANTS: A volunteer sample of 36 subjects (minus 5 dropouts), whose mean age was 68 years and had had their first stroke within the past 20 days. INTERVENTIONS: The experimental group received two 30-minute sessions a day, 5 days a week, for 4 weeks, during which the affected upper limb was placed in maximum comfortable external rotation and 90 degrees of flexion. Both the experimental and control groups received up to 10 minutes of shoulder exercises and standard upper-limb care. MAIN OUTCOME MEASURES: Contracture was measured as the maximum passive shoulder external rotation and flexion of the affected side as compared with the intact side. Measures were taken at 2 and 6 weeks after stroke by an assessor blinded to group allocation. RESULTS: The 30-minute program of positioning the shoulder in maximum external rotation significantly reduced the development of contractures in the experimental group, compared with the control group ( P =.03). The 30-minute program of positioning the shoulder in 90 degrees of flexion did not prevent contractures in the experimental group as compared with the control group ( P =.88). CONCLUSIONS: At least 30 minutes a day of positioning the affected shoulder in external rotation should be started as soon as possible for stroke patients who have little activity in the upper arm.

Contracture↗
PubMed2005

Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation.

PURPOSE: To report the long-term results of a prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation after a first traumatic anterior dislocation of the shoulder. TYPE OF STUDY: Randomized clinical trial. METHODS: Forty subjects younger than 30 years with a first traumatic anterior shoulder dislocation were randomized to receive immediate anterior stabilization plus rehabilitation or immobilization followed by rehabilitation. Patients completed the American Shoulder and Elbow Surgeons (ASES), Disabilities of the Arm, Shoulder and Hand (DASH), and the Western Ontario Shoulder Instability Index (WOSI) questionnaires. RESULTS: At an average follow-up of 75 months, there was a significant difference in the rate of redislocation between the groups but no statistical significant difference in shoulder function with the ASES or the DASH. The mean difference between the 2 groups with the WOSI estimates a small, but clinically significant difference. CONCLUSIONS: It is recommended that immediate arthroscopic stabilization is the treatment of choice in a subset of patients who are younger than 30 years and are higher level athletes, and the timing for surgery is good or their sport is risky, i.e., rugby, football, kayaking, rock climbing. LEVEL OF EVIDENCE: Level II.

Adult↗
PubMed2004

Reliability of force direction dependent EMG parameters of shoulder muscles for clinical measurements.

OBJECTIVE: To assess the reliability of force direction dependent EMG parameters in shoulder muscles for future clinical research. DESIGN: EMG measurements of shoulder muscles including the rotator cuff were performed during isometrical external loading in various directions covering 360 degrees in a plane perpendicular to the humeral axis. BACKGROUND: Relating EMG to force direction bypasses problems associated with the unknown position and velocity dependence of the EMG signal. For clinical application, information on the reliability of force direction dependent parameters is required. METHODS: The EMG of shoulder muscles of healthy subjects was related to force direction. The activation patterns obtained where parameterised after least squares function fitting, returning three force direction dependent parameters, i.e. two on- and offset directions of the activity peak and the direction of highest EMG activity also called principal action. Within-trial, inter-trial, inter-day and inter-subject variabilities were estimated. RESULTS: With a group size of n = 10, the 95% confidence interval for inter-day measurements was found to be about +/-5 degrees on a scale of 360 degrees for the principal action and just below +/-10 degrees for the intercepts. CONCLUSION: The method allows for intra-individual measurements on different days with sufficient accuracy so that shoulder muscle co-ordination of patients before and after interventions like surgery or physical therapy can be evaluated. RELEVANCE: Quantitative data on shoulder muscle function in vivo are required to assess the effectiveness of interventions on the shoulder.

Adult↗