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PubMed2001

[Ultrasound study of the shoulder].

The sonographic examination of the shoulder joint is nowadays a matter of the daily routine. A standardized way of examination permits to evaluate all sonographic visible regions of the shoulder joint statically and dynamically as well. Pathologic findings in the shape of the humeral head, the joint (except of the joint pan and parts of the labrum), the rotator cuff, the long biceps tendon, the bursa subacromialis and the acromio-clavicular joint can be seen and assessed. A qualified examinator with excellent knowledge of the anatomy and the current diseases and injuries, and an adequate apparative condition as well, is of eminent importance. In comparison with MRI the advantage of the sonography is a higher resolution, the possibility of dynamic examination and an easy comparison with the opposite side. Availability is better and the price is lower. A disadvantage is the impossibility to judge the subacromial space and parts of the glenoid rim. Furthermore the skill of the sonographer limits the evidence of the examination. Sonographic examination should belong, together with the conventional x-ray to the first imaging procedures in shoulder diagnostics.

Humans↗
PubMedDate not supplied

The coracoid impingement of the subscapularis tendon: a cadaver study.

To study the anatomic relationships and varieties of anterior impingement of the rotator cuff, an examination of 124 shoulder joints from 62 embalmed cadavers was performed. The distance between the lesser tuberosity and the coracoid was measured at different degrees of humeral rotation in the shoulder joint. Neither lateral differences nor differences with respect to donor gender were found in the distance measurements between the coracoid process and the lesser tuberosity for any rotational angle. In addition, no significant differences were found between shoulders with and without rupture of the subscapularis tendon. No lateral dominance was found for the subscapularis tunnel area.

Adult↗
PubMed1998

[Imaging methods].

A number of abnormalities of the shoulder joint can cause pain or dysfunction. Imaging of this complex joint is demanding. Standard radiographs are considered to represent the basis of all imaging. For more detailed diagnoses, especially concerning soft tissue, more advanced imaging methods are required. Standard arthrography (without combination with either CT or MRI) is rarely indicated anymore. Bone scintigraphy is another imaging method with limited use in shoulder joint abnormalities (neoplasm, infection, occult fracture). Sonography is useful in abnormalities of the rotator cuff and the biceps tendon. This method is commonly employed for screening. CT is useful in the demonstration of complex fractures. CT arthrography is indicated in instability of the glenohumeral joint and is competing with MR arthrography. MRI and MR arthrography are the imaging method of choice for many indications, mainly due to their free choice of imaging planes and excellent contrast resolution. These methods provide the most detailed diagnosis mainly with regard to abnormalities of the rotator cuff (partial versus intact or full-thickness tears) and the biceps tendon and are useful in the assessment of instability.

Diagnosis, Differential↗
PubMed2003

Experimental studies of virtual reality-delivered compared to conventional exercise programs for rehabilitation.

This paper presents preliminary data from two clinical trials currently underway using flat screen virtual reality (VR) technology for physical rehabilitation. In the first study, we are comparing a VR-delivered exercise program to a conventional exercise program for the rehabilitation of shoulder joint range-of-motion in patients with chronic frozen shoulder. In the second study, we are comparing two exercise programs, VR and conventional, for balance retraining in subjects post-traumatic brain injury. Effective VR-based rehabilitation that is easily adapted for individuals to use both in inpatient, outpatient and home-based care could be used as a supplement or alternative to conventional therapy. If this new treatment approach is found to be effective, it could provide a way to encourage exercise and treatment compliance, provide safe and motivating therapy and could lead to the ability to provide exercises to clients in distant locations through telehealth applications of VR treatment. VR is a new technology and the possibilities for rehabilitation are only just beginning to be assessed.

Brain Injuries↗
PubMedDate not supplied

[Sonographic assessment of typical lesions in shoulder dislocation].

The traumatic dislocation of the shoulder joint is the most often joint luxation. The involved patients are often sporting and between the age of 20 to 40 years. The therapeutic and prognostic point of interest is to recognize and reconstruct injured structures. Among the soft tissue injuries the Bankart lesions, among the osseous injuries the Hill-Sachs defect are numeric well to the fore. Hitherto existing diagnostic methods for these injuries are either invasive or with X-rays. Its is demonstrated, that dynamic ultrasonography examination of the shoulder joint can visualize besides the rotator cuff abnormalities of the labrum glenoidale and the caput humeri outline.

Adult↗
PubMed1979

Subacromial bursography.

Subacromial bursography was performed on 250 patients with following results. Bursographically, the subacromial bursa was found to have three intercommunicating portions with various frequency; subacromial, subdeltoid and subcoracoid. In complete rotator cuff ruptures, the contrast medium leaked into the shoulder joint. In 'frozen shoulder' the subacromial bursa is reduced in size according to the degree of contracture. The intrabursal injections of steroid hormone and Lidocaine proved to have definite therapeutic and pain alleviating effects.

Acromioclavicular Joint↗
PubMed1998

Arthroscintigraphy in suspected rotator cuff rupture.

AIM: In order to evaluate the diagnostic efficiency of arthroscintigraphy in suspected rotator cuff ruptures this new imaging procedure was performed 20 times in 17 patients with clinical signs of a rotator cuff lesion. The scintigraphic results were compared with sonography (n = 20), contrast arthrography (n = 20) and arthroscopy (n = 10) of the shoulder joint. METHODS: After performing a standard bone scintigraphy with intravenous application of 300 MBq 99m-Tc-methylene diphosphonate (MDP) for landmarking of the shoulder region arthroscintigraphy was performed after an intraarticular injection of 99m-Tc microcolloid (ALBU-RES 400 MicroCi/5 ml). The application was performed either in direct combination with contrast arthrography (n = 10) or ultrasound conducted mixed with a local anesthetic (n = 10). Findings at arthroscopical surgery (n = 10) were used as the gold standard. RESULTS: In case of complete rotator cuff rupture (n = 5), arthroscintigraphy and radiographic arthrography were identical in 5/5. In one patient with advanced degenerative alterations of the shoulder joint radiographic arthrography incorrectly showed a complete rupture which was not seen by arthroscintigraphy and endoscopy. In 3 patients with incomplete rupture, 2/3 results were consistent. A difference was seen in one patient with a rotator cuff, that has been already revised in the past and that suffered of capsulitis and calcification. CONCLUSION: Arthroscintigraphy is a sensitive technique for detection of rotator cuff ruptures. Because of the lower viscosity of the active compound, small ruptures can be easily detected, offering additional value over radiographic arthrography and ultrasound, especially for evaluation of incomplete cuff ruptures.

Adult↗
PubMed1994

The shoulder-hand syndrome after stroke: a prospective clinical trial.

Shoulder-hand syndrome developed in 36 (27%) of 132 hemiplegic patients in a prospective study. Subluxation, paresis of the shoulder girdle, moderate spasticity, and deficits in confrontation visual field testing were the major risk factors. In a placebo-controlled, nonblinded trial, 31 of the 36 patients became almost symptom free within 10 days' treatment with low doses of oral corticosteroids. Shoulder joint capsules taken at autopsy of 7 patients showed signs of previous trauma of the affected shoulder. In the second part of this study on another 86 patients, early awareness of potential injuries to shoulder joint structures reduced the frequency of shoulder-hand syndrome from 27 to 8%. These clinical findings suggest that shoulder-hand syndrome in hemiplegia is initiated by peripheral lesions. A self-perpetuating vicious cycle may be established, followed by the clinical picture of a "reflex sympathetic dystrophy." In the majority of stroke patients, this clinical phenomenon seems to be preventable by avoiding shoulder trauma.

Adrenal Cortex Hormones↗
PubMed2006

Resection arthroplasty of the infected shoulder: a salvage procedure for the elderly patient.

Infection of the shoulder joint is a challenging problem for the orthopaedic surgeon. Several treatment options have been proposed. Here, we evaluate the results achieved following resection arthroplasty of the shoulder in seven patients. We performed resection arthroplasty in seven cases to treat a chronic uncontrollable infection of the shoulder. Three patients had an infected shoulder arthroplasty, one had an infected non-united arthrodesis, one was treated for an infected osteosynthesis, one had an infected rotator cuff repair and one patient had a septic arthritis of the shoulder joint. All patients were reviewed after a mean of 252 days. The functional outcome was evaluated using the Constant and DASH score. C-Reactive Protein levels were determined to evaluate the presence of residual infection. Except for one doubtful result, all our patients remained free of infection and there was excellent pain relief after the resection. Nevertheless, the functional outcome was poor: the mean Constant score was 25.7 and the mean DASH score was 69.3. Resection arthroplasty of the shoulder is a valuable treatment option for infection of the shoulder, especially in older patients with a poor mental and physical condition who suffer intolerable pain.

Adult↗
PubMed2002

[Clinical study on surgical repair of acute acromioclavicular dislocation by modified Weaver-Dunn technique].

OBJECTIVE: To investigate the clinical value of modified Weaver-Dunn technique in repair of acute acromioclavicular dislocation. METHODS: From January 1993 to December 1998, 18 cases of acromioclavicular dislocation were treated by modified Weaver-Dunn technique, and other 17 cases of the same suffering were treated by tension band fixation of the acromioclavicular joints. All of the patients were followed up for 12-36 months before clinical evaluation of the function of shoulder joints, according to University of Pennsylvanian Shoulder Score System. RESULTS: In short term, the shoulder joints recovered much more rapidly in the cases repaired by modified Weaver-Dunn technique; 12, 24 and 36 months after operation, the scores of the cases repaired by modified Weaver-Dunn technique were (189.7 +/- 6.7), (193.7 +/- 3.6) and (194.7 +/- 3.4) respectively according to the Shoulder Score System, while those of the cases treated by tension band fixation were (167.3 +/- 7.8), (170.2 +/- 6.3) and (165.6 +/- 5.9) respectively. The above data indicated that there was significant difference between two groups (P < 0.05). CONCLUSION: The modified Weaver-Dunn technique was a better surgical approach than tension band fixation for repair of acute acromioclavicular dislocation.

Adolescent↗
PubMed2000

Suprascapular neuropathy in volleyball players.

BACKGROUND: Suprascapular nerve entrapment with isolated paralysis of the infraspinatus muscle is uncommon. However, this pathology has been reported in volleyball players. Despite a lack of scientific evidence, excessive strain on the nerve is often cited as a possible cause of this syndrome. Previous research has shown a close association between shoulder range of motion and strain on the suprascapular nerve. No clinical studies have so far been designed to examine the association between excessive shoulder mobility and the presence of this pathology. AIM: To study the possible association between the range of motion of the shoulder joint and the presence of suprascapular neuropathy by clinically examining the Belgian male volleyball team with respect to several parameters. METHODS: An electromyographic investigation, a clinical shoulder examination, shoulder range of motion measurements, and an isokinetic concentric peak torque shoulder internal/external rotation strength test were performed in 16 professional players. RESULTS: The electrodiagnostic study showed a severe suprascapular neuropathy in four players which affected only the infraspinatus muscle. In each of these four players, suprascapular nerve entrapment was present on the dominant side. Except for the hypotrophy of the infraspinatus muscle, no significant differences between the affected and non-affected players were observed on clinical examination. Significant differences between the affected and non-affected players were found for range of motion measurements of external rotation, horizontal flexion and forward flexion, and for flexion of the shoulder girdle (protraction); all were found to be higher in the affected players than the non-affected players. CONCLUSIONS: This study suggests an association between increased range of motion of the shoulder joint and the presence of isolated paralysis of the infraspinatus muscle in volleyball players. However, the small number of patients in this study prevents definite conclusions from being drawn.

Adult↗
PubMed2000

Insertion abnormality of bilateral pectoralis minimus.

Bilateral insertion abnormality of pectoralis minimus (sterno-costo-coracoidian muscle) muscle was examined. The variant muscle was lying under the pectoralis major muscle and was medial to the pectoralis minor muscle. This muscle started from the first costal cartilage to the manubrium sterni and ended in the upper surface of the shoulder joint on the right side. On the opposite side, it took origin from the second costal cartilage to the manubrium sterni and the second costochondral joint, afterwards became a tendinous structure and divided into two on the coracoid process. The thicker part ended on the upper surface of the articular capsule of the shoulder joint, the thinner part inserted on the lateral third of inferior part of clavicle and fascia of subclavius muscle.

Adult↗
PubMed1985

Skeletal changes in dentists and farmers in Finland.

Two groups were studied: dentists and farmers from the Turku area. Radiologic examination of both groups included the spinal column, rib cage and shoulder joint. Spondylosis of the cervical spine was present in 68 (52.1%) of the dentists and 59 (19.2%) of the farmers. Lumbar spondylosis was more common among farmers than among dentists in the corresponding age group. Changes in the shoulder joint occurred significantly more often in dentists than in farmers. The findings in this study indicate that dentists appear to belong to the group doing heavy work.

Adult↗
PubMed2006

Electromyographic analysis in patients with multidirectional shoulder instability during pull, forward punch, elevation and overhead throw.

Multidirectional shoulder joint instability alters the role of dynamic stabilizers, as a result of which the motion patterns of the muscle around the shoulder joint are also changed. The aim of this study was to compare the muscle activity of patients with multidirectional shoulder instability and the control group during pull, forward punch, elevation and overhead throw. Fifteen subjects with multidirectional shoulder instability and fifteen control subjects with normal, healthy shoulders participated in the study. Both shoulders were tested in all subjects. Signals were recorded by surface EMG from eight different muscles during pull, forward punch, elevation and overhead throw. The mean and standard deviation of MVE% for the different movement types and time broadness values during overhead throw were determined for each muscle in both groups and compared with each other. Test results suggest that in case of patients with multidirectional shoulder instability the various motions are performed in a different way. The results give rise to the assumption that the centralization of the glenohumeral joint and the reduction of instability are attempted to be ensured by the organism through increasing the role of rotator cuff muscles and decreasing the role of the deltoid, biceps brachii and pectoralis maior muscles. The analysis of time broadness shows that in patients with multidirectional shoulder instability, the time difference between the peaks of normalized voluntary electrical activity is significantly greater than in the control group.

Adult↗
PubMed1985

Shoulder arthroscopy: a modified approach.

This paper proposes a modification of the classical position for shoulder arthroscopy. Two changes are proposed to improve visualization, accentuate pathology, and give better access to the inferior one half to one third of the shoulder joint. The direct lateral position is changed to a semilateral position in which the patient is allowed to rotate 30 to 40 degrees posteriorly, thus putting the shoulder joint on a horizontal plane. This allows for more comfortable arthroscopy and instrumentation. Also, if capsulorrhaphy is desired, better penetration of the scapula is possible since the scapula is vertical; thus, the angle of the approaching staple is less severe. The second change is to apply traction in a plane perpendicular to the long axis of the humerus rather than parallel to it. This modification elevates the humerus out of the glenoid rather than distracts the humerus into a subluxed position. The result accentuates labral pathology and gives a significantly improved view of the inferior one half to one third of the glenoid capsule. This new plane of traction allows excellent visualization with very little traction; thus, the problem of traction neuropraxia has been eliminated.

Adolescent↗
PubMedDate not supplied

Upper-limb fatigue-related joint power shifts in experienced wheelchair users and nonwheelchair users.

This paper evaluates power transfer or shifting across upper-limb segments, resulting from fatigue-inducing wheelchair propulsion. Nineteen manual wheelchair users (WCUs) and ten nonwheelchair users (NUs) participated in this study. Subjects propelled an instrumented wheelchair ergometer at a workload corresponding to 75% of the peak oxygen uptake attained during a maximal-graded exercise tolerance test. Subjects were required to propel the wheelchair for as long as they could at a constant velocity of 3 km/h (32 rpm). The test was terminated when subjects could no longer maintain the target velocity. Peak Performance video-capture system was used to determine upper-limb kinematics. Handrim forces and joint kinematics were used to calculate joint moments and power with the use of an inverse dynamics approach. Results showed that with fatigue, joint power shifts from the shoulder joint to the elbow and wrist joints. Implications for joint injury and propulsion efficiency are discussed.

Adult↗
PubMed1990

Distal humeral migration as a component of multidirectional shoulder instability. An anatomical study in autopsy specimens.

The object of the present study of autopsy specimens was to evaluate distal humeral migration during abduction allowed by sequential severance of capsular and ligamentous structures stabilizing the shoulder joint. A kinesiologic testing device continuously registered distal humeral migration, abduction angle, rotation, and flexion-extension. No distally directed force was applied to the humerus except the weight of the apparatus. Significant distal migration was recorded in the entire range of abduction (0 degrees -60 degrees) after solitary severance of the coracohumeral ligament as well as the proximal part of the anterior joint capsule. Further sectioning of the proximal part of the posterior capsule did not significantly increase distal humeral migration. Maximum distal migration (25 mm) was measured at 20 degrees of abduction. Applying an internal torque to the humerus significantly prevented distal migration as long as the posterior capsule was kept intact. Clinical testing for distal humeral migration should be performed with the shoulder joint at 20 degrees of abduction and neutral rotation. Furthermore, distal humeral migration can be significantly reduced by internal rotation of the humerus when the posterior joint capsule is intact.

Aged↗
PubMed2004

[Shoulder arthroplasty in traumatological indications, surgical technique].

PURPOSE OF THE STUDY: Shoulder arthroplasty in traumatological indications has a considerably worse prognosis than when the indication is osteoarthritis or rheumatoid arthritis. The problem lies in the technique of rotator cuff reconstruction and the restoration of adequate bio-mechanical properties of the shoulder joint. In this study, the difficult reconstruction of four-part fractures of the proximal end of the humerus was improved by the development of a new type of shoulder joint endoprosthesis. MATERIAL AND METHODS: Our endoprosthesis permits fixation of bone fragments of the greater and lesser tubercles to the shaft and to the diaphyseal fragment by using screws or a toothed plate designed for this purpose and produced in various shapes. In addition to the modularity of the head, the endoprosthesis has a component facilitating better recovery of biomechanical properties of the proximal end of the humerus, and this is a variable neck of the prosthesis. The modularity of the neck makes it possible to adjust the colodiaphysal angle and to adjust the head in relation to the stem in eight different positions. The shoulder replacement described, produced in two modifications by ProSpon (Czech Republic) and MIL (France), was used in surgical treatment of 43 acute fractures and 33 cases of post-traumatic destruction. The clinical outcome was assessed using the Constant rating score. RESULTS: In patients with acute trauma of a shoulder, an average of 59 points (range, 23-82) was achieved. The average maximal elevation was 88 degrees, with a range of 40 to 140 degrees. In 25% of the patients, no postoperative pain was present; mild pain at strain was reported by 73% of the patients and pain limiting the arm's activity by 3%. In patients with post-traumatic destruction of a shoulder, the average value vas 53.5 points (range, 20-88) and the average maximal elevation was 85 degrees (range, 30-130). No postoperative pain was reported by 36%, mild pain at strain was recorded in 52% and activity-limiting pain in 12% of the patients. DISCUSSION: The currently reported views are in agreement with our opinion that, at present, every method of shoulder replacement should enable the surgeon to achieve, as easy and reliably as possible, the reconstruction of fragments with the attachments of the rotator cuff. With our system, shoulder arthroplasty for the reconstruction of the proximal humerus, using the supplementary fixation components described, allowed us to treat even the most serious cases of traumatic destruction of the proximal humerus. CONCLUSIONS: To facilitate the treatment of trauma in displaced, three- or four-part fractures of the proximal end of the humerus, a new technique of reconstruction with the use of an endoprosthesis designed by us was developed. Fixation and reconstruction of fragments of the greater and lesser tubercles are carried out with screws and a special toothed plate that provides good fixation of the fragments to the stem. Compared with the current method of fragment fixation with simple suture, this technique offers an easy way of restoring the biomechanical properties in the region of the proximal end of the humerus and improves the stability of osteosynthesis. This aids in early mobilization and functional therapy of the patient, which results in a better overall outcome of the treatment.

Arthroplasty, Replacement↗