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At least 1,045 records · Page 58Linked to original sources
PubMed2002

Consequences of deltoid muscle elongation on deltoid muscle performance: a computerised study.

BACKGROUND: The deltoid muscle plays an important role in normal shoulder function. Knowledge of the position of the glenohumeral rotational centre and of the deltoid muscle length is essential to understand optimal placement of a total shoulder prosthesis. OBJECTIVE: This study is designed to analyse the effect of deltoid muscle elongation on shoulder joint function. DESIGN: A three-dimensional model of the glenohumeral joint with deltoid muscle analysis in the scapular plane. METHODS: A geometrical three-dimensional ball-and-socket model of the shoulder joint was developed. From dry bones, the position of the origins and insertions of the three parts of the deltoid muscle relative to the calculated centre of rotation of the humeral head was defined. The position and the direction of the muscle force working lines relative to this humeral centre were calculated using former measurements and CT-data of the deltoid. Muscle length-tension data were applied to obtain angle-force relationships. The model was used to calculate the angle-force relationships, the moment arm and the moment of the deltoid muscle components for successive arm elevation angles in the scapular plane. These data were compared to those of a theoretical situation assuming a 10% elongation of the muscle. RESULTS: Muscle angle-force curves show a more favourable slope after moderate (10%) deltoid muscle elongation. Elongating the muscle by changing the distance between the humeral rotation point and the deltoid insertion along the humeral axis does not affect moment arms. The moments of the deltoid muscle forces themselves, however, seem more adapted to elevation in the scapular plane. The deltoid maximal moment exceeds the arm-weight moment by about 40% instead of being approximately equal, and that the maximum is situated around 100 degrees of elevation. CONCLUSIONS: From a biomechanical point of view, stretching the deltoid muscle by 10% seems to result in a significantly more favourable position in case of shoulder elevation at 90 degrees of abduction in the scapular plane in a centred glenohumeral joint. RELEVANCE: This model suggests that a 10% elongation of the deltoid muscle, the most important shoulder abductor, improves its ability to elevate the arm. If properly implemented, this observation can be very important in the treatment and early rehabilitation of rotator-cuff-insufficient shoulders treated by a specific total shoulder replacement design.

Adult↗
PubMed1991

Importance of time in assessing arm and hand function after treatment of breast cancer.

Ninety-three patients were examined on two occasions at 24-month intervals after surgery and irradiation for breast cancer. Stiffness of the shoulder joint, brachial oedema, pain in the arm, and the patients' subjective assessment of the degree of functional disability were registered. The results indicated that both oedema and stiffness of the shoulder joint are acceptable measures of functional impairment. We conclude, however, that such measurements should not be used as indicators of prognosis, because spontaneous improvement can occur for two years or more after treatment.

Arm↗
PubMed2003

Articular branch of the axillary artery and its clinical implication.

Origin and course of the articular branch of the axillary artery was recorded in 151 (43.9%) out of 344 axilla during the routine dissection. The branch was observed in 60.5% right side and 39.4% left side of male axilla, whereas in 55.5% right and 44.4% left side of female axilla and the difference was found significant (P < 0.001) among the gender. The orientation of the articular branch on right and left side was of similar proportion in both the sexes. The articular branch entered into the shoulder joint either upper, middle or lower part of the capsule of joint. This articular branch originated mostly from the lateral aspect of second part of the axillary artery below to the origin of the lateral thoracic artery. This is a rare observation and is of importance to clinicians dealing with the shoulder joint.

Axillary Artery↗
PubMed1979

The Putti-Platt operation in the treatment of recurrent anterior dislocation of the glenohumeral joint.

In this prospective follow-up investigation the results in 65 patients treated by the Putti-Platt operation for recurrent dislocation of the glenohumeral joint were analysed. The data was collected at follow-up examinations performed one year after operation and from the replies to a questionnaire distributed to the patients 2--6 years postoperatively. Analysis of the data showed that 95% of the patients considered the condition of the shoulder joint as good or at least as better than preoperatively. During the period of follow-up 23 redislocations occurred and 25% of the patients experienced postoperative pain in the operated shoulder joint. Postoperative limitation of movement of the joint was in general slight and did not hinder normal activities. Owing to the high frequency of redislocation the Putti-Platt operation is not recommended in any event for active sportsmen, since redislocation occurred to a statistically significant extent more often in this group than in other patients.

Adolescent↗
PubMed2000

[Biomechanics of the shoulder].

The shoulder joint takes a special position among all the other joints of the human body because of its special requirements of stability and mobility. Knowledge of the biomechanics of the shoulder joint forms the basis for the development of modern concepts of reconstructive surgery and arthroplasty. Most of the biomechanical findings are the result of research performed on cadaver shoulders using increasingly sophisticated methods of measurement. These studies elucidate the interaction of the static and dynamic factors which contribute to the delicate balance of the glenohumeral joint. Recently performed research is increasingly being focussed on more detailed analyses of muscle forces and stress distribution in the subchondral bone and periarticular soft tissues. The efficiency of the computer systems now available has enabled the development of complex, virtual shoulder models and three-dimensional finite element analyses. In the future a pure mechanical understanding has to be modified to extend to a concept which includes more data obtained from living subjects, especially with regard to muscle activity under varying loads and neuromuscular feedback systems which currently are difficult to assess.

Biomechanical Phenomena↗
PubMed1991

[Osteochondral alloplasty of the humeral head in tuberculous omarthritis].

Techniques of the radical surgical treatment of tuberculosis of the shoulder joint with partial of subtotal osteochondral alloplasty are discussed, which was used in surgical treatment of 22 patients between the ages of 29 and 58 years. All patients had active tuberculous omarthritis that was accompanied in 9 cases by partial and in 13 by subtotal destruction of the humeral head. The results of treatment were followed up in 21 patients in terms varying from several months to 6 years. The tuberculous process alleviated in all patients with reconstruction of the destructed head anatomical structure and shoulder joint mobility was restored.

Adult↗
PubMed2006

Muscles within muscles: Coordination of 19 muscle segments within three shoulder muscles during isometric motor tasks.

The aim of the present study was to determine how the intra-muscular segments of three shoulder muscles were coordinated to produce isometric force impulses around the shoulder joint and how muscle segment coordination was influenced by changes in movement direction, mechanical line of action and moment arm (ma). Twenty male subjects (mean age 22 years; range 18-30 years) with no known history of shoulder pathologies, volunteered to participate in this experiment. Utilising an electromyographic technique, the timing and intensity of contraction within 19 muscle segments of three superficial shoulder muscles (Pectoralis Major, Deltoid and Latissimus Dorsi) were studied and compared during the production of rapid (e.g. approximately 400ms time to peak) isometric force impulses in four different movement directions of the shoulder joint (flexion, extension, abduction and adduction). The results of this investigation have suggested that the timing and intensity of each muscle segment's activation was coordinated across muscles and influenced by the muscle segment's moment arm and its mechanical line of action in relation to the intended direction of shoulder movement (e.g. flexion, extension, abduction or adduction). There was also evidence that motor unit task groups were formed for individual motor tasks which comprise motor units from both adjacent and distant muscles. It was also confirmed that for any particular motor task, individual muscle segments can be functionally classified as prime mover, synergist or antagonist - classifications which are flexible from one movement to the next.

Adaptation, Physiological↗
PubMedDate not supplied

[Relevant differences after post-traumatic and degenerative humeral head replacement (intermediate-term results)].

INTRODUCTION: In a comparative study, mid-term findings after posttraumatic and degenerative hemi-prosthetic shoulder joint replacement were analyzed and compared with current reports in the literature. METHODS: The patient sample in the retrospective study consisted of 20 patients with proximal fractures of the humeral head (x = 64 years) and 6 patients (x = 61 years) with degenerative shoulder joint disease. In 14 patients the humeral head was replaced as a primary procedure at < 4 weeks after the trauma and in 6 patients as a secondary treatment at > 4 weeks. The follow-up period was 38-41 months on average. Evaluation was based on the Constant Score, subjective assessment by the patient, and conventional radiographs. RESULTS: After posttraumatic shoulder replacement, the patients achieved a Constant Score of 65 (+/- 19) and after degenerative replacement 74 (+/- 34) points. In the posttraumatic group, the Constant Score after primary implantation was better than after secondary implantation (68 +/- 16 versus 59 +/- 15 points). After posttraumatic replacement, the only improvement over time was in pain levels (p < 0.05). 92% of all patients were satisfied with the result and would accept the same treatment again. Radiologically, a clinical correlate could be found for the arrosions at the acromion and occasionally for the secondary upwards displacement of the humerus. The results correlated well with data from the literature. CONCLUSIONS: For posttraumatic conditions, hemiarthroplasty led to better results within four weeks and seemed to be a suitable alternative to other procedures, especially in older patients. Patients with primary osteoarthritis and idiopathic humeral head necrosis can expect good to excellent results after hemiarthroplasty. In both groups, the overall results depend mainly upon patient compliance and the state of the rotator cuff.

Aged↗
PubMed2006

Restoration of shoulder function with nerve transfers in traumatic brachial plexus palsy patients.

Shoulder stabilization is of utmost importance in upper extremity reanimation following paralysis from devastating injuries. Although secondary procedures such as tendon and muscle transfers have been used, they never achieve a functional recovery comparable to that following successful reinnervation of the supraspinatus, deltoid, teres minor, and infraspinatus muscles. Early restoration of suprascapular and axillary nerve function through timely brachial plexus reconstruction offers a good opportunity to restore shoulder-joint stability, adequate shoulder abduction, and external rotation function. Overall, in our series, 79% of patients achieved good and excellent shoulder abduction (muscle grade, +3 or more), and 55% of patients achieved good or excellent shoulder external rotation after reinnervation of the suprascapular nerve. The best results were seen when direct neurotization of the suprascapular nerve from the distal spinal accessory nerve or neurotization by the C5 root was carried out. Concomitant neurotization of the axillary nerve yields improved outcomes in shoulder abduction and external rotation function.

Adolescent↗
PubMed2004

Neuropathic arthropathy caused by chondrosarcoma of the cervical spine.

We describe a 43-year-old woman with grade 1 chondrosarcoma of the cervical spine who developed neuropathic arthropathy. Plain radiography, computed tomography, and magnetic resonance imaging of the cervical spine revealed a so-called dumbbell tumor. We suggest that this tumor was responsible for the development of neuropathic arthropathy in bilateral hip joints, the left shoulder joint, and the left first metacarpophalangeal joint. This is the first reported case of neuropathic arthropathy secondary to chondrosarcoma of the cervical spine.

Journal Article↗
PubMedDate not supplied

Evaluation and treatment of shoulder subluxation in hemiplegia: relationship between subluxation and pain.

Shoulder subluxation in hemiplegic patients has been recognized as a difficult problem to manage. In the study contained herein, our aims are to evaluate shoulder subluxation, to clarify if shoulder subluxation causes pain, and to discuss the treatment of shoulder subluxation. The study included 75 hemiplegic patients with shoulder subluxation. Each patient was evaluated for the degree of shoulder pain, motor recovery of the upper limb, and shoulder range of motion. Some indexes for evaluating subluxation were measured with radiographs of the shoulders. Arthrograms of the affected shoulder joint were taken in 23 patients. The following results were found: (1) shoulder pain was significant more frequently in left hemiplegia; (2) vertical disparity was strongly correlated with discrepancy of the descendant ratio; (3) severe inferior subluxation had a tendency to show medial displacement of the humeral head; (4) there were correlations between shoulder pain and shoulder range of motion, especially external rotation; (5) adhesive changes in the arthrograms were seen in most subjects. These results indicate that there is no relation between shoulder subluxation and pain, and adhesive capsulitis is a main cause of shoulder pain. We conclude that correct positioning and shoulder range of motion exercises are advisable in hemiplegic patients with shoulder subluxation.

Adult↗
PubMed1996

Limb movement adaptations in horses with experimentally induced fore- or hindlimb lameness.

The kinematic patterns of all limbs of 11 clinically nonlame Dutch Warmblood horses were studied during induced supporting limb lameness to gain insight into the compensation mechanisms horses use to manage lameness and to test kinematic limb variables for their significance as lameness indicators. Using the locomotion analysis system CODA-3, the kinematics of the horses were recorded while walking (1.6 m/s) and trotting (3.5 m/s) on a treadmill. A transient lameness model, evoking pressure on the hoof sole, was used to induce 3 degrees of fore- and hindlimb lameness. Joint angle patterns and hoof movements were analysed using joint angle/time diagrams and the hoof trajectories in the sagittal plane. Quantitative analysis of 13 selected variables in each limb was done using a 2-way analysis of variance. Hyperextension of the fetlock joint and flexion of the coffin joint during the stance phase decreased significantly (P < 0.05) in the lame limb, both in fore- and hindlimb lameness, at both gaits. In the contralateral nonlame limbs both variables increased compensatorily. Flexion increased with increasing lameness in the proximal joints, i.e. the shoulder joint and even more the tarsal joint of the lame limb. The retraction of both forelimbs decreased during forelimb lameness at the walk, while in the lame hindlimb the protraction decreased. The hoof arcs were lower in the lame limb than in the nonlame limb, due to an increased hoof height in the nonlame limb during forelimb lameness and to a decreased height in the lame limb during hindlimb lameness. It was concluded that patterns of the distal joints reflect the different loadings of the limbs during lameness. Proximal joints acted as load dampers to reduce peak forces in the lame limb. Hyperextension of the fetlock and flexion of the coffin joint proved to be the most sensitive indicators for fore- and hindlimb lameness.

Adaptation, Physiological↗
PubMed2003

Stroke motor recovery: active neuromuscular stimulation and repetitive practice schedules.

OBJECTIVE: To investigate progress toward motor recovery in patients with chronic hemiparesis (mean time since stroke 3.2 years), comparing different types of practice schedules. DESIGN: To increase voluntary control of the upper extremity, active neuromuscular stimulation was administered during blocked and random practice schedules as patients performed three specific movements: wrist/finger extension, elbow joint extension, and shoulder joint abduction. METHODS: 34 stroke subjects volunteered to participate and were randomly assigned to one of three treatment groups: blocked practice (the same movement was repetitively performed on successive trials) combined with active neuromuscular stimulation; random practice (different movements on successive trials) along with active stimulation; or no active stimulation assistance control group. Subjects completed two days of 90 minute training for each of two weeks with at least 24 hours of rest between sessions. A session was three sets of 30 successful active neuromuscular stimulation trials with the three movements executed 10 times/set. RESULTS: Mixed design analyses on three categories of behavioural measures indicated motor improvements for the blocked and random practice/stimulation groups in comparison with the control group during the post-test period, with a larger number of blocks moved, faster premotor and motor reaction times, and less variability in the sustained muscular contraction task. CONCLUSIONS: Upper extremity rehabilitation intervention of active stimulation and blocked practice performed as well as stimulation/random practice. Moreover, these purposeful voluntary movement findings support and extend sensorimotor integration theory to both practice schedules.

Aged↗
PubMed1996

Musculoskeletal Symptoms among Computer-assisted Design (CAD) Operators and Evaluation of a Self-assessment Questionnaire.

A self-administered questionnaire with questions related to the physical workload at video display units (VDUs) was tested for intra- and intermethod reliability among 36 men and 64 women working with research and documentation. The results showed an acceptable test-retest agreement. The answers to three questions were validated by direct measurements: the locations of keyboard and mouse on the table, and the distance between elbow and keyboard heights when working. The self-reported locations of keyboard and mouse showed good agreement with the direct measurements. A revised version of the questionnaire was used at a telecommunication laboratory to study work postures and musculoskeletal symptoms. Among CAD operators with identical work tasks, the women (n = 67) reported a higher prevalence of musculoskeletal symptoms than did the men (n = 475). Calculated prevalence rate ratios (women/men) for musculoskeletal symptoms ranged from 1.4 (low back) to 3.4 (left elbow). The CAD operators with at least 5.6 hours of mouse use/week (median) reported more symptoms in the arms than did the CAD operators with fewer hours' work. Operators with the mouse located outside an "optimal" area on the table reported more symptoms from shoulder joints (upper arms), shoulders (scapular), elbows, and wrists than did operators with the optimal mouse location. Thus, long hours of work with the mouse, as well as working with the mouse non-optimally located on the table, seemed to be risk factors for upper-limb symptoms.

Journal Article↗