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At least 109 records · Page 6Linked to original sources
PubMed1997

Putting the shoulder to the wheel: a new biomechanical model for the shoulder girdle.

The least successfully modeled joint complex has been the shoulder. In multi-segmented mathematical shoulder models rigid beams (the bones) act as a series of columns or levers to transmit forces or loads to the axial skeleton. Forces passing through the almost frictionless joints must, somehow, always be directed perfectly perpendicular to the joints as only loads directed at right angles to the surfaces could transfer across frictionless joints. Loads transmitted to the axial skeleton would have to pass through the moving ribs or the weak jointed clavicle and then through the ribs. A new model of the shoulder girdle, based on the tension icosahedron described by Buckminster Fuller, is proposed that permits the compression loads passing through the arm and shoulder to be transferred to the axial skeleton through its soft tissues. In this model the scapula 'floats' in the tension network of shoulder girdle muscles just as the hub of the wire wheel is suspended in its tension network of spokes. With this construct inefficient beams and levers are eliminated. A more energy efficient, load distributing, integrated, hierarchical system is created.

Biomechanical Phenomena↗
PubMed1987

Anatomic basis of ligamentous control of elevation of the shoulder (reference position of the shoulder joint).

The authors describe in detail the position of greatest stability of the shoulder joint. They review the mechanical importance of this position in the overall physiology of the shoulder-girdle and stress the essential role of two articular ligaments of the shoulder joint (the coracohumeral and inferior glenohumeral ligaments) in arrival at this reference position. There thus exists a passive control, of ligamentous origin, of movements of the shoulder-girdle. The position is essential if the shoulder is to benefit from the full range of movement and full stability which it needs in every day functioning.

Humans↗
PubMed2005

Forced shoulder abduction and elbow flexion test: a new simple clinical test to detect superior labral injury in the throwing shoulder.

PURPOSE: Although several clinical tests for detecting superior labral injury of the shoulder have been reported, some of the maneuvers involved are complicated and diagnosis is still inaccurate. The purpose of this report is to introduce our forced shoulder abduction and elbow flexion test (forced abduction test) along with an assessment of its efficacy in the throwing shoulder in comparison with other clinical tests. TYPE OF STUDY: Prospective nonrandomized clinical trial. METHODS: Fifty-four throwing athletes who underwent arthroscopic surgery were prospectively studied. Superior labral injury was present in 24 cases (Snyder's classification was type 2 in 22, and type 3 in 2). Several clinical tests were performed preoperatively and the results were recorded on our original chart. The condition of the superior labrum was then examined during arthroscopic surgery. The results of these tests were compared with the arthroscopic findings as a standard. The forced abduction test was defined as positive when pain at the posterosuperior aspect of the shoulder on forced maximal abduction was relieved or diminished by elbow flexion. RESULTS: The sensitivity, specificity, and accuracy of the forced abduction test were 67%, 67%, and 67%, respectively. It was one of the most useful tests, along with the crank test and O'Brien's test (crank test, 58%, 72%, 66%; O'Brien's test, 54%, 60%, 57%; respectively). Furthermore, the results of the forced abduction test showed a significant correlation with the presence of superior labral injury (P = .0275, chi-square test). CONCLUSIONS: The forced abduction test was technically simple and its usefulness was comparable to the O'Brien's and crank tests for diagnosing superior labral injury in throwing shoulders. LEVEL OF EVIDENCE: Level II.

Adolescent↗
PubMed2006

Delivery of the posterior arm reduces shoulder dimensions in shoulder dystocia.

OBJECTIVE: To evaluate a possible reduction in shoulder diameter and circumference by extending the posterior arm during delivery, for an easier birth in cases of shoulder dystocia. METHODS: In this study of 33 neonates the bisacromial diameter and axilloacromial circumference were measured within 72 h of birth, first with the neonate's arms by its chest and then with 1 arm extended above its head. Reductions in diameter and circumference were evaluated. RESULTS: The mean +/- SD differences in bisacromial diameter and axilloacromial circumference were 1.9 +/- 0.69 cm and 2.52 +/- 1.18 cm, respectively. A greater reduction was observed in neonates with a greater shoulder diameter. CONCLUSION: In cases of shoulder dystocia, delivery of the posterior arm should significantly reduce shoulder dimensions, especially in larger fetuses, and prevent a need for excessive traction.

Arm↗
PubMedDate not supplied

Shoulder arthroplasty for atraumatic avascular necrosis of the humeral head: nineteen shoulders followed up for a mean of seven years.

Nineteen shoulder arthroplasties for the treatment of nontraumatic avascular necrosis of the humeral head were evaluated. The osteonecrosis was idiopathic in 6 shoulders, was a result of corticotherapy in 10, occurred after radiation in 2, and occurred after Gaucher's disease in 1. A total shoulder arthroplasty was performed in 5 cases and a hemiarthroplasty in 14. At 7 years' follow-up (range, 2 to 12 years), there were 7 excellent, 9 satisfactory, and 3 unsatisfactory results. The Constant score averaged 58 points, for an adjusted score of 78%. Radiolucent lines were present around 2 glenoid components, and 1 was radiographically loose. In 2 cases with humeral head replacement, there was painful glenoid wear. Shoulder arthroplasty for nontraumatic avascular necrosis yields satisfactory results with a pain-free shoulder in more than 80% of cases. However, limitation of motion often persists. Better results can be expected with shorter preoperative delay, when preoperative pain is moderate and range of motion preserved and when the etiology is not postradiation avascular necrosis, which in our series yielded the worst results.

Adult↗
PubMed2003

Shoulder kinematics in subjects with frozen shoulder.

OBJECTIVES: To describe 3-dimensional humeral motion in subjects with frozen shoulder and to determine whether a consistent capsular pattern of restriction was present. DESIGN: Descriptive study including repeated measurements of shoulder kinematics. SETTING: Motion-analysis laboratory. PARTICIPANTS: Ten (9 women, 1 man) volunteers with a diagnosis of idiopathic adhesive capsulitis and 10 (9 women, 1 man) subjects with asymptomatic shoulders as comparison subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Electromagnetic tracking sensors monitored the 3-dimensional position of the trunk, scapula, and humerus throughout active shoulder motions. Peak humeral positions relative to the trunk and scapula were determined for shoulder flexion, abduction, scapular plane abduction, external rotation (ER), and internal rotation (IR). Descriptive statistics (means, standard deviations, percentage of normal) were calculated and capsular patterns described. RESULTS: For humeral position relative to the trunk, subjects' mean peak motion was as follows: abduction, 98.4 degrees; ER at the side, 4.5 degrees; ER with the arm abducted, 33.5 degrees; flexion, 116.9 degrees; IR at the side, 54.3 degrees; IR with the arm abducted, 17.8 degrees; and scapular plane abduction, 113.4 degrees. For humeral position relative to the scapula, subjects' mean peak motion was as follows: abduction, 46.4 degrees; ER at the side, 34.7 degrees; ER with the arm abducted, 45.3 degrees; flexion, 70.5 degrees; IR at the side, 10.3 degrees; IR with the arm abducted, -6.4 degrees; and scapular plane abduction, 61.7 degrees. CONCLUSIONS: Symptomatic subjects demonstrated substantial kinematic deficits during humeral range of motion. No single capsular pattern emerged.

Biomechanical Phenomena↗
PubMed2004

Magnetic resonance imaging of the rotator cuff in destroyed rheumatoid shoulder: comparison with findings during shoulder replacement.

PURPOSE: To evaluate the predictive value of preoperative magnetic resonance imaging (MRI) with respect to rotator cuff ruptures. MATERIAL AND METHODS: Thirty-one patients with rheumatic disease underwent preoperative MRI before shoulder arthroplasty. The scans were reviewed independently by two experienced radiologists. Three surgeons performed all the replacements (hemiarthroplasties), and the condition of the rotator cuff was assessed. Complete and massive tears of the rotator cuff were recorded and compared at surgery and on MRI. RESULTS: With MRI, 21 shoulders (68%) were classified as having complete or massive tears of the rotator cuff and at surgery 14 shoulders (45%). Cohen's kappa coefficient was 0.44 (95% CI: 0.16 to 0.72) and accuracy 0.71 (95% CI: 0.52 to 0.86). CONCLUSION: In severely destroyed rheumatoid shoulder, the findings of soft tissues were incoherent both with MRI and at surgery. The integrity of tendons could not readily be elucidated with MRI because of an inflammatory process and scarred tissues; in surgery, too, changes were frequently difficult to categorize. Preoperative MRI of severely destroyed rheumatoid shoulder before arthroplasty turned out to be of only minor importance.

Adult↗
PubMed1999

Electromyographic study relating to shoulder motion: control of shoulder joint by functional electrical stimulation.

The purpose of this study is to create the standard stimulation patterns of shoulder motion from electromyographic (EMG) data in 13 healthy human volunteers in order to control the movement of the paralyzed shoulder in quadriplegic and hemiplegic patients by functional electrical stimulation (FES). Simultaneous EMG measurement was made at 24 points of 17 major muscles relating to shoulder motion. Since the number of the output channels in the portable FES apparatus is limited, 12 major muscles were selected from statistically processing these EMG data and stimulation patterns were created based on the EMG data of these muscles. Thus three standard stimulation patterns were created to move the shoulder, i.e., (i) 90 degrees flexion to 90 degrees horizontal abduction, (ii) 90 degrees flexion to 20 degrees horizontal adduction, and (iii) 90 degrees abduction to 90 degrees horizontal adduction. With the created stimulation patterns, the restoration of the shoulder motion in plegic patients was successful and it will be reported in the next paper.

Adolescent↗
PubMed2001

Revision of shoulder replacement with a reversed shoulder prosthesis (Delta III): report of five cases.

The authors report on their experience in revision total shoulder arthroplasty using the Delta III shoulder prosthesis, a reversed constrained prosthesis which is known to give good functional results in the rotator cuff-deficient shoulder. It was implanted in patients with a failed total or hemishoulder prosthesis. The Constant-Murley score was used to assess the functional outcome. The preliminary results achieved in four patients (one bilaterally) are discussed and compared with the results of other treatments. After two years follow-up, the Constant-Murley score has improved from 14/100 preoperatively to 62/100 postoperatively. Although these initially good functional results may be temporary and loosening may occur over the longer term, the authors recommend the Delta III shoulder prosthesis as an alternative solution for revision shoulder arthroplasty.

Adult↗
PubMed1992

The hinged shoulder spica cast for management after shoulder surgery.

A shoulder spica cast is often required after major surgery to the shoulder. This type of cast is usually heavy and awkward. A lightweight fiberglass spica has proven to be useful after repair of the deltoid origin, repair of complete rupture of the rotator cuff, and shoulder arthrodesis. Hinges have been incorporated in the spica at the elbow and shoulder to permit maximum motion appropriate to the surgery. This cast is light and well tolerated. Elbow and shoulder stiffness is reduced by the hinges, which may be fabricated out of stock devices heretofore used in knee orthoses.

Adolescent↗
PubMed2006

Efficacy of shoulder slings in shoulder subluxation of stroke patients.

OBJECTIVE: To assess the efficacy of the two types of shoulder slings in reducing shoulder subluxation in acute stroke patients. MATERIAL AND METHOD: Twenty-one acute stroke patients with shoulder subluxation were assessed for the subluxation distance before and after wearing the slings by physical examination and radiological measurement. The comparison by radiological measurement was performed by two radiologists who were blinded to each other as well as to the types of sling used. RESULTS: The mean difference of subluxation distance on the affected side after wearing the slings number 1 and 2 were 0.48 mm and 1.14 mm respectively on physical examination and 2.09 mm and 1.14 mm respectively on radiological assessment. There was no statistically significant difference of subluxation distance on either physical examination or radiological assessment (p > 0.05). CONCLUSION: There was no difference in efficacy of shoulder slings in reducing shoulder subluxation in acute stroke patients.

Female↗
PubMed1995

Measuring shoulder function with the Shoulder Pain and Disability Index.

OBJECTIVE: To extend the validity of the Shoulder Pain and Disability Index (SPADI) by (1) making it suitable for telephone administration; (2) determining its convergent validity with other health status measures; and (3) assessing the responsiveness of the SPADI to clinical change. METHODS: Consecutive primary care patients with shoulder discomfort were followed for 3 months. At enrollment, a detailed shoulder specific history was obtained by a trained research assistant, and the Health Assessment Questionnaire (HAQ), the Medical Outcomes Study SF-20 (SF-20), and numeric and visual analog versions of the SPADI were completed by the patient. At 2, 4, and 12 weeks the numeric scaled SPADI was administered by telephone and patients rated globally the change in shoulder discomfort. RESULTS: One hundred and two subjects were enrolled; 96 completed at least one followup assessment and 75 completed all followup assessments. Subjects were men (98%), predominantly white (73%), with a median age of 60 years, and the majority had experienced shoulder discomfort for > 3 months (66%). At baseline the visual analog (VAS) and numeric scaled SPADI were highly concordant (intraclass correlation coefficient = 0.86), and the SPADI correlated substantially with the HAQ (r = 0.61) and the physical functioning (r = -0.50) and pain (r = -0.43) domains of the SF-20. The SPADI delta (baseline-followup) discriminated accurately between subjects who improved versus those who stayed the same or worsened [receiver operating characteristic cure, (ROC) = 0.91, likelihood ratio for improvement = 34]. CONCLUSION: The numerically scaled SPADI is highly correlated with the original VAS version of the SPADI and other measures of health status. The SPADI is responsive to change and accurately discriminates among patients who are improved or worsened.

Aged↗
PubMed2005

Modification of the Constant-Murley shoulder score-introduction of the individual relative Constant score Individual shoulder assessment.

The Constant-Murley shoulder assessment score has proven to be a valuable diagnostic instrument. Thus, in the literature it has been mentioned that the clinical accuracy of this score varies especially when comparing patients in larger, inhomogeneous patient groups. The "relative Constant score" (CS(rel)) tries to minimize these problems by using reference parameters out of healthy age and gender related control groups. The authors of this study tried to show that it is even more accurate to use the functional performance of the uninjured collateral shoulder of the same individual as reference, introducing the "individual relative Constant score" (CS(indiv)). The CS(indiv) and the CS(rel) were compared for 125 consecutive patients with shoulder disorders, and a group of 125 healthy volunteers as a control group. In a non-parametric comparison of the reciever operating characteristics the CS(indiv) shows the higher ability to discriminate between patients and healthy volunteers (p=0.004). This indicates that the individual relative Constant score gives a more accurate view about the functional result for shoulder disorders. It is expected to be more reliable for larger and incoherent patient populations, because specific interindividual differences, regarding the patient's age, gender and constitution are eliminated as well as other individual physiological parameters.

Adult↗
PubMedDate not supplied

Results of suture anchor repair of anteroinferior shoulder instability: a prospective clinical study of 85 shoulders.

The results of an open Bankart procedure with use of suture anchors were evaluated in 85 shoulders in 83 patients. The mean age was 30 years (range, 16-59 years). The mean number of preoperative dislocations was 18.5. Patients were evaluated prospectively by the Rowe score. Eighty-five shoulders were followed for 1 year and seventy-seven for at least 2 years. The mean follow-up was 3.5 years (range, 1-8.3 years). The Rowe score increased from 30 to 92 points. An excellent or good result was found in 81 of 85 shoulders after 1 year and in 68 of 77 shoulders after 2 years. Seven redislocations occurred, four due to a new trauma. Two patients had recurrent subluxations, one due to a new trauma.

Adolescent↗
PubMedDate not supplied

Patterns of flexibility, laxity, and strength in normal shoulders and shoulders with instability and impingement.

Imbalance of the internal and external rotator musculature of the shoulder, excess capsular laxity, and loss of capsular flexibility, have all been implicated as etiologic factors in glenohumeral instability and impingement syndrome; however, these assertions are based largely on qualitative clinical observations. In order to quantitatively define the requirements of adequate protective synergy of the internal and external rotator musculature, as well as the primary capsulolabral restraints, we prospectively evaluated 53 subjects: 15 asymptomatic volunteers, 28 patients with glenohumeral instability, and 10 patients with impingement syndrome. Range of motion was evaluated by goniometric technique in all patients with glenohumeral instability and impingement. Laxity assessment was performed and anterior, posterior, and inferior humeral head translation was graded on a scale of 0 to 3+. Isokinetic strength assessment was performed in a modified abducted position using the Biodex Clinical Data Station with test speeds of 90 and 180 deg/sec. Internal and external rotator ratios and internal and external rotator strength deficits were calculated for both peak torque and total work. Patients with impingement demonstrated marked limitation of shoulder motion and minimal laxity on drawer testing. Both anterior and multidirectional instability patients had excessive external rotation as well as increased capsular laxity in all directions. Sixty-eight percent of the patients with instability had significant impingement signs in addition to apprehension and capsular laxity. Isokinetic testing of asymptomatic subjects demonstrated a 30% greater internal rotator strength in the dominant shoulder. Comparison of all three experimental groups demonstrated a significant difference between internal and external rotator ratios for both peak torque and total work. Conclusions are that there appears to be a dominance tendency with regard to internal rotator strength in asymptomatic individuals. Impingement syndrome and anterior instability have significant differences in both strength patterns of the rotator muscles and flexibility and laxity of the shoulder. Isokinetic testing potentially may be helpful in diagnostically differentiating between these two groups in cases where there is clinical overlap of signs and symptoms.

Adult↗
PubMed2002

Shoulder fusion and free-functioning gracilis transplantation in patients with elbow and shoulder paralysis caused by poliomyelitis.

Six children between 7-16 years of age presented with flail shoulder and elbow caused by poliomyelitis. Shoulder fusion was followed by free-functioning gracilis transplantation to replace the atrophied biceps muscle. The transplanted muscle was reinnervated by either the spinal accessory or phrenic nerve. Follow-up averaged 44 months (range, 56-23 months). All cases developed at least grade 3 power of elbow flexion and were able to place their hands to their mouths. Five out of 6 cases were able to flex their elbow against resistance. One case required tension readjustment, and elbow flexion contracture of 45 degrees developed in another case. On average, the transplanted gracilis started to contract 3 months after transplantation, and muscle power reached grade 2 at 5-6 months and grade 3 at 9-12 months. Muscles supplied by the spinal accessory nerve were earlier to contract and ultimately attained more power than those supplied by the phrenic nerve, probably because of easier rehabilitation. Shoulder fusion and free-functioning gracilis transplantation for biceps replacement provide a solution for restoration of function in children with flail shoulder and elbow, as caused by poliomyelitis. The procedure can be useful in other neuromuscular conditions, such as late-presenting Erb's palsy, especially when no other muscles are available for local transfer.

Adolescent↗
PubMedDate not supplied

MR findings in asymptomatic shoulders: a blind analysis using symptomatic shoulders as controls.

We performed a blind prospective analysis of the shoulders of 20 asymptomatic volunteers, aged 25 to 55 years, to determine the frequency of magnetic resonance (MR) findings considered abnormal in symptomatic patients. Twenty symptomatic patients were used as controls. With regard to the asymptomatic shoulders, all 20 had intact rotator cuff tendons, although six (30%) of the tendons had abnormal internal signal, and one (5%) had abnormal morphology. Subdeltoid and subacromial fat planes were intact in 20 (100%) and 19 (95%) shoulders respectively. Subdeltoid or subacromial fluid was not present in any shoulder. Acromioclavicular osteophytes and supraspinatus depression were seen in seven (35%) and six (30%) respectively. The glenoid labrum was intact in all volunteers, although it had abnormal internal signal in 10 (50%). MR findings of abnormal signal in the glenoid labrum, and of abnormal signal and morphology of the rotator cuff tendons, supraspinatus depression, and acromioclavicular osteophytes have been reported as signs of instability, tendinitis, and impingement. Similar findings were seen in asymptomatic volunteers, indicating that these findings may not be a sign of clinically significant pathology.

Adult↗
PubMedDate not supplied

The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: results of a prospective, randomized study.

This prospective, randomized trial was performed to compare the results of treating subacromial impingement syndrome of the shoulder by a guided self-training program with the treatment by conventional physiotherapy or a functional brace. Sixty patients with the diagnosis of an outlet impingement syndrome of the shoulder (Neer I and II) were treated either by strengthening the depressors of the humeral head with a guided self-training program, by conventional physiotherapy, or by wearing a functional brace. The Constant-Murley score was assessed after 6 and 12 weeks. Shoulder pain was monitored with a visual analog scale. All three groups showed a significant improvement in shoulder function as well as a significant reduction in pain. There were no statistically significant differences among the groups. Guided self-training can lead to results similar to those of conventional physiotherapy. The comparable effect of the functional brace remains unclear and might be explained by an influence on proprioception.

Adult↗