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PubMed1996

[Rheumatoid orthopedics and endoprosthetics of the shoulder joint].

The first part of the present article gives a comprehensive description of the pathology, diagnostics and forms of therapy of rheumatically impaired shoulder joints. Improved operative methods and methods such as bursectomy, synovectomy, reconstructive soft-tissue management and joint replacement depending on the stage of impediment have enhanced the use of surgery in the treatment of rheumatic shoulder joints. The second part gives a critical evaluation of indications, methods and results of modern shoulder joint replacement. A survey of written publications on the results of hemi- and total endoprostheses on the one hand, our own clinical experiences on the other, have shown that the use of modular hemiendoprostheses produces clinically excellent results with no problems of loosening of the glenoid part.

Arthritis, Rheumatoid↗

PubMed2001

Shoulder proprioception: a comparison between the shoulder joint in healthy and surgically repaired shoulders.

Proprioceptive mechanisms appear to play a role in stabilizing the glenohumeral joint and may serve as a means for interplay between the static stabilizers and the dynamic muscle restraints. The aim of this study was to investigate proprioception of the joint in healthy and surgically repaired shoulders. Shoulder proprioception was measured in 44 subjects who were assigned to two experimental groups: group 1, healthy subjects (n = 24); and group 2, patients who have undergone surgical reconstruction (n = 20). Joint position sense was measured with a Cybex NORM isokinetic dynamometer. The results revealed no significant differences in proprioception between the dominant and nondominant shoulders in group 1. No significant mean differences were revealed between the surgical and contralateral shoulder in group 2 under any test condition. These results imply that arm dominance in healthy individuals does not influence the proprioceptive sensibility and that reconstructive surgery appears to restore some of these proprioception characteristics.

Adolescent↗

PubMed1994

Reproducibility of isokinetic peak torque and angle at peak torque in the shoulder joint.

Adequate reliability studies of knee flexion and extension are currently available for isokinetic measurements, but not for the shoulder joint. For this reason, this study examines the variability (%) in the determination of peak torque (PT) and the angle at peak torque (AP) in the test-retest procedure. Differentiation is made between the various types of work (concentric, isometric, eccentric) and the degrees of freedom in the shoulder joint (flexion/extension, abduction/adduction, external rotation/internal rotation). The results show a variability of PT for concentric measurements of 15.0%-19.0% for all degrees of freedom; for flexion/extension and abduction/adduction in isometric and eccentric work, the variability is 17.5%-25.3%. External and internal rotation show generally greater deviation (29.0%-35.3%), except in concentric work. The angle at peak torque can only be reproduced to a limited degree (25.1%-41.1% variability). It is concluded that lower reproducibility can be attained for the shoulder joint compared to the knee joint, depending on the degree of freedom and exercise form tested. It appears meaningful to cite only ranges for the angle at peak torque.

Adult↗

PubMedDate not supplied

Quantitative determination of articular pressure in the human shoulder joint.

The objective of this study was to determine experimentally the effect of individual variations in articular surface geometry on the shoulder joint pressure distribution in functionally important arm positions. The location and size of the load-bearing areas and maximal pressures of 10 cadaver shoulder joints were examined at 30 degrees, 90 degrees, and 150 degrees of abduction (+/-90 degrees external rotation) and 120 degrees flexion with pressure-sensitive film. Only parts of the glenoid cavity were involved in the load transfer, some specimens showing central and other bicentric (superior-inferior) pressure maxima during abduction and flexion. The load-bearing areas were more central at external rotation, suggesting that the humeral head is not a perfect sphere. The maximal pressure was recorded at 90 degrees of abduction with 90 degrees external rotation, with 5.1 MPa for the elevation for single- and >10 MPa for double-arm weight. The study demonstrates that shoulder joint pressure cannot be calculated analytically but depends on subtle variations of joint incongruity.

Adult↗

PubMed1998

Ultrasound and operative evaluation of arthritic shoulder joints.

OBJECTIVE: To assess the diagnostic value of ultrasonography (US) in the evaluation of arthritic shoulder joints. METHODS: Twenty shoulders of 20 inpatients with arthritis were evaluated by US one day before the shoulder operation. Changes in the subacromial-subdeltoid bursa, biceps tendon and tendon sheath, rotatof cuff, and glenohumeral joint were recorded and compared with findings at operation. RESULTS: In the detection of effusion/hypertrophy in the subacromial-subdeltoid bursa, US had a sensitivity of 93% and a specificity of 83%. For a biceps tendon rupture US had a sensitivity of 70% and a specificity of 100%. US missed three intraarticular biceps tendon ruptures. For effusion/hypertrophy in the biceps tendon sheath US had a sensitivity of 100% and a specificity of 83%. For a rotator cuff tear US had a sensitivity of 83% and a specificity of 57%. US missed two small longitudinal rotator cuff tears. Three thin membranous, but intact, rotator cuff tendons were classified as full thickness tears by US. Synovial effusion/hypertrophy was detected by US and at operation in all of the 12 glenohumeral joints that were evaluable at surgery. CONCLUSION: US is a reliable method in experienced hands for the evaluation of inflammatory changes of an arthritic shoulder. In advanced stages of rheumatoid shoulder joints, however, US is not useful, because destructive bone changes and tendon ruptures change the normal anatomy and restrict shoulder motions, limiting the visibility of US.

Adult↗

PubMed1980

[Fresh and habitual dislocation of the shoulder joint (author's transl)].

In case of the most common anterior-inferior dislocation of the shoulder joint the humeral head is forced out of the glenoidal cavity and tears the capsule. In about 20% of cases the dislocation is complicated by tears of the rotatory cuff, avulsion fractures and lesions of vessels and nerves. Reduction as soon as possible according to the method of Arlt or Hippokrates is recommended to avoid further damage. X-ray examination in 2 directions is necessary to confirm the position of the head. Clinical examination must be done to detect lesions of nerves or vessels caused by the procedure. In cases of recurrent dislocation a Hill-Sachs lesion and/or a Bankart lesion is responsible for instability of the shoulder joint. The elevation of the margin of the glenoid by autologous bone grafting (Eden-Hybinette, Trillat) and/or the derotation of the humeral head (Weber) reliably avoids redislocation. Except rare infections no severe complications are known. The operative correction of the severe disability should be recommended to all patients suffering from recurrent dislocation of shoulder joint.

Humans↗

PubMed1991

[Amputation and arthrodesis of the shoulder joint after brachial plexus lesions].

Nine patients with severe irreversible brachial plexus lesions were submitted to arthrodesis of the shoulder joint and/or amputation of the forearm, the latter with the object of fitting an artificial limb. In one patient, the arm was re-implanted and biceps function of strength M2 was obtained. Three patients were submitted to microsurgical interventions on the plexus. All of the patients were visited in their homes after an average period of observation of three years (1-8 years). Seven patients were equipped with prostheses, three of these with myoelectric prostheses. One patient employed an orthosis and one had been submitted to arthrodesis of the shoulder joint only. Three of the patients were fitted with prostheses 12 years after the accident but nevertheless obtained good prosthetic function. One of these patients had even been fitted with a prosthesis on the non-dominant side. Forearm amputation was chosen in order to control rotation and to avoid projection of the proximal part of the prosthesis up over the shoulder joint. The absent/reduced sensibility at the level of the amputation did not result in pressure problems from the prosthesis. All of the patients used their prostheses. Pain is not an indication for amputation surgery but does not hinder a good functional result.

Accidents, Traffic↗

PubMedDate not supplied

Modification to the conventional wheel for measuring the range of movements of the shoulder joint.

A simple modification to the conventional shoulder wheel is suggested. This would enable both the therapist and the patient to make an objective assessment of the range of movement taking place in a painful and stiff shoulder joint. The most common factors in producing an error in the evaluation of range of movement are trunk movement and shoulder elevation. This modification would help to avoid them. It is cheap and easy to manufacture.

Humans↗

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↗

PubMed1998

Shoulder joint luxation in large animals: 14 cases (1976-1997).

OBJECTIVE: To determine clinical and radiographic findings in and treatment and outcome of large animals with shoulder joint luxations. DESIGN: Retrospective study. ANIMALS: 5 horses, 3 goats, 1 calf, 1 sheep, 1 Himalayan tahr, 1 pot-bellied pig, 1 reindeer, and 1 white-tailed deer. PROCEDURE: Medical records and radiographs were reviewed to determine signalment, history, physical examination findings, type of luxation, treatment, and outcome. Owners and referring veterinarians were contracted for follow-up information. RESULTS: Goats, sexually intact males, and animals < 1 year old were overrepresented, compared with the general hospital population during the study period. Closed reduction was attempted in 3 animals and was successful in 1. Open reduction and internal stabilization was attempted in 4 animals, including 1 in which closed reduction was unsuccessful. Long-term stabilization of the joint was achieved in 3 animals, but overall results were poor because of osteoarthritis and chronic lameness. Three animals were not treated, and 5 were euthanatized because of a poor prognosis. CLINICAL IMPLICATIONS: Large animals with shoulder joint luxation and concurrent fractures had a poorer prognosis than did those with shoulder joint luxation alone.

Animals↗

PubMed1991

[Nuclear magnetic resonance tomography and ultrasound imaging of anatomic structures of the shoulder joint].

The possibilities of MRI and ultrasound in visualizing the structures of the shoulder joint are compared. Both methods have a good accuracy in detecting changes of the soft tissue of the shoulder. Changes of the cartilage and the bony structures are better seen in the MRI. The MRI gives a static and clear view of the shoulder joint, meanwhile the ultrasound depends on the dynamic examination. Ultrasound and MRI are both reproducible and non-invasive methods, who seem to complete one another at the examination of the shoulder.

Acromioclavicular Joint↗

PubMed1999

Shoulder joint impairment among Finns aged 30 years or over: prevalence, risk factors and co-morbidity.

OBJECTIVES: To describe the prevalence, risk factors and consequences of shoulder joint impairment in the population. METHODS: A representative sample (n = 7217) of the Finnish population aged > or = 30 yr participated in a health examination survey (the Mini-Finland Health Survey). The design of the survey allowed an independent assessment of disability, reported shoulder pain, shoulder joint impairment and major chronic co-morbidity. RESULTS: Shoulder impairment was observed in 8.8%, while pain was reported by 30%. The prevalence of shoulder pain decreased among the elderly, whereas impairments increased up to 20% of those aged 75-80 yr. In addition to age, sex, previous injury to the shoulder joint and a history of physically heavy work, diabetes was associated with shoulder impairment (OR 1.6, 95% CI 1.2-2.1). Shoulder impairment was associated with disability (adjusted OR 2.0, CI 1.6-2.5). CONCLUSIONS: Shoulder impairment is an important component of ill health among the elderly, and cannot be reduced to reported pain alone.

Adult↗

PubMed1992

[Anatomical bases of ultrasonic examination of the shoulder joint].

Authors present the parts of the shoulder that can be represented by ultrasound. Beside the rotator cuff of accentuated significance (within this, first of all the tendon of the supraspinatus muscle) the subacromial bursa, the tendon of the long head of the biceps, the muscle-tendon junction of the infraspinatus muscle are analysed. It is stated that the ultrasonography is suitable for a reliable representation of the soft tissues, surrounding the shoulder joint, further in possession of literary data they see possibility for a very exact judgement of the pathological alterations, too.

Humans↗

PubMed2003

Shoulder joint involvement in patients with newly diagnosed rheumatoid arthritis. Prevalence and associations.

OBJECTIVE: To estimate the prevalence of reduced function, compared to normative values, and tenderness in the shoulder in patients with newly diagnosed rheumatoid arthritis (RA), and to investigate associated factors. METHODS: Eighty consecutive patients with RA, participating in a prospective study of early rheumatoid arthritis, were examined and assessed within one year of the onset of symptoms. RESULTS: The prevalence of tenderness from any of the shoulder joints was 50%, while 30% had decreased shoulder function, compared with age matched controls, in at least one shoulder. Both tender shoulder joints and decreased shoulder function were related to higher age and more severe disease, reflected by disability (HAQ) and the patient's assessment of pain and global disease activity. CONCLUSION: The shoulder girdle is involved early and often in rheumatoid arthritis and involvement is associated with a substantially more severe disease status. The study suggests that the shoulder should be given attention in patients with newly diagnosed rheumatoid arthritis, and that both tenderness and shoulder function should be evaluated.

Adult↗

PubMedDate not supplied

[Final results after operative treatment of shoulder joint infections].

PURPOSE: In a consecutive case series the results of operative treatment of patients with shoulder joint infections following rotator cuff surgery, endoscopic subacromial decompression or subacromial injection were studied. PATIENTS AND METHODS: Between 1990 and 2001 26 patients developed a postoperative infection. 24 patients were available for a mean follow-up of 4.3 (1-12) years. The mean age of the study group was 59.8 (28-84) years. Patients were divided into three groups. Group I consisted of 9 patients with infection after rotator cuff repair, group II consisted of 4 patients with infection after endoscopic subacromial decompression and there were 11 patients in group III with an infection that developed following subacromial injection. Patient evaluation was done according to the Constant and ASES Scores, the SF-36 and a visual analogue scale (VAS) for postoperative pain and satisfaction. RESULTS: The mean postoperative Constant Score was 68.6 pts (SD 25.1) in group I, 84.6 pts (SD 10.4) in group II and 75.6 pts (SD 25.1) in group III. The mean ASES-Score was 65.6 pts (SD 30.0) in group I, 69.8 pts (23.6) in group II and 78.5 pts (SD 25.7) in group III. The SF-36 showed for the summarized physical scale 37.3 pts (SD 12.6) in the first, 39.8 pts (SD 5.8) in the second and 37.7 pts (SD 12.4) in the third group and for the summarized psychometric scale 40.4 pts (SD 2.7) in the first, 44.3 pts. (SD 10.8) in the second and 45.7 pts. (SD 10.1) in the third group. For the VAS for pain, group I had 4.3, group II 4.0 and group III 2.5 pts Patient satisfaction showed similar results with 6.4 pts in the first, 6.5 pts in the second and 6.8 pts in the third group. CONCLUSION: Considering the functional results of operative revision, infection of the shoulder joint following rotator cuff surgery, endoscopic subacromial decompression or subacromial injection is a rare but severe complication.

Acromioclavicular Joint↗

PubMed1976

[Effect of muscular dysfunction on the development of shoulder joint in children with Erb's paralysis].

In order to evaluate the disturbances of development of the shoulder joint in children with Erb's paralysis the authors conducted an X-ray examination of the shoulder girdle and the shoulder in the anterior-posterior projection. The assessment of the functional state of the muscles of the shoulder girdle was made with the aid of clinical EMG. It was established that there was a retardation of growth and ossification of the radial head of the humerus on the affected side, a decrease in the longitudinal and cross-sectional sizes of the humerus, a retardation in the development of the joint scopular cavity, disorders in spacial interrelationship in the components of the shoulder joint and internal rotation of the shoulder joint. The structural and anatomical changes in the components of the shoulder joint are associated with disorders of the neurotrophic processes in the bone tissue and the muscular dysbalance.

Adolescent↗

PubMed2006

A comparison of shoulder joint forces during ambulation with crutches versus a walker in persons with incomplete spinal cord injury.

OBJECTIVE: To compare 3-dimensional (3D) shoulder joint reaction forces and stride characteristics during bilateral forearm crutches and front-wheeled walker ambulation in persons with incomplete spinal cord injury (SCI). DESIGN: Cross-sectional cohort study. SETTING: Biomechanics laboratory. PARTICIPANTS: Fourteen adult volunteers with incomplete SCI recruited from outpatient rehabilitation hospital services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Peak force, rate of loading, and force-time integral were compared for each component of the net 3D shoulder joint reaction force during ambulation with crutches and a walker. Stride characteristics were also compared between assistive device conditions. RESULTS: The largest weight-bearing force was superiorly directed, followed by the posterior force. The superior joint force demonstrated a significantly higher peak and rate of loading during crutch walking (48.9N and 311.6N/s, respectively, vs 45.3N and 199.8N/s, respectively). The largest non-weight-bearing force was inferiorly directed with a significantly greater peak occurring during crutch ambulation (43.2N vs 23.6N during walker gait). Walking velocity and cadence were similar; however, stride length was significantly greater during crutch walking (62% vs 58% of normal). CONCLUSIONS: Shoulder joint forces during assisted ambulation were large. Crutch use increased the superior force but did not increase walking velocity.

Adult↗

PubMed1979

Gerontological aspects of degenerative changes of the shoulder-joint. (Radiological and clinical studies).

In a series of radiological studies of both shoulder joint of 505 aged persons considering themselves healthy, the authors have systematized and statistically analysed the changes detected. Based on an increasing frequency as a function of age, on the identical ratio of occurrence by sexes and sides, on simultaneous occurrence, and on the identity of bilateral phenomena, the authors interpret these radiological changes as the consequence of a primary degenerative process. In the course of detailed clinical examinations and tests made in 100 cases taken at random, the authors have found no evaluable number and degree of limitations of motion, nor any evaluable difference in respect of the right and left shoulder joint of males and females.

Aged↗