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At least 1,081 records · Page 60Linked to original sources
PubMed2003

[Ultrasonographic evaluation of the rotator cuff after shoulder arthroplasty].

AIM: Ultrasonography of the rotator cuff tendons is a standard imaging technique. Although increasing numbers of shoulder arthroplasty are performed, there is no available data concerning the use of ultrasound after shoulder replacement. Our experimental study was performed to analyse the value of ultrasonography after shoulder arthroplasty a) in an ex-vivo-setting and b) in a retrospective analysis of our patients after shoulder hemiprothesis. METHOD: After defrosting, anatomic modular humeral head replacement was performed in four fresh-frozen specimens with intact rotator cuffs. The supraspinatus and subscapularis tendons of each specimen were either detached to simulate a cuff defect or reattached anatomically (four times per specimen). Two experienced examiners then performed ultrasonography to evaluate the two tendons to be either intact or deficient. In a retrospective study, 22 patients with 25 hemiprotheses of the shoulder underwent clinical and sonographic examination. For documentation of the clinical findings, the Constant score was used. RESULTS: In the cadaver study, the reliability of the method was slightly higher for the subscapularis tendon (13 correct, 3 false results) than for the supraspinatus tendon (12 correct, 4 false results). In our patients, rotator cuff defects and effusions around the biceps tendon and in the subdeltoid bursa could be detected. Normal sonograms correlated with good clinical results. CONCLUSION: In the cadaver study, we found a good reproducibility of in-vivo conditions. We believe that ultrasonography is beneficial in follow-up evaluation after shoulder arthroplasty.

Arthroplasty↗
PubMed2005

[Isokinetic testing of the shoulder of handball players].

Aim of the study was to evaluate an isokinetic profile testing handball players to describe muscular imbalance. 30 athletes (15 male and 15 female) were measured at the Cybex 6000 test-unit for concentric internal and external rotation. Both shoulders, throwing arm (dominant shoulder) and the opposite shoulder were tested by speeds at 60 degrees/s and 180 degrees/s. There were sex specific differences which are also found in other sports. But these contrary data are not useful to define effective training concepts for handball-players with shoulder problems. From our point of view isokinetic testing of the shoulder joint in handball players can not reach any sufficient result. From our point of view there is no reason for using isokinetic testing to evaluate shoulder problems.

Adult↗
PubMed1998

The relationship of strength and muscle balance to shoulder pain and impingement syndrome in elite quadriplegic wheelchair rugby players.

Wheelchair athletes are susceptible to injuries related to overuse of the shoulder, in particular shoulder impingement syndrome. The present study examined the relationship of shoulder pain to demographic details, isokinetic strength and muscle balance in 8 elite quadriplegic rugby players. Demographic data were collected using personal interviews and each subject was clinically examined for signs of impingement syndrome by a physician. In addition each subject underwent bilateral isokinetic strength testing of the shoulder at 60 and 180 deg/s for abduction/adduction and internal/external rotation. A series of step-wise multiple discriminant analysis successfully predicted clinical symptoms from demographic, muscular strength and balance data. In particular, there was a significant deficit in adductor strength and this was related to shoulder pain and wasting of the scapular muscles. This strength deficit may be due to the high level of spinal lesions in the quadriplegic population. The level of spinal lesion may contribute to the aetiology of shoulder pathology in quadriplegia, and differentiate it from that observed in able-bodied athletes who exhibit weak abductors.

Adult↗
PubMed1991

[Standardized shoulder examination with reference to computerized isokinetic strength testing (Cybex II)].

The complexity of shoulder movement makes it difficult to test normal or pathological shoulder function, as well as therapy results after injury. There are also problems to classify therapy results and to compare those with the results of other persons or other treatment methods. The aim of this paper is to introduce a standardised examination method of the shoulder and a standardised score regarding "subjective feelings", "clinical examination", "technical examination" such as x-ray, CT, sonogram, and "computerised isokinetic strength test", which enables us to conduct a follow-up case study of different patient groups after shoulder injury. Standardised examination programmes of the most common shoulder injuries like AC separations, rotator-cuff tears and luxations of the shoulder are given in this paper. A retrospective study of surgically treated AC separations Type III at the Staatliche Orthopädische Klinik München/Harlaching showed that therapy results can be established with the help of this score. The efficacy of different treatment methods (e.g. Bosworth and tension-band wire) can be both elucidated and compared.

Acromioclavicular Joint↗
PubMedDate not supplied

Indwelling interscalene catheter anesthesia in the surgical management of stiff shoulder: a report of 100 consecutive cases.

One hundred consecutive stiff shoulders in 93 patients resistant to conservative therapy were treated with surgery and intermittent regional anesthesia via indwelling interscalene catheter. Each patient underwent manipulation and one of several operative treatments to release any additional contracture. The indwelling interscalene catheter remained in place and functioned well for an average of 3 days in 87 shoulders. At an average follow-up of 3.0 years, overall clinical results according to Neer's criteria were excellent in 39 shoulders (39%), satisfactory in 28 (28%), and unsatisfactory in 33 (33%). Patients reported no or mild pain in 83 (83%) of the shoulders in the study. At final follow-up, average gains in motion were 44 degrees of elevation (115 degrees to 159 degrees), 31 degrees of external rotation (22 degrees to 53 degrees), and 5 spine segments of internal rotation (L4 to T11). At final follow-up, 95% of the elevation and 79% of the external rotation achieved intraoperatively were maintained. The best results were obtained in those shoulders with idiopathic stiffness (88% excellent or satisfactory results); the worst results were in the postsurgical shoulders (47% excellent or satisfactory results). There were no catheter-related complications. The use of an indwelling interscalene catheter for postoperative pain control is a safe technique that facilitates early physical therapy in a patient population with a high risk of developing recurrent stiffness.

Adult↗
PubMedDate not supplied

The effect of cytokines on the migration of fibroblasts derived from different regions of the canine shoulder capsule.

This study examined the effect of several cytokines on the chemotactic migration of fibroblasts derived from 3 different parts of the canine shoulder: the upper part of the medial glenohumeral ligament (equivalent to the anterior part of the inferior glenohumeral ligament of the human shoulder); the inferior part of the medial glenohumeral ligament (equivalent to the axillary pouch of the human shoulder); and the posterior capsule (equivalent to the thin posterior capsule in the human shoulder). Platelet-derived growth factor-AB stimulated the migration of all 3 cell types in a dose-dependent manner, with increases from 150% to 300% at 1 ng/mL to 500% to 700% at 10 ng/mL. Hepatocyte growth factor also stimulated the migration of all 3 cell types in a dose-dependent manner (130% to 310%). Insulinlike growth factor-1 increased the migration of all 3 types of fibroblasts by 160% to 250%. Bone morphogenic protein-2, interleukin-1, and transforming growth factor-b had no significant effect on migration of shoulder capsular fibroblasts. These data demonstrate that capsular fibroblasts are responsive to specific growth factors and suggest the potential for use of growth factors to augment healing and/or remodeling of the shoulder capsule.

Animals↗
PubMedDate not supplied

The effect of articular malposition after total shoulder arthroplasty on glenohumeral translations, range of motion, and subacromial impingement.

The articular surface of the normal humeral head has a variable posterior and medial offset with respect to the central axis of the humeral shaft. Recreation of the normal humeral head shaft offset is postulated to be an important consideration during shoulder arthroplasty. However, the effect of humeral head malposition is unknown. The purpose of this study was to determine the effect of articular malposition after total shoulder arthroplasty on glenohumeral translation, range of motion, and subacromial impingement. Twenty-one human cadavers were dissected and tested with the use of an active or passive shoulder model. Range of motion and translation were recorded by means of an electromagnetic tracking device. The experiment was performed in 2 phases. For kinematics study, 11 cadaver shoulders were positioned both passively and actively from maximum internal rotation to maximum external rotation at 90 degrees of total elevation in the scapular plane. Three rotator cuff and 3 deltoid muscle lines of action were simulated for active joint positioning. Passive joint positioning was accomplished with the use of a torque wrench and a nominal centering force. The testing protocol was used for the natural joint as well as for 9 prosthetic head locations: centered and 2- and 4-mm offsets in the anterior, posterior, inferior, and superior directions. Repeated-measures analysis of variance was used to test for significant differences in the range of motion and translation between active and passive positioning of the natural joint as well as all prosthetic head positions. (2) For impingement study, 10 cadaver shoulders were used in a passive model, loading the tendons of the rotator cuff with a 30-N centering force. The humerus was passively rotated from maximum internal rotation (1500 Nmm) to maximum external rotation (1500 Nmm) by means of a continuous-recording digital torque wrench. Trials were performed with the use of centered, 4-, 6-, and 8-mm offset heads in the anterior, posterior, superior, and inferior positions before and after removal of the acromion and coracoacromial ligament. The relation between change in mean peak torque (with and without acromion), passive range of motion, and humeral head offset was analyzed by means of repeated-measures analysis of variance. In the kinematics study, total range of motion and all humeral translations were greater with passive joint positioning than with active positioning (P =.01) except for total superior-inferior translation and superior-inferior translation in external rotation. Anterior to posterior humeral head offset was associated with statistically significant changes in total range of motion (P =.02), range of internal rotation (P =.02), range of external rotation (P =.0001), and total anterior-posterior translation (P =.01). Superior to inferior humeral head offset resulted in statistically significant changes in total range of motion (P =.02), range of internal rotation (P =.0001), anterior-posterior translation during external rotation (P =.01), and total superior-inferior translation (P =.03). In the impingement study, there was a significant increase in torque from centered to 4-mm inferior offset (P =.006), 6-mm inferior offset (P <.001), and 8-mm inferior offset (P <.001). There was no significant increase in torque with superior, anterior, and posterior offsets. Glenohumeral motion significantly decreased from 129 degrees for centered head to 119 degrees for 8-mm superior (P =.002), 119 degrees for 8-mm anterior (P =.014), 118 degrees for 8-mm inferior (P <.001), and 114 degrees for 8-mm posterior (P =.001). Humeral articular malposition of 4 mm or less during prosthetic arthroplasty of the glenohumeral joint may lead to small alterations in humeral translations and range of motion. Inferior malposition of greater than 4 mm can lead to increased subacromial contact; offset of 8 mm in any direction results in significant decreases in passive range of motion. Therefore if subacromial contact is to be minimized and glenohumeral motion maximized after shoulder replacement, anatomic reconstruction of the humeral head-humeral shaft offset to within 4 mm is desirable.

Adult↗
PubMedDate not supplied

Long-term results with the Bankart and Bristow-Latarjet procedures: recurrent shoulder instability and arthropathy.

We retrospectively analyzed 26 shoulders in 24 patients 16 to 20 years (mean, 17.5 years) after a Bankart repair and compared these with a prospective series of 30 shoulders in 28 patients 15 years (mean, 15.1 years) after a Bristow-Latarjet repair for recurrent anterior dislocation of the shoulder. At follow-up one patient in each group had undergone revision surgery for recurrent instability. Two patients in the Bankart group had spontaneous stabilization of postoperative instability. Further, one patient in this group had had one subluxation during the follow-up period. In the Bristow group one patient reported 3 recurrences 3 years postoperatively. This patient has had no further redislocations during the past 12 years. Subluxations occurred occasionally several times in 2 patients in the Bristow group, but these patients were satisfied with the procedures at follow-up. No patient in the Bankart group had apprehension at follow-up. Eight patients in the Bristow group had subjective and/or objective apprehension. Throwing ability after surgery in the dominant shoulder was considered normal in 8 of 12 patients in the Bristow series and in 1 of 11 patients in the Bankart series. In the Bankart group 17 patients were "very satisfied" with the operative result, 7 were "satisfied," and 1 was "dissatisfied." The corresponding figures for the Bristow group were 24 who were very satisfied and 5 who were satisfied. Dislocation arthropathy was found in 16 of 26 Bankart shoulders (14 mild and 2 moderate) and in 9 of 30 Bristow shoulders (5 mild, 3 moderate, and 1 severe). The Bankart procedure seemed to be more successful than the Bristow-Latarjet repair when stability at follow-up was considered. However, when other criteria, as well as the patients' assessment of the operative result, are included, both methods can be recommended without any major differences.

Adolescent↗
PubMed2002

The influence of climatic factors on non-specific back and neck-shoulder disease.

An epidemiological study was carried out to explore the relationship between climatic factors and non-specific low-back and neck-shoulder symptoms in working populations. In a review of published literature, 27 studies were found which related climatic factors to musculoskeletal symptoms, but none of these studies specifically addressed the subject. It can be concluded that a relationship between climatic factors and musculoskeletal symptoms is considered at least plausible by both researchers, workers and patients, but that the epidemiological evidence appearing from literature is very weak. Questionnaire data which were collected on musculoskeletal symptoms, workload and perceptions of climatic conditions of 2030 workers in 24 different occupations were analysed multi-variately. About one-quarter of the workers related symptoms of the low back and neck-shoulders to climatic factors. They perceived climatic factors in most cases as aggravating factors for their symptoms. No seasonal influence on prevalence rates was reported. For low-back and neck-shoulder symptoms and for sick leave due to neck-shoulder symptoms, an association was found with climatic factors, and in particular with respect to draughts in relation to neck-shoulder symptoms. In addition, neck-shoulder symptoms were negatively related to frequent outdoor work. The findings suggest a relationship between climatic factors and musculoskeletal symptoms and call for further detailed investigations.

Adult↗
PubMed2002

Significance of house painters' work techniques on shoulder muscle strain during overhead work.

House painters represent a group of construction workers with a high frequency of neck and shoulder complaints and concomitant high risks for early retirements. Shoulder tendinitis, especially supraspinatus tendinitis, occurs frequently among house painters. The tasks of sanding and painting of ceilings with extension handles are particularly strenuous for these body regions. The purpose of this study was to identify work techniques that would be less strenuous to the arms and shoulders during sanding work. A biomechanical model was applied to quantify the shoulder loads during sanding and to determine the likely muscle force distribution. The necessary input data were measured experimentally for the model by means of a load cell and strain gauges on an extension handle, a Kistler force plate, and a MacReflex motion analysis system. Forty experienced male painters participated in the study. Three different work techniques were identified: the normal technique, the reversed grip and the pushing technique. The pushing technique was characterized by shorter stroke length and lower speed of the grinding block than the other techniques. The painters among the group of subjects who used the pushing technique were found to report fewer shoulder disorders during sanding than the others. The most common shoulder tendinitis is the supraspinatus tendinitis, also among house painters, and using the Pushing technique could possibly prevent from this disorder. However, further research in larger groups of house painters is needed to be able to recommend this technique for a wider use.

Adult↗
PubMed2004

Mechanical loading of the low back and shoulders during pushing and pulling activities.

The objective of this study was to quantify the mechanical load on the low back and shoulders during pushing and pulling in combination with three task constraints: the use of one or two hands, three cart weights, and two handle heights. The second objective was to explore the relation between the initial and sustained exerted forces and the mechanical load on the low back and shoulders. Detailed biomechanical models of the low back and shoulder joint were used to estimate mechanical loading. Using generalized estimating equations (GEE) the effects were quantified for exerted push/pull forces, net moments at the low back and shoulders, compressive and shear forces at the low back, and compressive forces at the glenohumeral joint. The results of this study appeared to be useful to estimate ergonomics consequences of interventions in the working constraints during pushing and pulling. Cart weight as well as handle height had a considerable effect on the mechanical load and it is recommended to maintain low cart weights and to push or pull at shoulder height. Initial and sustained exerted forces were not highly correlated with the mechanical load at the low back and shoulders within the studied range of the exerted forces.

Adult↗
PubMed1989

Shoulder posture and localized muscle fatigue and discomfort.

In many industries workers perform manual assembly tasks with hands postured above the shoulders. Awkward shoulder and arm postures are often viewed as acceptable given costs of workplace modification, postural exertions which are in compliance with current design recommendations, ready availability of strong workers, and numbers of electromyographic studies which fail to detect significant signs of localized muscle fatigue (LMF). An experiment was conducted to: (a) study the onset and severity of (LMF) in the shoulder when performing a stylus-to-hole Fitts reciprocal movement task under a range of postures, hand loads, ratios of work-to-rest, and task durations, and (b) to evaluate the efficacy of three techniques (i.e., changes in EMG behaviour, postural tremor, and cross-modal matching estimates) in detecting and monitoring posturally-based LMF and discomfort in the shoulder complex. Experimental findings showed that posturing hands above shoulder level significantly increased the risk of LMF and postural discomfort even in light-weight manual assembly environs where postural exertions are small, and that cross-modal matching estimates and postural tremor were more sensitive metrics of LMF in the shoulder complex than EMG RMS voltage and mean spectral power frequency metrics. The basis for experimental findings, as well as potential application of LMF metrics in future postural stress investigations, are discussed. Recommendations for workplace posture are provided for job designers facing work height decisions in manual assembly environs.

Adult↗
PubMed1992

Net shoulder joint moment and muscular activity during light weight-handling at different displacements and frequencies.

The purpose of this study was to calculate net shoulder (gleno-humeral) joint moments from inverse dynamics and to measure muscular activity from six shoulder muscles (supraspinatus, infraspinatus, middle deltoid, anterior deltoid, trapezius, and pectoralis major) during light weight-handling at two different displacements (horizontal and vertical) and frequencies (40 and 60 cycles/min), to simulate an occupational cervicobrachial working task (light weight displacement). Ten normal adult male subjects were asked to move a known weight, representing 15% of the maximal lifted weight, in both horizontal and vertical conditions at frequencies of 40 cycles/min and 60 cycles/min. Raw EMG signals from six shoulder muscles were recorded and synchronized with the cinematographic data during three trials of 6 s each. The raw EMG signals of each muscle were full wave rectified and filtered at 3 Hz. The linear envelope (LE EMG) signals were normalized by time (% cycle) and by amplitude (% MVC), and for the analysis of variance, the normalized LE EMG signals were integrated (IN LE EMG). The average shoulder angular velocities, joint moments, and moment powers were computed from cinematographical data. No significant differences were observed between both tasks for the supraspinatus, infraspinatus, and pectoralis major IN LE EMG data as well as for integrated normalized shoulder joint moment for the whole cycle of movement. IN LE EMG data from middle deltoid, anterior deltoid, and trapezius muscles were significantly higher (p less than 0.05) when performing the vertical displacement task for the whole cycle of movement. This muscular activity difference between vertical and horizontal tasks indicated that the vertical displacement conditions induced higher muscular loads on the shoulder than the horizontal weight displacement conditions, although the vertical displacements were approximately 15% longer than the horizontal displacements. The non-significant difference of IN LE EMG between frequencies obtained for all muscles indicated that neither frequencies induced more muscular activity.

Adult↗
PubMed2006

The relationship between shoulder alignment and elbow joint angle in cricket fast-medium bowlers.

The aim of this study was to examine the relationship between shoulder alignment and elbow angle during the delivery action of fast-medium bowlers. The elbow and upper trunk alignment were recorded for 13 high-performance bowlers (mean age 20 years) using a 12-camera Vicon motion analysis system operating at 250 Hz. The three highest velocity trials for "good" and "short" length deliveries were analysed. Results showed that bowlers with a more front-on shoulder alignment at back-foot impact and when the upper arm was horizontal to the ground experienced a significantly greater elbow flexion--extension range when compared with those who had a more side-on orientation at the same point in the delivery action. Bowlers with greater shoulder counter-rotation also recorded higher elbow flexion and subsequently extension during the period from upper arm horizontal to ball release. Shoulder alignment and elbow angles were similar for "short" and "good" length deliveries. It was concluded that bowlers with a more front-on shoulder orientation at back-foot impact demonstrated a higher elbow extension from upper arm horizontal to ball release and are therefore more likely to infringe International Cricket Council elbow tolerance levels, compared with those who adopt a more side-on shoulder orientation at back-foot impact.

Adult↗
PubMed2006

Predictive and discriminative value of shoulder proprioception tests for patients with whiplash-associated disorders.

OBJECTIVE: To evaluate whether patients suffering from whiplash-associated disorders have impaired shoulder proprioception and whether the acuity of shoulder proprioception is reflected in the patients' symptoms and self-rated function. DESIGN: A comparative group design, including a correlation design for the patient group. SUBJECTS: Patients with chronic whiplash-associated disorders (n=37) and healthy subjects (n=41). The groups were matched for age and gender. METHODS: All subjects underwent a shoulder proprioception test involving active ipsilateral arm position-matching. Group difference was evaluated by multiple analysis of variance and analysis of variance. The patient group completed questionnaires addressing functioning and health and performed pain ratings. Associations between proprioceptive acuity and self-rated functioning and symptoms were studied by correlation and regression analyses. RESULTS: The patient group showed significantly lower acuity of shoulder proprioception. Moderate correlations were found between proprioceptive acuity and questionnaire scores representing physical functioning, so that low proprioceptive acuity was associated with low self-rated physical functioning. Scores representing pain-intensity did not correlate with proprioceptive acuity. CONCLUSION: The results show that, at the group level, patients with whiplash-associated disorders have impaired shoulder proprioception. The clinical relevance of this finding is strongly supported by the association between shoulder proprioceptive acuity and self-rated functioning in the patient group.

Adult↗
PubMed2005

Job strain and neck-shoulder symptoms: a prevalence study of women and men white-collar workers.

BACKGROUND: Neck-shoulder symptoms are frequent among workers. Psychosocial factors at work have been associated with neck-shoulder symptoms, but few studies have examined job strain, the combined effect of high psychological demands (PD) and low decision latitude (DL). AIMS: To examine the association between psychosocial factors at work and the prevalence of self-reported neck-shoulder symptoms among white-collar workers. METHODS: In a cross-sectional study of 1543 white-collar workers, PD and DL at work were measured with Karasek's questionnaire. Prevalent cases were workers for whom neck-shoulder symptoms were present for >or=3 days during the previous 7 days and for whom pain intensity was greater than half the visual analogue scale. Gender and social support at work were evaluated as potential effect modifiers. RESULTS: Workers exposed to high job strain had a higher prevalence of neck-shoulder symptoms [adjusted prevalence ratio (PR): 1.54, 95% confidence interval (CI): 1.00-2.37]. No modifying effect of gender was observed in this association. The effect of job strain was stronger in workers with low social support (adjusted PR: 1.84, 95% CI: 0.92-3.68). These associations tended to be stronger and/or more precise when using alternative exposures and case definition. Namely, a stronger job strain effect was observed when a tertile cut-off was used to classify exposure (adjusted PR: 2.47, 95% CI: 1.15-5.32). CONCLUSION: These results suggest that primary prevention of neck-shoulder symptoms among white-collar workers should consider the exposure to job strain, especially when workers are exposed to low social support at work.

Adult↗
PubMed1986

Documentation of medial rotation accompanying shoulder flexion. A case report.

We dissected a fresh cadaver to determine which glenohumeral structures causes medial rotation of the humerus during flexion in the sagittal plane. All structures associated with both shoulders were dissected thoroughly. Both elbows were disarticulated to expose the distal end of each humerus to be used as measurement landmarks. We used a universal goniometer for measurements of shoulder flexion. To determine which structures cause passive medial rotation, the associated shoulder muscles, ligaments, and the capsule were individually reflected from the humerus. Passive shoulder flexion to the point where medial rotation started was measured after each structure was resected. The end passive glenohumeral flexion without rotation was 60 degrees after reflection of all musculature and other periarticular shoulder structures. Our results support Steindler's conclusion that during flexion of the humerus beyond the horizontal there is forced rotation caused by ligamentous tension. We also found that the bony configuration of the glenohumeral joints also plays an important role in medial rotation accompanying shoulder flexion.

Biomechanical Phenomena↗
PubMed1987

Work-related shoulder-neck complaints in industry: a pilot study.

Twenty-six industrial workers, selected from employment records, were examined with a questionnaire, anthropometric measures, muscle strength measurements and filming during work cycles to study the influence of ergonomic factors on shoulder-neck complaints. No differences were observed when comparing age or anthropometric measurements between the nine workers with and the 17 without shoulder-neck complaints. Significantly weaker shoulder muscles were found in workers with shoulder-neck complaints than in those without. A higher median strain on the shoulders in the working situation of workers with shoulder-neck complaints than in the group with no complaints was suggested from the results of a biomechanical analysis of the different work tasks.

Absenteeism↗