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PubMed1996

[Biomechanics of arthrodesis of the major joints of the extremities].

Insufficient movement after an arthrodesis must be compensated for by other joints. Arm movements with an ankylotic shoulder joint can be executed by rotation and tilting of the scapula. The trapezius muscle plays an important role in these movements. Arthrodesis of the hip joint requires an extended range of movement in the intact contralateral joint and sufficient mobility of the lumbar spine. Moreover, every ankylotic joint is stressed by bending because compensation of the torque due to the weight of the corresponding part of the body by the balancing muscles is no longer necessary. The architecture of the spongy bone is adapted to that bending stress. Characteristic examples are anatomic specimens of ankylotic hip and knee joints.

Arthrodesis↗
PubMed2000

[In Process Citation]

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.

Journal Article↗
PubMed2001

Assessment and management of the painful shoulder.

The shoulder joint is a complex structure composed of intricate bony architecture and an ornate system of muscles, tendons, and ligaments. What many refer to as the "shoulder joint" is actually a combination of 4 articulations--the glenohumeral joint, acromioclavicular joint, sternoclavicular joint, and the scapulothoracic articulation. These structures work together to provide the shoulder complex with multiple degrees of freedom, which allow the upper extremity to be abducted, adducted, rotated, flexed, and extended. Although this flexibility is vital for positioning the arm in space, it can make the evaluation of pathology difficult. Furthermore, neck pathology can refer pain to the shoulder, which may require a screening evaluation of the neck. This article reviews the relevant anatomy and discusses an approach to the differential diagnosis of shoulder pain.

Algorithms↗
PubMed2001

Bipedicled vascularized fibula flap for proximal humerus defect in a child.

Vascularized bone transfer is becoming the most important option in the many cases in which durable, long-standing bone reconstruction is needed. The transfer of the vascularized epiphyseal plate, although controversial, is advantageous in cases where future growth is needed (i.e., congenital anomalies and tumor resections in children). The use of the free fibular head flap, based on epiphyseal blood supply augmentation, was reported using the anterior tibial artery, or part of it, as the nutritional vessel. By using both the peroneal artery and the specific branch to the fibular head as a bipedicled free flap, we ensured both long-bone fibula reconstruction and augmented blood supply to the head. We report a case of subtotal resection of the humerus due to osteosarcoma in a child that was reconstructed by this method. A preoperative study was conducted on fresh cadavers to identify the specific pedicle of the fibular head. The biceps femoris tendon was used to better stabilize the shoulder joint. The child recovered well and showed good progress in rehabilitation. On follow-up 1 year postoperatively, the shoulder joint remained limited, but showed no signs of substantial remodeling on x-ray. Good elbow and wrist-hand functions were noted. The child developed a single lung metastasis that was also removed. The question remains if the theoretical advantages in bone remodeling, shoulder stability, and bone growth are worth the extra time of surgery or the possible added donor and recipient site complications.

Bone Neoplasms↗
PubMed1994

Documenting rotation at the glenohumeral joint. A technical note.

Present methods of documenting internal rotation of the shoulder joint are based on the point reached over the back by the tip of the fully extended thumb. Disease or stiffness of the joints distal to the shoulder gives a false measure of internal rotation. Using the interepicondylar line of the humerus in the coronal plane as the neutral position, internal rotation can be documented accurately as the angle formed by this line with the coronal plane when the shoulder is rotated inwards.

Biomechanical Phenomena↗
PubMed2002

Comparison between macaques' and humans' kinematics of prehension: the role of morphological differences and control mechanisms.

Reaching and grasping has been widely studied in both macaques and humans, mainly with the aim of finding similar patterns of behavior in the two species. Little attention has yet been given to how morphological and behavioral differences between the two species might affect the kinematics of the movement. In this study, we present a careful analysis of the similarities and differences between humans' and macaques' prehension movements and discuss these with respect to both the control system and the biomechanics of the arm. Five humans and five macaques performed the same task, namely grasping small feeding objects using a precision grip. Macaques were observed in unconstrained conditions, free to adjust their body posture. The behavioral protocol for macaques revealed a postural preference for sitting and keeping the elbow slightly flexed when applying a precision grip. In agreement with the literature, kinematics revealed general features of movement common to both humans and macaques. However, within a similar timeframe, macaques produced steeper and wider excursion of the elbow and of the wrist, smaller abduction of the shoulder joint and larger displacement of the torso than humans did. The three-joint limb revealed stronger irregularities for the macaques. We hypothesize that the larger kinematic irregularities and the specific elbow--shoulder posture in macaques result in part from an effort of the control system to compensate for different biomechanical constraints, namely for limited shoulder-joint excursion, in order to achieve a similar range of comfort of motion. Finally, we briefly consider the influence of primitive neural circuits responsible for arm motion during locomotion and speculated on their influence on the control of reaching in macaques.

Adult↗
PubMed1999

Rocker handle for endoscopic needle drivers. Technical and ergonomic evaluation by infrared motion analysis system.

BACKGROUND: The design of the handle on instruments for endoscopic surgery determines comfort and efficiency of use by the surgeon. This applies particularly to needle drivers. METHODS: A novel rocker handle was designed to provide holding comfort and intuitive function. This rocker handle was compared with a finger-loop handle in a study involving 10 surgeons who tied a total of 360 intracorporeal surgeons' knots in a random sequence. The end points in this study were the execution time, knot quality, and motion analysis parameters of the surgeon's elbow and shoulder joints. RESULTS: Intracorporeal surgeon's knots tied with the rocker-handle driver exhibited a better knot quality, although this was not significant (p = 0.097). A significant improvement in the knot quality score (KQS) was observed between the first and the second sessions (p = 0.045) with the rocker handle, whereas no significant learning effect was observed for the finger-loop handle. During intracorporeal knot tying, the angular velocity at the elbow and shoulder joints was consistently lower with the rocker handle, suggesting that more controlled movements are enacted by the surgeon with this handle. Discomfort from finger-loop pressure on the thumb was reported by 3 of 10 surgeons with the finger-loop handle, whereas no discomfort was reported for the rocker handle. CONCLUSIONS: The new rocker handle improves the quality of task performance by eliminating discomfort and reducing angular velocities at the shoulder and elbow joints during use.

Endoscopes↗
PubMed1990

Aided gait in rheumatoid arthritis following knee arthroplasty.

A study is presented of a biomechanical comparison of two different aided gait patterns used by rheumatoid arthritis patients after knee joint surgery. Subjects using alternating and step-to gait patterns were compared when ambulating with forearm-support crutches. Data were collected via instrumented walking aids and 16mm cameras. Values were derived for load transmission through the crutches and for moments at the elbow and shoulder joints. The alternate gait was, on average, 87% faster than the step-to gait, and imposed average loads less than 80% of that in the step-to gait. Peak upper limb joint moments attained values approaching 12Nm at the shoulder joint in both gaits. Given the vulnerability of the upper limb joints in these patients, the load transmission through the upper limb may be unacceptably high in both aided gait patterns.

Aged↗
PubMed1995

[Tendovaginitis of the musculi biceps brachii in dogs].

Successful surgical correction of bicipital tenovaginitis and extensive new bone formation in the shoulder joint of an 8-year-old dog is described. Radiography and computed tomography revealed severe arthrosis of the shoulder joint with osteophyte formation encircling the bicipital tendon in the intertubercular groove. The diagnostic approach and therapy are described and discussed with reference to recent literature.

Animals↗
PubMed1993

Rehabilitation approaches to children with osteogenesis imperfecta: a ten-year experience.

Twenty-five children with severe osteogenesis imperfecta were followed and treated with physical and occupational therapy for a mean of five years, two months, 80% since the first two years of life. According to their highest achieved motor skill, they fell into three groups: (A) able to stand in braces, (B) able to ambulate short distances without braces, and (C) able to ambulate in the community without assistance. Preventable functional impairment is caused in group A by shoulder joint and hand contractures and upper extremity weakness, group by hip flexion and plantar flexion contractures of the feet, shoulder joint contractures, and upper extremity weakness, and group C by poor lower extremity joint alignment, impaired balance, and low endurance. Appropriate rehabilitation strategies have led to slow, continued functional improvement in the majority of patients. Results of the ten-year retrospective study suggest that clinical groupings based in part on functional needs will enable the clinician to provide optimal rehabilitation services.

Braces↗
PubMed1990

Electromyogram mean power frequency in non-fatigued trapezius muscle.

In this study we have examined the variation of mean power frequency (MPF) in the electromyogram (EMG) from the non-fatigued trapezius muscle, with different external hand loads, in different shoulder joint positions, different torques and different planes of movement. The study was limited to the functional range of movement in the shoulder joint. It was performed on 19 healthy subjects. Surface EMG was recorded, analysed by means of a computer programme and examined by regression analysis. Normalized MPF values were calculated by dividing the MPF by the individual average MPF for all positions and loads. The results indicated no major variation in normalized MPF. The largest systematic variation of normalized MPF, +/- 8%, was related to joint angle. We have concluded that the MPF value obtained initially can be used within the functional range of movement to calculate the relative decrease in MPF as a result of muscle fatigue, and that the decrease is significant if it exceeds 8% of the initial value.

Adult↗
PubMed1990

Evaluation of the prognostic value of positive-contrast shoulder arthrography for bilateral osteochondrosis lesions in dogs.

To investigate whether arthrographic findings had any prognostic value with respect to treatment and outcome of bilateral osteochondrosis, shoulder arthrograms (n = 80) from 40 dogs with bilateral lesions were evaluated. Arthrography was performed, using 1.5 to 4 ml of a 25% solution of meglumine-sodium diatrizoate, with admixture of 0.2 mg of epinephrine. A shoulder with signs of pain and lameness was surgically treated. The contralateral shoulder was treated conservatively, and the final outcome was compared with the arthrographic findings. In 37 dogs, signs of lameness and pain were associated with a loose cartilage flap and, in 3, with a detached cartilage flap. In 2 dogs, admitted with bilateral lameness, a loose cartilage flap was detected in both shoulders. Of 12 dogs with a detectable loose cartilage flap in the contralateral shoulder joint, 6 became lame 2 to 4 months after initial surgical intervention and needed bilateral surgery. In the contralateral joint, development of thick articular cartilage over the subchondral defect or a detached cartilage flap lodged in the caudal pouch of the shoulder joint was a favorable prognostic sign. Such dogs had no signs of lameness on the contralateral side during a follow-up period that ranged from 1 to 7 years.

Animals↗
PubMed1997

[The value of leukocyte scintigraphy in suspected implant infection in patients with chronic polyarthritis].

When infection of implants is suspected, optimal management requires accurate confirmation or exclusion of infection. However, in spite of demonstrative clinical signs cultures of smears or chemical parameters of inflammation frequently are ambiguous. Scintigraphy with indium-labeled white blood cells (WBC) has been reported to be sensitive and specific in the diagnosis of low-grade sepsis of the musculoskeletal system. Twenty-eight patients with possible infection were prospectively studied. Infection was suspected in 19 cases with total hip joint prosthesis, 14 cases with knee joint prosthesis and 1 case with shoulder joint prosthesis. All of them underwent scanning with indium-111-labeled WBC and subsequently underwent surgery. At surgery infections were determined by means of culture or histologic results. When correlated with culture and histologic results sensitivity of 111-indium-WBC imaging was 89% with a specificity of 67% and a predictive accuracy of 77%. In patients with rheumatoid arthritis, however, predictive accuracy of 111-indium-labeled WBC imaging was higher than with standard diagnostic methods. The difference was statistically significant (P < 0.05, chi(2)-test). In the patients examined as a whole, predictive accuracy of 111-indium-labeled WBC imaging does not differ from that of standard diagnostic methods. That is why expensive and time-consuming 111-indium-WBC imaging is not justified generally in diagnosis of infection of implants. 111-Indium-WBC imaging is well suited to supplement standard diagnostic methods in patients with rheumatoid arthritis.

Adult↗
PubMed2005

Draft design of a rehabilitation aid for patients with acute painful fractures of vertebrae.

AIM OF THE STUDY: To model the influence of abduction and adduction of the upper limb on the spinal load with the help of the laws of theoretical mechanics and the application of its results in clinical medicine. BIOMECHANICAL SOLUTION: Biomechanical model of an upper limb is demonstrated as a construction consisting of a lever arm and a joint connection in articulation of the shoulder joint. CONCLUSION: Our application of results of the spine load modelling in relation to excess upper limbs load: A) designing a methodology of active therapy aimed at exercising upper limbs for osteoporotic patients, B) the application of basic principles of motoric activity in daily life, C) the draft design of a rehabilitation aid for patients with acute painful fractures of vertebrae in the thoracic area (Fig. 5, Ref. 17).

Biomechanical Phenomena↗
PubMed2001

[Indication and technique for shoulder endoprostheses in fractures].

In the treatment of fractures of the humeral head, prosthetic replacement today is accepted as part of the therapeutic repertoire. The indication for this procedure is given if alternative conservative or operative techniques of preserving the humeral head in hemiarthroplasty of the shoulder joint led to universally poor outcomes. The models of endoprostheses that are currently available on the market mainly differ in the stem fixation method and means of securing the tuberosities and rotator cuff. Functional outcome of hemiarthroplasty of the shoulder joint after trauma is less than satisfactory regardless of the type of implant. However, a stable, painless joint is obtained yielding satisfactory subjective patient outcomes. For correct indications for prosthetic replacement of a fractured humeral head the surgeon also has to know the results that can be achieved by other methods in a given situation.

Follow-Up Studies↗
PubMedDate not supplied

Chronic, infantile, neurological, cutaneous and articular syndrome in Japan; two case reports.

We report two Japanese children with chronic, infantile, neurological, cutaneous and articular syndrome. Although the shoulder joint lesion has been rare in the literature of Europe and America, our first case showed overgrowth of the epiphysis in the bilateral shoulder joints. The second case exhibited severe growth retardation caused by early closure of the physis. The influence of GH is irrelevant in this syndrome. The existence of this syndrome in the Orient should be recognized.

Abnormalities, Multiple↗
PubMed2005

[Effect of age on the natural history of the shoulder: a clinical and radiological study in the elderly].

PURPOSE OF THE STUDY: Classically, the shoulder joint is thought to age more by its tendons than by its cartilages, the incidence of rotator cuff tears being considered to increase with age. The purpose of this work was to assess the natural history of the shoulder joint based on a clinical and radiological study of 200 patients aged 70 to 101 years. MATERIAL AND METHODS: The cohort was composed of 48 men (34%) and 152 women (76%), aged 84.25 +/- 6.7 years. All patients underwent a physical examination and the Constant score was established. The radiographic examination included an AP view in neutral rotation of both shoulders. The Hamada classification was used to stage full thickness cuff tears. The glenohumeral compartment was analyzed to search for osteophyte formation and joint narrowing. RESULTS: The subacromial height was greater than 6 mm, mean 9.89 +/- 2 mm, in 349 shoulders (87.25%), corresponding to stage I in the Hamada classification; it measured less than 6 mm, mean 3.08 +/- 1.7 mm in 51 shoulders (12.75%) in 38 subjects (19% of the total cohort). The Hamada classification for the other shoulders was stage II (n = 21 shoulders, 5.25%), and stage III (n = 16 shoulders, 4%), stage IV (n = 5, 1.25%) and stage V (n = 5, 1.25%). The Hamada stage could not be determined for four shoulders. There was a strong statistical correlation between the Constant score and Hamada stage. The glenohumeral space was normal in 288 shoulders (72%). Ninety-three shoulders (23.25%) in 62 patients (31%) presented humeral and/or inferior glenoid osteophytes without glenohumeral impingement and 19 shoulders (4.75% in 14 patients (7%) presented complete glenohumeral impingement. There was a significant correlation between the Constant score and severity of the glenohumeral degradation. The proportion of subacromial impincement increased significantly and regularly with degradation of the glenohumeral space (p < 104). For half of the shoulders, glenohumeral impingement was associated with subacromial impingement (eccentric osteoarthritis). DISCUSSION: The results of this study confirm that the frequency of rotator cuff tears increases with age. One out of five patients aged 70-90 years presented subacromial impingement versus one out of three among patients aged over 90 years. Clinical tolerance of subacromial impingement or subacromial osteoarthritis is good. Glenohumeral impingement, associated or not with subacromial impingement, is poorly tolerated, the patients presenting shoulder pain and marked stiffness. CONCLUSION: Our results demonstrate that the natural history of the shoulder does not exhibit a regular linear relationship with the Hamada radiological classification.

Aged↗