Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SHOULDER”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,099 records · Page 61Linked to original sources
PubMed2006

Ambulatory continuous interscalene nerve blocks decrease the time to discharge readiness after total shoulder arthroplasty: a randomized, triple-masked, placebo-controlled study.

BACKGROUND: A continuous interscalene nerve block (CISB) may be used to provide analgesia after shoulder arthroplasty. Therefore, inpatient stays may be shortened if CISB (1) provides adequate analgesia without intravenous opioids and (2) improves shoulder mobilization. This study investigated the relationship between ambulatory CISB and the time to reach three discharge criteria after shoulder arthroplasty. METHODS: Preoperatively, patients received a CISB. All patients received a perineural 0.2% ropivacaine infusion from surgery until 06:00 the following morning, at which time they were randomly assigned either to continue perineural ropivacaine or to switch to normal saline. The primary endpoint was the time from the end of surgery until three discharge criteria were attained (adequate analgesia, independence from intravenous analgesics, and tolerance to 50% of shoulder motion targets). Patients were discharged home as early as the afternoon after surgery with their CISB using a portable infusion pump. RESULTS: Patients receiving perineural ropivacaine (n = 16) attained all three discharge criteria in a median (10th-90th percentiles) of 21 (16-41) h, compared with 51 (37-90) h for those receiving perineural normal saline (n = 13, P < 0.001). Unlike patients receiving perineural ropivacaine, patients receiving perineural normal saline often required intravenous morphine, but still experienced a higher degree of pain and tolerated less external rotation. CONCLUSIONS: An ambulatory CISB considerably decreases the time until readiness for discharge after shoulder arthroplasty, primarily by providing potent analgesia that permits greater passive shoulder movement and the avoidance of intravenous opioids. Additional research is required to define the appropriate subset of patients and assess the incidence of complications associated with earlier discharge.

Aged↗
PubMed1995

Functional evaluation of the shoulder following latissimus dorsi muscle transfer.

The dynamic muscle function of the shoulder in 26 patients (10 males, 16 females) who underwent a pedicled or free vascularized latissimus dorsi muscle transfer between 1985 and 1991 (mean follow-up, 4.4 yr) was studied. Instrumented muscle testing was performed on the Kinetic Communicator machine (Kin Com) and the Baltimore Therapeutic Equipment (BTE) work simulator. The female unilateral pedicle group (n = 13) showed a significant difference between operated and nonoperated shoulders for both peak torque (power) and work (endurance) measurements of shoulder adduction and extension on the Kin Com (mean ratios operated/nonoperated shoulders, 55% to 69%). They also showed significant differences for work performance on three of four BTE tests (mean ratios, 77% to 84%). The male free vascularized group (n = 10) similarly showed a significant deficit of both peak torque and work for shoulder extension and adduction on the Kin Com (mean ratios, 74% to 84%); however, they showed no deficit on the BTE tests. In conclusion, dynamic muscle tests demonstrate a deficit of muscle power and endurance of shoulder extension and adduction following latissimus dorsi muscle transfer.

Adult↗
PubMed1997

Anterior release test. A new test for occult shoulder instability.

Occult shoulder instability is recognized as a significant contributor to shoulder dysfunction in throwing athletes. Diagnosis of occult instability by physical examination remains challenging. The anterior release test is a test for physical examination of the shoulder. It was developed to facilitate detection of occult anterior instability. One hundred shoulders were examined preoperatively by the same examiner. Based on surgical findings, the shoulders were classified as anterior instability or other. The results of examination were compared with the operative findings. Sensitivity was calculated as 91.9%, specificity 88.9%, positive predictive value 87.1%, negative predictive value 93.0%, and accuracy 90.2%. The anterior release test is a reliable and reproducible test for the detection of the unstable shoulder.

Adolescent↗
PubMed1991

Proximal humeral osteotomy to correct the anatomy in patients with recurrent shoulder dislocations.

Surgical treatment of patients with traumatic shoulder dislocations is usually successful, but soft-tissue surgery in patients with nontraumatic shoulder dislocation often fails to stabilize the joint. Previous studies have shown that decreased humeral head retroversion might be one cause of anterior shoulder instability. Eleven patients with anterior recurrent dislocations, five traumatic and six nontraumatic, and all with a small humeral head retroversion angle, have been operated on using a proximal humerus osteotomy to correct the abnormal anatomy. After surgery, the humeral head retroversion was normalized to a mean angle of 34 degrees. All shoulders became stable. External rotation increased 7 degrees on the average, and internal rotation decreased 10 degrees on the average. One year after surgery, shoulder function was excellent in all operated shoulders.

Adult↗
PubMed2003

Development and psychometric evaluation of the Flexilevel Scale of Shoulder Function.

BACKGROUND: Existing measures of self-reported shoulder function fail to measure effectively the full range of shoulder functioning. The classic approach for improving the reliability of a scale is adding items, but a scale with a substantial number of items imposes a large response burden on participants. A more efficient approach is to use modern psychometric methods to construct an adaptive scale in which patients respond only to items that are targeted at their level of shoulder function. METHODS: We developed a Flexilevel Scale of Shoulder Function (FLEX-SF). This scale includes three testlets that target low, medium, and high shoulder function. Scores on the testlets were equated to a common mathematical metric. DESIGN AND SUBJECTS: We developed an initial pool of 68 items. This pool was administered to 400 patients, and responses were calibrated using a rating scale model. Subsets of items were identified for an easy, medium difficulty, and hard testlet. Properties of the scale were evaluated in a 3-month longitudinal study of 200 shoulder patients. RESULTS: The FLEX-SF exhibited high reliability at both the scale level (intraclass correlation coefficient [3,1] = 0.90) and specific trait levels. The validity of the FLEX-SF was supported by its internal and external responsiveness (Guyatt responsiveness index = 1.12) and the pattern of its associations with other health status measures. CONCLUSIONS: The FLEX-SF can be used as a primary endpoint in clinical trials even when there are relatively few people in each treatment group. The scale also has excellent properties for use in clinical settings tracking individual changes over time.

Adult↗
PubMed1998

Frozen shoulder syndrome: diagnostic and treatment strategies in the primary care setting.

The term "frozen shoulder" has been used to describe an array of clinical conditions. The authors consider a patient as meeting the criteria of primary or secondary frozen shoulder syndrome if he/she has a clinical history of worsening painful shoulder motion loss of at least 1 month duration and a physical examination documenting painful restricted shoulder motion. In the evaluation of the patient with suspected FSS, initial screening shoulder radiographs are required to exclude other conditions. The physical examination of the frozen shoulder patient should include observation, cervical examination, assessment of range of motion, and the use of provocative testing. The treatment of the patient with FSS should include preventative education, various medications including NSAIDS and oral corticosteroids, physical therapy, and finally, for the patient with refractory symptoms, surgical intervention. For those patients necessitating surgical intervention, the authors recommend a selective arthroscopic capsular release.

Arthroscopy↗
PubMed2001

Reciprocal strength ratio in shoulder abduction/adduction in sports and daily living.

PURPOSE: Functionally, the shoulder is considered a ball joint, whereby high mobility is attended by low stability. Therefore, muscular balance is decisive for stability. Altered strength ratios are frequently described as "muscular dysbalances" and considered one of the causes of shoulder pathologies, whereby objective quantification is difficult. METHODS: In order to quantify physiological muscle balance, the strength ratio of shoulder abduction/adduction (AB/AD) was determined in 166 untrained men (UM) concentrically at 60 degrees.s-1 (LIDO-Active). The influence on this norm of one-sided (25 high-performance (TPH), 18 leisure tennis players (TPL)) and two-sided athletic exercise (32 gymnasts (GY)), altered daily exercise (11 paraplegics with paralysis time < 4 months (PP), 11 paraplegics with paralysis time > 2 yr (PU)), and a combination of altered daily exercise and athletic activity (16 trained paraplegics (PT)) was examined (ANOVA, alpha = 0.05). RESULTS: Determination of the AB/AD quotient in UM was 0.82. Shoulder stress in sports led to a decrease in quotients compared with UM because of a relatively increased torque in AD (P < 0.01). At the beginning of a paraplegia, the quotient of AB/AD is elevated (P < 0.05). This altered ratio decreases with duration of paralysis (PU) and athletic activity (PT). CONCLUSION: With increased shoulder stress, the altered strength ratios reflect specific requirements of the performance attained. However, the importance of muscular dysbalances for the onset of shoulder complaints must be considered more important than their influence on athletic performance capacity.

Activities of Daily Living↗
PubMed2002

Helmet and shoulder pad removal in suspected cervical spine injury: human control model.

STUDY DESIGN: Digital fluoroscopy was used to evaluate the motion in normal men during helmet and shoulder pad removal. OBJECTIVES: To observe the amount of motion that occurs during the removal of helmet and shoulder pads in an uninjured spine. SUMMARY OF BACKGROUND DATA: Removal of shoulder pads and helmet from a football player with suspected cervical spine injury can be particularly hazardous. Previous studies have been performed in cadavers with known created injuries. No control study in uninjured players has been done to show if there is similar motion with removal of football equipment. METHODS: Four people removed the helmet and shoulder pads with a technique consistent with that described by the National Athletic Trainers' Association (NATA). Before positioning, with the helmet and shoulder pads on the subject and the subject lying flat on the table, one static lateral image was obtained as a baseline. With the neck stabilized and everyone in position, the torso, head, and neck were elevated approximately 30-40 degrees off the table bending at the waist. After elevation, continuous fluoroscopy was turned on as the helmet and shoulder pads were removed. Once the equipment was removed, the subject was carefully placed back down on the table and a final static lateral image was obtained. All images were saved digitally. Measurements were made for change in angulation, translation, distraction, and space available for the cord. RESULTS: The results for change in disc height, translation, and space available for the cord showed no significant change. The results for change in angulation also did not show any significant motion in either flexion or extension from baseline or between each step in the protocol. CONCLUSIONS: In the conscious player with no cervical injury the protocol used by the NATA is effective in limiting cervical motion.

Athletic Injuries↗
PubMed2006

Comparison in the effect of linear polarized near-infrared light irradiation and light exercise on shoulder joint flexibility.

OBJECTIVE: This study aimed at comparing the effect of linear polarized near-infrared light irradiation (PL irradiation) and bicycle exercise with 50%HRreserve on the flexibility of the shoulder joint. DESIGN: Placebo-controlled trial. SETTING: Twenty-four healthy young adults (10 males: mean+/-SD, age 20.9+/-3.1 y, height 171.0+/-3.9 cm, body mass 63.4+/-3.5 kg and 14 females: age 21.2+/-1.7 y, height 162.0+/-7.8 cm, body mass 56.2+/-7.2 kg). INTERVENTIONS: PL-irradiation (100%, 1800 mW), placebo-irradiation (10%,180 mW), and light exercise (50%HRreserve) for 10 minutes. OUTCOME MEASUREMENTS AND RESULTS: The shoulder joint angles were measured twice-before and after each intervention. We measured the angles when the right shoulder joint extended forward and flexed backward maximally without support, and analyzed these shoulder joints and range of motion. Trial-to-trial reliability (intraclass correlations) of each joint angle was very high, over 0.98. All joint angles showed significant changes, and values in post-PL-irradiation and postlight exercise were significantly greater than that in postplacebo-irradiation. Shoulder forward flexion and backward extension angles had significantly greater change rates in PL-irradiation and light exercise than placebo-irradiation, and their range of motion angle was in the order of PL-irradiation, light exercise, and placebo-irradiation. CONCLUSIONS: It is suggested that PL-irradiation produces almost the same effect on shoulder joint range of motion as light exercise.

Adult↗
PubMed2005

Prevention of shoulder stiffness after rotator cuff repair.

UNLABELLED: Predisposing factors for shoulder stiffness after rotator cuff repair have yet to be determined. The potential for recovery of range of motion and amelioration of pain in patients with this complication also remains unclear. Accordingly, data collected prospectively for 209 patients with a primary rotator cuff repair were retrospectively reviewed. Two groups, Group A (early motion recovery) and Group B (shoulder stiffness), were selected according to passive shoulder range of motion outcomes 6 weeks postoperatively. Both groups were compared for 10 descriptive and clinical characteristics, and for passive range of motion, muscle force, and functional outcomes obtained 0, 6, 12, 24, and 76 weeks postoperatively. Of the potential prognostic factors examined, restriction of range of motion for the preoperative hand behind the back best predicted shoulder stiffness at 6 weeks postoperatively. For patients with postoperative shoulder stiffness, pain had subsided by 24 weeks postoperatively, whereas range of motion steadily improved between 6 weeks and 76 weeks postoperatively. Results of the current study support a predictive role for restriction of range of motion for the preoperative hand behind the back, and affirms the potential for nearly complete recovery of range of motion and amelioration of pain in patients who have shoulder stiffness after rotator cuff repair. LEVEL OF EVIDENCE: Prognostic study, Level I-1 (prospective study).

Adult↗
PubMed2007

Do shoulder vibration signals vary among asymptomatic volunteers?

Numerous studies document vibrations emanating from joints during active or passive motion. It has been proposed these vibrations, termed vibroarthrographic signals, are associated with changes in the shape or quality of tissues in and around the joint. Vibroarthrographic signals in articular joints have been tested to correlate a particular signal with a particular feature of a joint such as a specific lesion. Because of the limited morphologic changes noted in dominant and nondominant articular joints, we hypothesized shoulder vibroarthrographic signals would be similar between subjects. We determined vibroarthrographic signals in young, adult, asymptomatic volunteers evaluated by 21 different active physician-assisted physical examination tests. Comparisons of data from both shoulders with a two-sample statistical test and a neural network demonstrated difficulty distinguishing the dominant and nondominant shoulder. Four percent of the comparisons were different, and the sensitivity of the neural network averaged 50% for most physical examination tests when classifying shoulder signals as dominant or non-dominant. Our findings suggest future studies investigating vibroarthrographic signals from symptomatic shoulders can be compared with asymptomatic shoulders from young patients with little regard to limb dominance for most physical examination tests.

Adolescent↗
PubMed1998

The false-positive rate of thoracic outlet syndrome shoulder maneuvers in healthy subjects.

OBJECTIVE: To estimate the incidence of false-positive findings of thoracic outlet syndrome (TOS) shoulder maneuvers, Adson's test (AT), costoclavicular maneuver (CCM), elevated arm stress test (EAST), and supraclavicular pressure (SCP) in healthy subjects. METHODS: A cross-sectional, observational study was performed in a medical school and affiliated emergency medicine residency program setting. Participants included healthy adult volunteers without symptoms of TOS. The shoulder maneuvers AT, CCM, EAST, and SCP were performed in randomized order for 30 sec, 30 sec, 3 min, and 30 sec, respectively. Pulse quality and the presence and timing of pain or paresthesias were assessed. RESULTS: 53 subjects were enrolled, including 27 women, aged 29.7 +/- 6.4 years (range 21-58 years). AT, CCM, EAST, and SCP resulted in an altered pulse in 11%, 11%, 62%, and 21%; pain in 0%, 0%, 21%, and 2%; and paresthesias in 11%, 15%, 36%, and 15% of cases, respectively. The following outcomes had reasonable false-positive rates (upper 95% confidence limit): pain with the AT (7%), CCM (7%), SCP (10%), or any 2 TOS shoulder maneuvers (10%); discontinuing the EAST because of symptoms (16%); or any symptom with 3 (13%) or 4 (7%) TOS shoulder maneuvers. CONCLUSIONS: In a study of TOS shoulder maneuvers in healthy subjects, the outcomes of pulse alteration or paresthesias were unreliable in general. However, TOS shoulder maneuvers have reasonably low false-positive rates when a positive outcome is defined as pain after AT, CCM, or SCP; discontinuation of the EAST secondary to pain; pain in the same arm with > or =2 maneuvers; or any symptom in the same arm with > or =3 maneuvers.

Adult↗
PubMed2004

Clinimetric evaluation of shoulder disability questionnaires: a systematic review of the literature.

OBJECTIVE: To identify all available shoulder disability questionnaires designed to measure physical functioning and to evaluate evidence for the clinimetric quality of these instruments. METHODS: Systematic literature searches were performed to identify self administered shoulder disability questionnaires. A checklist was developed to evaluate and compare the clinimetric quality of the instruments. RESULTS: Two reviewers identified and evaluated 16 questionnaires by our checklist. Most studies were found for the Disability of the Arm, Shoulder, and Hand scale (DASH), the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons Standardised Shoulder Assessment Form (ASES). None of the questionnaires demonstrated satisfactory results for all properties. Most questionnaires claim to measure several domains (for example, pain, physical, emotional, and social functioning), yet dimensionality was studied in only three instruments. The internal consistency was calculated for seven questionnaires and only one received an adequate rating. Twelve questionnaires received positive ratings for construct validity, although depending on the population studied, four of these questionnaires received poor ratings too. Seven questionnaires were shown to have adequate test-retest reliability (ICC >0.70), but five questionnaires were tested inadequately. In most clinimetric studies only small sample sizes (n<43) were used. Nearly all publications lacked information on the interpretation of scores. CONCLUSION: The DASH, SPADI, and ASES have been studied most extensively, and yet even published validation studies of these instruments have limitations in study design, sample sizes, or evidence for dimensionality. Overall, the DASH received the best ratings for its clinimetric properties.

Disability Evaluation↗
PubMed1976

Periarthritis of the shoulder. I. Aetiological considerations with particular reference to personality factors.

186 patients with periarthritis of the shoulder have been studied. The sex ratio was female:male, 1-52:1. The peak age of onset was 54-59 years in both sexes. Over 40% of the patients were referred to the clinic after 6 months had elapsed from the time of onset of the disease. The right shoulder was more frequently involved than the left, particularly in the men. One shoulder only was affected in 75% of patients. There was frequently a previous history of 'rheumatism' before the episode of periarthritis. In one-third of the women 'nonspecific rheumatism' had occurred. Cervicobrachial pain and a previous episode of shoulder pain had occurred more often in the women. There were a number of associated diseases, ischaemic heart disease, thyroid disease among women, diabetes among women, hemiplegia, pulmonary tuberculosis, chronic bronchitis, and epilepsy. Acute trauma was rarely a precipitating factor. Manual workers were more frequently seen than sedentary workers in the sample, and there were more in the sample than in the general population of Leeds. The general psychological background was no different from a control group. The Maudsley Personality Inventory gave no different results among patients with periarthritis of the shoulder than among a control group and among the general population. It is suggested that there is no evidence in this study for a 'periarthritic personality'. It is suggested that the cause of periarthritis of the shoulder is likely to be related to chronic trauma occurring in an age range when changes in connective tissue are occurring. Certain associated diseases may predispose the patient to this disorder.

Adult↗
PubMed1984

Frozen shoulder: an arthrographic and radionuclear scan assessment.

The diagnostic criteria and nomenclature used to describe the painful stiff shoulder remain confused. Arthrographic features of capsulitis have come to be accepted as characteristic of the frozen shoulder. Increased technetium uptake has also been noted. Both features have been considered to have possible prognostic and therapeutic importance. During a therapeutic study of strictly defined clinical frozen shoulder 35 of 38 patients showed increased technetium diphosphonate uptake in the affected shoulder in comparison with the opposite side. Of 36 patients who had arthrography 15 showed evidence of capsulitis, 11 rupture of the rotator cuff, and five no abnormality. Five tests failed owing to technical difficulty. There was no association between the technetium uptake and the arthrographic features, and neither was useful in predicting the rate or extent of recovery. Frozen shoulder of traumatic onset behaved no differently from that which arose spontaneously. We do not therefore consider that arthrography or technetium diphosphonate scanning performed at presentation contributes to the assessment of the painful stiff shoulder.

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↗
PubMed2000

Relation of glenohumeral and acromioclavicular joint destruction in rheumatoid shoulder. A 15 year follow up study.

OBJECTIVES: To evaluate the relation of glenohumeral (GH) and acromioclavicular (AC) joint involvement in a cohort of 74 patients with seropositive and erosive rheumatoid arthritis (RA) followed up prospectively. METHODS: At the 15 year follow up radiographs of 148 shoulders were evaluated, and the grade of destruction of GH and AC joints were assessed by the Larsen method. One GH joint arthroplasty had been performed after 13 years of the disease onset and the preoperative radiograph was evaluated. RESULTS: Erosive involvement (Larsen grade >/= 2) was observed in 96 of 148 (65%) of the shoulders. Both GH and AC joints were affected in 62 of 148 (42%) shoulders. GH joint alone was involved in nine (6%) shoulders and only AC joint was affected in 25 (17%) shoulders. AC joint destruction correlated with the GH joint destruction, r=0.74 (95% confidence intervals (CI) 0.65 to 0.80 ). CONCLUSION: In RA AC joint is affected more often than the GH joint, but in half of the patients both joints are involved. This should be remembered when treating painful rheumatoid shoulder.

Acromioclavicular Joint↗
PubMed2000

Isokinetic performance and shoulder mobility in elite volleyball athletes from the United Kingdom.

OBJECTIVES: To evaluate the differences in strength and mobility of shoulder rotator muscles in the dominant and non-dominant shoulders of elite volleyball players. METHODS: Isokinetic muscle strength tests were performed at speeds of 60 and 120 degrees/s, and shoulder mobility was examined in ten players from the England national men's volleyball squad. The subjects also completed a questionnaire that included a visual prompt and analogue pain scale. RESULTS: The range of motion of internal rotation on the dominant side was less than that on the non-dominant side (p < 0.01). The average peak strength at 60 degrees/s external eccentric contraction was lower than that of internal concentric contraction in the dominant arm, but was higher in the non-dominant arm. Six of the ten subjects reported a shoulder problem, described as a diffuse pain located laterally on the dominant shoulder. CONCLUSIONS: These elite volleyball players had a lower range of motion (internal rotation) and relative muscle imbalance in the dominant compared with the non-dominant shoulder.

Adult↗