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In this case report, an atypical impingement in a 40-year-old male patient with terminal restrictions in the shoulder joint is used to show the development of an atypical synovial fold through the sublabral hole with protrusion into the glenoid fossa.
A simple and inexpensive battery-powered device was constructed to alert a patient with left hemiplegia and left-sided neglect when his flaccid upper extremity was in a dependent position. The patient was instructed to retrieve his left extremity with his functional arm and place it on a lapboard. This decreased the mechanical forces placed on the shoulder joint. Concomitantly, his complaint of left shoulder pain decreased while his range of motion (ROM) increased. Because of on-going physical and occupational therapy, his symptomatic relief and increased ROM could not be attributed solely to this device, but it gave him greater control over his own treatment. The use of this device may result in increased awareness of the involved extremity as well as greater carry-over into activities of daily living.
Because of the anatomy and biomechanics intraarticular pressure modifications are caused by loading and movement of a joint. These continuous pressure alterations are examined in the hip joint of cadavers and in the shoulder-joint of cadavers and volunteers. The clinical importance is shown. The hereto hardly know changes of intraaticular pressure cause a strong synoviamovement and serve the provisioning of the joint-cartilage with the help of the changing, pressure pump-system.
A new operative approach is presented for treatment of fractured distal end of clavicle associated with recurrent anterior shoulder subluxations. One case is presented in which open reduction of the fractured clavicle and stabilizing the anterior shoulder joint were accomplished by transfer of the coracoid process with its attached muscles under the subcapularis muscle onto the clavicle. The operation was followed by complete reduction of the fracture and a stable shoulder joint.
A theoretical framework is presented that describes a way in which the inverse dynamics equations of motion of planar two-joint arm movements (EX-model) are reformulated in a simple form. A single point was assumed to define both the wrist and elbow joint centers, and thus the motion of two points in extrinsic space was represented by second-order differential equations to provide the variables in the reformulation (RE-) model. Through an analytical processes, it was shown that the RE-model for reproducing the shoulder joint torque consists of the linearly scaled moment per unit mass responsible for accelerating the wrist and elbow points about the shoulder joint, while that for reproducing the elbow joint torque consists of the linearly scaled moment per unit mass responsible for accelerating the wrist point about the elbow. The scaling factors for variables in the RE-model were based solely on the values for segment lengths, while in the EX-model the inertial parameter data for the segments are involved in its representation. The inertial parameter data of six-arm specimens from the cadaver experiment of Chandler et al. (1975, AMRL Technical Report, Wright-Patterson Air Force Base, OH) were used to develop and verify the numeric solutions of the RE-model. The adequacy of the model varied somewhat among subjects, but minor changes of the physical parameters of the arm segments enabled perfect reformulation, regardless of the specimens. The potential abilities of the RE-model to deal with the complexities in motor control with more simple control schemes are discussed.
Scapular dyskinesis is an alteration in the normal position or motion of the scapula during coupled scapulohumeral movements. It occurs in a large number of injuries involving the shoulder joint and often is caused by injuries that result in the inhibition or disorganization of activation patterns in scapular stabilizing muscles. It may increase the functional deficit associated with shoulder injury by altering the normal scapular role during coupled scapulohumeral motions. Scapular dyskinesis appears to be a nonspecific response to shoulder dysfunction because no specific pattern of dyskinesis is associated with a specific shoulder diagnosis. It should be suspected in patients with shoulder injury and can be identified and classified by specific physical examination. Treatment of scapular dyskinesis is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain-based rehabilitation protocols.
The trotting gait of 4 approved Swedish Warmblood stallions with a mean gait score > or = 8.67 (maximum score = 10) at official performance tests was recorded by high speed film (approximately 250 frames/sec). Angular patterns and hoof trajectories of the left fore and hind limbs were analysed, and presented as mean and standard deviation curves. The horses had a mean stride duration of 794.0 msec (sd 13.7) and the mean diagonal advanced placement was +29.8 msec (sd 7.6). The variation in angular patterns between the horses was greatest during the swing phase. The trajectory of the hind hoof reference point and the shoulder joint angle showed the largest maximum variation (44 and 29% of the total range, respectively). The swing phase retraction was much longer in the forelimbs than the hind limbs. The shoulder joint angle, fore and hind fetlock joint angles, hock joint angle and pelvis inclination decreased during the first part of the stance phase and are assumed to be important for weight absorption and storage of elastic strain. Kinematic gait analyses have potential in the selection of performance horses.
On the one hand synovial chondromatosis is a rare disorder and usually involves the knee and hip but rarely the shoulder joint. On the other hand bursal causes of impingement are rare too. We report a case of synovial osteochondromatosis presenting as chronic impingement syndrome in a 44 year old hobby tennis player. In the course of four years impingement problems and a "tumorous" growth on the outer surface attacked attraction to the patient. An MRI presented several nodular structures with sclerosis in the anteriomedial region of the shoulder joint. The mass was completely removed by operative treatment. The histological result showed a synovial chondromatosis with chronical synovitis. After the operative exstirpation of the calcified bodies the patient had no discomfort for 15 months and is now able to play tennis again.
The principles ot total joint arthroplasty recently have been expanded to the upper extremity, following the dramatic success with total hip and total knee replacement procedures. New problems have been encountered with the rebalancing of the soft tissues and the technical nature of joint mechanics in the upper extremities. Work on shoulder joint replacement is in the very early stages and of unknown success. Several prostheses are being used and tested. For elbow and wrist replacement, early and predictable success has been accomplished, enabling relief of pain and satisfactory motion. Total joint replacement in the fingers and thumb has provided excellent relief of pain but has been hindered by difficulties in rebalancing the soft tissues in patients with rheumatoid arthritis. It appears that total reconstruction of arthritic upper-extremity joints will be commonplace in the not-too-distant future. Clinical trials are being expanded, with increasing success.
The functional interpretation is delivered of the principal morphological subdivisions of the paired limbs in the vertebrate animals, that is of the girdles and free parts. To distinguish between those, the functional criteria are suggested. On this basis the variants are considered of suspension of the fore and hind limbs in various groups of Gnathostomata. In the hind limbs the boundary between the girdle and the free part does always pass through the hip joint. In the fore limb the corresponding boundary passes through the shoulder joint in fishes. However, in most tetrapods it shifts proximally due to the release of the scapulocoracoid mobility. This tendency reached its maximum in turtles and viviparous mammals. The main attention is paid to the analysis of the arrangement of the scapulocoracoid suspension in various groups of tetrapods.
Arm lymphedema can produce an additional burden from a psychosocial point of view. Although edema reduction through treatment can be an advantage in terms of reduced weight of the arm and simplified clothing needs, the purpose of the present study was to register changes in psychosocial parameters during one year after treatment. Thirty-five patients underwent liposuction combined with postoperative CCT (Controlled Compression Therapy), while 14 received CCT alone. Edema volume and range of motion in the shoulder joint were measured and effects on quality of life were assessed with various questionnaires. Liposuction+CCT removed the arm lymphedema completely, whereas CCT alone reduced it by half. The treatments improved range of motion in the shoulder joint and patients' quality of life in relationship to the volume reduction. Liposuction+CCT improves patients' quality of life, particularly qualities related to the volume reduction and hence qualities associated with everyday activities. CCT is beneficial too, but the effect is less obvious than when combined with surgery, probably because the edema reduction is less. The consequences of arm lymphedema for more psychologically oriented qualities and social life in general seem to be less serious and we found few notable effects of treatment in these domains.
Double contrast arthrography, a method in which a dye and then oxygen is injected, can be used to visualize pathologic changes in the knee joint, that otherwise cannot be recognized preoperatively. In 28 cases in which the procedure was carried out there was no evidence of damage owing to it. This method is worthy of consideration for visualization of conditions in the shoulder joint, hip, or any joint having a distensible cavity.
OBJECTIVE: To compare the peak whole-body center of mass (COM) velocities and joint angular contributions in successful and unsuccessful sit-to-stand (STS) trials in a subject with traumatic brain injury (TBI). DESIGN: Single-case study. SETTING: Motion research laboratory. PARTICIPANT: A 24-year-old man who was 3.5 years post-TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak horizontal and vertical velocities of the whole-body COM and peak angular velocities of the ankle, knee, hip, and shoulder joints. RESULTS: The peak whole-body COM vertical velocity was significantly lower in the unsuccessful STS trials. Angular velocities at the hip, knee, ankle, and shoulder joints in successful trials exceeded those in unsuccessful trials (P<.001). The subject's peak knee extension velocity was the single major predictor of the peak whole-body COM vertical velocity (r(2)=.90). Knee extension angular velocities greater than 3.25 radian/s were associated with successful STS trials. Knee extension angular velocities between 2.75 and 3.25 radian/s were associated with successful rising 50% of the time; the subject had no success in rising when velocities were less than 2.75 radian/s. CONCLUSIONS: For this subject, sit-back failures occurred in STS attempts characterized by peak whole-body COM vertical velocities that were lower than those generated in successful rising trials. These unsuccessful rising attempts were primarily the result of the subject's inability to generate sufficient knee extension angular velocity.
Radiographs and medical and surgical records of 51 patients following spinal injury have been reviewed. All the patients had been paraplegic for 20 years or more at the time of the survey. The reason for the survey was to assess the incidence of degenerative change of the hips, sacroiliac and shoulder joints in patients following spinal injury. Our review indicates that the number of paraplegic patients who develop degeneration of hip and sacroiliac joint changes is less significant than has been previously reported. Analysis of our figures has revealed certain important associations which predispose these patients to joint degeneration. The associations (anatomical level of injury, urinary tract infections, and the level of the patients' activity) with joint degeneration are described.
OBJECTIVE: To assess results of exchange nailing in nonunion after intramedullary (IM) nailing of humeral shaft fractures. METHODS: This was a retrospective study; 24 patients with nonunion after IM nailing of humeral shaft fractures were reviewed. In 13 cases, nonunion was treated using exchange nailing, and 11 patients were treated nonoperatively. Union was assessed from radiographs. Shoulder joint symptoms and function were assessed after a mean 4.7 years' follow-up using Constant-Murley scoring and self-administered questionnaires devised by L'Insalata et al. RESULTS: Single or repeated exchange nailing resulted in union in 6 of 13 patients. Shoulder joint function was satisfactory (mean Constant-Murley score of 72) for those patients whose fracture eventually united and poor (mean Constant-Murley score of 39) for those left with nonunion. CONCLUSION: Exchange nailing results in a poor union rate in nonunion after IM nailing of humeral shaft fractures. Permanent nonunion of the humeral shaft leaves the patient with severe disability.
The starting point of the retrospective analysis of 177 primary dislocations was the question of frequency of habitual dislocations, the correlation between habitual dislocation and time of early immobilisation, as well as the search for additional statements which would result in a differentiated therapy. 18.1% habitual dislocations were seen to develop, mostly after immobilisation for less than three weeks. It is an interesting fact that the technique of immobilisation made no difference. We found that after the first even there was generally no loss in function, whereas 14.5% of the men and 34.3% of the women complained of severe subjective symptoms. The 12 patients who underwent an operation because of habitual dislocation suffered neither from dysfunction nor from painful movement, and no dislocation was found. The rate of habitual dislocation in our patients showed a lower rate of dislocation of the shoulder joint. We found 18.1% dislocations, whereas the literature showed an average quota of 30%. To improve the results we recommend a special X-ray technique following the first reposition. In the age group between 20 and 30 years, which is most susceptible, we also recommend arthrography and arthroscopy of the shoulder joint. To improve typical lesions, such as osseous rupture of the capsule or what is known as Hill-Sachs lesions, primary operation is discussed as an alternative treatment.
Studies on 574 subjects demonstrated the prevalence of shoulder pain and its relationship to occupational work load and psychosocial factors. The prevalence of shoulder pain was 14% (13% men, 15% women). Women had more often myalgias with a tenderness on palpation of the shoulder muscles and rhizopathia-brachialgia type of pain, whereas men had mainly intraarticular pain. Three percent had been on sick leave because of shoulder pain in the year preceding the examination and 5% had a reduced range of shoulder joint motion. The subjects with shoulder pain were less satisfied with their jobs and had been less successful in a childhood intelligence test. No difference could be demonstrated between subjects with or without shoulder pain in estimated overall work load, but women with signs of supraspinatus tendinitis more often had jobs with physical demands.
OBJECTIVE: The authors' purpose was to report their experience with the use of locked nails in treating humeral surgical neck nonunions. Locked nailing has the advantages of minimal soft tissue trauma, automatic fracture reduction, and stable fracture fixation. METHODS: Excluding 3 patients with severe medical illness, a total of 15 consecutive patients with 15 nonunions were treated by humeral locked nailing and bone grafting. Delay from trauma to surgery averaged 13.8 months, and 10 patients had previous operations. The average age of patients was 55.1 years; average follow-up time was 22.4 months. There were two hypertrophic and 13 atrophic nonunions. The average preoperative Neer score for shoulder joints was 53.5. All but three cases had varus deformity, with an average angle of 32.3 degrees. RESULTS: Seven nonunions were nailed with 8-mm nails and eight with 7-mm nails. With a single operation, all but one patient achieved osseous union in an average of 5.4 months. This one patient, who had a Neer score of 72, refused further surgery. At follow-up, 13 of the 15 patients had excellent or good functional recovery of shoulder joints, with an average Neer score of 86.7. Four patients had residual varus angulation averaging 15.5 degrees. For patients with solid union, the average range of shoulder motion was 152.3 degrees in flexion and 146.4 degrees in abduction. No patients had significant limitation of elbow motion. Three patients had occasional shoulder pain and no patients had evident shoulder impingement. CONCLUSION: For humeral surgical neck nonunions in which the head fragment still preserves the greater tuberosity, locked nailing with transfixing screws appeared to be a useful alternative, especially in fractures with osteoporosis, severe varus deformity, or severe soft tissue scarring.