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PubMedDate not supplied

[Efficiency of a postoperative treatment after rotator cuff repair with a continuous passive motion device (CPM)].

AIM: The main objective of this study was to prove that a postoperative combined continuous passive motion (CPM) and physiotherapy treatment protocol (CPM group) can achieve 90 degrees active abduction in the shoulder joint earlier than physiotherapy alone (PT group). The indication was a complete tear of the rotator cuff. METHOD: The study was conducted under in-patient and out-patient conditions. 55 patients were included in this study. The prospective, randomized multicenter study design complies with DIN EN 540. The primary endpoint was the time span until 90 degrees active abduction was achieved by the patients. RESULTS: Patients in the CPM group reached the primary endpoint on average 12 days earlier than the control group. This difference was statistically significant (p = 0.0292). Analyzing the secondary endpoints, e. g., pain and disablement, the results in the CPM group showed again advantages of the combined treatment protocol (CPM + physiotherapy). CONCLUSION: The postoperative treatment of a total tear of the rotator cuff with a combined continuous passive motion and physiotherapy protocol provided a significantly earlier range of motion in the shoulder joint than physiotherapy alone. There was no report of CPM-related adverse effects.

Double-Blind Method↗
PubMed1987

Postural load and the development of musculo-skeletal illness.

Early in the 1970s, high rates of sick-leave due to musculo-skeletal complaints were frequently recorded among workers at Standard Telefon and Kabelfabrik's (STK's) factory in Norway. Workstations were redesigned according to ergonomics principles that allowed workers a wider choice of working postures and following their introduction in 1975, there was a marked reduction in sickness absence. Postural load was studied in groups of female workers in well defined assembly tasks. Trapezius load was recorded by electromyography (EMG). Simultaneously, postural angles of the upper arm in the shoulder joint and flexion/extension of head/neck and back were measured by using pendulum potentiometers. A quantitative relationship was found for the group between its median value of static trapezius load and the development of musculo-skeletal sick-leave, as a function of length of employment. Further support for a relationship between musculo-skeletal injury and trapezius load was found for the same subjects who suffered less musculo-skeletal sick-leave, consistent with the reduced trapezius load when working at the redesigned work stands. The relationship between postural load and musculo-skeletal injury was studied in comparable groups of the female workers with respect to age, working hours per day and time of employment. Psychosocial problems, spare time activities and living habits of workers did not show any significant difference across the groups. Postural load, both in terms of the magnitude of the flexion angle of the upper arm in the shoulder joint and the distribution of the work load between flexors and extensors, appeared to influence the incidence of load-related musculo-skeletal illness in the upper part of the body. The incidence of musculo-skeletal sick-leave in a group of workers with a median static trapezius load of about 1 to 2% MVC (Maximum Voluntary Contraction) for most of the work day, was approximately the same as for a group of comparable female workers without continuous work load. This suggests that a static trapezius load level of about 1% MVC is acceptable for the major part of the work day if adequate breaks in the load pattern are allowed when needed. At the same time, a median arm flexion of 15 degrees and a median arm abduction less than 10 degrees indicate the amplitude of these angles for 50% of the recording time. No details about the work-pause pattern was obtained, therefore these limits are only a rough indication of an acceptable arm position.

Absenteeism↗
PubMed2006

[Observation on therapeutic effects of different needling methods at tiaokou (ST 38) on periarthritis of shoulder].

OBJECTIVE: To compare therapeutic effects of different needling methods at Tiaokou (ST 38) on periarthritis of shoulder. METHODS: Eighty cases of periarphritis of shoulder were randomly assigned to four groups. Tiaokou (ST 38) was selected in all the 4 groups. The treatment group were treated with penetration needling, and the control group A, B, C were treated by needling into 40 mm deep, needling into the subcutaneous tissue, sham acupuncture, respectively. Therapeutic effect was evaluated by Constant-Murley shoulder joint scale. RESULTS: The clinical effective rate was 100.0% in the treatment group and 68.4% in the control group A, 52.6% in the control group B, 38.0% in the control group C with significant differences as the treatment group compared with the control groups A, B, C (P < 0.05 or P < 0.01). And with no significant difference as the control group A compared with the control group B, C, and the group B with the group C (P > 0.05). CONCLUSION: Different needling depths of Tiaokou (ST 38) have different therapeutic effects, the penetration needling being the best and the sham needling being worse which can be used as control method.

Acupuncture Therapy↗
PubMed1998

Morphological study of mechanoreceptors on the coracoacromial ligament.

We performed gold chloride staining of coracoacromial ligaments removed at operation, observed the peripheral nerve endings in the ligament, and studied their distribution and changes with aging in order to clarify the proprioception of the shoulder joint. The coracoacromial ligament was found to contain four types of typical nerve endings: Pacinian corpuscles, Ruffini receptors, Golgi tendon organ-like receptors, and free nerve endings. In addition, non-typical Pacinian corpuscles and Ruffini receptors with non-typical morphology were present. There were also unclassifiable nerve endings with a morphology which did not fit any of the above categories. These typical, non-typical, and unclassifiable nerve endings were all widely distributed on the surface of the subacromial side at the insertion into the acromion and around the coracoid process in the ligament. Free nerve endings were found sporadically on the surface of the subacromial bursal side in the ligament. The resected coracoacromial ligaments (23 specimens) were divided into two groups based on the disorder that required surgery: a fracture group without subacromial impingement (5 specimens) and a group with subacromial impingement (18 specimens). Age-related changes in the number of nerve endings were compared in each group. The total number of nerve endings decreased with age in both groups. The number of Pacinian corpuscles, Ruffini receptors, Golgi tendon organ-like receptors, and free nerve endings of typical morphology tended to decrease with age. The data from the fracture and subacromial impingement groups were not analyzed statistically because of the difference in the number of specimens in each group. However, the total number of nerve endings was lower in the subacromial impingement group than in the fracture group at all ages. The typical nerve endings of the coracoacromial ligament in both groups tended to decrease in the elderly, suggesting that the proprioception of the shoulder joint may become impaired with aging.

Acromioclavicular Joint↗
PubMed1990

Postural maintenance during movement: simulations of a two joint model.

Voluntary movements of the upper body are accompanied by anticipatory postural adjustments to the lower body in a standing subject. The long-standing hypothesis is that these anticipatory adjustments serve to counteract the perturbation to the body's center of gravity caused by the voluntary arm movement. This paper presents model simulations investigating the possible roles of anticipatory postural activity that accompanies a rapid, upward arm swing. The model incorporates two (idealized) antagonistic muscle pairs controlling the movements of a double-joint system, with a "shoulder joint" between the arm and stiff body links, and an "ankle joint" between the stiff body-leg segment and the ground. Each muscle is represented by a nonlinear viscoelastic element and also includes proprioceptive feedback. Four inputs to the model define the motor control signals for muscle force generation in both the arm and the postural muscle pairs. The neurological component of the model describes consequences of alternate strategies for cocontractions, stretch reflex activity, and anticipatory and synchronous postural activities (or combinations thereof). Simulations with this model show that: (1) none of the postural maintenance schemes considered in these simulations (including varying anticipation) could suppress the initial backward thrust on the body link; (2) the more important destabilizing perturbation is a subsequent forward sway that, left uncountered by postural activity, would eventually leave the body to fall flat on its face; and (3) anticipatory silencing of the postural extensor followed by a brief period of extensor activation (descending control) and synchronous reflex activity (feedback control) appears to be the most likely postural stabilizing strategy that inhibits the continuous forward sway and is consistent with the experimental evidence.

Arm↗
PubMed1985

Overloading changes in the motor system occurring in elite gymnasts.

Top-level gymnasts were examined in 1976 and in 1980. During both examinations X-ray osteal changes as a result of training were found. In 1980 complaints of pain during the training process were analyzed. It was found that radiological changes appeared in the elbow joints (73.2%), spinal column (65.8%), in the area of the shoulder joints (59.8%), and in the wrist joints (58.5%). The L-S segment of the spinal column had such anomalies as schistorrhachis of the S1 arc, lumbarization, and sacralization. A characteristic feature was the frequent discrepancy between complaints of pain and radiological changes. In many cases permanent radiological changes were not accompanied by pain. Longer training periods were associated with more pronounced changes. It was concluded that radiological examinations should be one of the criteria for selecting gymnasts and a change in the FIG regulations is proposed to reduce the work load of the motor system.

Adolescent↗
PubMed1987

General and local [corrected] aetiologic factors in canine osteochondrosis.

Observations based on necropsy findings in 89 dogs with osteochondrosis are presented. Osteochondrosis was most common in the elbow joint, followed by the shoulder joint, the stifle and the hock joint. There were 59 male and 30 female dogs, and the mean age was 2 years. The high frequency of bilateral lesions and the occurrence of osteochondrosis in more than one pair of joints in 25 of the 89 dogs indicates that general factors are important. The various manifestations of osteochondrosis and their frequency are reported. Various local factors believed to be important for the occurrence of the lesions within the joints are also considered.

Animals↗
PubMed1975

Malignant schwannoma of the brachial plexus in a dog.

A 4-year-old Labrador bitch was presented for veterinary examination with a history of lameness and muscle atrophy of the left forelimb. On clinical examination a painful mass was detected medial to the left shoulder joint. Radiographs of the shoulder showed mineralisation of this mass. Exploratory surgery revealed a tumour involving the radial nerve, axillary nerve and the trunk of the median and ulnar nerves. Histopathologic diagnosis was a malignant Schwannoma.

Animals↗
PubMed1997

[Value of ultrasound of the support and locomotor system--with special reference to radiation exposure and cost reduction].

In recent years, ultrasonic assessment of the locomotory system has become established both as a screening method in patients with chronic disorders and for evaluating acute injuries. Thanks to technical improvements to the equipment (use of high-frequency probes up to 20 MHz), ever smaller structures can be visualized. Ultrasonography can be carried out immediately following the clinical- and possibly radiological-assessment, by one and the same investigator, and requires little extra time. A bilateral examination in particular permits good evaluation of the extent of an injury and, with appropriate experience and good-quality equipment, an accurate assessment of the anatomical topography. Ultrasonography should now be used as the primary imaging method in the diagnosis of injuries to the following parts of the locomotory system, thus helping to minimize the number of expensive, and more invasive, diagnostic procedures: muscles and tendons, peri-articular soft tissue (in particular shoulder, knee and elbow joints), detection of intra-articular effusions, collections of fluid and, where applicable, ultrasonically guided puncture. In numerous other problems, too (postoperative complications, foreign bodies, fractures, osteomyelitis, soft tissue inflammation, etc.), ultrasound can deliver the first information. In this way, expensive diagnostic techniques can be reserved for special cases only, thus reducing costs. Furthermore, used as an adjunctive method, ultrasonography can reduce the number of diagnostic and follow-up X-rays in the case of injuries to the AC joint, shoulder dislocations, Hill-Sachs lesions, fractures in children, and for the detection of foreign bodies, again reducing radiation exposure and overall costs.

Cost Savings↗
PubMed1990

Treatment of suppurative arthritis by percutaneous catheter drainage.

Percutaneous catheter drainage to treat suppurative arthritis was performed in five joints in five patients. Joints drained included the hip in two cases and one case each of a hip joint prosthesis, an ankle joint, and a glenohumeral joint. Organisms isolated from the joints included Staphylococcus aureus in one hip joint and the hip prosthesis, and Haemophilus influenzae in the ankle joint. Specific organisms were not isolated in the other hip joint or in the shoulder joint. Systemic antibiotic therapy was used in all five patients, and in two patients gentamicin was instilled through the catheters. Joint infection was managed successfully with catheter drainage and antibiotics in three patients. In all three cases, the range of motion was restored and the patients became free of pain after catheter drainage. These three patients remained asymptomatic at follow-up ranging from 3 weeks to 9 months. In two patients, percutaneous drainage failed. In one patient, the catheter positions could not be maintained and the catheters repeatedly became dislodged. In the other, superimposed osteomyelitis necessitated surgical debridement. No complications occurred. Our experience suggests that suppurative arthritis can be successfully treated with drainage of the joint via a percutaneous catheter in combination with antibiotic therapy.

Adult↗
PubMed1992

[Arthroscopy of the shoulder].

Shoulder arthroscopy has grown considerably for several years in a row. The progress obtained nevertheless should not lead to an underrating of both clinical and para-clinical investigations. Arthroscopic technique as applied to the shoulder joint has now reached a mature state. Diagnostic benefits due to arthroscopy are scant because the recent development of medical imaging techniques made its usefulness less obvious. A great number of reliable therapeutic acts are currently performed as well in the glenohumeral joint, as in the sub-acromial space.

Arthroscopy↗
PubMed2000

Understanding multidirectional instability of the shoulder.

OBJECTIVE: To provide an overview of the evaluation and treatment of the patient with multidirectional shoulder instability. DATA SOURCES: I searched MEDLINE for the years from 1980 to 2000 using the key words "shoulder joint," "instability," "dislocation," "multidirectional shoulder instability," and "inferior capsular shift." DATA SYNTHESIS: Multidirectional instability is symptomatic glenohumeral subluxation or dislocation in more than 1 direction: anterior, inferior, or posterior. The primary pathology is a loose and patulous capsule, and the entity is more common than previously recognized. Multidirectional instability affects young, sedentary patients with generalized ligamentous laxity, often with bilateral symptoms and an atraumatic history, but it also affects athletes, many of whom have sustained injuries. Patients with multidirectional instability may also have Bankart lesions and humeral head impression defects. CONCLUSIONS/RECOMMENDATIONS: Patients with multidirectional instability must be identified before appropriate treatment can be initiated. If a course of rehabilitation fails to improve the patient's symptoms, an inferior capsular shift procedure has been demonstrated to be an effective surgical option.

Journal Article↗
PubMed2003

Kinetics of the upper extremity in the open and square stance tennis forehand.

Seven right-handed teaching professionals and eight intermediate tennis players were filmed using two high-speed cameras (100 Hz) as they performed open and square stance forehand drives. Three-dimensional coordinates (3D) were reconstructed using the DLT method. A three-segment rigid body model of the racket and upper extremity was used to calculate the kinetics of the wrist, elbow, and shoulder joints up to impact. The open stance created lower resultant velocities of the racket at impact (21.2 and 15.8 m/s) than the square stance (22.3 and 16.4 m/s) for professional and intermediate subjects, respectively. The largest components of the resultant joint torques were generated by the shoulder horizontal adductors, followed by elbow varus torques, and shoulder internal rotation torques. Torques were similar across stance and skill level except for significantly (p < 0.05) greater peak shoulder internal rotation torques in the square compared to the open stance, greater peak wrist flexion torques in the intermediate compared to the professionals, and greater peak wrist flexion torques in the square stance compared to the open stance. The data did not support the hypothesis that the open stance technique creates greater loading throughout the upper extremity than the square stance technique. Peak upper extremity torques were similar to peak torques reported for baseball pitching and represent loads that could contribute to strength imbalances and overuse injuries.

Biomechanical Phenomena↗