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PubMedDate not supplied

Glenohumeral joint kinematics and kinetics for three coordinate system representations during wheelchair propulsion.

The shoulder plays a very important role during manual wheelchair propulsion. Unfortunately, substantial numbers of manual wheelchair users eventually develop shoulder injury or pain. Recently, studies have begun to investigate the etiology of wheelchair user shoulder injuries. This study compared three coordinate systems used to represent the shoulder during wheelchair propulsion. Our results show statistically significant differences between the three shoulder representations analyzed. Differences are seen for individuals and for the subjects as a group. Based upon our results, the fixed-z model appears preferable over the other representations due to its simplicity, low hardware requirements, and the similarity of the results to the free representation. This article also provides some insight into maximal shoulder joint forces and moments recorded during manual wheelchair propulsion. Future work should include more sophisticated models of the shoulder complex.

Acceleration↗
PubMed2004

Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial.

OBJECTIVE: To determine whether arthrographic distension with a mixture of saline and steroid, in patients with painful stiff shoulder for at least 3 months, is better than placebo in improving function, pain, and range of motion at 3, 6, and 12 weeks. METHODS: A randomised, placebo controlled trial with participant and outcome assessor blinding in which shoulder joint distension with normal saline and corticosteroid was compared with placebo (arthrogram). Outcome measures, assessed at 3, 6, and 12 weeks, included a shoulder-specific disability measure (SPADI), a patient preference measure (Problem Elicitation Technique (PET)), pain, and range of active motion. RESULTS: From 96 potential participants, 48 were recruited. Four withdrew from the placebo group after the 3 week assessment and three subsequently received arthrographic distension with saline and steroid. At 3 weeks, significantly greater improvement in SPADI (p = 0.005), PET, overall pain, active total shoulder abduction, and hand behind back was found in participants in the joint distension and steroid group than in the placebo group. At 6 weeks the results of the intention to treat analysis favoured joint distension, although the between-group differences were only significant for improvement in PET (difference in mean change in PET between groups = 45.9 (95% CI 3.2 to 88.7). Excluding the four withdrawals, the between-group differences for the disability and pain measures significantly favoured distension over placebo. At 12 weeks, both the intention to treat analysis and an analysis excluding the four withdrawals demonstrated a significantly greater improvement in PET score for the distension group. CONCLUSIONS: Short term efficacy of arthrographic distension with normal saline and corticosteroid over placebo was demonstrated in patients with painful stiff shoulder.

Anti-Inflammatory Agents↗
PubMed2002

Utilization and compensation of interaction torques during ball-throwing movements.

The manner in which the CNS deals with interaction torques at each joint in ball throwing was investigated by instructing subjects to throw a ball at three different speeds, using two (elbow and wrist) or three joints (shoulder, elbow, and wrist). The results indicated that the role of the muscle torque at the most proximal joint was to accelerate the most proximal joint and to produce the effect of interjoint interaction on the distal joints. In the three-joint throwing, shoulder muscle torque produced the assistive interaction torque for the elbow, which was effectively utilized to generate large elbow angular velocity when throwing fast. However, at the wrist, the muscle torque always counteracted the interaction torque. By this kinetic mechanism, the wrist angular velocity at the ball-release time was kept relatively constant irrespective of ball speed, which would lead to an accurate ball release. Thus it was concluded that humans can adjust the speed and accuracy of ball-throwing by utilizing interaction torque or compensating for it.

Adult↗
PubMed1986

[Connection of the ligamentum coracoglenoidale with the muscular pectoralis minor].

The ligamentum coracoglenoidale and its connection with the m. pectoralis minor are described. We have found three different shapes of this ligament. In 47% of the dissected specimens it was a strong round ligament, and in 39% it was a membraneous ligament that always inserted above the lig. coracohumerale. In 14%, separation of the lig. coracoglenoidale from the lig. coracohumerale at the coracoidal insertion was either impossible at all or only feasible by sharp dissection. In 16% we found a bundle of fibres of the m. pectoralis minor running over the processus coracoideus towards the head of the scapula. In two instances this bundle inserted at the humeral head. Possibly, there is a similar function as that of the meniscotibial and the meniscofemoral ligaments of the knee joint. A connection with the 'impingement syndrome' of the shoulder joint will be the base of further investigations.

Adolescent↗
PubMedDate not supplied

[Shoulder-hand syndrome in patients after stroke].

Basing on the literature, the information on the shoulder-hand syndrome in stroke patients is presented. The syndrome is believed to be a clinical form of algodystrophy of the upper extremity. The main signs and symptoms include pain and considerable reduction of movement in shoulder joint, wrist and hand. The condition usually develops 1-6 months after stroke with pain and loss of range of motion in the shoulder at the beginning; then the distal part of the extremity is involved. The syndrome is considered to develop in three consecutive phases: I--acute, II--dystrophic and III--atrophic. Besides classical clinical form, affecting distal and proximal part of extremity, the incomplete forms confined only to one of this parts may exist. The prevalence of the condition is rated at 12.5-27% in stroke patients. It is believed that the development of the syndrome is related to altered biomechanics of the hemiplegic shoulder. Stability of the joint is considerably affected due to paresis or palsy of shoulder girdle muscles what results in partial subluxation of humeral head. Repeated microtraumas of shoulder joint may cause chronic pain and may initiate development of abnormal, regional sensory-sympathetic reflex arch, or--according to the other concept--it results in "sensitization" of neurons in the dorsal horn; this state may alter dorsal horn central mechanisms processing sensory and painful stimuli. The diagnosis of the syndrome is based on clinical ground. Three-phase bone scintigraphy is believed to be the most useful additional diagnostic test. The diagnostic and predictive value of this technique is presented. For all advantages of scintigraphic examination, it does not need to be performed in the majority of stroke patients since the presence of typical signs and symptoms is usually sufficient to make a diagnosis. The treatment of shoulder-hand syndrome included administration of steroids with satisfactory response. The role of proper physical therapy in improving of the results of treatment as well as in prophylactics of the syndrome is emphasised. Considering the fact that many of stroke patients may have contraindications to steroid therapy, other methods of effective treatment are proposed.

Cerebrovascular Disorders↗
PubMed1998

[Current status of shoulder arthroscopy].

Arthroscopic and open shoulder surgery have to be combined for a successful surgical therapy of the shoulder joint. A surgeon performing open surgery only or just treating by arthroscopic measurements can not cover the full spectrum of modern shoulder surgery. Isolated diagnostic arthroscopy is rarely indicated. Far more common, diagnostic arthroscopy is combined with an operative procedure both to confirm preoperative assessment of pathology and to uncover associated lesions. The results of arthroscopic stabilisation of chronic anterior posttraumatic dislocations fail to compare with high success rates of open procedures. Better patient selection will probably be the key to improving results. In case of acute traumatic first time dislocation in young highly sportive athletes the arthroscopic repair of the isolated Bankart-Perthes lesion offers the attractive advantage of anatomic reconstruction with minimal soft tissue dissection. Further indications for arthroscopic measurements of pathologies of the glenohumeral joint are synovectomy in rheumatoid arthritis, capsulotomy of shrunk capsule in frozen shoulder and tenodesis for lesions of the long head of the biceps. The arthroscopic subacromial decompression according to Ellman is the most often and successful performed procedure at the shoulder joint and has overcome the classic Neer open acromioplasty. For smaller tears of the supraspinatus tendon the arthroscopic acromioplasty can be combined with an all arthroscopic suture repair or with an mini-open repair. Larger tears of the rotator cuff are still the domain for open reconstructive procedures. In case of associated or isolated AC-joint arthritis an arthroscopic Mumford procedure can be performed. For chronic calcific tendinitis isolated arthroscopic excision of the calcium deposit is of great value. Additionally, acromioplasty is needed for true mechanical obstruction of the subacromial space.

Acromioclavicular Joint↗
PubMed2005

Clinical features and microbiology in 204 cases of septic arthritis in Malawian children.

We examined 204 children (137 boys and 67 girls) aged 12 years and under with septic arthritis. Their mean age was 31.1 months (1 to 144; SD 41.6). The most common joints affected were the knees and shoulders. Joints in the upper limb were affected more often in younger children and in the lower limb in those who were older. The mean age for an infection was 12 months in the shoulder and 73 months in the hip. The most common organisms cultured were species of Salmonella.

Age Distribution↗
PubMedDate not supplied

Suprascapular axonotmesis and rheumatoid disease: report of a case treated conservatively.

Axonotmesis of the suprascapular nerve mimics rupture of the musculotendinous cuff of the shoulder. Arthrography of the shoulder joint and electromyographic studies of the shoulder muscles are essential in arriving at the proper diagnosis. Axonotmesis of the suprascapular nerve should be suspected in the patient who presents with signs of ruptured musculotendinous cuff and who has a normal arthrogram.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Radiographic analysis of the acromion in the loose shoulder.

To investigate the contribution of bony stability to the pathogenesis of the loose shoulder, geometric parameters of the acromion by use of cineradiography were evaluated in patients with a loose shoulder and compared with those in the normal shoulder. One hundred twenty healthy individuals and eighty-two patients were enrolled. To evaluate the size of the acromion and the coverage of the humeral head by the acromion, the anterior width of the acromion and three angle parameters were measured. The findings demonstrated that the loose shoulder had a relatively smaller and more upwardly inclined acromion that was against the glenoid and provided less coverage of the humeral head. These characteristics of the acromion may contribute to the hypermobility and functional instability of the shoulder joint observed in patients with a loose shoulder. Therefore, a radiographic evaluation of the geometry of the acromion is important to determine the pathogenesis of the loose shoulder.

Acromion↗
PubMed1983

Crystal populations in human synovial fluid. Identification of apatite, octacalcium phosphate, and tricalcium phosphate.

Defatted joint fluid pellets from 4 patients with the "Milwaukee shoulder" syndrome, an aspirate of milky fluid from subcutaneous tissue of a girl with dermatomyositis/calcinosis, and 2 rabbit synovial membranes calcified by calciphylaxis were studied by Fourier transform infrared analysis. This method permits sequential electronic subtraction ("stripping") of known patterns of highly characterized reference compounds from an unknown sample pattern. Collagen and hydroxyapatite, with carbonate partially (1-3%) substituted for phosphate, and to a lesser extent hydroxyl, were found in all samples. Octacalcium phosphate (OCP) was found in all samples except that from a patient with synovial chondromatosis which contained tricalcium phosphate (TCP). Sulfate was found in 2 of the shoulder joint fluid specimens. An unidentified organic phase was present in all samples. This study confirms recent observations by others that pathologic calcifications contain several mineral phases. These data raise the possibility that hydroxyapatite nucleation may be controlled by hydrolytic alteration of precursor calcium phosphate phases such as OCP or TCP. Studies of the biologic effects of synthetic calcium phosphate crystals must take into account the existence of several crystalline phases in natural pathologic calcifications.

Animals↗
PubMed1999

Automatic synthesis of synergies for control of reaching--hierarchical clustering.

In this paper we describe a novel method for determining synergies between joint motions in reaching movements by hierarchical clustering. A set of recorded elbow and shoulder trajectories is used in a learning algorithm to determine the relationships between angular velocities at elbow and shoulder joints. The learning algorithm is based on optimal criteria for obtaining the hierarchy of descriptions of movement trajectories. We show that this method finds complex synergism between optimal joint trajectories for a given set of data and angular velocities at the shoulder and elbow joints. Three other machine learning techniques (ML) are used for comparison with our method of hierarchical clustering of trajectories. These MLs are: (1) radial basis functions (RBF), (2) inductive learning (IL), and (3) adaptive-network-based fuzzy inference system (ANFIS). Better error characteristics were obtained using the method of hierarchical clustering in comparison with the other techniques. The advantage of the method of hierarchical clustering with respect to the other MLs is in integrating the spatial and temporal elements of reaching movements. Determination and analysis of spatio-temporal events of movement trajectories is a useful tool in designing control systems for functional electrical stimulation (FES) assisted manipulation.

Algorithms↗
PubMed2004

Isometric shoulder muscle activation patterns for 3-D planar forces: a methodology for musculo-skeletal model validation.

OBJECTIVE: To present an isometric method for validation of a shoulder model simulation by means of experimentally obtained electromyography and addressing all muscles active around the shoulder joints. BACKGROUND: Analysis of muscle force distribution in the shoulder by means of electromyography during motion tasks is hampered by artificial and non-linear amplitude modulation and is often limited to downward directed external forces. This application of EMG is therefore inadequate and insufficient for the validation of shoulder model simulations. We suggest an isometric method including multi-directional forces to overcome these problems. METHODS: A force with constant magnitude is actively rotated stepwise in 20 directions perpendicular around the arm while kept in one position. The isometric muscle activation (EMG) is a function of the clockwise-rotated force angle, characterized by baseline activation, and a section of increased muscle activation characterized by baseline interception and direction and magnitude of maximum muscle activation. Comparison of the parameterized muscle activation with predicted muscle forces from model simulation illustrates the applicability for musculo-skeletal model validation. RESULTS: All recorded shoulder muscles were active over a section of force angles of at least 180 degrees. Some muscles demonstrated two activation sections. The estimated model sensitivity for the baseline interception was SD=5 degrees -10 degrees. The Principal Action was the most reliable parameter (SD=4 degrees ). A correlation of 0.778 was observed between model simulations and EMG recordings. CONCLUSIONS: The methodology addresses all shoulder muscles over a substantial section of planar force directions. This enables the comparison of experimentally determined direction of activation on- and offset and direction of maximum activation with equivalent muscle forces, predicted from model simulation.

Algorithms↗
PubMed2004

Arthrography of the shoulder: a simple fluoroscopically guided approach for targeting the rotator cuff interval.

OBJECTIVE: The objective of this article is to describe a simplified fluoroscopically guided technique of shoulder joint injection that uses the rotator cuff interval. CONCLUSION: Shoulder arthrography using an anterior approach through the rotator cuff interval is an effective, rapid, and easy-to-perform injection technique. In most patients, this technique can be performed using a 1.5-inch (3.8-cm), 22-gauge needle.

Adolescent↗
PubMedDate not supplied

[The hyperostotic shoulder].

A systematic study of shoulder joints in 30 DISH patients demonstrates the frequency of shoulder involvement in this disease and its characteristic radio-clinical features. Radiological abnormalities observed in DISH shoulders are contrasted with those encountered in rotator cuff tears. However, both disorders can occur together, producing a "complex shoulder" syndrome. The most typical aspect of this is the presence of an osteoarthritic pseudoarthrosis between the greater tuberosity and the acromion which has developed from the subacromial enthesopathy.

Diabetes Complications↗
PubMed2003

Counteractive relationship between the interaction torque and muscle torque at the wrist is predestined in ball-throwing.

Many investigators have demonstrated that in swing motions such as ball-throwing, the motion of the proximal joint (shoulder) produced assistive interaction torque for the distal joint (elbow). In line with these studies, the shoulder and elbow motions would be expected to produce the assistive interaction torque for the wrist joint as well. However, we recently showed that the interaction torque at the wrist was always counteractive to the wrist muscle torque during ball-throwing. The purpose of this study is to clarify, by means of computer simulation, whether the counteractive relationship at the wrist during ball-throwing is caused by the neural contribution or the musculoskeletal mechanical properties of the human arm. First, we simulated the throwing motions of the normal forearm-hand model by systematically changing the proximal-to-distal delay of muscle activities and could line up two candidates for the determinant of the counteractive relationship: the rest angle (neutral angle) of the wrist and the length and mass of the hand. Second, we simulated the throwing motions of the virtual forearm-hand models, showing that only nonrealistic elongation of these two parameters produced the assistive relationship between the interaction torque and muscle torque. These results suggested that the mechanical properties of the human wrist are the main determinant of the counteractive relationship, which is advantageous for keeping the state of the wrist joint stable in multi-joint upper-limb movements and would lead to avoidance of excessive wrist extension or flexion and simplification of extrinsic finger control.

Adult↗
PubMed1993

Does the glenohumeral joint capsule have proprioceptive capability?

We performed a clinical study examining 60 volunteers with stable shoulder joints randomized to two groups. In group 1 we injected 5 ml lidocaine intra-articularly. In group 2 we injected 5 ml saline with 5 ml contrast dye the same way. After the injection we measured the amount of passive anteroposterior translation that occurred during anterior and posterior drawer tests and the amount of inferior subluxation during downward stress. We documented the extent of the passive glenohumeral translation using ultrasound. We had no complications related to the intra-articular injection or to the stability measurement. After the injection neither group had significant pain, and the patients were not apprehensive about the ensuing stability test. In group 1 (lidocaine) anteroposterior translation of 13.2 +/- 6.3 mm was seen in the anterior and posterior drawer test, whereas in group 2 (no lidocaine) the anteroposterior translation was only 6.8 +/- 3.2 mm. The difference between the two groups was statistically significant (P < 0.05). With downward stress during the sulcus test the distance between the acromion and the humeral head increased by 5.6 mm (+/- 3.2) in group 1 and by 2.7 mm (+/- 2.1) in group 2. This difference was also statistically significant (P < 0.05). Clinical consequences: Taking our preliminary findings into account, the capsule of the glenohumeral joint seems to have proprioceptive capability. Nerve fibres and mechanoreceptors seem to be localized in the capsule tissue, being part of a physiological feedback mechanism. If our conclusions proprioceptive capability. Nerve fibres and mechanoreceptors seem to be localized in the capsule tissue, being part of a physiological feedback mechanism.

Adolescent↗
PubMed1997

MR-guided joint puncture and real-time MR-assisted contrast media application.

OBJECTIVE: To develop, in MR arthrography of the shoulder joint, an MR-guided technique for localizing the needle puncture and confirming the intracapsular needle-tip position by visualization of the contrast media inflow. MATERIAL AND METHODS: Three unfixed human shoulder specimens were examined on a 1.0 T MR unit. On the basis of MR-compatible markers, the optimal entrance point for puncturing the joint was determined. The precise localization of the needle tip (MR-compatible 0.7-mm needle) in the shoulder joint was determined with rapid localizer GRE sequences in 2 orthogonal planes. To confirm the intracapsular position of the needle tip, diluted Gd-DTPA was applied via a long connecting tube and contrast medium inflow into the joint space was controlled on an LCD screen in real-time MR imaging (local-look technique). RESULTS: MR-compatible markers on the skin allowed the rapid determination of the optimal entrance point for needle puncture. An adequate localization of the intra-articular needle-tip position was possible in all specimens although significant artifacts were present on rapid localizer GRE sequences which resulted in an increase in the apparent width of the needle shaft. Real-time MR imaging of the contrast medium inflow was made possible by the local-look technique and LCD screen on the MR unit and this allowed confirmation of the intracapsular position. CONCLUSION: In MR arthrography of the shoulder, an MR-guided technique in conjunction with the LCD screen and real-time MR imaging would seem to be a practical alternative to conventional fluoroscopic guidance.

Artifacts↗
PubMed2004

Shoulder stiffness: diagnosis.

BACKGROUND: Pain and stiffness of the shoulder is a common complaint, particularly in the 40-80 years age group. There are several causes of painful, stiff shoulders, but the most common cause in the fifth decade of life is idiopathic capsulitis ('frozen shoulder'). OBJECTIVE: This article summarises the functional anatomy of the shoulder joint, the pathology of the conditions that lead to shoulder stiffness, and methods to differentiate them. DISCUSSION: Clinical history and examination is effective in differentiating rotator cuff tears, impingement and frozen shoulder. Restriction of glenohumeral joint motion, particularly in external rotation, with no abnormality on X-ray is strongly suggestive of the diagnosis of frozen shoulder. Plain true anteroposterior X-rays are important to identify glenohumeral joint arthritis. Ultrasound is often helpful for confirming or denying rotator cuff tears when there is doubt on the clinical examination.

Humans↗