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PubMed2002

[Results of an inverted shoulder prosthesis after resection for tumor of the proximal humerus].

PURPOSE OF THE STUDY: Treatment of primary bone tumors of the proximal humerus is a major challenge, both in terms of oncological cure and limitation of functional handicap. Extracorporal radiation and reimplantation have provided satisfactory results for the treatment of bone tumors and the inverted shoulder prosthesis has be found to be effective in treating rotator cuff deficiency. We therefore assessed patients treated with a combination of these two treatments in order to search for a better functional outcome. MATERIAL AND METHODS: Conservative resection of the tumor with reconstruction using an inverted shoulder prosthesis was performed in six patients with a tumor of the proximal humerus of type Ia or Ib in the Malawer classification or type S3-S4-S5 in the Musculoskeletal Tumor Society classification. Patients whose tumor involved the deltoid or the glenohumeral joint were not considered for this procedure. The series included four men and two women (4 left and 2 right shoulders) aged 51 years on the average at the time of surgery. RESULTS: Mean follow-up was 12 months. The mean age- and sex-adjusted Constant score was 74% (70-85%). The patients were generally satisfied and were able to continue their daily activities. There were two displacements, one of which was diagnosed immediately and reduced without anesthesia. An abduction pad was worn for six months after reduction. The post-operative period was uneventful. No local recurrence has been observed. DISCUSSION: Our results compared favorably with other therapeutic options for resection-reconstruction reported in the literature: functional outcome was better and more predictable, at least in the short term; oncological results were satisfactory although the follow-up is short, particularly for the three primary malignant tumors. It is known however that the long-term oncology result depends on the quality of the resection and the efficacy of the extracorporeal radiation. Shoulder motion outcome was the least satisfactory in patients who experienced peri-operative complications. We were unable to find any relation between less satisfactory functional outcome and the number of surgical procedures for local recurrence before extracorporeal radiation and arthroplasty (deltoid dystrophy). Normal deltoid function appeared to be crucial for optimal functional outcome with this prosthesis which allows sacrifice of the rotators. The rate of complications was low and recovery of active shoulder movement was more rapid. Despite the short-term nature of these results, and despite the risk of loosening, the inverted shoulder prosthesis appears to be an interesting therapeutic option for these patients.

Activities of Daily Living↗
PubMed2002

[In vivo measurements of shoulder movements by a goniometer with six degrees of freedom: preliminary study].

PURPOSE OF THE STUDY: The purpose of this work was to develop a goniometer with six degrees of freedom (6DOF) to achieve global measurement of the main movements of the shoulder and to examine the reproducibility of the measurements obtained. MATERIAL AND METHODS: Movement amplitudes, inter- and intra-observer reproducibility of the methodology and the device were tested in a population of ten young subjects with asymptomatic shoulders. RESULTS: Maximal amplitudes obtained for each movement were: abduction 111.8 +/- 11 degrees; flexion 127.9 +/- 12.7; external rotation 86.3 +/- 14 degrees; free elevation 129.3 +/- 9 degrees. The curves traced in the plane of rotation and rotation were plotted against elevation. Comparison between amplitudes on the right and left were not significantly different. DISCUSSION AND CONCLUSION: This preliminary study demonstrated the potential contribution of a 6DOF-goniometer for a 3D assessment of shoulder movement. Measurements made when positioning the goniometer demonstrated good reproducibility. Our data are similar to others reported in the literature. The plane of the scapula and the position in physiological internal rotation, as described in the literature, were also observed. Studying shoulder movements, particularly their association, should provide a new means of assessing function in patients with complex disease of the shoulder joint. The device should be helpful in obtaining an objective measurement of the shoulder kinetics that would be useful for patient follow-up and assessment of corporal damage.

Adult↗
PubMed2002

Idiopathic frozen shoulder treated by arthroscopic brisement.

Arthroscopic brisement serves as an useful procedure in the treatment of idiopathic frozen shoulder. This series included 186 shoulders with a diagnosis of idiopathic frozen shoulder who had symptoms for an average of 8 months and failed conservative treatment of at least 12 weeks. Using the arthroscopic brisement (distension, debride, release and manipulation) to treat the idiopathic frozen shoulder, it is beneficial not only to detect the inside lesion but also a solution to the problem of stiffness. The average follow-up time was 23 months from 6 months to 5 years. One hundred and seventy (92%) of 186 shoulders had yielded overall satisfactory results in this series. There was no relationship between the end result and the initial pathologic condition. We believe that arthroscopic brisement is an effective way of shortening the course of frozen shoulder and should be considered when conservative treatment has failed.

Adult↗
PubMedDate not supplied

Changing glenoid version after open reduction of shoulders in children with obstetric brachial plexus palsy.

Twenty-three patients who had obstetric brachial plexus palsy and shoulder subluxation or dislocation that required open reduction and tendon lengthening were entered into a prospective study to evaluate glenoid version after surgery. All the patients had a preoperative computerized axial tomograph and postoperative computed tomography scan of both shoulders at approximately yearly intervals to assess the degree of congruity of the glenohumeral joint and glenoid version. Surgery was performed between 1988 and 1997. There were 11 girls and 12 boys. The mean age was 2 years 5 months (range 8 months-6 years 7 months). The left shoulder was affected in 12 patients and the right shoulder was affected in 11 patients. At mean follow-up of 3 years 7 months, the mean glenoid retroversion for the dislocated shoulder progressively decreased. The difference in glenoid version between the dislocated and the normal side decreased. The angle of glenoid retroversion in the affected shoulders decreased by a mean of 31% after open reduction, and the retroversion continued to improve at 9% per year.

Brachial Plexus Neuropathies↗
PubMedDate not supplied

Sonographic study of painful shoulder.

OBJECTIVE: To identify sonographically the site and entity of alterations in a high number of patients with shoulder pain. METHODS: Two different experienced operators (both rheumatologists), who were blinded to the clinical data, performed sonographic examinations on 528 shoulders of 425 consecutive patients with painful shoulder and in both shoulders of 198 control subjects. They carried out ultrasound examinations separately using a 7.5 MHz linear transducer. Investigation included the long head of the biceps tendon, the supraspinatus tendon, infraspinatus tendon, subscapularis tendon, acromioclavicular joint, glenohumeral joint, subacromial-subdeltoid bursa, subscapularis bursa, and finally identification of calcifications. Before the ultrasonographic exam, a third experienced rheumatologist performed a physical examination in all patients using specific tests of movement for evaluation of the long head of biceps tendon, the supraspinatus tendon, infraspinatus tendon, subscapularis tendon, and acromioclavicular joint. RESULTS: Sonographic alterations were found in a total of 94.1% of patients. The structure most frequently involved was the supraspinatus tendon (64.6%). The long head of the biceps tendon (48.1%) and the acromioclavicular joint (51.5%) were also frequently involved. Different types of alterations in the various structures were detected. Significant differences were found with respect to controls. A high sensitivity and specificity of sonography was demonstrated compared to physical examination. CONCLUSIONS: Sonography evaluates accurately the single anatomic structures of the shoulder and identifies both the site and type of changes in patients with painful shoulder. The high sensitivity/specificity, non-invasiveness and low costs of this technique justify its routine utilisation in clinical rheumatological practice.

Adolescent↗
PubMed2003

[Arthroscopic stabilization of the shoulder using anchors].

PURPOSE OF THE STUDY: The purpose of the current report was to present our initial experience with an arthroscopic technique for anterior stabilization of the shoulder with an anchor in 64 patients who had recurrent anterior glenohumeral instability. MATERIAL: The application of arthroscopic techniques for the operative treatment of recurrent anterior instability of the glenohumeral joint has generated widespread interest. The goal of all arthroscopic techniques for stabilization of the shoulder is the re-establishment of a functioning inferior glenohumeral ligament. This is achieved by reattaching the avulsed anteroinferior aspect of the labrum or capsule to the anterior aspect of the glenoid neck with one of a variety of methods. Arthroscopically assisted repair of the anterior aspect of the labrum with use of a bioabsorbable/nonabsorbable suture with an anchor was performed in 64 consecutive patients who had chronic anterior instability of the shoulder. The average age of the patients was twenty-seven years (range, sixteen to fifty-two years). The etiology of the instability was a traumatic injury in 53 patients. All fifty-three shoulders had a Bankart lesion. The patients were evaluated at an average of 18 months (range, 3 to 36 months) after the procedure. METHODS: During shoulder arthroscopy in typical laying position with traction applied on upper extremity we made diagnosis of capsule defect or laxity in all the cases. Using anchor technique we sutured capsule defect, or tightened loose capsule to glenoid rim. Two or three sutures were used. The anchors were Mitek GII implants, or Arthrex screws, with non-absorbable sutures in most cases. RESULTS: Fifty (78 per cent) of the patients were asymptomatic and were able to participate in sports without restriction. The repair was considered to have failed in three (4.5 per cent) of the patients. In one of them, the failure resulted from a single traumatic reinjury during participation in a contact sport, and was treated operatively. The remaining two failures occurred atraumatically. DISCUSSION: It is difficult to compare the results from the present study with those from other reports on arthroscopic techniques of anterior stabilization because of variation among the indications, the techniques, and the implants that were used. The degree of capsular laxity is central to the success or failure of arthroscopic stabilization. CONCLUSION: Anterior stabilization of the shoulder with an anchor may be indicated for patients who have anterior instability with or without Bankart lesion and need suture of the lesion and capsulorrhaphy or capsular imbrication to reduce the joint volume.

Adolescent↗
PubMed1992

[Etiological considerations of the loose shoulder from a biochemical point of view--biochemical studies on collagen from deltoid and pectoral muscles and skin].

In order to elucidate the etiology of the loose shoulder, biochemical characteristics of deltoid and major pectoral muscles and skin collagen from patients with loose shoulder have been investigated. Amounts of soluble collagen, reducible cross-links of collagen and their precursors in both muscles and skin from the loose shoulder were found to be higher than those in the control. These data suggest that soft tissues, especially deltoid muscles, of patients with loose shoulder contain relatively immature collagen fibers compared with normal shoulders. In re-operation cases of the loose shoulder, the collagen fibers in skin were more immature, which may reflect the clinical features of the disease.

Adolescent↗
PubMed2004

A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder.

OBJECTIVE: Local corticosteroid injections, commonly accepted by rheumatologists to be effective treating painful shoulder, have shown controversial results. High frequency ultrasonography is an accurate and safe imaging modality for guiding musculoskeletal injections. We prospectively compared the short term response to randomized blind injection versus sonographic-guided injection of local corticosteroid in patients with painful shoulder. METHODS: We studied 41 consecutive patients with painful shoulder. Patients with previous trauma or chronic inflammatory arthritis were excluded. No patient had received previous physiotherapy or local steroid injection in the shoulder. Patients were randomized to receive either a blind subacromial injection of 20 mg triamcinolone (Group 1, n = 20) or a sonographic guided injection of 20 mg triamcinolone (Group 2, n = 21) by the same rheumatologist blinded to the clinical evaluation. In both groups we recorded shoulder abnormalities and the location of the steroid postinjection by ultrasound. Each patient was clinically assessed within 5 days before injection and 6 weeks after injection by another rheumatologist without knowledge of the injection technique performed. Clinical assessment included demographic and clinical data, a visual analog scale (VAS) for pain (0-100), the Shoulder Function Assessment (SFA) scale (0-70), and postinjection adverse effects. No patient received physical therapy during the followup period. Initially, demographic, clinical, and ultrasonographic findings in both groups showed no significant differences. RESULTS: Six weeks after injection, the VAS and the SFA score showed a significantly greater improvement in Group 2 compared with Group 1 (mean VAS score change 34.9 for Group 2 vs 7.1 for Group 1, p < 0.001; and mean SFA score change 15 for Group 2 vs 5.6 for Group 1, p = 0.012). One patient in Group 1 reported mild postinjection adverse effects. CONCLUSION: We suggest that sonographic-guided corticosteroid injections should be indicated, at least, in patients with poor response to previous blind injection to ensure accurate medication placement in order to improve therapeutic effectiveness.

Adrenal Cortex Hormones↗
PubMed2005

A radiological study of the intraprosthetic movements of the bipolar shoulder replacement in rheumatoid arthritis.

A radiological study of the intraprosthetic movements of a bipolar shoulder replacement was undertaken in 25 shoulders in 20 patients with rheumatoid arthritis and rotator cuff arthropathy. No significant difference was found between intraprosthetic movement and shell - glenoid movement. Some shoulders were found to exhibit paradoxical movement at the intraprosthetic interface. Repeating the measurements after an interval of three years in a subgroup of 12 shoulders showed a significant reduction in intraprosthetic movement over this time interval. In conclusion, movement of the bipolar shoulder prosthesis in shoulders affected by rheumatoid arthritis was preserved up to eight years from operation. Intraprosthetic movement was independent from shell - glenoid movement and paradoxical to glenohumeral movement.

Aged↗
PubMed2005

[Efficacy of pulsed mode radiofrequency lesioning of the suprascapular nerve in chronic shoulder pain secondary to rotator cuff rupture].

Suprascapular nerve blockade can be performed in chronic shoulder pain secondary to rotator cuff lesions, shoulder joint osteoarthritis, and adhesive capsulitis. Local anesthetics and steroids are commonly combined for the blockade. In this report, we present pulsed mode radiofrequency lesioning of suprascapular nerve for persistent shoulder pain in 8 patients. 8 patients with no response to six weeks physical or medical treatment were hospitalized in our Algology Clinic for suprascapular nerve pulsed mode radiofrequency lesioning. All blocks were performed in sitting position with a 22-Gauge, 100 mm "SMK" needle with 5 mm active tip and "Radionics" radiofrequency generator. Sensory stimulation at 50 Hz, 0.2 millisecond pulse width was performed and paresthesias in the shoulder joint occurred at 0.3 V. Motor stimulation at 2 Hz, 0.2 millisecond pulse width showed the contractions of the infraspinatus and supraspinatus muscles occurred at 0.4-0.5 V. Pulsed mode radiofrequency lesioning was then carried out two times for 120 seconds at 2 Hz frequency and pulse width of 20 milliseconds at 42 degrees C. Patients were evaluated for pain scores and shoulder joint movements at 1, 2, 4, 8, and 12 weeks after the procedure. Pulsed mode radiofrequency lesioning of suprascapular nerve block provided pain control for at least twelve weeks and improved shoulder joint movements.

Humans↗
PubMed1992

Frozen shoulder. A long-term follow-up.

Sixty-two patients (sixty-eight shoulders) who had been treated non-operatively for idiopathic frozen shoulder were evaluated subjectively and objectively at two years and two months to eleven years and nine months of follow-up (average, seven years). Thirty-one (50 per cent) of these patients still had either mild pain or stiffness of the shoulder, or both. The range of motion averaged 161 degrees of forward flexion, 157 degrees of forward elevation, 149 degrees of abduction, 65 degrees of external rotation, and internal rotation to the level of the fifth thoracic spinous process. Thirty-seven (60 per cent) of the sixty-two patients still demonstrated some restriction of motion as compared with study-generated control values (calculated as the average motion, in each plane, for the thirty-seven unaffected shoulders of the patients who had unilateral disease). Ten patients had restriction of forward flexion; eight, of forward elevation; seventeen, of abduction; twenty-nine, of external rotation; and ten, of internal rotation. However, when the motion of each affected shoulder of thirty-seven patients who had unilateral involvement was compared with that of the unaffected contralateral shoulder, eleven (30 per cent) demonstrated some restriction. None of these patients had restriction of forward flexion; two had restriction of forward elevation; two, of abduction; seven, of external rotation; and seven, of internal rotation. The patients who had substantial restriction in three planes or more were thirteen times more likely to be men (p greater than 0.05). Marked restriction, when it was present, was most commonly in external rotation. Only seven patients (11 per cent) reported mild functional limitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed2005

[Clinical observation on acupuncture at pain point combined with moxibustion at Zusanli (ST 36) for treatment of periarthritis of shoulder].

OBJECTIVE: To find an effective therapy for periarthritis of shoulder. METHODS: Sixty cases were divided into two groups, 30 cases in each group. They were treated by acupuncture at pain point combined with moxibustion at Zusanli (ST 36) and routine acupuncture, respectively. Pain of the shoulder and movement functions of shoulder joints were used as indexes of therapeutic effects and their therapeutic effects were compared. RESULTS: The total effective rate was 96.7% in the treatment group and 90.0% in the routine group with no significant difference between the two groups (P > 0.05); the cured rate in the two groups were 46.7% and 20.0% respectively with a significant difference between the two groups (P < 0.05). There were statistically significant differences between the two groups in improvement of movement function of shoulder joints and alleviation of pain (both P < 0.01). CONCLUSION: Acupuncture at pain points combined with moxibustion at Zusanli (ST 36) in increase of the cured rate and alleviation of pain, and improvement of movement function of shoulder joints is better than the routine acupuncture and moxibustion for treatment of periarthritis of shoulder.

Acupuncture Therapy↗
PubMed2005

Shoulder arthrodesis in brachial plexus injuries--a review of six cases.

Shoulder arthrodesis is a secondary reconstructive option for patients with brachial plexus injuries requiring a stable shoulder. This study was undertaken to evaluate the clinical and radiological outcomes of shoulder fusion in six patients with flail upper limbs following complete brachial plexus injuries. The shoulder was fused in 30 degrees abduction, 30 degrees internal rotation and 30 degrees flexion via a direct lateral approach by using a 4.5 mm reconstruction plate without bone grafting. The average follow-up was 10.3 months. Radiological union was obtained in all patients. Five patients (83%) had relief of pain after the shoulder fusion. Improvement of function was observed in all patients with a mean improvement of 56.6 degrees (range 30 degrees-75 degrees) and 47.5 degrees (range 30 degrees-60 degrees) active flexion and abduction respectively. One patient developed humeral fracture distal to the plate and the fracture eventually healed with a splint. Successful stable fusion of the shoulder in patients with brachial plexus injuries requires rigid fixation with a single 4.5 mm reconstruction plate, protection of bone healing with a triangular abduction brace for 12 weeks and functional trapezius, levator scapulae, serratus anterior and rhomboid muscles for optimizing the functional result.

Adult↗
PubMed2005

Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis.

Persistent shoulder pain is a very common condition that often has a multifactorial underlying pathology and is associated with high societal cost and patient burden. In 2000, the direct costs for the treatment of shoulder dysfunction in the United States totaled $7 billion. Persistent shoulder pain can result from bursitis, tendinitis, rotator cuff tear, adhesive capsulitis, impingement syndrome, avascular necrosis, glenohumeral osteoarthritis (OA), and other causes of degenerative joint disease or from traumatic injury, either in combination or as a separate entity. Rotator cuff disorders, adhesive capsulitis, and glenohumeral OA are all common causes of persistent shoulder pain, accounting for about 10%, 6%, and 2% to 5%, respectively, of all shoulder pain. All 3 conditions have complex etiologies, but they can be diagnosed in the majority of patients on the basis of medical history, focused physical examination, and plain film radiographs. This brief review and the following articles in this supplement focus on persistent shoulder pain associated with rotator cuff disorders, adhesive capsulitis, and glenohumeral OA.

Chronic Disease↗
PubMed2006

Restoration of shoulder abduction by transfer of the spinal accessory nerve to suprascapular nerve through dorsal approach: a clinical study.

BACKGROUND: In recent years, transfer of the spinal accessory nerve to suprascapular nerve has become a routine procedure for restoration of shoulder abduction. However, the operation via the traditional supraclavicular anterior approach often leads to partial denervation of the trapezius muscle. The purpose of the study was to introduce transfer of the spinal accessory nerve through dorsal approach, using distal branch of the spinal accessory nerve, to repair the suprascapular nerve for restoration of shoulder abduction, and to observe its therapeutic effect. METHODS: From January to October 2003, a total of 11 patients with a brachial plexus injury and an intact or nearly intact spinal accessory nerve were treated by transferring the spinal accessory nerve to the suprascapular nerve through dorsal approach. The patients were followed up for 18 to 26 months [mean (23.5 +/- 5.2) months] to evaluate their shoulder abduction and function of the trapezius muscle. The outcomes were compared with those of 26 patients treated with traditional anterior approach. And the data were analyzed by Student's t test using SPSS 10.5. RESULTS: In the 11 patients, the spinal accessory nerves were transferred to the suprascapular nerve through the dorsal approach successfully. Intact function of the upper trapezius was achieved in all of them. In the patients, the location of the two nerves was relatively stable at the level of superior margin of the scapula, the mean distance between them was (4.2 +/- 1.4) cm, both the nerves could be easily dissected and end-to-end anastomosed without any tension. During the follow-up, the first electrophysiological sign of recovery of the infraspinatus appeared at (6.8 +/- 2.7) months and the first sign of restoration of the shoulder abduction at (7.6 +/- 2.9) months after the operation, which were earlier than that after the traditional operation [(8.7 +/- 2.4) months and (9.9 +/- 2.8) months, respectively; P < 0.05]. The postoperative shoulder abduction was 62.8 degrees +/- 12.6 degrees after transfer of the spinal accessory nerve, better than that after the traditional (51.6 degrees +/- 15.7 degrees). All the 11 patients could extend and externally rotate the shoulder almost normally. CONCLUSIONS: The accessory nerve transfer through dorsal approach is a safe and reliable procedure for the treatment of brachial plexus injury. Its postoperative effect is confirmed, which is better than that of the traditional operation.

Accessory Nerve↗
PubMed2006

[Three-dimensional geometry of the proximal humerus and rotator cuff attachment and its utilization in shoulder arthroplasty].

PURPOSE OF THE STUDY: The aim of the study was to provide a method of measurement and data collection, based on morphologic analysis of the proximal humerus, that would facilitate precise placement of the humeral stem and would be easy to apply in clinical medicine in patients requiring shoulder arthroplasty. MATERIAL: Three groups of materials were used. Materials for the first and second groups were provided by the Department of Anatomy, First Faculty of Medicine, Charles University. The first group included 10 specimens (five left and five right humeral bones) obtained at routine anatomical dissection. The second group contained 110 so-called dry preparations from the collections of the Department of Anatomy and the third group comprised nuclear magnetic resonance (NMR) scans of 20 patients. To show spatial relationships between the proximal and the distal humerus, another coil was applied to the epicondylar region in addition to the one placed over the proximal humerus. METHODS: The first group material was used to study proximal humerus morphology and to determine reference points for the other two groups. The points were constructed to make seven planes perpendicular to the axis of the proximal humeral metaphysis. Based on the reference points, parameters of the proximal humerus were assessed in the defined planes also in the other two groups. We measured angles between the reference points and the transepicondylar line or the humeral head axis. The vertex of each angle was always placed in the point of intersection of the metaphyseal axis and the given transverse plane. Reference points of the greater tubercle were marked on the medial margin continuous with the intertubercular groove, on the lateral margin of the lesser tubercle and in the "deepest" place of the intertubercular groove. We also measured humeral head retroversion and the position of maximal bony mass of both the greater and the lesser tubercle (this parameter can be used with advantage for optimal insertion of screws in proximal humerus reconstruction). RESULTS: The angle between the medial margin of the greater tubercle and the humeral head axis was on average 164.8 degrees on the left side and 163.2 degrees on the right side; the angle between the great tubercle margin and the transepicondylar line was 137.0 degrees on the left humerus and 137.7 degrees on the right humerus. The lateral margin of the lesser tubercle and the humeral head axis formed on average an angle of 124.4 degrees and of 122.6 degrees on the right and the left side, respectively. The intertubercular groove/ humeral head axis relationship was 143.4 degrees and 144.8 degrees for the left and the right humerus, respectively, and the intertubercular groove/transepicondylar line angle was 115.6 degrees for the left and 119.5 degrees for the right humerus. The humeral head axis and the transepicondylar line made an angle of 27.8 degrees for the left and 25.3 degrees for the right humerus. These values corresponded to the angle of the humeral head retroversion. The reference point of maximal bony mass of the greater tubercle and the humeral head axis made an angle of 181.1 degrees and of 180.2 degrees for the left and the right humerus, respectively; between this point and the lesser tubercle was an angle of 120.2 degrees for the left and 126.9 degrees for the right humerus. DISCUSSION: One of the most important parameters in restoring shoulder function by alloplasty is humeral head retroversion. If this is not correct, ventral or, less frequently, dorsal instability of the shoulder may result. The correct setting of retroversion is guided by the transepicondylar line or several specific landmarks on the greater and the lesser tubercle of the humerus. Another important factor is the correct reconstruction of anatomic position of the greater and the lesser tubercle in relation to the insertion of rotator cuff muscles into the humeral head. Relationships of diaphyseal, metaphyseal and humeral head axes have been reported in the relevant literature dealing with proximal femoral morphology. None of the reports, however, has dealt with tubercular angles and position of the maximal body mass, which is a decisive factor for insertion of screws fixing the prosthetic stem. CONCLUSIONS: The values provided here can be used for a more precise construction of implants for shoulder replacement. The method of three-dimensional presentation of the proximal humerus may aid in a more exact implantation procedure during shoulder arthroplasty. An optimal position of the implant can also be based on parameters obtained from the healthy contralateral shoulder joint.

Anthropometry↗
PubMed2006

A survey of decision-making processes in the treatment of common shoulder ailments among primary care physicians.

To encourage consistent care for patients with musculoskeletal complaints, the AAOS developed treatment algorithms to aid primary care physicians in the management of these patients. A survey was designed to assess whether a random group of primary care physicians treated their patients in a manner consistent with these algorithms. The AAOS algorithm for shoulder pain was used to develop a questionnaire for primary care physicians. An Internet company provided access to a national base of physicians who volunteered to complete the survey. Ten questions were presented on five shoulder conditions: rotator cuff disease, fractures, instability, arthritis, and frozen shoulder The "correct" answer was based upon the AAOS algorithm. The survey was completed by 706 physicians who treated variable (one to greater than ten) numbers of shoulder patients per month. Forty-eight percent of the physicians treated acute trauma according to the algorithm, 87% treated arthritis, and 58% treated instability. Only 46% of physicians chose the correct answer for an acute rotator cuff tear and 29% for chronic rotator cuff symptoms. Forty-four percent followed the algorithm for frozen shoulder. Overall only 49% of the patients described were treated according to the AAOS algorithms. Based on the number of shoulder patients seen each month, in one month over 2000 patients could be tested by the surveyed physicians in a manner inconsistent with the treatment algorithms, suggesting the need for improved musculoskeletal education for primary care physicians.

Algorithms↗
PubMed2006

[A new thinking of acupuncture and moxibustion treatment of shoulder pain after hemiplegia].

Analysis from anatomy and physiology indicates that causes of shoulder pain are (1) decline and after-constriction of the scapula;(2) the adduction and intorsion of the humerus; (3) the spasm of the upper limb flexor. The acupuncture and moxibustion prescriptions stipulated for prevention and treatment of shoulder pain are Jianjing (GB 21), Jianzhongshu (SI 15), Jugu (LI 16), Tianzong (SI 11), Jianliao (SJ 14), Jiquan (HT 1) at the flaccid hemiplegia, and Jugu (LI 16), Jianyu (LI 15), Tianzong (SI 11), Jianliao (SJ 14), Xiaoluo (SJ 12), Shanglian (LI 9), Wenliu (LI 7) at the spastic hemiplegia , in combination with cupping at the Urinary Bladder Meridian on the back and around shoulder. Thus, it is indicated that shoulder pain not only is involved in the shoulder joint but also in all muscle groups of the shoulder girdle and the upper limb extensor at the affected side.

Acupuncture Therapy↗