Rotational tendonitis of the shoulder and elbow joints.
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Anticoagulants↗
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[Indications for surgery of the shoulder and elbow joints in chronic rheumatoid arthritis (author's transl)].
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Adult↗
Some peculiarities of the rotator cuff muscles.
The authors studied the origin, course and insertion as well as some peculiarities of RC muscles on 25 cadaverous fixed limbs. They discovered that RC muscles exchange muscle bundles and are secured by synovial sheaths. They described the articular muscles in all of the observed muscles, including the deltoid muscle, which significantly stretch the capsule of the glenohumeral joint. They expressed the opinion that the subscapular bursa enhances motions in the shoulder joint. Due to the possibilities of arthroscopic diagnostic and treatment methods, they are convinced that more attention must directed to this issue from both the morphological and functional perspective.
Aged↗
Histiocytic lymphadenitis associated with a large joint prosthesis.
Distinctive microscopic findings in enlarged axillary lymph nodes removed during modified radical mastectomy in a 76-year-old woman with a previous ipsilateral total shoulder joint replacement are described. The sinuses of the lymph nodes were distended by numerous large macrophages that had abundant granular eosinophilic cytoplasm. Periodic acid-Schiff staining was positive, and polarization microscopy revealed birefringent particles of polyethylene. These findings were diagnostic of the reactive lymphadenopathy that is seen uncommonly in lymph nodes draining large joint prostheses.
Aged↗
Postural development in school children: a cross-sectional study.
BACKGROUND: Little information on quantitative sagittal plane postural alignment and evolution in children exists. The objectives of this study are to document the evolution of upright, static, sagittal posture in children and to identify possible critical phases of postural evolution (maturation). METHODS: A total of 1084 children (aged 4-12 years) received a sagittal postural evaluation with the Biotonix postural analysis system. Data were retrieved from the Biotonix internet database. Children were stratified and analyzed by years of age with n = 36 in the youngest age group (4 years) and n = 184 in the oldest age group (12 years). Children were analyzed in the neutral upright posture. Variables measured were sagittal translation distances in millimeters of: the knee relative to the tarsal joint, pelvis relative to the tarsal joint, shoulder relative to the tarsal joint, and head relative to the tarsal joint. A two-way factorial ANOVA was used to test for age and gender effects on posture, while polynomial trend analyses were used to test for increased postural displacements with years of age. RESULTS: Two-way ANOVA yielded a significant main effect of age for all 4 sagittal postural variables and gender for all variables except head translation. No age x gender interaction was found. Polynomial trend analyses showed a significant linear association between child age and all four postural variables: anterior head translation (p < 0.001), anterior shoulder translation (p < 0.001), anterior pelvic translation (p < 0.001), anterior knee translation (p < 0.001). Between the ages of 11 and 12 years, for anterior knee translation, T-test post hoc analysis revealed only one significant rough break in the continuity of the age related trend. CONCLUSION: A significant linear trend for increasing sagittal plane postural translations of the head, thorax, pelvis, and knee was found as children age from 4 years to 12 years. These postural translations provide preliminary normative data for the alignment of a child's sagittal plane posture.
Journal Article↗
MR study of normal joint function using a low field strength system.
A functional MR study was performed using a 0.064 T permanent magnet MR system. The shoulder joints, elbow joints, hip joints, and knee joints of three volunteers (mean height and weight, 176 cm and 71 kg, respectively) were examined at incremental joint angles in three to eight stages during flexion-extension, abduction-adduction, or pronation-supination movement. Each set of 16 images was obtained in 4 min, 49 s using three-dimensional Fourier transformation methods with gradient echo pulse sequences. The images were evaluated in static mode and sometimes in cine mode. The findings obtained about the physiology of these normal joints was generally compatible with findings previously accumulated in the field of kinesiology. The study suggests that this method can be useful for in vivo study of kinesiology and pathogenesis of diseases and that patients with most types of contracture or deformity can be examined by MR imaging.
Adult↗
[Fixed and functional decentering of the head of the humerus in patients with omarthrosis].
AIM: To determine whether in patients with specific types of osteoarthritis of the shoulder not only a fixed but also a functional decentering of the humeral head exist. METHOD: The shoulder joints of 10 healthy volunteers and of 16 patients with osteoarthritis of the shoulder were examined in various arm-positions, using an open MR scanner. After segmentation, 3D reconstruction of the scapula and humerus were performed and the position of the midpoint of the humeral head calculated relative to the center of mass of the glenoid cavity. RESULTS: At 30 degrees of abduction, 4 of 16 patients demonstrated a fixed posterior (12.9 +/- 2.8 mm) position and 8 (all patients with cuff-arthropathy) a fixed superior (6.6 +/- 2.6 mm) position of the humeral head. At 90 degrees of abduction the patients showed a significant (p < 0.001) combined decentering in the superior and posterior direction as compared to the healthy shoulders (functional decentering). CONCLUSIONS: This study demonstrates, that in most of the patients with osteoarthritis of the shoulder, a significant functional decentering occurred during abduction and external rotation, even if they showed no fixed decentering of the humeral head at 30 degrees of abduction.
Aged↗
Neuroarthropathy: an overuse injury of the shoulder in quadriplegia.
The shoulder joint of the spinal cord injured patient is the primary joint used for transfer and wheelchair propulsion. In addition to ordinary use, the shoulder is subject to overuse injury with resultant functional impairment. Frequent overuse injuries of the shoulder include subdeltoid bursitis, bicipital tendonitis, rotator cuff tear and secondary degenerative arthritis. Neuroarthropathy of the shoulder, an overuse injury of an insensate shoulder girdle, has been rarely described in the literature. The case presented is that of an active 47 year old, right hand dominant, C7 complete quadriplegic male with a one week history of painless right shoulder girdle swelling. Radiologic evaluation documented right proximal humerus destruction. Magnetic Resonance Imaging (MRI) confirmed syringomyelia. The pathophysiology of neuroarthropathy is presented here and limited treatment options are discussed.
Arthropathy, Neurogenic↗
A penetration-based finite element method for hyperelastic 3D biphasic tissues in contact: Part 1--Derivation of contact boundary conditions.
In this study, we extend the penetration method, previously introduced to simulate contact of linear hydrated tissues in an efficient manner with the finite element method, to problems of nonlinear biphasic tissues in contact. This paper presents the derivation of contact boundary conditions for a biphasic tissue with hyperelastic solid phase using experimental kinematics data. Validation of the method for calculating these boundary conditions is demonstrated using a canonical biphasic contact problem. The method is then demonstrated on a shoulder joint model with contacting humerus and glenoid tissues. In both the canonical and shoulder examples, the resulting boundary conditions are found to satisfy the kinetic continuity requirements of biphasic contact. These boundary conditions represent input to a three-dimensional nonlinear biphasic finite element analysis; details of that finite element analysis will be presented in a manuscript to follow.
Anisotropy↗
[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↗
Efficacy of shoulder range of motion exercise in hospitalized patients after coronary artery bypass graft surgery.
The rationale for inpatient (phase 1) exercise therapy after coronary artery bypass graft (CABG) surgery has been generalized from studies after myocardial infarction (MI) and bed rest. However, patients after CABG surgery are unlike patients after MI with regard to surgical trauma restoration of coronary circulation, and length of hospital stay. Most phase 1 exercise routines include a variety of range of motion (ROM) exercises, many of which focus on shoulder joint mobility. The purpose of our study was to examine the effect of shoulder ROM exercise therapy on inpatients after CABG surgery, because data in this area are limited. The results indicate that ROM exercises do not significantly (p greater than 0.05) ameliorate the early ROM loss associated with surgery. We conclude that the loss of shoulder ROM observed after surgery is a function of the surgical procedure and not lack of ROM challenge.
Aged↗
Structural correlates of forelimb function in fur seals and sea lions.
Dissections, manipulation of ligamentary preparations, analysis of limb proportions, and quantitative aspects of forelimb myology are used to correlate forelimb morphology in fur seals and sea lions (sub-family Otariinae) with previously published data as to their locomotor function (English, '76a). Comparisons to structure and function in generalized fissiped carnivores are then used to elucidate locomotor adaptations in fur seals and sea lions. Unique features of forelimb function during swimming in these pinnipeds include the amounts of abduction-adduction and rotary movements used. Modifications of the size, attachments and fasicle architecture of the muscles and the structure and range of possible movement of the joints suggest that in fur seals and sea lions these movements (1) take place about the glenohumeral (shoulder) joints, (2) that the movements are probably finely controlled, and (3) that they contribute to the generation of massive forward thrust via the cooperative activity of muscles capable of generating large amounts of force throughout the range of movement. Recovery movements occur through a similarly large range, and modifications of forelimb anatomy either to minimize or overcome water resistance are noted. The adaptive significance of these modifications is interpreted as allowing fur seals and sea lions to swim at speeds necessary to feed on the fast swimming prey presumably abundant in their adaptive zone.
Animals↗
Shoulder arthroscopy.
Arthroscopy of the shoulder joint has been carried out in 81 patients with different shoulder disorders. Thirty-two patients had rupture of the rotator cuff. Through cadaver studies and practice, a functional routine for examination has been established. Arthroscopy provides detailed and exact information of intraarticular conditions, and is valuable in planning for surgery and approach.
Arthroscopy↗
[A case of neglected shoulder anterior dislocation with preservation of joint function].
Shoulder neglected anterior dislocation is a rare event and intolerated in young patients. We report a case of shoulder antero-medial dislocation among 15 years. It was a woman aged 35, who had a left shoulder trauma with an unnoticed antero-medial dislocation. Fifteen years later, the patient presented an inesthetic deformity with presevating function. The Rowe and Zarsins score was good. The radiographs showed the humeral neack in a neo-cavity of the joint associated to Malgaine lesion with an advanced arthrosis of the joint.
Adult↗
Early rheumatoid arthritis--onset, course, and outcome over 2 years.
Eighty-nine patients, 33 men and 56 women, with early definite rheumatoid arthritis were followed for 2 years. Two-thirds were seropositive. About 1/3 were eventually treated with second line drugs. The disease mostly had an insidious onset initially involving the finger joints. Early remission occurred in 16%. Patient relevant measures such as pain, patient's overall assessment of disease activity and anxiety decreased significantly. Disability evaluated by the HAQ disability index remained at a low level. The joint damage score (JDS) in hands and feet increased steadily and only 18% were nonerosive after 2 years. One-third developed hand deformities which was associated with higher JDS. A joint function index (SOFI) correlated significantly with JDS. Twenty-eight percent had a slower rate of joint damage progression the second year. There was no significant correlation between JDS and disease duration. Six patients developed rapidly progressive damage in larger joints, five in the hip joints and one in the shoulder joint, all requiring joint replacement. The ability to predict outcomes with clinical and laboratory variable obtained at entry was of limited clinical usefulness. By applying discriminant analyses 67%-80% of the cases who fared worst regarding clinical, functional, and radiological features could be correctly classified.
Adult↗
Adaptive internal model of intrinsic kinematics involved in learning an aiming task.
The elbow-joint angle and the shoulder-joint angle of participants aiming at targets were multiplied in an experiment that used a position-recording system and a cathode-ray tube screen. The linear transformation in joint angles (intrinsic coordinates) corresponded to a nonlinear transformation between the hand coordinates and the screen coordinates (extrinsic coordinates). We examined whether participants could learn this transformation in the intrinsic coordinates or in the extrinsic coordinates by investigating intermanual (between-hands) transfer under an intrinsically consistent condition and an extrinsically consistent condition. Positive intermanual transfer was observed in the former condition but not in the latter condition. Results suggest that participants can learn the linear transformation in joint angles under the intrinsic coordinates and that the central nervous system adaptively represents the intrinsic kinematics.
Adaptation, Psychological↗
Upper limb salvage with microvascular bone transfer for major long-bone segmental tumor resections.
A series of 14 young, active patients who underwent vascularized bone graft reconstructions of large (9-15 cm) segmental skeletal defects of the upper extremity resulting from resection of a variety of bony tumors is presented. Eight defects involved the proximal humerus and required shoulder joint reconstruction, two were mid humeral and four involved the distal radius. Surgical techniques for both distal radius reconstruction with vascularized iliac crest and vascularized fibular head and glenohumeral reconstruction using the vascularized fibula are described. Several cases are discussed in detail, including achievement of bony union, postoperative range of motion and pain, and each patient's ability to resume activities. The literature is reviewed, and other reconstructive options for large bony defects of the upper extremity after tumor resection are discussed: nonvascularized bone grafts, allograft transfer, and custom prosthetic devices. The authors think that vascularized bone grafting offers the most favorable method of upper extremity salvage with preservation of joint function, especially at the shoulder.
Adolescent↗
Management of shoulder pain in patients with stroke.
Shoulder pain affects from 16% to 72% of patients after a cerebrovascular accident. Hemiplegic shoulder pain causes considerable distress and reduced activity and can markedly hinder rehabilitation. The aetiology of hemiplegic shoulder pain is probably multifactorial. The ideal management of hemiplegic stroke pain is prevention. For prophylaxis to be effective, it must begin immediately after the stroke. Awareness of potential injuries to the shoulder joint reduces the frequency of shoulder pain after stroke. The multidisciplinary team, patients, and carers should be provided with instructions on how to avoid injuries to the affected limb. Foam supports or shoulder strapping may be used to prevent shoulder pain. Overarm slings should be avoided. Treatment of shoulder pain after stroke should start with simple analgesics. If shoulder pain persists, treatment should include high intensity transcutaneous electrical nerve stimulation or functional electrical stimulation. Intra-articular steroid injections may be used in resistant cases.
Hemiplegia↗