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At least 1,207 records · Page 67Linked to original sources
PubMed1984

Recurrent posterior instability (subluxation) of the shoulder.

A retrospective survey of fifty shoulders in thirty-five patients with recurrent posterior instability revealed generally poor results of treatment, particularly of operative treatment. Only eleven of the shoulders had a primary traumatic insult as the event initiating the instability. Although forty-one of the affected shoulders demonstrated voluntary instability, it was the associated involuntary, unintentional instability of these shoulders that prompted the patients to seek medical attention. Pain and functional impairment relating to work and to the activities of daily living were not significant in most of these patients. The results of surgical reconstruction were generally poor, the recurrence rate was 50 per cent (thirteen of twenty-six shoulders), and there were complications in five of the twenty-six shoulders that had been operated on. Attention is drawn to the complication of degenerative osteoarthritis that is associated with posterior glenoid osteotomy. We advise care in the selection of patients for surgical reconstruction.

Activities of Daily Living↗
PubMed1983

Compressive, invasive referred pain to the shoulder.

The painful shoulder can be the presenting complaint of a wide variety of local, as well as systemic, problems. Compression of the brachial plexus or occlusion of the subclavian vessels caused by narrowing of the thoracic outlet is best diagnosed by a thorough history and physical examination, and by performing the appropriate test maneuvers. Patients who do not respond to an exercise program to strengthen the shoulder girdle may require surgical excision of the first rib to enlarge the thoracic outlet. Referred pain in the shoulder originating from the cervical spine or peripheral nerves can be determined by cervical spine roentgenograms and nerve conduction tests. Neoplasms and parenchymal disease of the lung, and infections of the pleural and subdiaphragmatic areas can refer pain to the shoulder through the phrenic nerve. For those patients with persistent shoulder pain and no discernible musculoskeletal abnormalities who do not respond to standard therapeutic measures, another source of the shoulder pain should be sought.

Diagnosis, Differential↗
PubMed1982

Prosthetic arthroplasties of the shoulder.

Twenty-two Neer shoulder arthroplasties were performed in rheumatoid and osteoarthritic patients and followed for a minimum of two years, with an average of four years, seven months. In addition to the Neer humeral prosthesis, eight had Neer glenoid components and seven had a subacromial spacer inserted. Two years postoperation, 11 patients had no pain and eight had only mild discomfort. Shoulder function improved more than 100% compared with the preoperative ratings while the range of motion increased relatively little. There was one failure. Although the hemiarthroplasty group scored similarly to the total shoulder group, total shoulder arthroplasty is preferred because of possible further glenoid deterioration. A subacromial spacer is used if the rotator cuff cannot be repaired. The Neer shoulder prosthesis is recommended for the relief of rheumatoid or osteoarthritic shoulder pain.

Adult↗
PubMed1982

[Direction of the course and changes in the cross-section of the subclavian vein depending on the positions of the shoulder].

Dental mold material was injected into the right subclavian veins of 10 human cadavers presenting six different positions of the right shoulder. By means of the so produced preparations the position of the subclavian vein was defined precisely in relation to the frontal plane. Besides that the direction of the first rib's groove for the subclavian vein was determined in 10 skeletons. The subclavian vein swerves slightly anterior arching over the first rib in an acute angle to the frontal plane. Cross sections of the preparations mentioned above were made and used for prints; thus the changes of the lumen in different shoulder positions could be clearly perceived. If the shoulder is lifted or pushed forward the subclavian vein expands; in upward-forward position of the shoulder the vein gains its maximum width. If the shoulder is lowered the subclavian vein is slightly constricted; if the shoulder is pushed back the vein is compressed to a minimum width. The significance of these: facts in regard to subclavian vein catheterization is discussed.

Aged↗
PubMed1995

Arthroscopic evaluation and treatment of shoulder instability.

The use of the arthroscope for shoulder instability has improved our understanding of normal and pathologic shoulder anatomy. We must emphasize, however, that the majority of shoulder problems can be accurately diagnosed with a thorough history and good physical examination. The arthroscope is helpful, however, to confirm a clinical diagnosis or assist in making a diagnosis in difficult or complex pathologic findings. Further, as our surgical techniques and understanding of shoulder instability improve, more pathologic entities about the shoulder become amenable to arthroscopic surgical procedures. We must emphasize that most of these arthroscopic procedures are technically demanding and significant learning curves exist. These procedures should be undertaken only by physicians who have excellent arthroscopic skills and are comfortable recognizing normal and pathologic arthroscopic anatomy of the shoulder.

Arthroscopy↗
PubMed1995

[Arthroscopic shoulder surgery].

In the field of orthopedic surgery, arthroscopic surgery has become widespread since its first development by Dr. Watanabe in 1950. Arthroscopic surgery for the knee joint is now a common procedure, but this surgery is not so common when the procedure involves the shoulder joint. Although using arthroscopic surgery is not so common on the shoulder joint, there are several benefits by utilizing arthroscopy in such cases. Some of the benefits are; minimal scar formation, no functional limitation of the deltoid muscle, and a quick recovery time. So it is believed that due to these benefits, shoulder arthroscopy will become common in the future. The glenohumeral joint and subacromial bursa are the area of shoulder where arthroscopic surgery proves to be useful. In the glenohumeral joint, it is possible to see the biceps tendon, glenoid surface, humeral head, labrum, glenohumeral ligament, subscapularis tendon, supraspinatus tendon, infraspinatus tendon, teres minor, and rotator interval. In the subacromial bursa, it is possible to see the acromion, coracoacromial ligament, acromioclavicle joint, and the bursal side of the cuff. For recurrent anterior dislocation of the shoulder, Caspari's method is the arthroscopic Bankart repair. This is the multiple suture technique for a detached labrum-anteroinferior glenohumeral ligament complex from glenoid neck by using Caspari's suture punch. This is the anatomical repair for anterior instability. Superior labral injuries of the shoulder are usually caused by trauma or over use.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroscopy↗
PubMed1994

Bipolar shoulder arthroplasty.

Bipolar shoulder arthroplasty was designed as a salvage procedure for the arthritic shoulder with a massive rotator cuff tear. Between 1985 and 1989, 14 patients were treated with a bipolar shoulder arthroplasty and were followed for a mean of 3.3 years (range, 2-4.8 years). Two patient populations were studied, including: (1) rheumatoid patients undergoing a primary shoulder arthroplasty, and (2) reconstructive patients undergoing a secondary reconstructive procedure. The rheumatoid group had overall good pain relief. The average postoperative active forward flexion, abduction, and external rotation was 79 degrees, 66 degrees, and 20 degrees, respectively. The reconstructive group had fair pain relief, with an average postoperative active forward flexion, abduction, and external rotation of 39 degrees, 44 degrees, and 12 degrees, respectively. Six of seven complications were noted in the reconstructive group, including two bipolar cup dislocations, one bipolar cup subluxation, and one loosening of the prosthesis. The factors associated with complications included absence of an intact subacromial arch and deltoid abnormality. The bipolar shoulder arthroplasty appears to be an alternative to a primary arthroplasty for the arthritic rheumatoid shoulder with a massive rotator cuff tear.

Activities of Daily Living↗
PubMed1994

[Muscle power and shoulder joint function after removal of the latissimus dorsi muscle].

Free transplantation of the latissimus dorsi muscle has become the treatment of choice in extensive soft-tissue defects of the lower leg after trauma. However, neither the ability of the remaining muscles of the shoulder to compensate for the lost function nor the long-term effects of latissimus dorsi removal on the function of the shoulder have been objectively measured. Therefore, the postoperative shoulder function in 23 patients was compared after removal of the latissimus dorsi muscle with 23 control subjects. The evaluation included a questionnaire, physical examination, and instrumented muscle-testing (cybex system). No significant statistical differences in the function of the shoulders of all the patients and control subjects could be verified, with the exception that 16 patients exhibited weakness during isokinetic torque during extension of the shoulder in a 55 to 65 degree flexion (4.2 +/- 1.2%). The latissimus dorsi free flap can therefore be recommended as a procedure for soft-tissue coverage of extensive wounds resulting only in negligible loss of function and a slightly altered appearance of the shoulder-girdle.

Adult↗
PubMed1993

[The initial traumatic shoulder dislocation. Prospective study].

The goal of this prospective study was to investigate possible factors which might prevent the recurrence of dislocation after a first time traumatic shoulder dislocation. Of the 504 patients initially recorded, 376 were followed up clinically and radiologically after 1 year, and 324 were followed up after 5 years. 20% (64/324) of the patients examined after 5 years sustained a recurrent dislocation of the shoulder. We can confirm age dependency in the occurrence dislocations (50% of the patients > 30 yrs; 15% > 30 yrs). However, we were unable to find a relationship between the duration of immobilization and the incidence of recurrence redislocation (20% recurrence for 0, 1, 2, 3, > 3 weeks of immobilization). A simultaneous avulsion fracture of the tuberculum majus seems to improve the prognosis for recurrent shoulder dislocation (3/114 = 3%), whereas other bony injuries detected using conventional radiology do not appear to influence the incidence of recurrence. A shoulder stabilisation operation had to be carried out in a total of 10% of the follow-up cases. Based on our experience, we recommend a sufficiently long immobilization period of the freshly injured shoulder. In young patients, extensive and invasive procedures (arthro-MRI, pneumo-arthro-CT, shoulder arthroscopy) should be carried out after the first redislocation.

Adult↗
PubMed1996

Shoulder disorders in general practice: prognostic indicators of outcome.

BACKGROUND: Shoulder pain is common in primary health care. Nevertheless, information on the outcome of shoulder disorders is scarce, especially for patients encountered in general practice. AIM: To study the course of shoulder disorders in general practice and to determine prognostic indicators of outcome. METHOD: For this prospective follow-up study, 11 Dutch general practitioners recruited 349 patients with new episodes of shoulder pain. The participants filled out a questionnaire at presentation and further ones after 1, 3, 6 and 12 months; these contained questions on the nature, severity and course of the shoulder complaints. The association between potential prognostic indicators and the status of shoulder complaints (absence or presence of symptoms) was evaluated after one and 12 months of follow-up. RESULTS: After one month, 23% of all patients showed complete recovery; this figure increased to 59% after one year. A speedy recovery seemed to be related to preceding overuse or slight trauma and early presentation. A high risk of persistent or recurrent complaints was found for patients with concomitant neck pain and severe pain during the day at presentation. CONCLUSION: A considerable number of patients (41%) showed persistent symptoms after 12 months. It may be possible to distinguish patients who will show a speedy recovery from those with a high risk of long-standing complaints by determining whether there is a history of slight trauma or overuse, an early presentation or an absence of concomitant neck pain.

Family Practice↗
PubMed1996

Arthroscopic stabilization of acute initial anterior shoulder dislocation: the West Point experience.

Arthroscopic stabilization for acute initial shoulder dislocation has been the subject of thorough investigation at West Point over the past decade in an attempt to improve on the natural history of shoulder instability in our young athletic population. From January 1986 to December 1995, 127 patients were treated for acute initial shoulder dislocation at the United States Military Academy. Of the 55 patients treated nonoperatively, 47 (85%) have had recurrence of instability. Seventy-two patients were treated operatively during three separate phases in the evolution of arthroscopic management at our institution. The initial phase (1986 to 1988) of operative treatment included either arthroscopic abrasion or staple repair. The low recurrence rate (2 of 9) was promising. In the operative technique for the second phase (1988 to 1991) transglenoid sutures were used. Of the 21 patients treated in this manner, 18 (86%) had no recurrent instability at last follow-up (average, 32 months). In the third phase (1991 to 1993), patients were treated with a bioabsorbable tack and interscalene anesthesia, and in the sitting position. Thus far, 39 of the latest 42 cadetathletes with acute initial anterior shoulder dislocations have had stabilization with this bioabsorbable cannulated fixation device. The average age was 19.5 years (range, 17 to 23 years). Follow-up averaged 22 months. There were no perioperative complications. Of these 39 patients, 35 (90%) have a stable shoulder and have returned to preinjury performance status. One of 2 patients with recurrent subluxation and 1 of 2 patients with a traumatic redislocation required an open Bankart repair. In young athletes known to have high recurrence rates with nonoperative treatment, acute arthroscopic stabilization appears to be an effective minimally invasive treatment option that favorably alters the natural history of shoulder instability.

Adolescent↗
PubMedDate not supplied

[Painful shoulder syndrome with drooping after cervical lymphatic dissection].

A study was made of 12 patients with head and neck cancer who underwent surgical neck dissection in 1993 to evaluate quantitatively the degree of postoperative shoulder dysfunction after surgical neck dissection. Nerve conduction studies were made of the accessory nerve and the range of motion, strength and position of the shoulder were evaluated. Patients were invited to complete a questionnaire about daily living activities, shoulder pain, shoulder movement and shoulder droop. Our results showed that abnormalities can be found in shoulder and arm function after any type of neck dissection and that these are evident when the accessory nerve is damaged. Subjective questionnaire findings generally coincided with objective postoperative dysfunction.

Aged↗
PubMed1997

Shoulder, elbow and wrist movement impairment--predictors of disability in female patients with rheumatoid arthritis.

To explore and describe how shoulder, elbow and wrist movement impairment and age, disease duration, disease activity and shoulder-upper arm pain are associated with disability in rheumatoid arthritis, these variables were investigated in 63 females. Multiple linear regression analysis indicated that limitations in functional shoulder-arm movement and in active wrist motion ranges explained 30-35% of the variation among the patients' results within each of the physical disability instruments used. The Ritchie index for the upper-extremity might be a predictor of disability, explaining 6-28% of the variation within different disability questionnaires, while shoulder tendalgia explained 24% of the variation in shoulder-arm disability. Altogether, however, our predicting variables only explained 11-30% of the variation in shoulder-arm disability and 25-50% of the variation in the other disability areas studied. Thus, other factors not studied here, e.g. muscle strength and hand grip function, and e.g. psychological and social factors are probably also of importance and remain to be elucidated.

Activities of Daily Living↗
PubMed1998

Three-dimensional kinematics of the shoulder complex during wheelchair propulsion: a technical report.

Methods for the three-dimensional (3-D) kinematic analysis of the shoulder complex (humerus relative to trunk) are presented and their use demonstrated in this analysis of shoulder motion during wheelchair propulsion. Ten subjects propelled two different wheelchairs (adjustable and conventional chairs) while the motions of the left arm and trunk were measured using a video tracking system. Eulerian angles described the sequence-dependent rotations of the humerus relative to the trunk. Wheel angular velocity and acceleration, hand position on the handrim, and duration of cycle subphases were also measured. Selected temporal and kinematic parameters were derived from the time-normalized average cycle of each subject on each wheelchair. Within-subject variation of these parameters according to wheelchair type were compared using a two-tailed t-test for paired observations. The adjustable chair made available a larger propulsion are compared with the conventional chair. Only the minimum amount of elevation demonstrated a significant difference between chairs (the conventional chair had a smaller minimum than the adjustable chair) at the corrected significance level of p < 0.001. Other differences, though not statistically significant, were still informative. Less shoulder internal rotation but more overall shoulder motion was observed during recovery phase in the adjustable chair as compared with the conventional chair. The methods presented for measuring the 3-D kinematics of the shoulder complex during wheelchair propulsion proved feasible for future use in studies that will address shoulder kinetics, energy requirements, wheelchair design, and chronic use disorders.

Adult↗
PubMed1993

[Arthroscopy of the shoulder joint. Technique, indications, surgery and complications].

Diagnostic and operative arthroscopy of the shoulder joint has gained considerable importance in traumatology and orthopedic surgery over the last years. Injuries of the limbus glenoidalis, in particular traumatic shoulder luxation, injuries of the rotator cuff, infection of the glenohumeral joint and unclear posttraumatic pain are indications for diagnostic and operative arthroscopy. Arthroscopy of the shoulder is a procedure, which offers exact diagnosis and the possibility of immediate surgery at the same time. The technique of the shoulder joint arthroscopy has to be carried out carefully and according to a standard protocol. The complication rate of around 5% of shoulder arthroscopy has not to be neglected.

Arthroscopy↗
PubMed2006

[MR imaging of the shoulder. Impingement and instability-related abnormalities].

In addition to the case history and the clinical examination, MR imaging has an important role in the diagnosis and differential diagnosis of numerous shoulder abnormalities and in the investigation of chronic shoulder pain. Important indications for MR imaging are any conditions or symptoms making assessment of the rotator cuff and the labrocapsular complex necessary. Assessment of the rotator cuff muscles, in particular, is crucial. The value of MR arthrography, which is still controversial, is discussed. The greatest potential benefit of MR arthrography is the accurate evaluation of subtle rotator cuff abnormalities and shoulder instability-related lesions, and the assessment of pathologic conditions of the long biceps tendon. This paper describes the most common pathologic findings of the shoulder joint and describes how the relevant findings are reported and quantified for the orthopaedic shoulder surgeon.

Humans↗
PubMed2004

Arthroscopic findings in atraumatic shoulder instability.

PURPOSE: The goal of this study was to evaluate the intra-articular pathology in patients with atraumatic shoulder instability who did not respond to conservative treatment. TYPE OF STUDY: Prospective case series. METHODS: Of 226 patients treated for shoulder instability over a 2-year-period, 43 patients (average age, 27.5 years; 26 men and 17 women) were classified as having atraumatic instability. None had responded to physiotherapy. The intra-articular pathology was documented during diagnostic arthroscopy before the definitive surgical procedure. RESULTS: Three types of lesions of the capsulolabral complex were defined: incomplete labral lesions, pathologic elongation of the capsule or "non-Bankart lesions" (type I), classic Bankart lesions (type II), and complex lesions of the labrum and capsule (type III). Type I was found in 19 patients (44.2%); type II lesions were seen in 13 (30.2%); and type III in 11 (25.6%) patients. Hill-Sachs lesions were found in 26 shoulders (60.5%). Chondral lesions of the glenoid were seen in 10 shoulders (23%); SLAP lesions in 5 (11.7%); and partial, articular-side defects of the supraspinatus tendon in 3 (6.9%) patients. CONCLUSIONS: Atraumatic onset of shoulder instability does not imply the absence of intra-articular lesions, at least in patients not showing a response to physiotherapy. Arthroscopy is helpful to diagnose the definite intra-articular pathology. LEVEL OF EVIDENCE: Level IV.

Adult↗
PubMed2003

Classification of shoulder complaints in general practice by means of nonmetric multidimensional scaling.

OBJECTIVES: To determine if a classification of shoulder complaints in general practice can be made from variables of medical history and physical examination with nonmetric multidimensional scaling and to investigate the reproducibility of results from an earlier hierarchical cluster analysis. DESIGN: A classification study performed using nonmetric multidimensional scaling. SETTING: Four general practices in the Netherlands. PARTICIPANTS: Ninety-eight consecutive patients presenting with shoulder complaints in general practice were examined at study entry and after 2 weeks of treatment. INTERVENTION: All patients were treated with a nonsteroidal anti-inflammatory drug during the first 2 weeks of treatment. MAIN OUTCOME MEASURES: Eleven variables of the medical history and 19 variables of the physical examination were used in a nonmetric multidimensional scaling analysis. RESULTS: The analysis of the data at inclusion as well after 2 weeks shows that a 1-dimensional configuration can be used to represent the shoulder complaints. The results of the cluster analysis are consistent with the results of the nonmetric multidimensional scaling. The degree of limitation in range of motion and the degree of pain felt by the patients together determine the position of the patients on the dimension. CONCLUSIONS: The analysis shows that detailed classifications for the diagnosis of patients with shoulder complaints in general practice cannot be confirmed by empirical data available to the general practitioner. The results confirmed the recommendations of the new Dutch Guidelines for Shoulder Complaints, issued in 1999.

Adult↗