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At least 1,207 records · Page 67Linked to original sources
PubMed2001

The relationship between impairments in joint function and disabilities in independent function in children with systemic juvenile idiopathic arthritis.

OBJECTIVE: Knowledge about the impact of joint impairment on functional ability is needed in planning care and setting treatment goals in children with juvenile idiopathic arthritis (JIA). We investigated the relationship between joint impairments and upper and lower limb function. METHODS: Twenty-one children with systemic JIA with an average age of 9.2 years and a mean disease duration of 4.8 years participated in this study. Joint impairments were assessed by the following variables: joint counts on swollen (JCS) and tender (JCT) joints and the loss of joint motion as determined by the Joint Alignment and Motion scale (JAM). Functional performance and functional ability were determined by the Juvenile Arthritis Functional Assessment Scale (JAFAS) and Childhood Health Assessment Questionnaire (CHAQ), respectively. The relationship between impairments and functional disabilities was studied at the level of (1) the complete instruments, (2) upper and lower limb function separately, and (3) the individual joints and items. RESULTS: Regarding complete instruments, the Spearman rank correlation between functional disabilities and loss of joint motion was moderate to good (JAM/CHAQ rs = 0.66, JAM/JAFAS rs = 0.77). A fair correlation was found between functional disabilities and the joint count on swollen joints (JCS/CHAQ rs = 0.45, JCS/JAFAS rs = 0.52), but no significant relationship was found with the number of tender joints (JCT/CHAQ rs = 0.02, p > 0.05, and JCT/JAFAS rs = 0.14, p > 0.05). At the extremity level (upper and lower limb function), the relationship between functional disabilities and the loss of joint motion appeared to be stronger in the leg than in the arm. At the level of the individual joints and questionnaire items, loss of joint motion in hip or shoulder joint appeared to be the most important factor in predicting limitation in leg or arm function. CONCLUSION: Our study shows that with respect to joint impairments, loss of joint motion is the strongest indicator of functional disability in children with systemic JIA. Loss of joint motion has a greater effect on lower limb function.

Activities of Daily Living↗
PubMed2001

[Allografting for massive bone defect: bone and soft tissue reconstruction and postoperative rehabilitation].

OBJECTIVE: To evaluate the results of limb function and the methods of bone and soft tissue reconstruction of patients treated with allografting. METHODS: From May 1992 to January 1999, 90 patients suffered from bone malignant tumor were treated with allografting in different methods of internal fixations. The average follow-up was 37.5 months. The limb postoperative function, complications related to different surgical methods were compared according to Enneking evaluation system. RESULTS: Skin necrosis, infection, non-union, fracture of allograft were the main complications which affect patients' limb postoperative functions. Of the 90 fresh-frozen allografting procedures, the final results of operation showed that hip joints and knee joints were better than the shoulder joints. More than 80% of the patients treated with interlocked intramedullary nail and allograft-prosthesis combination led to an over-all result that was excellent and good. Interlocked intermedullary nail was of recommended method of internal fixation. Early exercises of operative limbs could promote function recovery. CONCLUSION: Using of interlocked intramedullary nail and allograft-prosthesis combination are of recommended operation method and can be applied with better results, and early exercises of operative limbs will lead to better functions.

Adolescent↗
PubMed1994

Ergonomic aspects on snowmobile driving.

From self-reported health surveys in Finland, Sweden and Norway we know that the reindeer herders have work related disorders. It is very likely that disorders such as lumbar back pain, neck and arm pain, knee pain and white finger syndrome are related to snowmobile driving. Our hypothesis was that driving postures, vibrations, impact from the driving surface and handling are the main reasons for the health problems, and that snowmobiles are not designed according to ergonomic principles. Our work started in the winter of 1993. We studied the general literature available on ergonomic postures, measurements of vibrations and body impact and we set out to explain the problems associated with driving and handling snowmobiles from a physiological, ergonomic and biomechanical point of view. At this point we identified some ergonomic requirements and requirements for the springing system of snowmobiles. We made static tests in which we watched the sitting position of the driver and tested the springing suspension. This was followed by a driving test and field observations of reindeer herders in 1994. The total load when driving comprises the load of the posture added with the load from vibrations and impact from the ground (3-10 G). The driving positions probably giving the most health problems are sitting with bent back, hyperlordotic neck, too high upper arms, more or less straight elbows and flexed and ulnar deviated wrist positions. The design of the snowmobile should enable the driver to sit with straight back, the hip joints at less than 90 degrees, knee joints at about 45 degrees, shoulder joints at 45 degrees, elbow joints around 60-70 degrees and the hand in a neutral position. The seat should be higher at the back and narrowed between knees. The height of the seat should be about 50 cm. The height of the steering-bar should be around 80 cm. The distance between the body of the driver and the steering-bar should be about 50 cm. Only one snowmobile was close to our requirements with a seat height of 48 cm and steering-bar height of 75 cm. The seat height varied with 10 cm, and the height of the steering-bar from 64 to 75 cm. The gas-bar should be placed on the thumbside so that it is possible to use the accelerator with the fingers.(ABSTRACT TRUNCATED AT 400 WORDS)

Ergonomics↗
PubMed2004

The anterior glenohumeral joint capsule: macroscopic and MRI anatomy of the fasciculus obliquus or so-called ligamentum glenohumerale spirale.

The purpose of this study was to demonstrate the macroscopic and MRI anatomy of the fasciculus obliquus, otherwise known as the ligamentum glenohumerale spirale or spiral GHL of the anterior shoulder joint capsule. Conventional and MR arthrography (1.5-T device Somatom Symphony, Siemens with shoulder coil) images in standard planes were compared with gross anatomic dissection findings in six fresh shoulder specimens from three cadavers. The MR imaging protocol included T1, PD and DESS 3D WI sequences. The macroscopically recognisable band-the spiral GHL-was identified by anatomic dissection and MRI in all the specimens. It was best visualised by MR arthrography on axial and oblique sagittal planes (T1; PD WI) and appeared as a low signal intensity stripe within the superficial layer of the anterior joint capsule. The absence of the variable middle glenohumeral ligament did not influence the anatomic properties and the MR imaging of the spiral GHL. Diagnostic visualisation of the normal anatomic structures is a prerequisite to distinguish between normal and pathologic conditions. Anatomy of the spiral GHL can be used by radiologists for more detailed interpretation of the anterior shoulder joint capsule ligaments on MR images.

Aged↗
PubMed1999

Real-time MR-guided joint puncture and arthrography: preliminary results.

The purpose of this study was to evaluate interactive MR-guided joint puncture with intra-articular application of contrast agent. MR-guided arthrography of the shoulder joint was successfully performed in three patients using an interactive guidance system implemented in an open-configuration MR system. Visualization of the needle pathway and contrast inflow was comparable to that with conventional X-ray fluoroscopy. The position of the intra-articular needle tip was accurately confirmed and subsequent MR arthrography was diagnostic in all cases.

Adult↗
PubMed1979

A bioceramic endoprosthesis for the replacement of the proximal humerus.

In patients with malignant tumors in the region of the shoulder, radical resection can avoid amputation in most instances. To improve the function of the arm, endoprosthetic replacement of the defect is desirable. A three-component endoprosthesis made of a bioceramic material (aluminium oxide) was designed, implanted without bone cement. Fast anchorage to bone is achieved by using a conical sleeve, fixed upon the previously conically reamed humerus shaft. A stable primary fit is always feasible. Subsequent bone in growth into grooves inside the conical sleeve provides a permanent anchorage of the endoprosthesis. The authors experiences are based on implantations of 38 endoprostheses. The original diseases were primary malignant bone tumors in 19 patients, one case of "solitary" plasmocytoma and metastases into the proximal humerus in 16 patients. In two women, resection was made because of posttraumatic subcapital humeral pseudarthrosis. The follow-up study includes only those 27 cases operated on at least one year ago. 12 of the 14 patients with primary tumors have been surviving for 12-55 months (range 27.4) without signs of metastases or recurrent disease. Seven patients with metastases died of their original diseases after 7.7 months on the average. Owing to extensive resection of the shoulder musculature the mobility in the shoulder joint is considerably reduced. All the patients have good movement of the elbow joint and free function of the hand.

Activities of Daily Living↗
PubMed2006

Proprioception and EMG pattern after capsulolabral reconstruction in shoulder instability: a clinical and experimental study.

The anterior capsulolabral reconstruction according to JOBE [13] is a modification of the Bankart operation. The capsular shift is performed via a subscapularis-split approach avoiding any incision into the musculature. A total of 43 patients with posttraumatic, chronic anterior shoulder instability underwent surgery. All patients had at least four dislocations preoperatively. Thirty-five patients were examined after an average of 3.7 +/- 1.4 years. Twenty-nine (82.9%) of these patients were free of pain, with functional assessment showing a mean external rotation deficit of 4.1 degrees +/- 2.9 degrees without any further movement restrictions. On average, a Rowe-Score of 86.1 +/- 12.4 points and an ASES-Score of 93.3 +/- 8.4 were achieved. The reluxation rate was 7.7%. The study demonstrated that despite the good clinical results, only 69% of patients were able to return to their previous sports activity level. This special problem is in agreement with other similar studies [4, 18] so that this relevant fact was further addressed by determination of proprioception and electromyographic muscle activity. Postoperatively, in contrast to other studies [1, 21, 24], a persisting proprioceptive deficit as well as an altered EMG pattern was found together with a significant reduction in activity of the deltoideus muscle on the operated side. These results may explain the problem to achieve complete restitution of the function of the shoulder joint after capsulolabral reconstruction.

Adolescent↗
PubMed2005

Permanent articulated antibiotic-impregnated cement spacer in septic shoulder arthroplasty: a case report.

We report a case of a patient with an infected shoulder hemiarthroplasty in whom a permanent antibiotic-impregnated cement spacer was employed with satisfactory results. This method of treatment has limited applications and would not be appropriate in all cases of septic shoulder joint arthroplasties. However, its use may represent a valid alternative in low physical demand patients who are unwilling to undergo major surgery or when inadequate bone stock is present.

Aged↗
PubMed1999

A commonsense approach to shoulder problems.

Shoulder pain is a common entity in a primary care physician's practice. The unique anatomy of the shoulder allows for almost unrestrained motion in all planes. A thorough history and physical examination are important to ensure efficient patient evaluation. Further assessment may include radiographic and diagnostic laboratory tests. This article presents an organized approach to the anatomy, physiology, and pathology of common shoulder disorders for the primary care physician. The distinction between disorders that are intrinsic or extrinsic to the shoulder joint is discussed. Treatment and the need for appropriate referral are described.

Diagnosis, Differential↗
PubMed1991

The painful shoulder: Part I. Extrinsic disorders.

Shoulder disorders are most commonly manifested by pain and limited function. Careful history and examination help the physician localize the problem to the shoulder joint, the surrounding tissues or adjacent sites that can cause referred pain to the shoulder. Common extrinsic causes of shoulder pain include postural problems and cervical spine disorders.

Diagnosis, Differential↗
PubMed1991

[Calcareous tendinitis--special forms of the upper extremities. Clinical aspects and differential diagnosis].

Calcifying tendinitis of the shoulder joint is a relatively common condition. Its pathogenesis is well documented in anatomical-pathological terms. The clinical observation of four unusual locations in the upper limb makes us to suspect the same pathological process as in the supraspinatus location. The clinical course of calcifying tendinitis in a typical location is discussed in detail.

Adult↗
PubMed1981

Tenosynovial chondromatosis of the shoulder.

Two cases of tenosynovial chondromatosis of the shoulder are presented, the literature on this rare lesion is reviewed, and the differential diagnosis, diagnosis, and treatment are discussed. Synovial chondromatosis is a benign monoarticular lesion. It may also be found in tendon sheaths de novo and secondary to local extension. The two cases presented show tenosynovial chondromatosis involving both the shoulder joint and extension into the bicipital groove.

Adult↗
PubMed1975

Periarticular new bone formation in patients suffering from severe head injuries.

A total of 35 cases of periarticular new bone formation (PNBF) was observed among 160 patients with coma following severe craniocerebral trauma. All cases were associated with blunt trauma and none with penetrating wounds. Only 6 of 500 cases of acute non-traumatic hemiplegia developed PNBR, and all 6 of them followed craniotomy, brain surgery and coma. New bone formation first appeared mainly between 50 and 120 days after craniocerebral injury with prolonged coma. Three-quarters of the patients with PNBF showed involvement of the shoulder joint, but this was not associated with previous subluxation. Metabolic studies were done in some patients; no disturbances were found in the metabolism of calcium, phosphorus or alkaline phosphatase. The pathologic process of PNBF seemed to stabilize some 6 to 8 months following trauma, and surgery after this period produced functional improvement in the 3 patients in whom it was tried. No satisfactory pathophysiological explanation has been found for the phenomenon of PNBR. Prolonged coma is common to all patients who suffered from PNBF and is probably an etiologic factor. The absence of PNBF in cases of cerebrovascular accident with subluxations of the gleno-humeral joint and intensive physiotherapy seems to contradict the suggestion of microtrauma as an etiological factor.

Adult↗
PubMed1995

Glenohumeral instability.

Glenohumeral instability can be defined as pain associated with loss of shoulder function due to excessive translation of the humeral head on the glenoid fossa. It can be classified according to many factors, such as direction, degree, mechanism, and frequency. A thorough understanding of the anatomy and biomechanics of the shoulder joint as they relate to instability is helpful in understanding the pathophysiology of this condition. All components of the instability must be correctly diagnosed so that appropriate treatment can be selected. Clinical examination is most important in making the correct diagnosis, but plain radiographs, arthrography, computed tomography, magnetic resonance imaging, examination under anesthesia, and arthroscopy can be helpful in difficult and challenging cases. Conservative treatment with a rehabilitation program can be successful in a large percentage of cases and should be the initial approach for most patients. Operative treatment is based on the direction and type of instability and is recommended only after an adequate trial of conservative therapy has failed to improve recurrent instability.

Arthroscopy↗
PubMed1983

Voluntary anterior dislocation of the shoulder: case study.

Anterior shoulder dislocation can be willfully produced by a subject through abnormal unbalanced muscle contraction at the shoulder joint. It may be associated with pathologic lesions at the shoulder. Treatment consists of vigorous shoulder strengthening exercises and/or surgery to increase anterior stability at the joint. For any treatment approach to be successful the subject must avoid dislocation of the shoulder. A psychologic component frequently associated with this condition is its use as a mechanism for attention, sympathy or defense--a factor that has a significant negative effect on response to treatment.

Adult↗
PubMed1986

Painful shoulders in patients with rheumatoid arthritis. Prevalence, clinical and radiological features.

The shoulder joints of 105 patients with rheumatoid arthritis were examined. The patients were on average 62 years old and their mean RA duration 17 years. Ninety-six patients (91%) reported shoulder problems. Thirty-three patients had actual severe painful shoulder disability. The acromioclavicular joint was clinically tender in 36 shoulders and subacromial hypertrophic bursitis was recorded for 22 shoulders. One hundred and sixteen shoulders in 61 of the patients with shoulder pain were examined radiologically and classified according to the Larsen system. With increasing duration of the RA there was a progress of destructive changes and a decrease in the range of motion, indicating that intervention with surgical procedures may be warranted.

Arthritis, Rheumatoid↗
PubMed1997

Shoulder fusion for paralyzed upper limb.

Fusion of the shoulder joint after a brachial plexus injury is a well known procedure in cases of flail shoulder in combination with normal motor and sensory function in the band. However, in combination with modern orthoses to stabilize the elbow, fusion of the shoulder in cases of a totally flaccid and afunctional arm might be more beneficial. In a retrospective study the impact of shoulder fusion on daily abilities in a population with a completely flaccid arm caused by a brachial plexus injury was investigated. Compared with a similar population, consisting of 16 patients with an afunctional unstable shoulder, all 12 patients who underwent shoulder fusion proved to perform at a higher functional level. Shoulder fusion in combination with an elbow stabilizing orthosis for a completely flaccid upper limb is a beneficial procedure that leads to less disability and results in a better quality of life.

Brachial Plexus↗
PubMed1988

Shoulder arthroplasty with the Neer Mark-II prosthesis.

Total shoulder joint replacement was used as primary intervention in 50 shoulders--35 with rheumatoid arthritis, eight with osteoarthritis, and seven with traumatic arthritis. Follow-up time was 27 (12-42) months. The primary indication for the operation was chronic severe pain; improvements in motion and function were secondary objectives. Relief of pain was obtained in 46 of 50 shoulders. The best results regarding pain, motion, and function were obtained in the osteoarthritic group. The majority of patients with rheumatoid arthritis obtained pain relief and the largest increase in range of motion occurred in this group, although full range of motion was never regained. The results in patients with traumatic arthritis seemed unpredictable. Two shoulders were complicated by glenoid loosening, one by humeral subluxation, and one by musculocutaneous nerve palsy.

Arthritis↗