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At least 1,225 records · Page 68Linked to original sources
PubMed1996

Clinically significant abnormalities in postreduction radiographs after anterior shoulder dislocation.

STUDY OBJECTIVE: To determine the incidence of clinically significant fractures or other abnormalities seen on postreduction shoulder radiographs which were not seen on postreduction should radiographs which were not seen on the prereduction films obtained for anterior shoulder dislocations. METHODS: Retrospective chart review of 131 patients who presented with a total of 175 anterior shoulder dislocations to the emergency department of an urban, university-affiliated, Level 1 Trauma Center with an emergency medicine residency program. All patients had complete medical records, radiographs before and after reduction, and no fractures reported on the prereduction films. RESULTS: There were three avulsion fractures (1.7%; 95% confidence interval [CI], 0% to 4.5%) detected on postreduction radiographs. In all three cases, a radiologist who was blinded to the original interpretations and the purpose of the study also noted the fractures on the prereduction films, although these fractures were not detected on the original interpretations. There were 14 new Hill-Sachs deformities (8%; 95% CI, 4% to 12%). In one case (.6%; 95% CI, 0% to 2.8%), the postreduction radiograph demonstrated a persistent dislocation, which was subsequently reduced in the ED. This was the only postreduction finding that altered acute management. CONCLUSION: Postreduction radiographs rarely reveal any clinically significant abnormality after an anterior shoulder dislocation has been reduced. Emergency physicians and orthopedic surgeons should question whether the time and expense of obtaining routine postreduction films in the ED for anterior shoulder dislocations is justified. A prospective study is needed to validate our findings.

Adult↗
PubMedDate not supplied

A review of self-report scales for the assessment of functional limitation and disability of the shoulder.

A shoulder disorder affects a patient's overall quality of life. Self-report outcome measures can be used to assess the effects of shoulder dysfunction in terms of patients' functional limitations and disabilities. Selection of a shoulder-specific scale from the numerous scales available can be overwhelming. The purpose of this study was to review the self-report scales in current use for assessing the shoulder joint. A MEDLINE literature search was performed to locate scales appropriate to the assessment of function and disability of the shoulder. Only scales with established measurement properties were selected for review. Eleven scales were reviewed. Methodological and practical criteria were established to evaluate each scale. All scales met the minimal criteria, but not all scales were equal with regard to the criteria established for analysis.

Health Status Indicators↗
PubMed2001

Variation in shoulder position sense at mid and extreme range of motion.

OBJECTIVE: To determine the effect of different joint positions on position sense of asymptomatic shoulders. DESIGN: Repeated-measures design. SETTING: Laboratory in an educational institution. PARTICIPANTS: Thirty-four asymptomatic, right-handed men. INTERVENTIONS: The ability of subjects to replicate 3 criterion positions was examined on subjects' right shoulders by using an isokinetic dynamometer. Three criterion positions were the 50th, 75th, and 90th percentiles of each individual's total passive shoulder rotation range measured from the full internal rotation position. MAIN OUTCOME MEASURE: Repositioning accuracy, indicating the difference in degrees between the criterion and matching positions. RESULTS: All subjects were able to reproduce the criterion position near the end of external rotation range more accurately and consistently than in the middle range of motion (ROM). CONCLUSIONS: Position sense acuity at the shoulder complex varied across the ROM and may be enhanced near the end of rotation range where there is more tension on the restraints to movement. Therefore, an individual's ROM should be factored into any attempt to assess or rehabilitate shoulder proprioception.

Adult↗
PubMed1997

[Ultrasound findings after shoulder dislocation].

AIM: Sonography of the shoulder is an effective method for detecting tears of the rotator cuff and bone lesions. The purpose of this study was to evaluate prospectively the sonographic findings after shoulder dislocation. METHODS: Sonography was performed on 208 patients with 210 shoulder dislocations, which were all verified by radiography. RESULTS: We diagnosed 62 rotator cuff lesions (29.5%), which were all in the group with traumatic shoulder dislocation. The incidence of tears in patients with first traumatic dislocation (n = 134) was 36.5%. 12 tears (21.8%) of the rotator cuff were noted in recurrent dislocations (n = 55). 23 fractures or bony avulsions of the greater tuberosity of the humerus (11%) and 168 Hill-Sachs lesions (80%) were seen. CONCLUSION: Sonographic examination of the shoulder revealed a significant amount of information that would remain undetected without the aid of expensive and/or invasive diagnostic tools.

Adolescent↗
PubMedDate not supplied

Neuro-orthopedic management of shoulder deformity and dysfunction in brain-injured patients: a novel approach.

Shoulder problems are common in patients with traumatic brain injury. Very little has been written about the evaluation and neuro-orthopedic management of these problems. This is largely because there have not been surgical treatments available other than release of contracted, nonfunctional shoulders. Shoulder problems can be classified and evaluated using several different strategies: bony versus soft tissue restrictions; static versus dynamic deformities; traumatic injuries versus impairments secondary to weakness and spasticity; or problems of active function versus problems of passive function. Regardless of the classification system employed a systematic approach to evaluation and treatment is essential. Shoulder impairments can be corrected leading to significant improvement in functional outcomes. In this paper we report on the novel evaluation and surgical management options developed in our program for the most common shoulder problems encountered in patients with traumatic brain injury.

Brain Injuries↗
PubMedDate not supplied

Long-term functional results of the modified Bristow procedure for recurrent dislocations of the shoulder.

Subjective shoulder function, range of motion, isokinetic muscular performance, and radiographs were analyzed in 44 patients at an average follow-up time of 6 years after a Bristow-Latarjet procedure for recurrent dislocations of the shoulder. The injured shoulder was compared with the healthy side in each patient. Ninety-five percent of the patients considered mobility, strength, and stability of the operated shoulder as good or excellent. Totally, 32 of 44 patients (72%) had no pain or discomfort at all, while the remaining 12 (28%) complained of moderate exertional pain. Range of motion in extension, flexion, abduction, and internal and external rotation did not differ significantly between the injured and healthy sides. Nor did isokinetic peak torque at 30 and 90 deg/sec differ in extension, flexion, or internal and external rotation. The rate of healing of the implant did not seem to influence the functional outcome of surgery. Two patients suffered from recurrent dislocations. The Bristow-Latarjet procedure provided a good or excellent long-term functional result in patients with recurrent shoulder dislocations.

Adolescent↗
PubMedDate not supplied

Scapular dyskinesis and its relation to shoulder pain.

Scapular dyskinesis is an alteration in the normal position or motion of the scapula during coupled scapulohumeral movements. It occurs in a large number of injuries involving the shoulder joint and often is caused by injuries that result in the inhibition or disorganization of activation patterns in scapular stabilizing muscles. It may increase the functional deficit associated with shoulder injury by altering the normal scapular role during coupled scapulohumeral motions. Scapular dyskinesis appears to be a nonspecific response to shoulder dysfunction because no specific pattern of dyskinesis is associated with a specific shoulder diagnosis. It should be suspected in patients with shoulder injury and can be identified and classified by specific physical examination. Treatment of scapular dyskinesis is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain-based rehabilitation protocols.

Athletic Injuries↗
PubMed1991

Current concepts and recent advances in the athlete's shoulder.

The demands placed on the shoulder girdle during athletics can often exceed its physiologic limits and result in significant injury. The goal of orthopedists, therapists, trainers, and ancillary personnel who care for athletes involved in sports which require extreme demands of the shoulder is to enhance athletic performance, extend their longevity, and prevent injury. With the new concepts available from basic science and clinical research, a clear understanding of normal architecture and biomechanical function of the shoulder girdle is better appreciated. A greater understanding of sporting activities and their physiologic demands on the shoulder are also more clear. The future of all this research seems to be pointing toward maintenance and restoration of normal anatomy and physiology about the shoulder girdle.

Athletic Injuries↗
PubMed1991

Imaging techniques of the shoulder: present perspectives.

Through its ability to evaluate the individual components of the rotator cuff, the labral-capsular complex, the subacromial and subdeltoid spaces, and the glenoid, humerus, clavicle, and acromion, MRI provides a means of comprehensively evaluating the shoulder. Further advances in the use of intra-articular MRI contrast agents will undoubtedly enhance the role of MRI in the evaluation of subtle labralcapsular pathology. Although they are experimental, kinematic studies of the shoulder may provide valuable insight into the pathogenesis of disorders such as impingement syndrome. The ability of MRI to provide detailed pathologic information about individual components of the shoulder, particularly the rotator cuff, presents a challenge to shoulder surgeons. Patient symptomatology should be correlated with MRI findings and the clinical significance attached to different pathologies reevaluated. Through rigorous confirmation of MRI findings, dedicated therapeutic algorithms can be established based on detailed clinicopathologic data. Present and future surgical and nonsurgical management of the shoulder will undoubtedly be shaped by MRI.

Athletic Injuries↗
PubMed1989

Double-contrast computed tomography of the shoulder.

As a modality for the study of abnormalities of the shoulder, double-contrast computed tomography (CT) is accurate, is relatively easy to perform, and requires only a low dose of radiation. The results can be extremely helpful in preoperative planning. In this study, CT images were obtained for 247 patients who had undergone routine double-contrast shoulder arthrography. Abnormalities shown on CT images included glenoid labrum attenuation and tears, glenoid fractures, loose joint bodies, intracapsular staples, intra-articular screws, adhesive capsulitis, rotator cuff tears, peritendinitis calcarea, biceps tendon tears, and capsular abnormalities. In the 41 cases in which surgical correlation was available, all of the confirmed abnormalities had been identified on double-contrast CT images. Of the patients with rotator cuff tears, 80% had other abnormalities of the shoulder, and 48% had glenoid labrum tears. Of the patients with peritendinitis calcarea, 40% had glenoid labrum tears, and 33% had rotator cuff tears. Double-contrast CT studies of the shoulder are recommended when patients experience a decrease in range of motion, persistent shoulder pain, or signs of instability. Frequently, patients with rotator cuff tears and peritendinitis calcarea have coexisting abnormalities.

Adolescent↗
PubMed1988

The shoulder of the tennis player.

A depression of the exercised shoulder was found among highly trained tennis players, and in other athletes employing the overhand motion. This deformity is attributed to stretching of the shoulder elevating muscles, and to hypertrophy of the racket-holding extremity. Most symptoms in the shoulders studied were in the region of the rotator cuff, and occurred upon strokes requiring abduction. Shoulder dependency causes a relative abduction of the extremity, which may result in impingement of the rotator cuff. Shoulder droop may lead to thoracic outlet syndrome, and, in the athlete, may simulate scoliosis.

Adult↗
PubMed2000

Frozen shoulder: a sympathetic dystrophy?

Diagnostic and clinical features of the frozen shoulder syndrome and the Sudeck syndrome are similar in many aspects. Radioisotope bone scan shows an increased uptake in affected areas in both diseases, while native radiographs show a progressive demineralisation. Measurement of bone mineral density (BMD) by quantitative digital radiography objectified these local decalcification processes in an early stage of the frozen shoulder syndrome; 10 of 12 patients with primary frozen shoulder had BMD decreases greater 21% in the humeral head of the affected shoulder compared to the non-affected side. In the immobilised control group with degenerative changes of the rotator cuff, calcifying tendinitis and shoulder instability (n = 12) and in the group of healthy probands (n = 20), the difference between the affected and non-affected side (left and right humerus of the healthy probands) was only more than 21% in one case each. There are several references in the literature that assume frozen shoulder to be an algoneurodystrophic process; our observations support this hypothesis, possibly leading to earlier diagnoses and extended therapeutic management.

Absorptiometry, Photon↗
PubMed1993

Recovery of the radiation survival-curve shoulder in CHO-KI, XRS-5 and revertant XRS-5 populations.

The response of wild-type CHO-KI, radiation-sensitive XRS-5 and radiation-resistant XRS-5 revertant populations was examined following single and fractionated doses of cobalt-60 gamma-radiation. The results show that it is possible to induce a shoulder on the fractionated dose-survival curve of XRS-5 radio-sensitive cells, which is the same size as the wild-type CHO-KI shoulder. This shoulder persists as does the wild-type CHO-KI shoulder even after correction of the curve for lethal damage occurring in the progeny. Since this mechanism involves induction of repair, CHO-KI cells, XRS-5 cells and revertant XRS-5 cells, which are repair-proficient, were exposed to 8-azacytidine--an agent which demethylates DNA and has been shown to recover repair proficiency in sensitive XRS-5 cells. The results confirmed that azacytidine had no effect on repair-proficient CHO-KI cells but it removed the shoulder and prevented split-dose repair in XRS-5 revertant populations. The absence of heritable, lethal defects in XRS-revertant cells exposed to single doses of radiation contrasts with the situation in the wild-type CHO-KI line where these defects occur in high numbers. These results suggest that the XRS revertant is not the same as the wild-type. They also suggest that the mechanisms involved in repair of damage and production of the survival-curve shoulder following single doses of radiation are different to those which occur following split doses of radiation.

Animals↗
PubMed1995

Muscular synergy in the shoulder during a fatiguing static contraction.

The synergic operation of shoulder muscles during a fatiguing submaximal arm flexion task was studied using both a biomechanical 3-dimensional shoulder model and electromyographic recordings. A new optimization scheme aiming to maximize the task endurance time by constantly regulating the force output of each muscle is utilized in the model. The method can be used to simulate the muscle rotation phenomenon, which has been proposed to occur during an endurance type contraction. The model predictions on the fatigue order of the shoulder muscles were compared to results derived using the median frequencies of the electromyographic signals from nine muscles or muscle parts. In the test performed 10 men held until exhaustion a weight (4 kg) suspended on the wrist with the arm in horizontal flexion. The deltoid, infraspinatus, and supraspinatus muscles were the first to show electromyographic signs of fatigue. The times for detecting electromyographic changes in the trapezius muscle were longer than those in the muscles first showing electromyographic signs of fatigue. The biomechanical model used predicted the upper and lower infraspinatus and the anterior part of the deltoid to be the first to show signs of fatigue during the flexion task. The predictions of the biomechanical model on the order of fatigue of the nine shoulder muscles monitored also using electromyographic recordings corresponded to the electromyographic results. However, the accuracy of this comparison is limited by the fact that the electromyographic recordings did not cover all the muscles used in the model. No clear order was found for the development of electromyographic signs of muscle fatigue. RELEVANCE--:The biomechanical model and the developed optimization methods provide new tools for studying the synergic operation of shoulder muscles during fatiguing contractions. Our results will help in analysing and optimizing shoulder load in problematic functions both of work and leisure activities.

Journal Article↗
PubMedDate not supplied

Barium enema "shoulder" sign: a useful predictor of pericolonic fat invasion in colorectal cancer.

PURPOSE: We aimed to determine the presence of the "shoulder" sign in prediction of pericolonic fat invasion on double-contrast barium enema (DCBE) studies in colorectal cancer. MATERIALS AND METHODS: Patients at our institution with apparent colorectal cancer were identified from a computer search of both radiological and surgical pathology records during a recent 30-month period. The presence of a shoulder sign was defined as a tumor margin having an abrupt transition from the intraluminal component to the adjacent normal mucosa, forming a shouldered edge on barium studies. RESULTS: A total of 49 patients (53 lesions) for whom the DCBE studies and surgical pathology records were available for review were proven to have colorectal carcinomas. DCBE studies revealed that 45 patients with lesions (85%) presented with a "shoulder" sign. All of these lesions were correctly diagnosed as colorectal cancer. Of these, 89% had pericolonic fat invasion and 44% had regional lymph node metastases. Of lesions without a shoulder sign, 25% had pericolonic fat invasion and 25% had nodal metastases. CONCLUSION: The presence of shoulder sign detected with barium enema can be a useful predictor of pericolonic fat invasion in colorectal cancer.

Adult↗
PubMed2003

Is maternal obesity a predictor of shoulder dystocia?

OBJECTIVE: To explore the relationship between maternal obesity and shoulder dystocia while controlling for the potential confounding effects of other variables associated with obesity. METHODS: We performed a case-control study of provincial delivery records audited by the Northern and Central Alberta Perinatal Outreach Program. Risk factors evaluated were selected based on previously published studies. Cases and controls were drawn from 45,877 live singleton cephalic vaginal deliveries weighing more than 2500 g between January 1995 and December 1997. There were 413 cases of shoulder dystocia (0.9% incidence). Controls (n = 845) were randomly chosen from the remainder of the target population to create a 1:2 case/control ratio. Univariate analysis with calculation of odds ratios (ORs) was used to determine which of the chosen risk factors were significantly related to the incidence of shoulder dystocia. Multivariable regression analyses were then used to determine the independently associated variables, and the adjusted ORs were obtained for each relevant risk factor. RESULTS: Maternal obesity was not significant as an independent risk factor for shoulder dystocia after adjusting for confounding variables (adjusted OR 0.9; 95% confidence interval [CI] 0.5, 1.6). Fetal macrosomia was the single most powerful predictor. The adjusted ORs were 39.5 (95% CI 19.1, 81.4) for birth weight greater than 4500 g and 9.0 (95% CI 6.5, 12.6) for birth weight between 4000 and 4499 g. CONCLUSION: The strongest predictors of shoulder dystocia are related to fetal macrosomia. For obese nondiabetic women carrying fetuses whose weights are estimated to be within normal limits, there is no increased risk of shoulder dystocia.

Comorbidity↗
PubMed1997

The variability of shoulder motions recorded by means of palpation.

OBJECTIVE: The objective of this methodological study is the quantification of the sources of variability in the recorded three-dimensional motions of the shoulder mechanism for comparative purposes. BACKGROUND: The palpation and subsequent digitization of skeletal landmarks of the shoulder mechanism is a non-invasive and relatively easy method to quantify shoulder orientations. Comparison of individual motions is subject to the accuracy of the palpation method, the magnitude of kinematic redundancy of the shoulder mechanism and inter-subject differences in morphology and physiology. Quantification of these sources of variance, i.e. the palpation error, motoric noise and inter-subject differences, demonstrated the accuracy of the method and the potential validity of the descriptive motion parameters, e.g. Cardan angles, in intra- and inter-individual studies for clinical, ergonomical and biomechanical studies. METHODS: The orientations of the shoulder bones were recorded five times for each of five subjects by palpation and digitization of 12 skeletal landmarks for 10 equidistant arm elevation postures in the scapular plane. The orientations were described by means of Cardan angles. The palpation error was determined at a standardized initial rest position and expressed by Cardan angles for each recorded posture. Adding motoric noise and inter-subject differences gave the inter-individual variance. RESULTS: The palpation error was approximately 2 degrees. The major recorded variance originated from motoric noise (+/-33%) and inter-subject difference (+/-55%). CONCLUSIONS: The palpation method is an accurate means of recording the three-dimensional orientations of the shoulder mechanism and for intra-individual studies. However, inter-subject variability is large.

Journal Article↗
PubMed1999

A qualitative assessment of shoulder girdle elevation during the upper limb tension test 1.

The 'feel through range' and the 'end-feel' of the elbow extension, and the elevation of the shoulder girdle during the upper limb tension test for the median nerve are considered important in clinical decision making. As no objective measurements have been published regarding these parameters, a special device was designed in order to obtain objective information on the force by which the shoulder girdle is elevated during the test. The purpose of this technical note is to describe the technical aspects of the device and its practical application. In a pilot study, five asymptomatic subjects have been assessed. The relationship between the elevation of the shoulder girdle and the range of elbow extension has been analysed. The data of five subjects and representative curves of one subject are presented. All five subjects demonstrate a considerable increase in force elevating the shoulder girdle. The results show that the device can be used to measure the force by which the shoulder girdle is elevated throughout the test. Although the number of subjects and the number of repetitions is limited, the data suggest that the method is accurate and that the phenomenon of shoulder girdle elevation during the upper limb tension test in asymptomatic subjects is consistent.

Adult↗