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PubMed2000

Review of shoulder dystocia at the Birmingham Women's Hospital.

A retrospective audit was performed of all deliveries between 1 January 1991 and 31 December 1995 at the Birmingham Women's Hospital, the main University Teaching Hospital in the West Midlands. This was performed by using the computer database of all hospital deliveries, at the Women's Hospital during the above-mentioned period, by entering a CCL code for shoulder dystocia. During that period of time there were 28 932 deliveries with a mean caesarean section rate of 16.7%. One hundred and fifty-four cases were identified, of which 134 case notes were available for review. The incidence of shoulder dystocia was 0.53%. Audit was performed of pre-pregnancy, antepartum and intrapartum risk factors, the severity of shoulder dystocia, the category of person delivering the baby, fetal outcome at birth and subsequent pregnancy outcome in cases of those with subsequent pregnancies. Overall, the majority of cases of shoulder dystocia were mild, and dealt with by midwives (101 cases 74%). No severe cases were encountered, however three out of eight moderate cases delivered by obstetricians had evidence of fetal trauma (one Erbs palsy and two limb fractures). Twenty women had a pregnancy after the pregnancy complicated by shoulder dystocia. Of these, 18 women delivered vaginally and there were two cases (10%) of repeat shoulder dystocia.

Journal Article↗

PubMed1986

Diagnostic techniques in the investigation of shoulder lameness.

Methods of investigating horses with suspected shoulder lameness are described and discussed. The gait of shoulder lameness is characterised and compared with that of lower forelimb lameness. If lameness is slight, differentiation may be difficult, but if moderate, upper forelimb lameness usually results in shortening of the cranial phase of the stride and a low limb flight. Clinically, it may not be possible to differentiate between shoulder and elbow lameness without intra-articular anaesthesia. Practical aspects of intra-articular anaesthesia of the shoulder joint are reviewed. Synovial fluid must be retrieved to ensure that the needle is intra-articular. Up to 60 mins may elapse after injection of local anaesthetic before significant improvement occurs. Lameness is often improved rather than eliminated. A technique for standing radiography of the shoulder is described and the limitations of assessing a joint only by lateral projections are highlighted. There may be difficulties in positioning weanling foals and yearlings, resulting in superimposition of the shoulder joint, cervical and thoracic vertebra and ribs. It is concluded that a combination of a thorough clinical examination, faradism, local anaesthesia, synovial fluid analysis and radiography usually enables an accurate diagnosis to be reached.

Animals↗

PubMed2005

A multi-modal treatment approach for the shoulder: a 4 patient case series.

BACKGROUND: This paper describes the clinical management of four cases of shoulder impingement syndrome using a conservative multimodal treatment approach. CLINICAL FEATURES: Four patients presented to a chiropractic clinic with chronic shoulder pain, tenderness in the shoulder region and a limited range of motion with pain and catching. After physical and orthopaedic examination a clinical diagnosis of shoulder impingement syndrome was reached. The four patients were admitted to a multi-modal treatment protocol including soft tissue therapy (ischaemic pressure and cross-friction massage), 7 minutes of phonophoresis (driving of medication into tissue with ultrasound) with 1% cortisone cream, diversified spinal and peripheral joint manipulation and rotator cuff and shoulder girdle muscle exercises. The outcome measures for the study were subjective/objective visual analogue pain scales (VAS), range of motion (goniometer) and return to normal daily, work and sporting activities. All four subjects at the end of the treatment protocol were symptom free with all outcome measures being normal. At 1 month follow up all patients continued to be symptom free with full range of motion and complete return to normal daily activities. CONCLUSION: This case series demonstrates the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder impingement syndrome.

Journal Article↗

PubMed2000

Diagnostic findings and prognosis following arthroscopic treatment of subtle osteochondral lesions in the shoulder joint of horses: 15 cases (1996-1999).

OBJECTIVE: To determine clinical, scintigraphic, radiographic, and arthroscopic findings and results of treatment in horses with lameness attributable to subtle osteochondral lesions of the shoulder joint. DESIGN: Retrospective study. ANIMALS: 15 horses. PROCEDURE: Medical records were reviewed, and results of physical examination, scintigraphy, radiography, arthroscopy, and treatment were recorded. RESULTS: Severity of lameness ranged from grade 1 to 4. Response to shoulder flexion or extension was variable. Twelve horses had a narrow upright foot. Intra-articular anesthesia of the shoulder joint localized the cause of the lameness to the shoulder joint in 9 of 10 horses. Scintigraphic abnormalities were detected in 4 of 6 horses. Radiographic lesions were subtle and included glenoid sclerosis, focal glenoid lysis, small glenoid cysts, and alterations in the humeral head contour. Arthroscopic evaluation confirmed clefts in the glenoid cartilage, glenoid cysts, a humeral head cyst, fibrillation of the humeral head cartilage, cartilage fragmentation, or a nondisplaced fracture of the humeral head. After treatment, 12 horses returned to their previous level of performance, 1 was sound for light riding, 1 remained lame, and 1 was euthanatized because of chronic lameness. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that a combination of physical examination, scintigraphy, and radiography is necessary to diagnose subtle osteochondral lesions of the shoulder joint in horses. Arthroscopy can be used to confirm the diagnosis and treat cartilage and subchondral bone lesions. Young and middle-aged horses with subtle osteochondral lesions of the shoulder joints have a good prognosis for return to performance following arthroscopic treatment.

Animals↗

PubMed2004

Non-injurious and injurious impact response of the human shoulder three-dimensional analysis of kinematics and determination of injury threshold.

Seven Post Mortem Human Subjects were submitted to three low velocity impacts (v=1.5 m/s) to the right shoulder at three different angles in the horizontal plane (-15 degrees , 0 degrees , +15 degrees ). Then, the left shoulder was submitted to a purely lateral high velocity impact (v=3, 4, 6 m/s). The load was delivered by a 23.4 kg impactor fitted with a rigid rectangular impacting plate. Shoulder and thoracic bone structures were equipped with tri-axial accelerometers and photographic markers, whose trajectories were tracked in 3D by seven high-speed cameras. The results were scaled in order to account for the differences between the subjects' anthropometry and to define response corridors for the evaluation of the dummies' shoulders. Impact forces as well as several shoulder deflections were analyzed with respect to each subject's injury survey in order to find the most relevant parameters for the prediction of injuries. In the case of oblique impacts, slight modifications in the shoulder responses were observed, with higher force peaks obtained for the +15 degrees impacts in comparison to the 0 degrees and -15 degrees impacts. Acromion-to-sternum deflection peak values were closely linked with a clavicle fracture, but could not predict other types of fracture for which acromion-to-acromion deflection was a better predictor.

Journal Article↗

PubMed2001

[A retrospective investigation of shoulder function after RND].

OBJECTIVE: This study was designed to investigate shoulder syndrome and its influence on daily life and employment, and to seek scientific rational standard for evaluating shoulder syndrome. METHODS: Retrospective investigation of shoulder function were carried out in 50 cases after RND through objective evaluation and subjective examination. RESULTS: 68% cases complained obvious handicap in their daily life and work, impaired shoulder function after RND can be seen in almost every case. CONCLUSION: RND can cause variable degree of disability in the shoulder which influences patients quality of life directly,self evaluation and abducting arm beyond 90 degrees are good standards for evaluating shoulder syndrome.

English Abstract↗

PubMed2004

Evaluation of pediatric use patterns and performance of lap shoulder belt systems in the center rear.

Lap and shoulder belts have been required in rear outboard positions since 1989. A recent congressional mandate encouraged the requirement of a lap and shoulder belt in the center rear seat position. This study utilized Data from the Partners for Child Passenger Safety study, a large-scale child-focused crash surveillance system, to quantify changes in seating patterns for children in vehicles that already have this feature compared to those which do not and measured the safety benefit associated with the provision of a shoulder belt in the center rear seat position. The data demonstrate that the presence of a shoulder belt in the center rear seating position influences seating practices only when there is a single child occupant in the vehicle. Belted children in the center rear of vehicles equipped with a lap shoulder belt are at an 81% reduction in risk of injury than those belted in the center rear equipped with a lap only belt. The data suggest that by requiring lap shoulder belts in the center rear, benefits would be realized to belted children, specifically the 4-8 year old group.

Adolescent↗

PubMed2000

The role of the scapula in the rehabilitation of shoulder injuries.

OBJECTIVE: To present a clinical understanding of the role the scapula plays in the mechanics of shoulder function and specialized techniques for the rehabilitation of injuries around the shoulder girdle. BACKGROUND: The scapular musculature is often neglected in the evaluation and treatment of shoulder injuries. This lack of attention often degenerates into the incomplete evaluation and rehabilitation of scapular dysfunction. Dysfunction or weakness of the scapular stabilizers often results in altered biomechanics of the shoulder girdle. The altered biomechanics can result in (1) abnormal stresses to the anterior capsular structures, (2) the increased possibility of rotator cuff compression, and (3) decreased performance. DESCRIPTION: We review the anatomy and role of the scapula, the pathomechanics of injury and dysfunction, and the evaluation and rehabilitation of the scapula. CLINICAL ADVANTAGE: Knowledge of how the scapular muscles influence function at the shoulder builds a strong foundation for the clinician to develop rehabilitation programs for the shoulder.

Journal Article↗

PubMed2000

An unusual case of shoulder pain.

Shoulder pain is a common musculoskeletal ailment. The process of determining the etiology of shoulder pain can be difficult. The differential diagnoses include: both intracapsular and extracapsular lesions; and neurologic, vascular, postural, and visceral causes. We present an unusual case of shoulder pain accompanied by loss of shoulder range of motion (ROM), initially thought to be caused by an intrinsic shoulder disorder. However, it ultimately was determined that a cervical radicular disorder caused both the impaired ROM and the patient's shoulder pain.

Journal Article↗

PubMedDate not supplied

Acute muscle stretching and shoulder position sense.

CONTEXT: Stretching is common among athletes as a potential method for injury prevention. Stretching-induced changes in the muscle spindle properties are a suggested mechanism, which may imply reduced proprioception after stretching; however, little is known of this association. OBJECTIVE: To evaluate whether acute stretching of the shoulder muscles affects position sense. DESIGN: A crossover design with subjects randomized to 3 groups. SETTING: A university human research laboratory. PATIENTS OR OTHER PARTICIPANTS: Nine male (age = 24 +/- 3 years) and 9 female (age = 21 +/- 2 years) healthy volunteers. INTERVENTION(S): Stretching of shoulder (1) agonists or (2) antagonists or (3) nonstretching control. MAIN OUTCOME MEASURE(S): We determined position sense acuity of the right shoulder before and after the interventions by having subjects attempt to reproduce arm positions of 15 degrees and 30 degrees (shoulder adduction) while starting at 45 degrees to the sagittal plane. The outcome variables were response variability (variable error) and overall accuracy (absolute error). RESULTS: The relative change in variable error (ie, variable error after/variable error before) was not significantly different between the interventions ( P = .38). Similarly, no change in absolute error was found ( P = .76). Furthermore, no differences were noted regarding test sequence or the interaction of intervention x sequence for either variable error ( P = .73 and .53, respectively) or absolute error ( P = .71 and .67, respectively). CONCLUSIONS: We found no effect on shoulder position sense after an acute bout of stretching of either agonist or antagonist shoulder muscles.

Journal Article↗

PubMed1996

[Finite element stress analysis of stress distribution endodontic posts at shoulder].

The objective of the present resarch is the comparative stress distribution of various design for post-core at shoulder. The purpose of this study was to analyse the stress distribution and concentration in the dentin of paralled-sided and taped posts by different shoulder designs with finite elements stress analysis method. It was found that stress tended to concentrate under the core shoulder with vertical force. When the force applied from the linqual side. The stress concentrated at the buccal side. The 90 degrees shoulder angles exhibited more even stress distribution than sharp shoulder angles. The analysis revealed that sharp angle should be avoided as occlusal shoulder in clinical practice because this design are less resistant to forces applied on them and are susceptible to fractures in the dentin.

Models, Biological↗

PubMed2004

A pilot study of a randomized controlled trial to evaluate the effects of progressive resistance exercise training on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in head and neck cancer survivors.

BACKGROUND: Shoulder dysfunction remains a frequent complication after neck dissection procedures for head and neck cancer. METHODS: We conducted a pilot study to evaluate the effects of progressive resistance exercise training (PRET) on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in patients with head and neck cancer. Twenty patients (mean age, 61 +/- 7.7 years) were randomly assigned to PRET or standard care intervention. Subjects assigned to the PRET group exercised three times per week for 12 weeks. The goal of the exercise program was to enhance scapular stability and strength of the upper extremity. The resistance-training program was progressive in terms of number of sets and repetitions performed, as well as the amount of weight lifted, depending on performance status. RESULTS: The completion rate for the trial was 85% (17 of 20). The exercise group completed 93% of scheduled exercise sessions. Significant improvements were found in favor of the PRET group in active shoulder external rotation (p =.001), shoulder pain (p =.038), and overall score for shoulder pain and disability (p =.045). CONCLUSIONS: The study results demonstrate a high rate of completion and adherence with our PRET program among patients with head and neck cancer. The preliminary findings, although limited, also suggest a potential therapeutic role for resistance exercise as an adjunct to standard physical therapy treatment.

Accessory Nerve↗

PubMedDate not supplied

A prospective study of shoulder disability resulting from radical and modified neck dissections.

A prospective longitudinal study of shoulder function after 103 neck dissections involving either preservation or sacrifice of the spinal accessory nerve is presented. The postoperative evolution and course of trapezius muscle denervation and resultant shoulder dysfunction were objectively determined for both radical and modified nerve sparing neck dissections. All patients were enrolled in a program of physical therapy aimed at maintaining range of motion at the shoulder joint. Shoulder function was examined preoperatively and for 12 months postoperatively with manual muscle strength testing, range of motion measurements, and electrodiagnostic testing. Results indicate that modified nerve sparing dissections are followed on the average by a significant, but temporary and reversible phase of shoulder dysfunction. By comparison, radical neck dissection is followed by profound and permanent trapezius muscle weakness and denervation.

Accessory Nerve↗

PubMed1990

Magnetic resonance imaging of the shoulder: rationale and current applications.

Because it can demonstrate a wide range of tissue contrast with excellent resolution, magnetic resonance (MR) imaging has revolutionized imaging in many areas of the musculoskeletal system and has generated excitement among those interested in the painful shoulder. Shoulder impingement syndrome and glenohumeral instability constitute the two major categories of shoulder derangements. Correct diagnosis requires the use of appropriate pulse sequences and imaging planes, proper patient positioning, and a satisfactory surface coil. In addition the imager must have a thorough understanding of shoulder anatomy and pathology. We present a summary of the current status of MR imaging of the shoulder including technical, anatomic, and pathologic considerations and a review of the pertinent literature.

Humans↗

PubMed1998

Anatomic and functional aspects of the kinetics of the shoulder joint capsule and the subacromial bursa.

This anatomic study was devoted to the kinetics of the shoulder joint and especially the subacromial region. Following dissection of the shoulder joint capsule and subacromial region of 80 unpreserved shoulder joints, the anatomic relationships of the subacromial space in the neutral position and in continuous abduction (30 degrees, 60 degrees and 90 degrees with fixed scapulae) were examined. These investigations were supplemented by histologic preparations. In the course of our examinations we discovered a gliding mechanism of the subacromial bursa. Moreover, we found a subcoracoid attachment of the shoulder joint capsule and a precoracoid ligamentous connection running between the short head of the biceps brachii m. and the coracoacromial ligament. We termed this the coracoid aponeurosis, which facilitates gliding behaviour of the shoulder joint capsule beneath the coracoid process. In view of this gliding mechanism of the subacromial bursa and the coracoid aponeurosis, discovered in the course of our investigations, we have to reassess the kinetics of the sub-acromial and subcoracoid space. Further, we should reconsider our operative technique in cases of the subacromial or subcoracoid impingement syndrome.

Bursa, Synovial↗

PubMed1996

[Diagnosis of shoulder impingement syndrome].

This article reviews the pathogenesis and clinical and imaging findings in shoulder impingement syndrome. Shoulder impingement is caused by compression of the supraspinatus tendon underneath the coracoacromial arch, mainly in forward flexion of the arm. Different stages of impingement syndrome are described. Stage I relates to edema and hemorrhage of the supraspinatus tendon. Stage II is characterized by bursal inflammation and fibrosis, as well as tendinopathy. In stage III there is a tear of the rotator cuff. Clinical signs may overlap. Moreover, calcifying tendinitis, fractures and pain originating from the cervical spine may mimic shoulder impingement syndrome. Imaging is important for the exact diagnosis. Standard radiographs are the basis of imaging in shoulder impingement syndrome. They may demonstrate subchondral sclerosis of the major tuberosity, subacromial spurs, and form anomalies of the acromion. They are also important in the differential diagnosis of shoulder impingement syndrome and demonstrate calcifying tendinitis, fractures and neoplasm. Ultrasonography has found acceptance as a screening tool and even as a final diagnostic method by many authors. However, there is a high interobserver variability in the demonstration of rotator cuff tears. Its usefulness has therefore been questioned. MR imaging is probably the method of choice in the evaluation of the rotator cuff and surrounding structures. Several investigations have demonstrated that differentiation of early findings, such as tendinopathy versus partial tears, may be difficult with MR imaging. However, reproducibility for fullthickness tears appears to be higher than for sonography. Moreover, specificity appears to be superior to sonography. MR arthrography is not universally accepted. However, it allows for more exact differentiation of discrete findings and may be indicated in preoperative planning. Standard arthrography and CT have a limited role in the current assessment of the rotator cuff.

Diagnosis, Differential↗

PubMed2001

Early arthroscopic release in refractory shoulder stiffness.

Frozen shoulder is still an enigma in shoulder surgery. It is reported that at 2 years after onset most patients will have recovered whether treated or not. To decrease time to recovery and improve the results of this condition, a number of different treatment modalities have been used. In our unit, all patients with frozen shoulder were selected for the arthroscopic release technique if a conservative program of physical therapy had failed to restore motion after 6 months and if they had no known extra-articular contractures. A prospective study was undertaken of 36 patients with refractory frozen shoulder who were treated with an arthroscopic capsulotomy between November 1997 and October 1999. There were 22 women and 14 men with an average age of 49 years (range 32-63 years). All of the patients were assessed for pain, function, and range of motion before surgery. Five patients were diabetic. An arthroscopic capsular release improved motion in all patients, with substantial relief of pain. Follow-up averaged 18 months (range 10-26 months). The median preoperative Constant score rose from 29 to 66 at the time of follow-up. By a mean of 8 weeks after treatment, 75% of the patients had returned to work. One patient developed recurrent refractory stiffness. There were no complications related to the procedure. This study demonstrates that arthroscopic capsular release can be a safe and effective tool in the management of refractory shoulder stiffness and is an effective way of shortening the course of an apparently self-limiting disease.

Adult↗

PubMed2002

Rationales of arthroscopic shoulder stabilization.

Arthroscopic reconstruction of glenohumeral instability has become more common during the past decade. Compared with open reconstruction, which is still the gold standard in the treatment of shoulder instability, arthroscopic techniques allow for improved diagnosis of numerous intraarticular findings. This review presents an appropriate system for the arthroscopic classification of most pathological findings in patients with anterior shoulder instability. Based on the presented classification, a rationale for arthroscopic reconstruction under special conditions is given. Several operative techniques and implants are discussed and their use in certain circumstances analyzed. Special emphasis is targeted on techniques of realizing sufficient capsular shift or plication. Arthroscopic procedures remain technically demanding and require skills to address the great variety of possible situations. On the other hand, arthroscopic techniques in shoulder reconstruction benefit patients by avoiding the morbidity of open surgery. However, the surgeon must be prepared to address numerous conditions beyond a mere Bankart lesion, especially those involving capsular laxity, rotator interval lesions, and SLAP (superior labrum lesions from anterior to posterior) lesions. Nowadays, considering all the new technical possibilities of arthroscopic shoulder reconstruction including capsular shift procedures, most cases of anterior shoulder instability are suitable for arthroscopic reconstruction. Further studies are necessary to validate the continued efficacy of arthroscopic stabilization.

Arthroscopy↗