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PubMedDate not supplied

Glenohumeral joint translation after arthroscopic thermal capsuloplasty of the rotator interval.

The treatment of recurrent anterior, posterior, or multidirectional glenohumeral instability by operative closure of the rotator interval has been proposed. The purpose of this study was to determine whether arthroscopic thermal capsuloplasty of the rotator interval with the radiofrequency probe significantly decreases anterior-posterior glenohumeral translation. Anterior and posterior loads of 10, 15, and 20 N were sequentially applied to 8 cadaveric shoulder joints while mounted in a translation testing apparatus with an electromagnetic tracking device measuring anterior and posterior glenohumeral translation. Arthroscopic thermal capsuloplasty was then performed on the rotator interval with a radiofrequency probe. The identical anterior-posterior loading protocol was then repeated, and translations were recorded. The results showed a significant reduction in anterior and posterior translation after thermal capsuloplasty. After rotator interval thermal capsuloplasty, anterior translation decreased by 31.5%, 28.8%, and 27.2% for the 10-, 15-, and 20-N loads, respectively. Posterior translation decreased by 43.1%, 43.8%, and 40.7%, respectively. The results of this study indicate that arthroscopic thermal capsuloplasty of the rotator interval is an effective way by which to decrease both anterior and posterior glenohumeral translation in vitro. To date, no in vivo studies that sufficiently document long-term clinically successful outcomes of such a procedure exist. Future studies are warranted to evaluate the effects of the biologic response to thermal shrinkage and whether these reduced glenohumeral translations will be maintained.

Aged↗
PubMed2005

A new shoulder orthosis for paralysis of the trapezius muscle after radical neck dissection: a preliminary report.

Despite recent advances using more conservative approaches, standard classical radical neck dissection is still one of the most frequently performed procedures in head and neck cancer patients who have advanced metastatic neck disease. The trapezius muscle paralysis following division of the spinal accessory nerve results in severe pain and cosmetic disturbance related to malalignment of the shoulder joint. The objective of this study is to report our results with a newly developed orthosis to prevent and correct shoulder dysfunction following standard radical neck dissection. Thirty-four patients who underwent standard radical neck dissection as a part of their surgical treatment from 1997-2002 were rehabilitated by the shoulder orthosis. Beginning 2 weeks after surgery, the patients were allowed to use their orthosis. By using a standard questionnaire, the pain and activity scores were recorded at the 1st, 3rd, 6th and 12th months postoperatively. Six patients were excluded from the study, of whom two succumbed to their disease and four discontinued the use of the orthosis. Of 28 patients included in the study, 20 (72%) were completely pain free within 3 months following the surgery. Four patients (14%) noted their pain level as tolerable, and four patients (14%) reported no considerable gain in the pain threshold and/or physical activity levels. Despite the fact that the active abduction range increased only 5 to 20 degrees , the relief of pain and improved malalignment of the scapula and consequently clavicle and humerus led to functional gains, which increased the patients' endurance. At the end of the study, 23 patients (82%) were able to return to their previous jobs or activity levels. Current preliminary reports suggest that this orthosis can be recommended to prevent significant disability in patients with trapezius palsy due to ablative cancer surgery or other reasons.

Accessory Nerve Injuries↗
PubMed1986

[Concomitant osseous and ligamentous injuries of traumatic shoulder dislocation and its significance for the pathogenesis of habitual dislocation].

161 consecutive patients with traumatic shoulder luxation between 1975 and 1983 are followed, concerning their evolution to recurrent shoulder dislocation. In 26 patients there was a recurrent shoulder dislocation in a mean time of 19 months after the first luxation. In literature the common level of recurrent dislocation is higher than our 16.1%, despite of the shorter immobilising time after the first shoulder luxation in our center. When there is no evolution to recurrent dislocation, a stable shoulder and a normal shoulder function without pain can be expected in 95%. The compression fracture of the humeral head and the avulsion of the glenoid margin were made responsible for the recurrent dislocation, mostly appearing in adult men, younger than 35 (55% of all recurrent dislocations). Because avulsion fractures of the tuberculum majus don't lead to an unstable fracture neither the existence of a compression defect in the humeral head is pathognomonic for an unstable shoulder, nor a lack of such radiological appearance excludes a recurrent dislocation. In first instance rotatory cuff injuries could be responsible for the instability of the shoulder joint. All patients with this invalidating injuries should be stimulated to an operative procedure, because after correction of an unstable shoulder by a derotation osteotomy of Weber or the elevation of the anterior margin of glenoid in the technique of Trillat good results with normal functional capacities of the shoulder can be expected.

Adolescent↗
PubMed1992

Suprascapular nerve block. A new approach for the management of frozen shoulder.

A new approach for the management of frozen shoulder associated with reflex sympathetic dystrophy is presented. A suprascapular nerve block was performed by needle insertion behind the lateral end of the clavicle at its junction with the insertion of the trapezius muscle; the needle was directed downwards and backwards. The suprascapular nerve was identified by its response to nerve stimulation. Three ml of 0.25% bupivacaine with 1:200,000 adrenaline was injected. The block was repeated twice weekly for a total of 2-4 treatments. Evaluation of the efficacy of the block was achieved by comparing subjective pain scores and passive range of movement before the first block and after the final one. Highly significant improvements were obtained. The choice of blockade of the suprascapular nerve is a new concept for the management of the frozen shoulder of reflex sympathetic dystrophy. This is based on the fact that the nerve contains a high proportion of sympathetic fibres supplying the shoulder joint. The new approach proved to be simple, highly successful, and reproducible.

Adult↗
PubMed1991

[The form and size of the glenoid cavity].

Measurements on 319 macerated scapulae showed a size of the surface of the glenoid cavity between 3.5 and 9.7 cm2. We tried also to evaluate the size of this surface in living humans. This is principally possible, but in 10% of all scapulae there is an error range of more than +/- 1 cm2. The error range in small scapulae (greater than 5 cm2) can be reduced to +/- 0.58 cm2. The shoulder joint is not a ligament but a muscle dependent joint. Therefore the adhesion in this joint, relying on the smaller surface is very important. The small surface of cavitas glenoidalis in the context of habitual shoulder dislocation could be an important role.

Humans↗
PubMed1996

Role of proprioception in pathoetiology of shoulder instability.

Proprioception is a specialized sensory modality that gives information about extremity position and direction of movement. This kind of afferent sensory feedback is probably important in mediating muscular control of the shoulder joint. As this articulation is minimally constrained, such a coordinated dynamic control of muscles about the joint is necessary for stability during arm motion. The authors evaluated proprioception in individuals with normal shoulders, unstable shoulders, and after surgical stabilization, by assessing threshold to detection of passive motion and the ability to passively reposition the arm in space. In normal shoulders there is no difference between the dominant and nondominant shoulder, though in unstable shoulders there is a significantly decreased proprioceptive ability. Surgical stabilization normalizes proprioception of the shoulder.

Adult↗
PubMed1993

The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder.

Recurrent anterior unidirectional instability of the shoulder is not always associated with a classic Bankart lesion, which is an avulsion of the anterior labroligamentous structures from the anterior glenoid rim. Because the anterior scapular periosteum ruptures, the labrum and the attached ligaments are found to float out anterior to the glenoid rim when viewed arthroscopically. The anterior labroligamentous periosteal sleeve avulsion (ALPSA) of the supporting anterior inferior ligamentous and labral structures of the shoulder joint was found in four of eight acute primary anterior shoulder dislocations. This lesion differs from the Bankart lesion because the anterior scapular periosteum does not rupture, thereby allowing the labroligamentous structures to displace medially and rotate inferiorly on the scapular neck. These lesions eventually heal, and lead to recurrent anterior dislocations because of the subsequent incompetence of the anterior inferior glenohumeral ligament. An arthroscopic technique that converts the ALPSA lesion to a Bankart lesion and subsequently reconstructs the supporting anterior inferior structures of the shoulder has been successful in 26 cases (4 acute and 22 chronic) which were followed for > or = 2 years. Only one dislocation occurred, and it was the result of severe trauma.

Acute Disease↗
PubMed1991

[Examination of the non-injured shoulder].

Modern imaging methods are undeniably very attractive. They should make possible an easy study of the musculotendinous rotator cuff of the shoulder joint, lesions of which are the cause of most painful or stiff shoulder syndromes. However, not all shoulder symptoms are due to rotator cuff lesions. Also, not all methods of imaging are equally suited to showing the different cuff lesions. Further, one cannot consider the treatment of a symptomatic shoulder without having an assessment of the present condition upon which to gauge the functional improvement due to the treatment. Hence clinical examination of the painful shoulder remains essential. This makes it possible (1) to exclude an extra-articular pathology, (2) to choose the method of imaging most suited to showing the suspected lesion, and finally (3) to quantify the functional state of the shoulder.

Arthrography↗
PubMedDate not supplied

The synergistic action of the capsule and the shoulder muscles.

The existence of a reflex arc from the glenohumeral capsule to several muscles crossing the shoulder joint was determined in the feline model. Three branches of the axillary nerve terminating in the glenohumeral capsule were identified and electrically stimulated with supramaximal, 100-microseconds pulses using bipolar hook electrodes. Stimulation of the anterior and the inferior axillary articular nerves elicited electromyographic activity in the biceps, subscapularis, supraspinatus, and infraspinatus muscles. Stimulation of the posterior axillary articular nerve elicited electromyographic activity in the acromiodeltoid muscle. Transection of the three articular nerves just distal to their emergence from the main axillary nerve resulted in the absence of any electromyographic activity in the muscles on stimulation, confirming the afferent nature of the articular branches. The time from application of the stimulus to the appearance of a response in the muscles varied from 2.7 msec in the biceps to 3.1 msec in the supraspinatus. The existence of a reflex arc from mechanoreceptors within the glenohumeral capsule to muscles crossing the joint confirms and extends the concept of synergism between the passive (ligaments) and active (muscles) restraints of the glenohumeral joint. This provides new information in orthopaedic sciences that has direct application in modification of surgical repairs and therapeutic modalities of shoulder injuries.

Animals↗
PubMed1987

[Extra-coracoid axillary approach to the gleno-humeral joint].

The authors advocate an elective approach to the lower part of the humeral (shoulder) joint by an original axillary route. This route is external to the short head of the biceps brachii muscle which is retracted together with the neurovascular bundle. The articular capsule is opened through the space between the subscapular and latissimus dorsi muscles. The skin incision is cosmetic. No muscle is cut, and in surgery for anterior instability of the shoulder the crucial area is automatically exposed. This technique, however, requires two assistants and may be arduous in very muscular subjects. In addition, the visibility of the rest of the humeral joint is limited. With a few precautions, the neighbouring vessels and nerves are well protected.

Axilla↗
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↗
PubMed2002

A new skeleton of Theropithecus brumpti (Primates: Cercopithecidae) from Lomekwi, West Turkana, Kenya.

A relatively complete skeleton of the fossil papionin, Theropithecus brumpti, from the site of Lomekwi, west of Lake Turkana, Kenya, is here described. The specimen, KNM-WT 39368, was recovered at the site of LO 5 (3 degrees 51'N and 35 degrees 45'E), from sediments dated to approximately 3.3Ma. The skeleton is that of an old adult male and preserves a number of articulated elements, including most of the forelimbs and tail. The cranial morphology is that of a large, early T. brumpti, exhibiting a deep mandible with a deeply excavated mandibular corpus fossa, and mandibular alveoli and cheek teeth arrayed in a reversed Curve of Spee. The forelimb skeleton exhibits a unique mixture of characteristics generally associated with a terrestrial locomotor habitus, such as a narrow scapula and a highly stable elbow joint, combined with those more representative of habitual arborealists, such as muscle attachments reflecting a large rotator cuff musculature and a flexible shoulder joint. The forelimb of KNM-WT 39368 also presents several features, unique toTheropithecus, which represent adaptations for manual grasping and fine manipulation. These features include a large, retroflexed medial humeral epicondyle (to which large pronator, and carpal and digital flexor muscles attached) and proportions of the digital rays that denote capabilities for precise opposition between the thumb and index finger. Taken together, these features indicate that one of the earliest recognized representatives of Theropithecus exhibited the food harvesting and processing anatomy that distinguished the genus through time and that contributed to its success throughout the later Pliocene and Pleistocene. Based on the anatomy of KNM-WT 39368 and the known habitat preference of T. brumpti, the species is reconstructed as being a generally terrestrial but highly dexterous, very large-bodied, sexually dimorphic, and possibly folivorous papionin. T. brumpti was adapted for propulsive quadrupedal locomotion over generally even ground, and yet was highly adept at manual foraging. The estimate of 43.8kg body mass for KNM-WT 39368 renders unlikely the possibility that the species, or at least adult males of the species, were highly arboreal. T. brumpti, as represented by KNM-WT 39368, is seen as a large, colorfully decorated, and basically terrestrial papionin that was restricted to riverine forest habitats in the Lake Turkana Basin from the middle to latest Pliocene.

Animals↗
PubMed1989

Shoulder arthrography with sodium meglumine metrizoate and iopamidol.

The purpose of this study was to analyze arthrographic imaging of the structures of the shoulder joint when using either sodium meglumine metrizoate or iopamidol as a contrast medium. Two hundred and ten patients underwent single-contrast shoulder arthrography. In patients with a full-thickness tear of the rotator cuff, both contrast agents reliably revealed this lesion. However, in patients with a full-thickness rotator cuff tear, the biceps tendon could be demonstrated more readily with iopamidol, which is a non-ionic contrast medium.

Adult↗
PubMed2006

Avascular necroses inducing limb-girdle syndrome.

Disuse myopathy can be caused by many disorders. However, disuse myopathy with symmetrical weakness of the proximal muscles in the four limbs is rare. Here we report a 45-year-old man who presented with the appearance of myopathy similar to the clinical picture of limb-girdle syndrome with symmetrical weakness of proximal muscles in four limbs. A battery of intensive investigations confirmed that the patient had symmetric disuse myopathy induced by multiple avascular necroses of hip and shoulder joints. After the patient had received bilateral total hip replacement operations he had remarkable improvement in his muscle power in both lower limbs. This report highlights that some myopathies can be reversed if their underlying causes are correctable.

Hip Joint↗
PubMed1976

[Arthrography in humeroscapular peri-arthritis].

Degenerative changes in the shoulder joint affect the capsule much more frequently than might be expected and are not seen on a plain radiograph. Arthrography of the shoulder has become of increasing significance in view of modern surgical management. Arthrography is used particularly to demonstrate a tear of the rotator cuff (especially the supra spinatus and infra spinatus). It also shows other important abnormalities which cause pain on movement, such as adhesions, tight capsule and the formation of septa. The indications, technique and necessary records, as well as typical pathological findings, are demonstrated in forty shoulder arthrograms. Hemuro-scapular peri-arthritis is a collective term for complex, primarily degenerative or posttraumatic, changes including peri-articular calcification. Demonstration of calcification alone does not justify the radiological diagnosis of humeroscapular peri-arthritis.

Calcinosis↗
PubMedDate not supplied

UCLA anatomic total shoulder arthroplasty.

The UCLA total shoulder arthroplasty was designed to mobilize the shoulder joint in order to permit normal anthropometric range of motion and durable long-term fixation of the components. The prosthesis is fundamentally nonconstrained for the usual arthritic conditions, currently with four sizes of femoral and glenoid components. For patients with deficient and irreparable rotator cuffs, additional restraint may be effected by using a superior glenoid subacromial rim. The first 11 patients have been followed for 1 1/2 to 3 1/2-years; relief of pain has been complete in all but two patients. The function and range of motion results were related to the status of the rotator cuff; five patients achieved excellent results, including two with osteoarthritis who had near normal function. Patients with deficient rotator cuffs achieved functional use of the extremity but without full range of motion. Functionally, in addition to the five patients who were rated excellent, two were rated as being good, three fair, and one poor. In addition to five with excellent range of motion, there were three good and four fair ratings. Two patients, one with grossly deficient musculature caused by a gunshot wound and a second who was posttrauma required revision surgery with a subacromial glenoid prosthesis. This prosthesis is now frequently utilized if muscles and rotator cuff are deficient at the primary surgery, in order to provide additional restraint. Determination of the efficacy of hooded components will require further follow-up. The additional size ranges and components together with improved instrumentation have greatly facilitated recent surgery.

Adult↗
PubMed1993

Normal regional anatomy of the shoulder.

The shoulder joint is a remarkable structure enjoying a greater range of motion than any other articulation in the human body. The shoulder is not a single joint but actually four separate articulations that act synergistically. The authors review the complex anatomy of the shoulder.

Humans↗