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PubMed1993

Intraarticular autogenous bone grafting in recurrent shoulder dislocations.

In a reexamination, 24 young soldiers who had been operated on using a new method of screwing an autogenous bone graft into the glenoid rim in cases of recurrent dislocation of the shoulder joint were investigated. A major functional problem is the reduced lateral rotation, even by using other procedures for operative treatment like Eden-Hybinette or Putti-Platt. This reduction of shoulder movement results in problems using the affected arm during sporting activities or military duties. There has been an excellent result without any redislocation in a follow through of 6 to 42 months and more than 90% satisfied patients, with only a very low rate of reduction of lateral rotations about 10 degrees using this procedure. The X-rays of all the patients, reinvestigated, showed a complete healing of the bone grafts into the glenoid rim and correct position of AO-screws.

Adolescent↗
PubMedDate not supplied

A new prosthetic design for proximal humeral fractures: reconstructing the glenohumeral unit.

A new shoulder prosthesis design for proximal humeral fractures has been developed. The rim of the articular component of this prosthesis has several holes to which the bone-tendon junction of the rotator cuff is fixed, to allow an anatomic reconstruction of the glenohumeral unit. The strength of the tuberosity fixation to this prosthesis is investigated in a cadaveric study. Artificial 4-part fractures were created in 18 human, fresh-frozen, paired shoulder joints with intact rotator cuffs. Two methods of tuberosity fixation were used in a matched-pair fashion. In group I the tuberosities were sutured to the rim of the prosthetic head, and in group II the tuberosities were circumferentially tension band-wired. Strength testing was performed on a material-testing machine, and displacement was recorded with an opto-electronic device. Both fixation methods proved to be equally reliable in the forces exerted during activities of daily living without significant displacement of the fracture fragments.

Aged↗
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↗
PubMed2003

Neurohistological examination of the inferior glenohumeral ligament of the shoulder.

The neural histology of the anterior band of the inferior glenohumeral ligament (IGHL) was studied in 11 fresh shoulder specimen using a special silver impregnation technique. Between the collagen fibers small myelinated and unmyelinated dendrites could be detected. The appearance of neurovascular structures in the adjacent synovial layer clearly exceeded the typical supply to soft tissues. Analysing about 11,000 sections Ruffini mechanoreceptors that are known to be slow adapting were found on the humeral insertion of the band. The sections containing these neural end organs were identified by means of transillumination and reflection-contrast microscopy and reconstructed using three-dimensional image processing. The presence of neural structures including Ruffini corpuscles in these most important passive stabilizers of the shoulder joint shows that these ligaments function also as an active safety device. There slow adaption is a prerequisite for muscular reflexes counteracting the tensile stresses to which the passive stabilizing structures of the shoulder are exposed. A disruption of the continuity of these structures by mechanical forces or surgery can reduce the biofeedback and proprioceptive quality and thus lead to a decrease of shoulder function and/or stability. These observations should be taken into account when planning surgical interventions involving the IGHL. Procedures like capsule shifts or plications may affect mechanoreceptor orientation and concentrations, thereby affecting the interaction between these structures and the synergistic muscles. When possible, these intervention should avoid receptor-dense regions while attempting to restore normal anatomical orientation and tissue tension.

Aged↗
PubMed2000

[Normal anatomy and related pathological changes of shoulder on MRI].

OBJECTIVE: To describe the normal anatomy and common abnormal changes of rotator cuff impingement and tears and recurrent anterior instability of shoulder joint in MRI pictures. METHODS: MRI was compared in 285 patients with shoulder diseases and 20 patients with symptomatic shoulder diseases. RESULTS: On oblique coronal image, the supraspinatus presented moderate signal intensity and low signal intensity in its tendon-muscle conjunction ranging from the humeral head to the greater tuberosity. The MRI manifestations of impingement lesion of the rotator cuff were as follows: high signal intensity of tendons, changes of their shapes, retraction of tendon-muscle conjunction, and muscle atrophy with high signal intensity. On T1-weighted axial image, the anterior and posterior glenohumeral labrum, the long head biceps tendon were displayed in low signal intensity. The anterior labrum manifested a sharp triangle contour and the posterior labrum a round one. The whole four muscles of the rotator cuff manifested on oblique sagital image. However, it was of less value in detecting the abnormalities of the rotator cuff and the glenohumeral labrum on sagittal imaging. The sensitivity in demonstrating rotator cuff complete tear was 95% for MRI and 91% for arthrography; the specificity was 88% for MRI and 100% for arthrography. The sensitivity and specificity of MRI were 96% and 75% for detecting glenoid labrum abnormalities, and 78% and 88% for detecting labrum tear in anterior recurrent dislocation of the shoulder. CONCLUSIONS: Magnetic resonance imaging with its excellent contrast resolution in multiple anatomic planes allows noninvasive visualization of bone and soft tissues in the rotator cuff and labrum.

Adolescent↗
PubMed1987

Cervical epidural anesthesia for surgery of the shoulder.

Regional anesthesia has some advantages over general anesthesia for shoulder surgery. Cervical epidural anesthesia, a regional technique not previously described for shoulder operations, was successfully used for surgical procedures on or near the shoulder joint. The technique provided good surgical anesthesia and postoperative analgesia, with few complications and a high degree of patient acceptance. Cervical epidural anesthesia offers some advantages over previously described techniques of regional anesthesia for shoulder operations, including a single needle insertion with no need to elicit paresthesias, lesser volumes of local anesthetic agents, and the ability to easily reinject the catheter intraoperatively if necessary and postoperatively for pain relief.

Adult↗
PubMed1983

Load moment, muscle strength and level of muscular activity during internal rotation training of the shoulder.

Existing studies of shoulder joint loading, muscle strength and muscular activity do not, from the point of view of clinical application, adequately cover these factors, knowledge of which is important for the design of optimal exercises for training shoulder impairments. In the present study, exercises using a weight-and-pulley device have been analysed in order to map the resistance moments of force in relation to the muscular strength capacity of shoulder internal rotators , and to map the activation of these muscles in response to the resistance from the device. The relationships established in the study provide a basis for optimising various types of shoulder training exercises. For example, an angle of 40 degrees between frontal plane and shoulder-pulley line has been found to give the best adaptation of resistance to strength. The study also demonstrates the possibility of using a pulley apparatus for shoulder inward rotator muscle training.

Adult↗
PubMed2005

Cortico-motoneuronal output to intrinsic hand muscles is differentially influenced by static changes in shoulder positions.

We investigated whether shoulder position influenced the recruitment properties of the abductor digiti minimi muscle (ADM) and first dorsal interosseous muscle (FDI). ADM and FDI motor evoked potentials (MEPs) in response to transcranial magnetic stimulation (TMS) were obtained in seven healthy volunteers at two different static positions of the shoulder joint (30 degrees adduction vs 30 degrees abduction) while the arm was passively supported at shoulder level (90 degrees in the horizontal plane) and the elbow joint was fixed at 90 degrees . ADM and FDI voluntary activity was also examined during (1) externally paced finger abductions at 2 Hz in the two different shoulder positions (EMG(ADM) and EMG(FDI) was back-averaged time-locked to the end of finger abduction) and (2) maximal voluntary abduction of the little finger and the index finger. Maximal EMG power and force were analysed in the two shoulder positions. H-reflexes from ADM and FDI were also obtained in two subjects. The ADM stimulus-response curve to TMS showed that the slope and plateau level were significantly reduced with the shoulder at 30 degrees abduction. In contrast, the FDI stimulus-response curve to TMS was not influenced by shoulder position. The back-averaged EMG(ADM) showed a significant decrease in peak amplitude and area with the shoulder at 30 degrees abduction, while no change in EMG(FDI) was observed under the same condition. Similarly, maximal EMG(ADM) and force exertion by the little finger were significantly reduced with the shoulder at 30 degrees abduction, while no such effect was observed for FDI. ADM H-reflex, but not FDI, was also decreased with shoulder abduction. These results indicate that the corticospinal pathway to ADM is less accessible to TMS and to voluntary command when the shoulder is placed at 30 degrees abduction. In contrast, activation of FDI, whether by TMS or by volition, is not influenced by shoulder position. This finding suggests that there are differences in the corticospinal innervation to ADM and FDI, possibly due to the different role of these muscles in hand function.

Adult↗
PubMed1998

Elderly onset rheumatoid arthritis and polymyalgia rheumatica: ultrasonographic study of the glenohumeral joints.

The glenohumeral joints of 32 patients (aged 60 or above) were examined using ultrasonography. Thirteen patients were suffering from characteristic polymyalgia rheumatica (PMR) symptoms. In contrast 19 other patients initially had similar complaints, but were diagnosed as having elderly onset rheumatoid arthritis (EORA) upon development of typical symptoms. Ultrasound examination revealed glenohumeral joint inflammation in 61% (8 out of 13) of the patients with PMR and 63.2% (12 out of 19) of the patients with EORA. These findings suggest that a subgroup of patients with PMR and EORA suffers from shoulder joint inflammation and this synovitis/bursitis/intraarticular effusion might play an important role in the understanding of their symptoms. We conclude that overlapping forms of PMR and a predominate rheumatoid factor negative subgroup of EORA might exist and should be further characterized.

Aged↗
PubMed2002

Ochronosis: a case of severe ochronotic arthropathy.

Ochronosis involves primarily the large cartilaginous joint surfaces, ribs, intervertebral discs, ear cartilage etc. We report on a 53-year-old woman with typical alkaptonuric ochronosis with dark urine, blue-black pigmentation of the auriculae and hands, focal brown hyperpigmentation of the sclera, spondylarthropathy and severe shoulder joint involvement.

Alkaptonuria↗
PubMed1997

Scapulothoracic rhythm in normal male volunteers.

Dynamic pattern of Scapulothoracic rhythm during arm abduction in scapular plane is studied using computer-imaging technique. Aim of the study is to produce a reproducible and reliable way of calculating the scapular movement and glenohumeral movement using least possible roentgenographic exposure. Moving X-ray screening picture of the shoulder joint is analysed using video capture computer programme and the images at different degrees of abduction are then analysed for scapular movement using computer aided designer and drafting software. Results were comparable to the authoritative shoulder analysis carried out in the past, the difference of radiation exposure, approximately 10 times less.

Adult↗
PubMed2001

Relationship between cocontraction, movement kinematics and phasic muscle activity in single-joint arm movement.

Patterns of muscle coactivation provide a window into mechanisms of limb stabilization. In the present paper we have examined muscle coactivation in single-joint elbow and single-joint shoulder movements and explored its relationship to movement velocity and amplitude, as well as phasic muscle activation patterns. Movements were produced at several speeds and different amplitudes, and muscle activity and movement kinematics were recorded. Tonic levels of electromyographic (EMG) activity following movement provided a measure of muscle cocontraction. It was found that coactivation following movement increased with maximum joint velocity at each of two amplitudes. Phasic EMG activity in agonist and antagonist muscles showed a similar correlation that was observable even during the first 30 ms of muscle activation. All subjects but one showed statistically significant correlations on a trial-by-trial basis between tonic and phasic activity levels, including the phasic activity measure taken at the initiation of movement. Our findings provide direct evidence that muscle coactivation varies with movement velocity. The data also suggest that cocontraction is linked in a simple manner to phasic muscle activity. The similarity in the patterns of tonic and phasic activation suggests that the nervous system may use a simple strategy to adjust coactivation and presumably limb impedance in association with changes in movement speed. Moreover, since the pattern of tonic activity varies with the first 30 ms of phasic activity, the control of cocontraction may be established prior to movement onset.

Adult↗
PubMed2005

Characterization of upper arm synergies during reaching tasks in able-bodied and hemiparetic subjects.

BACKGROUND: In the past, several studies showed the existence of a synergistic behavior between elbow and shoulder joints during reaching movements in able-bodied subjects. The aim of this paper was to characterize the modifications of upper arm synergies during reaching induced by stroke. METHODS: Ten able-bodied right-handed subjects, eight right-handed subjects with hemiparesis affecting the right (dominant) upper limb participated in the experiments. The kinematics of shoulder and elbow joints have been recorded in all the participants during selected reaching movements. From the eight-like plots characterizing the relationship between shoulder and elbow angular velocities, a topological parameter (named as C approximately ) representing the linear approximation of the synergy between the two angular velocities has been extracted. FINDINGS: The results of these experiments showed that C approximately could be used as a figure of merit for the comparison of performance in able-bodied and hemiparetic persons. The hemiparetic subjects showed a significantly higher spreading of the values of C approximately for the different reaching movements when compared with the performance of able-bodied subjects. INTERPRETATION: This work showed that hemiparesis modified upper arm synergies and could provide a protocol for the assessment of upper limb function. Moreover, important applications of this method could be found in the development of biomimetic algorithms for the control of upper extremities during reaching in humanoid robots, and in the design of customized "games" in neurorehabilitation procedures implemented by using robotic and mechatronic platforms.

Adult↗
PubMedDate not supplied

Histologic and scanning electron microscopic study of the glenoid labrum.

Three-dimensional fibrillar architecture of the glenoid labrum and its attachment to the glenoid rim were studied in 15 cadaveric shoulders to understand the pathophysiologic condition of various shoulder diseases. The true anatomic labrum was a narrow band located at the junction of the glenoid rim and fibrous capsule and varied considerably in size and shape. A triple-layered collagen structure of the labrum was observed by scanning electron microscopy. The thin superficial layer (articular surface) was a reticulated fibrillar network. The second layer was stratified. These two layers seem to act as a bumper against impact on the humeral head. The third, main layer of the labrum consisted of bundles of the fine fibrils densely arranged almost parallel to each other and oblique to the glenoid rim. This layer appears to act as a cushion to stabilize the shoulder joint.

Adult↗
PubMed1976

Synovial chondromatosis of the shoulder.

Articular synovial chondromatosis is a rare disease commonly affecting the knee, hip or elbow, and characterized by the formation of metaplastic cartilaginous foci in the synovium. A case of cynovial chondromatosis affecting the shoulder joint is now reported because of the extreme rarity of the disease in this situation.

Adult↗
PubMed2006

[Three-dimensional geometry of the proximal humerus and rotator cuff attachment and its utilization in shoulder arthroplasty].

PURPOSE OF THE STUDY: The aim of the study was to provide a method of measurement and data collection, based on morphologic analysis of the proximal humerus, that would facilitate precise placement of the humeral stem and would be easy to apply in clinical medicine in patients requiring shoulder arthroplasty. MATERIAL: Three groups of materials were used. Materials for the first and second groups were provided by the Department of Anatomy, First Faculty of Medicine, Charles University. The first group included 10 specimens (five left and five right humeral bones) obtained at routine anatomical dissection. The second group contained 110 so-called dry preparations from the collections of the Department of Anatomy and the third group comprised nuclear magnetic resonance (NMR) scans of 20 patients. To show spatial relationships between the proximal and the distal humerus, another coil was applied to the epicondylar region in addition to the one placed over the proximal humerus. METHODS: The first group material was used to study proximal humerus morphology and to determine reference points for the other two groups. The points were constructed to make seven planes perpendicular to the axis of the proximal humeral metaphysis. Based on the reference points, parameters of the proximal humerus were assessed in the defined planes also in the other two groups. We measured angles between the reference points and the transepicondylar line or the humeral head axis. The vertex of each angle was always placed in the point of intersection of the metaphyseal axis and the given transverse plane. Reference points of the greater tubercle were marked on the medial margin continuous with the intertubercular groove, on the lateral margin of the lesser tubercle and in the "deepest" place of the intertubercular groove. We also measured humeral head retroversion and the position of maximal bony mass of both the greater and the lesser tubercle (this parameter can be used with advantage for optimal insertion of screws in proximal humerus reconstruction). RESULTS: The angle between the medial margin of the greater tubercle and the humeral head axis was on average 164.8 degrees on the left side and 163.2 degrees on the right side; the angle between the great tubercle margin and the transepicondylar line was 137.0 degrees on the left humerus and 137.7 degrees on the right humerus. The lateral margin of the lesser tubercle and the humeral head axis formed on average an angle of 124.4 degrees and of 122.6 degrees on the right and the left side, respectively. The intertubercular groove/ humeral head axis relationship was 143.4 degrees and 144.8 degrees for the left and the right humerus, respectively, and the intertubercular groove/transepicondylar line angle was 115.6 degrees for the left and 119.5 degrees for the right humerus. The humeral head axis and the transepicondylar line made an angle of 27.8 degrees for the left and 25.3 degrees for the right humerus. These values corresponded to the angle of the humeral head retroversion. The reference point of maximal bony mass of the greater tubercle and the humeral head axis made an angle of 181.1 degrees and of 180.2 degrees for the left and the right humerus, respectively; between this point and the lesser tubercle was an angle of 120.2 degrees for the left and 126.9 degrees for the right humerus. DISCUSSION: One of the most important parameters in restoring shoulder function by alloplasty is humeral head retroversion. If this is not correct, ventral or, less frequently, dorsal instability of the shoulder may result. The correct setting of retroversion is guided by the transepicondylar line or several specific landmarks on the greater and the lesser tubercle of the humerus. Another important factor is the correct reconstruction of anatomic position of the greater and the lesser tubercle in relation to the insertion of rotator cuff muscles into the humeral head. Relationships of diaphyseal, metaphyseal and humeral head axes have been reported in the relevant literature dealing with proximal femoral morphology. None of the reports, however, has dealt with tubercular angles and position of the maximal body mass, which is a decisive factor for insertion of screws fixing the prosthetic stem. CONCLUSIONS: The values provided here can be used for a more precise construction of implants for shoulder replacement. The method of three-dimensional presentation of the proximal humerus may aid in a more exact implantation procedure during shoulder arthroplasty. An optimal position of the implant can also be based on parameters obtained from the healthy contralateral shoulder joint.

Anthropometry↗
PubMed1998

Shoulder movement after the treatment of early stage breast cancer.

At 18 months after surgery and post-operative radiotherapy, the function of the ipsilateral shoulder joint was assessed both subjectively and objectively in 141 patients with early stage breast cancer. Half of the patients said that function was reduced compared with before (any) treatment. Overall, 48% had measured limitation of at least one shoulder movement. Mastectomy patients had more problems than those who had a wide local excision (79% versus 35%) as did those (node positive patients) who had axillary irradiation (73%) compared with those who did not (35%). Patients with dysfunction of shoulder movement before radiotherapy had a 60% chance of persistent movement problems at 18 months, compared with 24% of those with normal postoperative function. Informal exercise did not appear to have had any impact on the development of movement limitation.

Activities of Daily Living↗