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Rehabilitation of the shoulder in tennis players.

The tennis player places unique demands on the shoulder by creating a high risk for overuse and overloading of the soft tissues. Tennis requires concentric work to position and move the arm, eccentric work to stabilize the shoulder, effective depression of the humeral head to avoid impingement in the overhead position, and normal stability to prevent secondary impingement. The tennis serve produces enormous angular velocities about the shoulder joint. A comprehensive rehabilitation program has been described in which the therapist, trainer, player, and physician alike need to have an understanding of the basic biomechanics of this sport. This program can be used to treat the painful shoulder, prevent injury, and enhance performance.

Athletic Injuries↗

Anatomy of the coracohumeral and coracoglenoidal ligaments.

The Ligg. coracohumerale and coracoglenoidale are constant anatomical structures, represented in all the 34preparations investigated. The Lig. coracoglenoidale is a strong band of dense connective tissue, running from the Processus coracoideus to the Tuberculum supraglenoidale. In 27 specimens out of 34 it was the continuation of the M. pectoralis minor tendon. The Lig. coracohumerale consists of two separate parts. The "inferior part" originates from the Processus coracoideus and the Lig. coracoglenoidale, which separates it from the base of the coracoid process. It is composed of the joint capsule anteriorly and a remnant of the M. pectoralis minor tendon posteriorly. The "superior part" arises from the medio-posterior surface of the Processus coracoideus, just below the Lig. coracoacromiale. Both parts of the Lig. coracohumerale run into the shoulder joint capsule under the M. supraspinatus tendon and insert into a capsular semicircular band. According to the shape and course of fibres between the greater and lesser tubercles of the Humerus, we propose to name it the "Lig. semicirculare humeri". None of the two parts of the Lig. coracohumerale begins from the base of the Processus coracoideus, and fibres of the Lig. coracohumerale do not reach the Tuberculum majus et minus directly.

Aged↗

Glenohumeral muscle force and moment mechanics in a position of shoulder instability.

The three-dimensional orientation of the shoulder girdle musculature was studied in five cadaver shoulders in the position of function at 90 degrees of abduction and 90 degrees of external rotation using a method of computer assisted gross muscle cross-section analysis. The muscle volume, muscle fiber length, and physiological cross-sectional area were obtained by dissecting two specimens. The line of action, the magnitude and orientation of the moment were calculated for each muscle crossing the shoulder joint. The quantitative description of the moment potential of muscle forces influencing shoulder function was thus obtained. The most effective flexors of the shoulder which also appear to resist anterior dislocation in the position studied are the pectoral, the short head of the biceps, coracobrachialis, anterior deltoid, and the subscapularis. Most of the rotator cuff muscles and the posterior deltoid acted as adductors, while the anterior deltoid, long and short head of the biceps, and supraspinatus were abductors. In this position, external rotation was effected by the long head of the biceps, coracobrachialis, and the posterior deltoid, while the majority of the remaining muscles acted as internal rotators.

Aged↗

[Cervico-omo-brachial pain and disability in a person of advanced age].

A person of advanced age usually has degenerative changes of bone, joint and ligament, which can be causes of cervico-omo-brachial pain and disability. He or she may also suffer from metastatic bone tumor of cervical spine or upper extremity. This article described pathology, signs and symptoms and recent treatment of these diseases. Cervical myelopathy and radiculopathy, which are most common causes of cervico-omo-brachial symptoms, are sometimes accompanied by peripheral entrapment neuropathy such as cubital tunnel syndrome or carpal tunnel syndrome (double crush syndrome). In this complicated situation, decompression of neural tissue in both cervical spine and carpal tunnel are necessary. In treatment for carpal tunnel syndrome, release of transverse carpal ligament under an arthroscope has proven to be useful and has been becoming popular. This minimally invasive surgery is also useful in shoulder surgery such as subacromial decompression in aged patients with rotator cuff tear and removal of calcium deposit in the shoulder joint. Osteoarthritis of the elbow also cause pain or disability of the elbow and the hand. Some metastatic bone tumors are treated by tumor resection and reconstruction with instruments, prosthesis or composite grafts, which are attempted not to cure the disease but to maintain or improve the quality of life of the patient.

Aged↗

Intra-articular inflammatory diseases of the shoulder.

Intra-articular disease processes of the shoulder are uncommon. Of all the processes, adhesive capsulitis is by far the most prevalent. Stage 1 of adhesive capsulitis mimics the impingement syndrome and must be ruled out by arthroscopy before decompression is performed. Other rare conditions of the shoulder joint, such as pigmented villonodular synovitis and synovial chondromatosis, can be treated with the same surgical techniques.

Arthritis↗

[Follow-up treatment with physiotherapy after arthroscopic reconstruction in SLAP lesions].

An appropriate physiotherapeutic treatment program complements an optimal operative result. In the instance of SLAP lesions, a differentiated therapy is only possible on consultation with the surgeon. A detailed treatment design allows optimal guidance of the patient to his or her personal goal. Important treatment elements include the optimization of the ability of the humerus head to centralize and the proprioception of the shoulder joint, as well as reinstatement of strength and endurance, especially of the rotator cuff.

Aftercare↗

[Results of shoulder isokinetic testing in volleyball players].

Isokinetic testing of the shoulder joint shows valuable indication to possible functional disorders and muscle imbalance. Concentric testing of several parameters using the Cybex 6000 practice unit was done by professional volleyball players performing external and internal rotation of the dominant and non-dominant shoulder at speeds of 60 degrees/s an 180 degrees/s. Sex-specific significant differences were shown which are comparable to other kind of sports.

Adult↗

A myoelectrically controlled shoulder-elbow orthosis for unrecovered brachial plexus injury.

Two myoelectrically controlled battery powered shoulder-elbow orthoses manufactured individually for two traumatic unilateral brachial plexus injury cases are reported. The first case was 24 years old and the other was 6 years old. Both patients had undergone unsuccessful microsurgical nerve repair procedures leaving them with elbow and shoulder paralysis and some residual hand motion. Manufactured orthoses were made of lightweight thermoplastic polyethylene. They stabilised the affected shoulder joint in the neutral position. Elbow extension and flexion were activated by a myoelectrically controlled battery powered orthosis, and the active range of motion of the elbow was between 60 and 140 degrees. These orthoses achieved elbow motions at a speed of 16 degrees per second. The rehabilitation time was 3 months in both patients. The older patient was rehabilitated using a 1 kg mass, and the younger one with 0.5 kg mass, throughout the full range of active elbow motions. After 21 months it was found, in both cases, that the orthotic treatment had been successful and that the patients had been given the ability to engage in two-handed activities of daily living.

Accidents, Traffic↗

Heterotopic ossification related to toxic epidermal necrolysis in a patient with Behçet's disease.

We describe a 44-year-old woman with an 18-year-history of Behçet's disease (BD) in whom heterotopic ossification (HO) developed as a complication of toxic epidermal necrolysis (TEN). The patient presented with high fever, a progressive erythematous rash including target-like lesions, flaccid blister formations, and severe detachment. The patient was diagnosed with TEN, and methylprednisolone therapy was started. In the 2nd month of her hospital course, painful limitation developed in both her elbow and shoulder joints. Laboratory and radiographic findings confirmed HO of these areas. BD associated with TEN and HO is a previously unreported entity. In such a condition, determination of underlying genetic abnormality is important. Additionally, HO should be considered as a potential cause of the symptoms related to the joints.

Adult↗

Brevundimonas vesicularis septic arthritis in an immunocompetent child.

Septic arthritis is a rapidly destructive form of joint disease. The most common causative agents in children are Staphylococcus aureus and Kingella kingae, followed by group A Streptococcus and Streptococcus pneumoniae, and in neonates, enterobacteracea and group B Streptococcus. In this paper, we describe a previously healthy toddler with septic arthritis of the shoulder joint caused by Brevundimonas vesicularis. Prompt treatment with cefuroxime resulted in a full recovery. This is the first report of septic arthritis in humans caused by this microorganism, and the first description of B. vesicularis infection in an immunocompetent child.

Anti-Bacterial Agents↗

[Magnetic resonance tomography in disorders of the rotator cuff].

Magnetic resonance imaging (MRI) has become a powerful diagnostic tool for the evaluation of the painful shoulder in general and of the diseased rotator cuff in particular. MRI evaluates cuff disease in terms of tendon morphology and pathologic signal alterations within diseased cuff tendons. Additionally, MRI displays important pathoanatomic changes of the coracoacromial arch which are predisposing factors for the development of shoulder impingement syndrome and cuff disease. The accuracy of MRI in diagnosing small rotator cuff tears and in assessing the integrity of the labral-ligamentous complex is improved by the intraarticular injection of a suitable contrast agent. In the preoperative assessment of patients with cuff disease, MR arthrography enhances the staging of the disease and allows a more confident exclusion of concomitant lesions of the shoulder joint.

Contrast Media↗

Synovial chondromatosis of the glenohumeral joint: a rare condition.

The case of a 22-year-old man with synovial chondromatosis (SC) of the shoulder joint is described. A literature review confirmed that SC of the glenohumeral joint is very rare and that the etiology of the disease is still unknown. The diagnosis is often delayed, and the preferred form of management remains controversial. We consider magnetic resonance imaging (MRI) a valuable tool in detecting SC at an early phase and estimating the intrasynovial extent of the disease. Shoulder arthroscopy today represents an elegant treatment option for removing the chondromas and performing a partial synovectomy. It might, however, be insufficent in cases of involvement of the bicipital tendon sheath and other recesses of the joint.

Adult↗

[The role of soft tissues in downward stability of the glenohumeral joint--an experimental study with fresh cadavers].

Inferior stabilizing mechanism was studied after anatomical dissection of vertical stabilizing tissues in 98 fresh shoulder joints from human autopsies and measuring relative restraint by stabilizing tissues in 8 fresh shoulder specimens from monkeys. This results demonstrated that the coracohumeral ligament and supraspinatus tendon were most important structure as static and dynamic stabilizers, and closely interacted with each other in preventing inferior subluxation of the glenohumeral joint.

Adult↗

Biomechanical analysis of swing-through gait in paraplegic and non-disabled individuals.

The purpose of this study was to determine if the deficit of motor function affects the displacement of the lower limbs and increases the physical strain of upper-body musculature in paraplegic individuals performing swing-through gait. A biomechanical model consisting of four linked rigid bodies was developed to analyze this type of gait. Data were obtained on the spatio-temporal characteristics, kinematics and kinetics from a sample of eight non-disabled and nine paraplegic individuals performing swing-through gait. Net muscle moments acting on the segments and mechanical powers at three joints (shoulder, elbow, hip) were estimated during a complete gait cycle from basic force equations and moments of force acting on a rigid body. Results show that the two groups selected a similar comfortable speed suggesting that the type of gait per se is an important factor in the selection of speed. Paraplegic individuals had a longer crutch stance phase duration than the non-disabled due to inadequate hip muscle activations as confirmed by the moment of force and power analyses. Moreover, a higher moment of force at the shoulder was observed in the paraplegics individuals, mostly during the crutch stance phase. Consequently, the loss of motor function of the lower limbs in paraplegic individuals modifies the biomechanical pattern of swing-through gait compared to non-disabled individuals, and seems to increase the physiological demand on the upper limbs during the stance and swing phases of the gait cycle.

Acceleration↗

Shoulder distension arthrography in adhesive capsulitis.

Capsular retraction of the shoulder often occurs as a solitary pathological process; half of the cases are of primitive nature. In the past 10 years or more, distension of the shoulder joint has proven to be an efficient percutaneous treatment, and various techniques have been proposed. We report on our technique, which was performed on a series of 200 patients, and on the results observed in 27 patients with a precise evaluation of progressive changes in movements of the joint.

Arthrography↗

Ultrasonography in lesions of the rotator cuff and biceps tendon.

Ultrasonography (US) of the shoulder joint was performed in 88 patients, 15 of whom were referred for surgery. US was made with a real-time linear-array scanner, provided with a transducer of 7.5 MHz. Subsequently, all patients underwent single-contrast arthrography of the shoulder. When compared with the arthrographic findings, diagnosis by US showed 21 true positive, 3 false positive, 57 true negative and 7 false negative cases of a full-thickness tear of the rotator cuff. Small tears (2 cm or less in diameter) may be the most difficult to assess. US readily revealed biceps tendinitis and rupture of the biceps tendon, as well as fluid collection in the bursae above the rotator cuff tendons.

Adult↗

Magnetic resonance evaluation of the labral capsular ligamentous complex: a pictorial review.

Magnetic resonance imaging of the shoulder is a common imaging test, and in the course of routine evaluation it can provide accurate information regarding the labral capsular ligamentous complex (LCLC). Common patterns of labral injury include fraying, flap tears and labral distraction, which can be readily identified on both coronal and axial planes by paying attention to signal and morphological characteristics. Capsular and ligamentous pathology may be subtle, but is recognizable using a high-resolution technique that has differential contrast between native intra-articular fluid and the adjacent labrum and capsular restraints. Common patterns of capsular injury include a thickened, hyperintense capsule, sometimes with disruption and retraction. The inferior glenohumeral ligament is the primary stabilizer of the shoulder joint, and although failure of this structure is uncommon, the injury is easily identified. Shoulder instability is a common presentation, the diagnosis of which is dependent upon recognizing various injury patterns including Bankart lesions, reverse Bankart lesions, anterior labroligamentous periosteal sleeve avulsion (ALPSA) and failure of the inferior glenohumeral ligament.

Humans↗