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PubMed2001

Acupuncture for frozen shoulder.

This randomised controlled trial was undertaken to evaluate the effectiveness of acupuncture as a treatment for frozen shoulder. Thirty-five patients with a diagnosis of frozen shoulder were randomly allocated to an exercise group or an exercise plus acupuncture group and treated for a period of 6 weeks. Functional mobility, power, and pain were assessed by a blinded assessor using the Constant Shoulder Assessment, at baseline, 6 weeks and 20 weeks. Analysis was based on the intention-to-treat principle. Compared with the exercise group, the exercise plus acupuncture group experienced significantly greater improvement with treatment. Improvements in scores by 39.8% (standard deviation, 27.1) and 76.4% (55.0) were seen for the exercise and the exercise plus acupuncture groups, respectively at 6 weeks (P=0.048), and were sustained at the 20-week re-assessment (40.3% [26.7] and 77.2% [54.0], respectively; P=0.025). We conclude that the combination of acupuncture with shoulder exercise may offer effective treatment for frozen shoulder.

Acupuncture Therapy↗
PubMedDate not supplied

The shoulder in baseball pitching: biomechanics and related injuries-part 2.

The extreme range of motion at the shoulder, the high angular velocities and torques, and the repetitious nature of the pitching motion combine to make the shoulder vulnerable to injury during the baseball pitch. An understanding of the biomechanics that contribute to shoulder injuries during each phase of the pitching motion can facilitate the athlete's diagnosis, treatment, and rehabilitation. The athlete's symptoms and signs, as well as radiographic imaging, are key elements in arriving at a diagnosis of shoulder injuries. Nonoperative treatment consisting of an initial period of rest and NSAIDS, followed by physical therapy and a gradual return to activity, is usually successful. When this approach fails, surgical intervention, either arthroscopic or open, may be necessary. Physical therapy and rehabilitation are directed toward restoring the integrity and strength of the dynamic and static stabilizers of the shoulder joint, yet preserving the range of motion necessary for performance. Through rehabilitation, the dedicated athlete can often return to the pitching mound at his previous level of performance.

Baseball↗
PubMed1992

Autotraction stress roentgenography for demonstration anterior and inferior instability of the shoulder joint.

A form of stress roentgenography is presented for the diagnosis of anterior and inferior shoulder instabilities. Stress is induced by anterioinferior traction concentrated on the shoulder during extension of the flexed hip, when patients hold their legs on the side being examined, with both hands. The anterior and inferior shifts of the humeral head in relation to the glenoid fossa then are measured from anteroposterior and modified axillary roentgenograms. This method was employed in 16 shoulders with recurrent anterior dislocation, 11 recurrent anterior subluxations, nine multidirectional instabilities, and 19 control shoulders. Mean anterior translations were 3 mm and 5 mm, and inferior translations were 7 mm and 10 mm for the control and recurrent dislocation groups, respectively. There were statistically no significant differences between those groups. In the recurrent anterior subluxations, the corresponding translations were of a completely different order, 21 mm and 19 mm, respectively, allowing the distinction from the controls and recurrent anterior dislocations in most cases. The shifts found in multidirectional instabilities, averaging 27 mm and 26 mm, respectively, were significantly greater than for the recurrent subluxations, but the differences were not great enough for accurate differential diagnosis in individual cases. Autotraction stress roentgenography of the shoulder may be of use in the diagnosis of recurrent anterior subluxations and anteroinferior multidirectional instabilities. It also gives good general views of the looseness of the glenohumeral joint.

Adolescent↗
PubMed2004

Acute shoulder injuries.

The shoulder is the most mobile joint in the human body. The cost of such versatility is an increased risk of injury. It is important that family physicians understand the anatomy of the shoulder, mechanisms of injury, typical physical and radiologic findings, approach to management of injuries, and indications for referral. Clavicle fractures are among the most common acute shoulder injuries, and more than 80 percent of them can be managed conservatively. Humeral head fractures are less common and usually occur in elderly persons; 85 percent of them can be managed nonoperatively. Common acute soft tissue injuries include shoulder dislocations, rotator cuff tears, and acromioclavicular sprains. Acromioclavicular injuries are graded from types I to VI. Types I and II are treated conservatively, types IV to VI are treated surgically, and there is debate about the best approach for type III. Eighty percent of shoulder dislocations are anterior. Diagnosis of this injury is straightforward. The injury usually can be reduced by employing a number of nonsurgical techniques. Traumatic or acute rotator cuff tears can be managed conservatively or surgically, depending on the patient and the degree of injury.

Acromioclavicular Joint↗
PubMed2004

[Reconstruction of humeral head retroversion in the treatment of anterior shoulder instability].

Reduction of the physiologic retroversion of the humeral head can lead to shoulder luxation. After shoulder luxation it can also lead to shoulder instability. The aim of the paper was to check the level of humeral head retroversion in patients with anterior shoulder instability and to estimate the effectiveness of treatment of this instability with the derotational Weber osteotomy. The study included 38 patients, 34 males and 4 females, ranged 16-48 yr. (mean 31) treated in our Clinic. Every patient was done CT in order to estimate the level of humeral head retroversion. Patients with reduced humeral head retroversion qualified for operational treatment with Weber method derotational osteotomy. The outcomes were estimated according to the Rowe and Zarins score. 34 patients had excellent or good results. Pain was retreated, patients could come back to their normal activities, before the first luxation. Only 4 patients had another luxation in spite of our treatment. The control CT showed that the humeral head retroversion was 30 or more degrees. The arthroscopy was performed, the Bankart lesion was found and the patients were qualified for treatment this lesion. Weber osteotomy could be the satisfactory method of treatment of anterior shoulder instability in patients with physiologic reduction of humeral head retroversion.

Adolescent↗
PubMed2005

Pathomechanics in atraumatic shoulder instability: scapular positioning correlates with humeral head centering.

The objective was to analyze three-dimensional scapular positioning and glenohumeral centering of normal and atraumatic unstable shoulders. We hypothesized that changes of humeral head position correlate with alterations of scapular positioning. The shoulders of 28 healthy volunteers and 14 patients with atraumatic instability were examined in various arm positions using open magnetic resonance imaging. After segmentation and three-dimensional reconstruction, three-dimensional analyses of scapular positioning and humeral head position relative to the glenoid were done. The coefficient of correlation (r) between both parameters was determined using the correlation z test. The glenohumeral to scapulothoracic ratio in the scapular plane was increased in nine of 14 patients and decreased in three patients, whereas the scapular internal rotation in the transverse plane was increased in all unstable shoulders. The unstable shoulders also had malcentering (greater than two times the standard deviation in the healthy volunteers) of the humeral head in the direction of instability during various arm positions. In healthy and unstable shoulders, the correlation between scapular position and glenohumeral positioning was high during passive elevation (r = 0.60-0.87). The high correlation suggests that scapular positioning is relevant for humeral head decentering. Therefore, physiotherapeutic strategy should consider the malpositioning of the scapula and be adapted to the direction of instability.

Adolescent↗
PubMedDate not supplied

Partial prosthetic replacement of the shoulder in fractures and fracture-dislocations of the proximal humerus.

A total of 48 patients submitted to partial shoulder replacement for fracture and fracture-dislocation of the proximal humerus were evaluated after a mean follow-up of 5.2 years (range 2 to 10 years). The absolute mean Constant score was 57.8, relative score 76.8% and corrected score 80.4%. A mean of 8.8 points were totalled in the Simple Shoulder Test. Out of 45 patients evaluated radiographically, tuberosity consolidation in the anatomical site was evident in 25 shoulders (55%) and the subacromial space appeared to be preserved in 20 shoulders (44%). More than 90% of the patients declared that he or she was satisfied with treatment. A comparative study on subgroups of patients in an attempt to identify the prognostic value of several factors was conducted. Better functional results were obtained in subjects aged under 70 years, in fracture-dislocations, in shoulders with whole rotator cuffs, in patients with dedicated modular prostheses.

Aged↗
PubMed2006

[Arthroscopic stabilization of the shoulder].

PURPOSE OF THE STUDY: Minimally invasive technique have recently gained importance because of their apparent advantages. One of them is arthroscopic stabilization of the shoulder used for treatment of traumatic anterior glenohumeral dislocation with subsequent instability. In this study we describe the results of and experience with this technique. MATERIAL: Conventional treatment of glenohumeral dislocation, which includes reduction and subsequent immobilization for 4 weeks, has a high risk of recurrent dislocation particularly in young patients.Therefore surgical treatment lowering this risk is preferred. Arthroscopic stabilization is effective in patients with post-traumatic anterior instability of the glenohumeral joint. This technique involves fixation of the torn glenoid labrum and reduction of the anterior articular space. The evaluation of 77 patients treated by this method is presented here. METHODS: The arthroscopic method of labrum fixation with Mitek anchors (Mitek, Norwood, Mass., USA) was used. Arthroscopic stabilization is carried out in a lateral recumbent position with an extension device, using two standard arthroscopic ports. After preparation of the glenoid rim, the torn labrum is sutured to GII anchors inserted in pre-drilled tunnels in the edge of the glenoid. Insertion of three anchors appears optimal, because the use of fewer anchors may result in failure and repeat dislocation. The anchors have to be inserted in a manner ensuring fixation of maximum of the torn labrum. RESULTS: A total of 90 shoulder joints were treated by arthroscopic stabilization and 77 patients were followed up. Excellent results were achieved in 58 patients (75.4 %). Good results in 14 joints (18.2 %) and poor in 4 patients (5.2 %). Three repeat dislocations were recorded and one patient experienced restriction of motion in the treated shoulder. DISCUSSION: The three repeat dislocations (3.9 %) correlate with the results reported in the recent relevant literature. CONCLUSIONS: Arthroscopic shoulder joint stabilization is a reliable method. It is a surgical procedure suitable for treatment of shoulder instability and is also indicated in patients with acute traumatic dislocation, because it significantly reduces the risk of recurrent dislocation that is high in conventional treatment. In the hands of an experienced surgeon this technique is fast and simple and, because of its minimal invasiveness, convenient for the patient. In comparison with open stabilization techniques, arthroscopy is associated with higher failure, but a classical open procedure can still be used for treatment of recurrent dislocations.

Adolescent↗
PubMed2006

[Forensic identification of floating shoulder injury].

OBJECTIVE: To discuss forensic identification of floating shoulder injury (FSI). METHODS: To analyze fifteen cases of FSI which were accepted from Jan. 1993 to Jan. 2006, including 15 shoulder neck fracture, 13 clavide stem fracture and 2 distal end clavide fracture, the function of shoulder joint was evaluated six months after injure considering the following three aspects: result of forensic examination such as X-ray photograph, CT and MRI, the injurers' symptom, objective sign and joint function, shoulder joint territory, degree of pain and local muscle power. RESULTS: Basing on the curative effect standard of Herscovic, all cases were divided into good. Modest, worst, which included 2, 4, 9 cases respectively; referring the standard of GA35-92, GB18667-2002, all cases were divided into six, seven, eight, nine and ten degree, which included 2,9,2,1,1 cases respectively. CONCLUSION: As a special powerful injure, FSI always companied with concurrent and multiple injure, and characterized by missed, incorrect and delayed diagnosis and infelicitous treatment, which lead to the high frequency and degree of injure. To prevent missed and incorrect forensic identification, we should have a full realization of the particularity of FSI, and evaluate the function of shoulder all-sidely, objectively and synseticaly.

Accidents, Traffic↗
PubMed1991

[Possibilities of diagnostic sonography in assessment of instability of the shoulder joint].

In a prospective study we evaluated diagnostic ultrasound investigation for shoulder instabilities. We measured the passive antero-posterior translation in 150 healthy persons in relation to the dorsal glenoid as well as the inferior subluxation in relation to the acromion. After establishing these normative data, we examined 23 patients with anterior unidirectional instabilities and 34 with multidirectional instabilities by ultrasound. Our results showed that the dorsal humeral head circumference of a normal joint is located about 8 to 10 mm dorsally to the glenoid. In the control group with non-injured shoulder is significantly higher as in the nondominant shoulder (p less than 0.01). Patients with anterior instabilities showed a highly significant increase of anterior translation in the injured shoulder (p less than 0.0001). In comparison with the control group there is a highly significant increase of downward subluxation under load in patients with multidirectional instabilities (p less than 0.001). In patients with multidirectional instabilities, there is also a significant increase of spontaneous downward subluxation of the dominant shoulder (p less than 0.01). In habitual or voluntary dislocations the relation of the humeral head to the glenoid can be judged staticly and dynamically. Secondary signs of dislocation (Hill-Sachs lesions, joint effusion) are evident. 13 patients of a total number of 22 patients we operated on, had bony or cartilaginous Hill-Sachs lesion. The specificity of preoperative ultrasound in detecting these Hill-Sachs lesions was 100% and the sensitivity was 89%.

Adolescent↗
PubMed1990

[Unreduced posterior luxations and fractures-luxations of the shoulder. Apropos of 30 cases].

Twenty-seven patients (30 shoulders) presenting with an unreduced posterior dislocation or fracture-dislocation were operated on and followed up for at least 2 years. The lesions were classified in 4 types, after Randelli: posterior dislocation with cephalic fracture inferior to 50 per cent (type I = 10 cases) or superior to 50 per cent (type II = 8 cases) and posterior fracture-dislocations with two fragments (type III = 6 cases) or several fragments (type IV = 6 cases). The first patients of the series underwent a resection of the humeral head (5 cases) or an open reduction (7 cases). During a second period 10 shoulders were reduced by a posterior approach and stabilized by transfer of the subscapularis tendon with or without the lesser tuberosity in the humeral defect 6 shoulders were reduced by an anterior approach together with derotation osteotomy. Lastly, one patient refused to be operated on and we performed a shoulder prosthesis to the last one. Necrosis of the humeral head (9 cases) appeared to be related to the severity of the lesion (type III and IV) and the type of surgical procedure (5 derotation osteotomy out of 6 and 3 open reductions out of 7) rather than to the approach route or the interval from injury to diagnosis. These results show that an anatomical repair may be attempted when the dislocation is less than 6 months old and when the impression defect involved less than 50 per cent of the articular surface. Otherwise and a fortiori in old posterior fracture-dislocations, an arthroplasty seems to be the best solution. Even if it may be clinically difficult, it offers the best chance for a functional shoulder in an active patient.

Adult↗
PubMed1984

Arthroscopic findings in the subluxating shoulder.

The arthroscopic findings in 19 shoulders (18 patients) with subluxation are described. The clinical diagnosis of subluxation of the shoulder is primarily based on clinical history with inconsistent physical findings and radiographic studies. Arthroscopic findings in these patients were consistent. Increased translation of the humeral head in the anteroposterior plane was noted secondary to attenuation of the anteroinferior glenohumeral ligament. Incompetence of this ligamentous structure obviated its function as an anterior buttress and allowed the humeral head to translate anteriorly on the glenoid. Fraying, tearing, or detachment of the anteroinferior glenoid labrum and articular defects in the posterolateral humeral head were also consistent findings, thought to be secondary to repeated injury as the humeral head translates forward and backward in the glenoid fossa. In several cases the classic "click" that occurs with subluxation of the shoulder could be reproduced under arthroscopic visualization and corresponded to the defect in the posterolateral humeral head riding over the torn labrum and/or anterior glenoid rim. Shoulder arthroscopy is an accurate method for confirming the clinical impression of subluxation of the shoulder, especially in subtle glenohumeral instability, and should be helpful in selecting specific surgical reconstruction procedures.

Adolescent↗
PubMed1983

Voluntary anterior dislocation of the shoulder: case study.

Anterior shoulder dislocation can be willfully produced by a subject through abnormal unbalanced muscle contraction at the shoulder joint. It may be associated with pathologic lesions at the shoulder. Treatment consists of vigorous shoulder strengthening exercises and/or surgery to increase anterior stability at the joint. For any treatment approach to be successful the subject must avoid dislocation of the shoulder. A psychologic component frequently associated with this condition is its use as a mechanism for attention, sympathy or defense--a factor that has a significant negative effect on response to treatment.

Adult↗
PubMed1995

Shoulder pain: a diagnostic dilemma.

The etiology of shoulder pain can usually be placed into one of five categories: fracture and/or contusion, shoulder separation involving the clavicle, instability of the glenohumeral joint, impingement syndrome involving the rotator cuff or biceps tendinitis, and frozen shoulder. Non-shoulder pathology, such as cervical strain, thoracic outlet syndrome and referred pain from phrenic nerve irritation, should be excluded when evaluating patients presenting with shoulder pain. After inflammatory or infectious arthritis has been ruled out, the history should point to either acute trauma or an overuse injury. Physical examination may provide information about neurovascular status, palpable tenderness, range of motion, strength, instability and impingement. Radiographic studies are usually indicated in patients with a history of trauma, but they are often not necessary in the initial evaluation of overuse injuries. Magnetic resonance imaging and arthrograms should be reserved for patients who have not responded to six to eight weeks of conservative treatment and are candidates for surgery.

Acromioclavicular Joint↗
PubMed1994

[Inferior glenohumeral subluxation: an indirect sign of sepsis of the shoulder].

Drooping shoulder is a roentgenographic abnormality consisting in a discontinuity in the scapulo-humeral arch due to inferior subdislocation of the humeral head. Drooping shoulder is commonly seen in patients with injuries to the shoulder or neurological loss. Two cases of drooping shoulder due to staphylococcal arthritis (after local corticosteroid injections) are reported herein. The mechanism of the downward humeral displacement in septic arthritis is discussed. The other causes of drooping shoulder are reviewed. Precautions needed to avoid increasing the displacement during rehabilitation therapy are outlined.

Adult↗
PubMed1995

[Hemi-arthroplasty of the shoulder: radiological, functional and dynamic studies].

From September 1973 to October 1992, forty-three shoulder arthroplasties were performed in forty-one patients with complicated fractures or degenerative disease. Radiological and functional assessment with a mean follow-up time of forty-five months permitted us to review twenty patients with fifteen Neer II prosthesis, three isoelastic prosthesis and two total shoulder replacements. Of these, eleven presented with traumatic injuries and four with degenerative disease. The mean age at operative time was 61 years. Radiological evaluation showed that all cases had a retroversion of about 30 degrees. Normal humeral length and lateral shifting were not achieved in most patients; in fact only one had a restored length and lateral shifting. The mean scapulothoracic range of motion was found to be half that of a normal gliding shoulder (angle 30 degrees instead of 60 degrees). The subacromial space was diminished by one third in all cases. Relief of shoulder pain was the most significant finding. Mobility was restored to a level of about 75% of normal according to Constant's Scale. Dynamometric measures showed an important loss of force (47% of normal) despite a normal external rotation force. Recent improvements in implant conception (modular prosthesis) and a better understanding of physiological shoulder mechanisms should improve the functional results of this arthroplasty in the future.

Adult↗
PubMed1996

[Magnetic resonance in the study of the painful shoulder. The surgical comparison in 30 consecutive cases].

Eighty patients complaining of shoulder pain were examined with MRI from January, 1993, through December, 1994. Thirty of them were submitted to surgery, with an exhaustive inspection of shoulder structures and the treatment of abnormal findings. In this subgroup of surgical patients, MRI had depicted 16 complete tears of the rotator cuff, 4 partial tears, 8 cases of subacromial impingement, I humeral head osteochondritis and, finally, I humeral head osteochondritis with complete rotator cuff tear. Surgical findings confirmed MR diagnosis in 97% of cases. MR findings were then compared with literature data and some atypical features were observed in our series. MRI was totally reliable in complete cuff tears (16/30 patients), always showing the involvement of supraspinatus tendons and, in some cases, of other cuff tendons. In partial cuff tears (4/30 patients), besides the classic pattern of a fissure in the deep/superficial supraspinatus tendon, we observed intra- and peritendinous changes, with no tendon interruption, due to diffuse microlesions. When impingement due to subacromial space narrowing, with no cuff tear, was present (8/30 patients), MRI depicted different causes--e.g., acromioclavear arthrosis, coracoacromial ligament hypertrophy and posttraumatic changes. MRI showed tendinosis in all patients but overestimated it in one case where partial cuff tear was not confirmed surgically--the only false positive in our series. At surgery, all these cases were classified as stage I-II impingement (according to Neer's classification). Finally, MRI was very reliable in the study of bone conditions (osteochondritis), both isolated and associated with cuff tears. The diagnostic accuracy of MRI in the study of the painful shoulder was very high (97%), in agreement with literature data. This is very important because many different causes of shoulder conditions (abnormal tendons, bones and mechanics) may present with similar clinical symptoms. MRI appears as the only imaging method yielding complete and accurate pieces of information in the patients with a painful shoulder.

Adult↗
PubMed1996

[Impingement syndrome following direct injuries of the shoulder joint].

Impingement is the most common cause of pain and limitation of movement in the shoulder, with painful arc syndrome its major clinical sign. It usually becomes manifest at between 70 degrees-120 degrees of abduction, but in severe cases, this may be reduced to only 50 degrees-70 degrees. We studied 22 patients who had developed shoulder impingement following direct injuries and who had been treated by anterior acromioplasty and decompression, with an average follow-up of 32 months. 5 had sustained fractures of the greater tuberosity of the humerus at the time of injury, 14 had tears of the rotator cuff of various sizes (1 in both shoulders) and 3 had developed fibrotic scars of the subacromial bursa. Excellent or good results were achieved in 86.6%. Healing time was shorter, and there was return of full range of shoulder movement in those with subacromial scars, undisplaced fractures of the greater tuberosity, or those with a small tear of the rotator cuff. Recovery took longer in those with larger tears of the rotator cuff and in those with displaced fractures of the greater tuberosity. Recovery time was proportional to the size of the rotator cuff tear. It is concluded that direct trauma to the shoulder bears a direct relationship to the development of impingement syndrome, and that at surgery a concomitant tear in the rotator cuff is seen more than 2/3. Because of the high rate of success in surgical treatment of this syndrome, operation is indicated when a few months of physical therapy and analgesics fail to provide relief. In the presence of fractures, decompression surgery should be postponed until the fracture has united.

Acromion↗