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At least 1,333 records · Page 74Linked to original sources
PubMed2002

Bone scintigraphy screening for osteonecrosis of the shoulder in patients with non-traumatic osteonecrosis of the femoral head.

OBJECTIVE: In patients with non-traumatic osteonecrosis of the femoral head (ONFH), the shoulder is one of the major affected sites secondary to the proximal and distal femur in cases of multiple osteonecrosis. The present study attempted to investigate whether technetium bone scintigraphy is useful for screening of non-traumatic osteonecrosis of the shoulder (ONS). DESIGN AND PATIENTS: A total of 170 shoulder joints in 85 patients with ONFH were evaluated by bone scintigraphy and the findings compared with those of magnetic resonance imaging (MRI). The MR diagnosis was used as the gold standard. RESULTS: Based on the diagnosis by MRI, ONS was detected in 43 shoulders of 27 patients (25%). All necrotic lesions were located in the humeral head. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of bone scintigraphy for ONS detection were 65%, 81%, 77%, 54% and 87%, respectively. When the necrotic angle of the lesions on the mid-coronal MRI was more than 40 degrees, the sensitivity of bone scintigraphy for ONS detection increased to 88% (21/24 shoulders). CONCLUSION: Bone scintigraphy may be useful for demonstrating medium or large ONS lesions on screening of patients with ONFH.

Adolescent↗
PubMed2004

Biomechanical mechanism for transitions in phase and frequency of arm and leg swing during walking.

As humans increase walking speed, there are concurrent transitions in the frequency ratio between arm and leg movements from 2:1 to 1:1 and in the phase relationship between the movements of the two arms from in-phase to out-of-phase. Superharmonic resonance of a pendulum with monofrequency excitation had been proposed as a potential model for this phenomenon. In this study, an alternative model of paired pendulums with multiple-frequency excitations is explored. It was predicted that the occurrence of the concurrent transitions was a function of (1) changes in the magnitude ratio of shoulder accelerations at step and stride frequencies that accompany changes in walking speed and (2) proximity of these frequencies to the natural resonance frequencies of the arms modeled as a pair of passive pendulums. Model predictions were compared with data collected from 14 healthy young subjects who were instructed to walk on a treadmill. Walking speeds were manipulated between 0.18 and 1.52 m/s in steps of 0.22 m/s. Kinematic data for the arms and shoulders were collected using a 3D motion analysis system, and simulations were conducted in which the movements of a double-pendulum system excited by the accelerations at the suspension point were analyzed to determine the extent to which the arms acted as passive pendulums. It was confirmed that the acceleration waveforms at the shoulder are composed primarily of stride and step frequency components. Between the shoulders, the stride frequency components were out-of-phase, while the step frequency components were in-phase. The amplitude ratio of the acceleration waveform components at the step and stride frequencies changed as a function of walking speed and were associated with the occurrence of the transitions. Simulation results using these summed components as excitatory inputs to the double-pendulum system were in agreement with actual transitions in 80% of the cases. The potential role of state-dependent active muscle contraction at shoulder joints on the occurrence of the transitions was discussed. Due to the tendency of arm movements to stay in the vicinity of their primary resonance frequency, these active muscle forces were hypothesized to function as escapements that created limit cycle oscillations at the shoulder's resonant frequency.

Acceleration↗
PubMed2000

MR imaging of the shoulder: imaging techniques and anatomy.

Since the development of dedicated surface coils and the more widespread use of state-of-the-art arthrographic techniques, MR imaging of the shoulder has come to maturity. In this article the imaging techniques of conventional MR imaging and MR arthrography of the shoulder are reviewed. The complex anatomy, the many anatomic variations and diagnostic variants and pitfalls and discrimination of pathologic entities from normal findings are discussed. Familiarity with the normal anatomy is a prerequisite to achieve a high diagnostic accuracy in the detection of a variety of pathologic conditions of the shoulder joint.

Arthrography↗
PubMed2001

Reliability of five methods for assessing shoulder range of motion.

In symptomatic subjects, the reliability of tests for shoulder joint range of motion has yet to be determined. For this reason, inter-rater and intra-rater agreement trials were undertaken to ascertain the reliability of visual estimation, goniometry, still photography, "stand and reach" and hand behind back reach for six different shoulder movements. Intra-class correlation coefficients (Rho) were derived by using a random effects model. For flexion, abduction and external rotation fair to good reliability was demonstrated for both trials using visual estimation (Inter-rater Rho = 0.57-0.70; Intra-rater Rho = 0.59-0.67), goniometry (Inter-rater Rho = 0.64-0.69; Intra-rater Rho = 0.53-0.65) and still photography (Inter-rater Rho = 0.62-0.73; Intra-rater Rho = 0.56-0.61). The tests had standard errors of measurement of between 14 and 25 degrees (inter-rater trial) and 11 and 23 degrees (intra-rater trial).

Adult↗
PubMedDate not supplied

Biomechanical properties of the biceps-labral complex submitted to mechanical stress.

PURPOSE: To determine biomechanical properties of the superior labrum-biceps tendon complex submitted to continuous and sudden mechanical strain. METHODS: Eighteen shoulder specimens from 15 unclaimed corpses, ages ranging from 20 to 40 years, were submitted to continuous or sudden tensile tests using 3 different traction machines. Shoulders presenting signs of degenerative diseases or preexisting traumatic lesions were excluded. RESULTS: Rupture of the distal portion of the long hand of the biceps occurred when stretching forces reached 290N in continuous traction and 384N in sudden traction. No labral-complex lesions were observed. CONCLUSION: Either a simple continuous or a sudden uniaxial traction of the arm do not play a role in the genesis of superior labrum anterior-posterior (SLAP) lesions in the shoulder joint.

Adult↗
PubMedDate not supplied

The globe system: an unambiguous description of shoulder positions in daily life movements.

Positions of the shoulder joint are commonly described in terms of degrees of humeral elevation in the principal planes. This approach is inadequate for an accurate and unambiguous description of functional arm movements that are not confined to these planes. In this paper, a general unambiguous method for describing shoulder positions is adopted and visualized in globe graphs. This facilitates the use and interpretation of the method in clinical practice. To illustrate this globe system of description, a healthy subject participated in the experiments. The shoulder position is described for several functional and standardized tasks for the upper limb with three angles: (1) the angle of the plane of elevation, (2) the angle of elevation within the plane of elevation, and (3) the angle of axial rotation. With these parameters, the position of the upper arm can be visualized as a position on a "globe" about the shoulderjoint. Although not perfect, the globe system provides the most unambiguous description of functional thoraco-humeral positions, which is easy to apply in clinical practice.

Activities of Daily Living↗
PubMed1986

Clarification of the role of the supraspinatus muscle in shoulder function.

The purpose of this study was to determine the torque produced by the supraspinatus muscle within the functional motion planes of forward flexion and elevation in the plane of the scapula. An isokinetic dynamometer was used to measure the reduction in torque produced by isolated paralysis of the suprascapular and axillary nerves in ten normal volunteers. A calculation of the potential torque of the supraspinatus and deltoid muscles was obtained from the product of the moment arm, cross-sectional area, and integrated electromyographic signal. The results of both the dynamometer measurement and the calculation of torque supported our conclusion that the supraspinatus and deltoid muscles are equally responsible for producing torque about the shoulder joint in the functional planes of motion.

Adult↗
PubMed1994

Isolated subacromial bursal fluid on MRI of the shoulder in symptomatic patients: correlation with arthroscopic findings.

Fluid in the subacromial bursa (SAB) is a common finding on magnetic resonance (MR) images of the shoulder, and the implications of this finding have not been clarified. We retrospectively reviewed and correlated the MR features with arthroscopic findings in 21 symptomatic patients who had fluid in the SAB on MR imaging without demonstrable rotator cuff tear. Rotator cuff impingement was the most frequent surgical finding (42.9%). Other frequent surgical observations were glenoid labrum abnormality (28.6%), bursitis (19%), and supraspinatus tendinitis (14.3%). Distribution of acromial types was similar to that reported by Bigliani et al., and impingement was evenly distributed among acromial types in our study population. We conclude that in our patient population group the MR finding of isolated SAB fluid in symptomatic patients is highly likely to be associated with the finding of other abnormalities in the shoulder joint at surgery.

Acromion↗
PubMed2005

Airway obstruction involving a laryngeal mask airway during arthroscopic shoulder surgery.

Several earlier reports have described life-threatening airway obstruction during arthroscopic shoulder surgery performed under regional anesthesia, caused by the leakage of irrigation fluid out of the shoulder joint space into the surrounding soft tissues and then the neck and the pharynx. Here, we present a case of airway obstruction that occurred in a patient under general anesthesia. A 77-year-old woman with a rotator cuff rupture who was to undergo right-shoulder arthroscopic surgery was anesthetized with fentanyl and propofol. Her airway was secured with a flexible laryngeal mask airway (LMA). During surgery, the compliance of her breathing bag became gradually poorer, and finally we were not able to ventilate her at an airway pressure of 60 cmH2O. We found that her chest wall, neck, and face were swollen and tense. Laryngoscopy revealed massive swelling of the pharyngeal soft tissues. The vocal cords were not visible. Her trachea was intubated blindly, and adequate ventilation was re-established. She was placed in the Fowler position and furosemide was given intravenously. Her neck and chest swelling were reduced over the next 2 h and she was extubated without any problem. We recommend that physicians should periodically examine the neck of any patient undergoing arthroscopic shoulder surgery, especially when general anesthesia is used, because anesthetized patients cannot complain of breathing difficulty and the airway swelling may progress until it becomes life-threatening.

Aged↗
PubMedDate not supplied

[Arthroscopic synovectomy of the shoulder and elbow joint].

We reviewed experiences and results of six shoulder and nine elbow joint synovectomies, performed in a time period between 1989 and 1990 by arthroscopic technique. The operation technique is pretentious an requires some expenditure. The postoperative course distinguishes itself by little pain and early increase of range of motion.

Arthritis, Rheumatoid↗
PubMed2000

Obstetrical brachial plexus injuries: incidence, natural course and shoulder contracture.

The incidence of obstetric brachial plexus injury (OBPI) was investigated and the natural course of this disorder and the frequency of shoulder contracture described. Between 1988 and 1997 13,366 children with a gestational age of 30 weeks or more, were born at the Academic Medical Center, Amsterdam. Of these, 62 had an OBPI (4.6 per 1000). Complete neurological recovery occurred in 72.6% of cases. Half of them had a delayed recovery of more than three weeks (mean recovery time 6.2 +/- 3.1 months). Shoulder contracture occurred in at least one-third of the children with delayed recovery and in at least two-thirds of the children with incomplete recovery. The incidence of OBPI in our hospital was found to be higher and to have a less favourable natural course than is usually reported in the literature. Contracture of the shoulder joint is frequently found even in infants with complete neurological recovery.

Academic Medical Centers↗
PubMed1989

Polyarticular Clostridium perfringens pyoarthritis.

A woman with rheumatoid arthritis presented with an abdominal mass and Clostridium perfringens septic arthritis in both wrists and shoulders. We believed this to be the first reported case of polyarticular septic arthritis due to Clostridium perfringens. Apatite, lipid, and cholesterol crystals in the shoulder joint effusions were a potential source of diagnostic confusion.

Arthritis, Infectious↗
PubMed2002

The effect of different surfaces on biomechanical loading of shoulder and lumbar spine during pushing and pulling of two-wheeled containers.

Seven waste collectors pushed and pulled a two-wheeled container on three different surfaces: flagstones, paving stones, grass. Net torques at the shoulder joint and the lumbar spine as well as the compression and shear forces in the lumbar spine at the L4/L5 level were calculated for the tilting, initial and sustained phases. The lumbar spine compression force was below 1800N and the shear force was below 200 N in all situations. The shoulder torque when pulling with one hand was up to 80 N m. The container weight affected the magnitude of the push/pull forces and the load on the shoulders but not the load on the lumbar spine. The type of surface affected the magnitude of the push/pull forces during initial and sustained phases, and affected the load on the shoulder in the sustained phase. However, it did not affect the compression in the lumbar spine.

Adult↗
PubMed2002

[Restoration of elbow joint flexion using pectoral muscle transfer in patients with arthrogryposis multiplex congenita. Part I: surgical method, rehabilitation and clinical results].

PURPOSE OF THE STUDY: In patients with type I arthrogryposis multiplex congenita, elbows are fixed in extension. The m. biceps brachii and m. brachialis are usually atrophic. The main objective of arm treatment is to restore flexion in the elbow that would enable the patient to reach the mouth with the hand as well as maintain active extension of the arm for hygienic purposes. This can be achieved by several techniques of muscle transfer. Of these, we selected and modified the method of Clark based on transfer of distal parts of the greater pectoral muscle. The aim of this study was to develop the surgical procedure in detail, to design the course of rehabilitation and to evaluate the outcomes of treatment. MATERIAL AND METHODS: The procedure for optimal transfer of three fifths of the m. pectoralis major was based on an anatomical study. In addition, a unified course of rehabilitation was developed. Between 1996 and 1999, this approach was applied to nine upper limbs in five patients (age range, 4.3 to 9 years). All the patients were evaluated in terms of their clinical state according to selected subjective and objective criteria. RESULTS: The outcomes of transfer of the m. pectoralis major were evaluated as very good and good in six cases. Active movement of the elbow was in the range of 15 degrees to 95 degrees; useful movement ranged from 40 degrees to 70 degrees. The strength of elbow flexion rated 4 or 4+. In three cases, although muscle transfer restricted active elbow extension it did not prevent the upper limb from being used for hygienic purposes. In the remaining three cases, the method failed to restore the patient's ability of reaching the mouth. The analysis of unsuccessful results showed that these were always related to a very limited pre-operative passive flexion of the elbow, restricted movement of the shoulder joint and a failure in distal fixation of the muscle transposed. DISCUSSION: Our results show that transfer of the distal three fifths of the m. pectoralis major, performed by a modified method of Clark, was an effective approach because the working capacity of this muscle was comparable with those of the m. biceps brachii and m. brachialis. Bilateral transfer enabled the patients to reach the mouth with both hands and to use the remaining elbow extension for hygienic purposes. The best function was achieved when active movement of the shoulder had permitted raising the arm above the horizontal and passive elbow flexion had been 90 degrees. Our results are comparable with those reported in the literature. The critical phase of this transfer involved fixation of the m. pectoralis major to the forearm. CONCLUSIONS: The surgical procedure for transfer of the m. pectoralis major and subsequent rehabilitation in patients with type I arthrogryposis are described in detail. Good results are achieved in patients who, pre-operatively, had passive movement of the elbow joint and active movement of the shoulder joint. The method is not suitable for patients with a markedly limited pre-operative movement of both the elbow and the shoulder in whom an alternative surgical treatment should be used.

Arthrogryposis↗
PubMed2004

Modified extra rotator-cuff entry point in antegrade humeral nailing.

INTRODUCTION: We describe an extra-articular, extra-rotator cuff entry point for antegrade humeral nailing, which preserves the articular surface and rotator cuff integrity. MATERIAL AND METHODS: Thirty-two patients with humeral shaft fractures underwent antegrade intramedullary nailing using a modified insertion point located 1 cm below the crest of the greater tuberosity, in a region outside the articular surface and rotator cuff area. RESULTS: In all cases, nailing was done successfully, without any perforation of the humeral inner cortex by the nail. Extension of the fracture line to the distal metaphysis happened intraoperatively in one case of a distal diaphysis fracture. In the remainder of the patients, postoperative reduction of the fracture was successful, with no sign of an iatrogenic incident of fracture comminution. Excellent active shoulder function and full early functional recovery of the shoulder joint (to 16th week postoperatively) were established in 98% of the patients. All fractures were united in a mean period of 14 weeks. CONCLUSION: We suggest an extra-articular, extra-rotator cuff entry point for antegrade humeral nailing as a possible and safe technique with beneficial results for the shoulder's postoperative function.

Female↗
PubMedDate not supplied

Radial-nerve palsy associated with septic shoulder in neonates.

Four neonates presented with septic shoulders after delays in diagnosis of 7-20 days. All lacked active extension of the wrist and thumb, and three lacked active extension of the fingers. Two had positive cultures for Staphylococcus aureus, and one had a positive Escherichia coli culture. Surgical treatment was one single aspiration and three arthrotomies. Recovery of extension began in 10-21 days and was normal at 18-35 days post-treatment. At follow-up 9-13 months later, all limbs were neurologically normal. Cadaver dissections showed that the radial nerve passed close to the shoulder joint, and when the capsule was distended, it impinged on the nerve.

Arthritis, Infectious↗
PubMed1997

Current concepts: the stabilizing structures of the glenohumeral joint.

Significant contemporary advances have permitted a more comprehensive understanding and development of some interesting concepts about the glenohumeral joint. The purpose of this review paper was to discuss current concepts related to the anatomic stabilizing structures of the shoulder joint complex and their clinical relevance to shoulder instability. The clinical syndrome of shoulder instability represents a wide spectrum of symptoms and signs which may produce various levels of dysfunction, from subtle subluxations to gross joint instability. The glenohumeral joint attains functional stability through a delicate and intricate interaction between the passive and active stabilizing structures. The passive constraints include the bony geometry, glenoid labrum, and the glenohumeral joint capsuloligamentous structures. Conversely, the active constraints, also referred to as the active mechanisms, include the shoulder complex musculature, the proprioceptive system, and the musculoligamentous relationship. The interaction of the active and passive mechanisms which provide passive and active glenohumeral joint stability will be thoroughly discussed in this paper.

Biomechanical Phenomena↗
PubMed1984

[Conventional roentgen diagnosis of the proximal end of the humerus].

Rarely the spectrum of conventional radiographic studies of the proximal humerus resp. shoulder joint is used in its full potential. This frequently results in erroneous interpretation. Five essential X-ray examinations are presented with respect to technique and diagnostic value.

Diagnosis, Differential↗