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PubMed1983

[Shoulder arthrography in rheumatoid arthritis].

Shoulder arthrography in a patient with rheumatoid arthritis is performed to differentiate between a rheumatoid flare and limitation of motion secondary to tear in the rotator cuff. Accurate diagnosis is important because of the therapeutic implications. The arthrographic findings characteristic of rheumatoid involvement of the shoulder joint are nodular filling defects of the joint, the subacromial and subdeltoideal bursa in case of rotator cuff tear, irregular capsular attachment, contracted joint space and visualized lymphatic drainage. A dilatation of the biceps tendon sheath has not been shown.

Arthritis, Rheumatoid↗
PubMed2000

Superposition of independent units of coordination during pointing movements involving the trunk with and without visual feedback.

Previous studies addressing the problem of the control of multiple degrees of freedom have examined the influence of trunk movement on pointing movements within the arm's reach. Such movements may be controlled by two functionally independent units of coordination (synergies): one involving only arm joints and producing the hand trajectory to the target (the transport synergy), and the other coordinating trunk and arm movements leaving the hand trajectory unchanged (the compensatory synergy). The question of whether or not this functional subdivision depends on visual feedback was addressed in the present study. We also tested whether or not the motor effects of different synergies are summated as independent components, a control strategy called "superposition." Finally, we investigated whether or not the relationship between different degrees of freedom within each synergy could be considered linear resulting in proportional changes in different joint angles. Seated subjects produced fast, uncorrected arm movements to an ipsi- or a contralateral target in the direction of +/-45 degrees to the sagittal midline of the trunk. Targets could be reached using the arm alone (control trials) or by combining the arm motion with a forward or backward trunk motion produced by hip flexion or extension (test trials), with and without visual feedback. The shape of the hand trajectory, its direction and tangential velocity, movement precision, joint angles and the sequence of the trunk and hand recruitment and de-recruitment were measured. In both visual conditions, the direction of the hand trajectory observed in control trials was generally preserved in test trials. In terms of sequencing, even in the absence of vision, the trunk movement was initiated before the onset of and outlasted the hand shift, indicating that the potential influence of the trunk on the hand movement was compensated by rotations in the elbow and shoulder joint. The analysis of other variables also implied that the effects of trunk recruitment on the hand trajectory were minor compared to those which could be observed if these effects were not compensated by appropriate changes in the arm joint angles. It was concluded that an arm-trunk compensatory synergy is present in pointing movements regardless of visual feedback. Principal component analysis showed that the relationship between elbow, shoulder and hip joint angles in individual arm and combined arm-trunk movements cannot be considered linear, implying that this relationship is adjusted according to the changing arm geometry. The changes in each arm joint angle (elbow, shoulder) elicited by a forward trunk bending in one block of trials were compared with those elicited by a backward bending in another block, whereas the hand moved to the same target in both blocks. These changes were opposite but of similar magnitude. As a result, for each moment of movement, the mean joint angle obtained by averaging across two directions of trunk motion was practically identical to that in control trials in which the trunk was motionless. It is concluded that the transport and arm-trunk compensatory synergies are combined as independent units, according to the principle of superposition. This principle may simplify the control of the coordination of a redundant number of degrees of freedom.

Adult↗
PubMed1991

The basic types of scar contractures after burns and methods of eliminating them with trapezeplasty flaps.

The study of postburn scar contractures in various locations has revealed four contracture variables: edge, medial, strip, and total. Following the surgical treatment of more than 2000 patients with such contractures, a trapezeplasty flap method has been worked out and applied since 1979. This method allows one to make up for deficient scar tissue of the same shape. Flaps are cut out of sheets of a fold with the maximum use of undamaged skin in adjacent sections. They move toward each other and merge with adjacent sides into a state of tension. This surgery is based on use of the reserve on the width of the surface of a fold and the high tension of skin with pressure on underlying tissue. The extended skin grows quickly, the tension disappears, and the scars dissolve. For each contracture type, there are trapeze-flap variables either in pure form or in combination with the transposition of split-thickness skin with a flap to create a flexible joint zone. The trapezeplasty flap method can be used to treat all edge, medial, strip, and total contractures of joints whose natural position is adduction, the shoulder joint, and contractures between fingers. Skin-fat or skin-fascia trapeze flaps prevent the relapse of contracture and make the weakened scars softer, which, as a rule, ensures a good functional and aesthetic result.

Burns↗
PubMed2001

Traction avulsion amputation of the major upper limb: a proposed new classification, guidelines for acute management, and strategies for secondary reconstruction.

Major replantation of a traction avulsion amputation is undertaken with the goal of not only the reestablishment of circulation, but also functional outcome. This type of amputation is characterized by different levels of soft-tissue divisions involving crushing, traction, and avulsion injuries to various structures. Between 1985 and 1998, 27 cases were referred for secondary reconstruction following amputation of the upper extremity involving both arm and forearm. Replantation was performed by at least 12 qualified plastic surgeons using different approaches and management, resulting in different outcomes. Initial replantation management significantly affects the later reconstruction. For comparing studies and prognostic implications, the authors propose a new classification according to the level of injury to muscles and innervated nerves: type I, amputation at or close to the musculotendinous aponeurosis with muscles remaining essentially intact; type II, amputation within the muscle bellies but with the proximal muscles still innervated; type III, amputation involving the motor nerve or neuromuscular junction, thereby causing total loss of muscle function; and type IV, amputation through the joint; i.e., disarticulation of the elbow or shoulder joint. Some patients required further reconstruction for functional restoration after replantation, but some did not. Through this retrospective study based on the proposed classification system, prospective guidelines for the management of different types of traction avulsion amputation are provided, including the value of replantation, length of bone shortening, primary or delayed muscle or nerve repair, necessity of fasciotomy, timing for using free tissue transfer for wound coverage, and the role of functioning free muscle transplantation for late reconstruction. The final functional outcome can also be anticipated prospectively through this classification system.

Adolescent↗
PubMed1990

[Symptoms of spinal osteochondrosis].

Having screened 384 patients suffering from Scheuermann's disease and 2992 eleven-year-old children, the authors conclude that the early and salient symptoms of the disease are mobile thoracic kyphosis associated with the flexious contracture of the hip joint, and occasional anteflexious contracture of the shoulder joint together with a left-curved functional scoliosis. The authors analyse the nature and frequency of scoliosis, excluding other causes of the flexion contracture of the hip joint. Their findings are supported by data processed on computer.

Child↗
PubMed1984

A postoperative long-term study of the deltoid contracture in children.

Sixty-eight children with contracture of the deltoid muscle (82 shoulders) were treated operatively. These cases showed a minimum angle of 25 degrees of abduction in the resting position. The postoperative course with a minimum follow-up of 5 years was analyzed in 40 cases (49 shoulders). Abduction contracture of the shoulder joint completely disappeared after surgery in 23 shoulders (47%), and winging of the scapula disappeared in 39 shoulders (78%). The angle of horizontal adduction was restored in 14 shoulders (41%) postoperatively. Contracture recurred in only three shoulders (6%).

Adolescent↗
PubMed1994

[Treatment of acromioclavicular joint dislocation with the Rahmanzadeh joint plate].

Type Tossy III dislocations of the acromioclavicular joint (AC) are treated surgically in German-speaking countries. There is considerable rotation and tilting in the AC joint with elevation or abduction of the shoulder joint over 90 degrees. Thus, in the majority of countless surgical procedures, the abduction and elevation are restricted or immobilized for long periods in abduction strapping or other types of movement restriction. The AC joint plate developed by Prof. Rahmanzadeh enables early functional, complete physical therapy since the plate permits rotation and tilting. Over a period of 13 years, 133 patients have been treated with this plate. 83 patients could be included in the follow-up examination. On the average, the follow-up was 4.8 years after surgery. In the evaluation score according to Taft et al., 76% of the patients in the follow-up showed very good or good results. The surgical procedure is standardized and will show that no immobilization is required postoperatively. It could already be seen of the first postoperative day that patients could passively elevate up to 90 degrees. At the latest, free active abduction and elevation are reached after 5 weeks. Material removal should take place after 12 weeks. Due to the limited tissue covering in the area of the AC joint, a higher rate of infection can be expected than in other osteosyntheses. However, there were no persistent infections. Transitory problems in the implantation were remedied by constructive changes in the course of its development. Rahmanzadeh's AC plate is outstandingly suited for surgical treatment of type Tossy III AC joint injuries and for the treatment of lateral clavicle fractures.

Acromioclavicular Joint↗
PubMed2007

Value of preoperative ultrasound marking of calcium deposits in patients who require surgical treatment of calcific tendinitis of the shoulder.

PURPOSE: The objective of our study was to evaluate whether preoperative ultrasound-guided marking of calcium deposits has a positive effect on the efficiency and speed of localization of calcium deposits during surgery, and whether this technique is a factor that increases the probability of good clinical results. METHODS: Twenty-four patients who required surgery for calcific tendinitis in the years 2001 and 2002 were divided into 2 groups of 12 patients by week. Before undergoing surgery, those in group 1 (weeks 1, 3, 5, etc.) were given a standard ultrasound examination, along with preoperative ultrasound-guided marking (pre-USM) of calcium deposits, whereas group 2 (weeks 2, 4, 6, etc.) received the standard ultrasound examination without pre-USM. In both groups, arthroscopic removal of calcium deposits was carried out and the postoperative treatment plan was identical. The clinical result was evaluated by the Constant-Murley score. RESULTS: At the 6-week and 2-year follow-up visits, the clinical result was significantly better (P < .05) in the pre-USM group than in the unmarked group (Constant score of 76 v 70 points and 80 v 74 points, respectively). After 12 weeks, the clinical outcomes of both groups showed an approaching significance, with better results seen in the pre-USM group (79 v 74 points; P = .052). The time required for intraoperative localization of calcium deposits was 16 versus 22 minutes. The difference showed an approaching significance (P = .057). Removal of calcium was possible in 12 versus 10 cases; complete removal was possible in 8 versus 6 cases, respectively. However, none of these variables had a statistically significant influence on our results. CONCLUSIONS: Preoperative ultrasound-guided marking of calcific deposits is a procedure that statistically significantly improves the clinical results of arthroscopic surgery as seen at 6 weeks and 2 years; statistical significance of .052 was approached only at 12 weeks, as we have shown here for calcifying tendinitis of the shoulder joint. LEVEL OF EVIDENCE: Level III, development of diagnostic criteria with nonconsecutive patients.

Adult↗
PubMed1977

Investigation of shoulder disability by arthrography.

Fifty patients with pain and limitation of movement at the shoulder joint were investigated by arthrography. Normal findings using a double contrast technique are described. The main arthrographic patterns encountered were found in complete and incomplete tears of the rotator cuff, and capsulitis. Abnormalities of the bicipital tendon sheath were non-filling and leakage of contrast medium from the sheath. Extravasation of contrast medium from the bicipital tendon sheath and subscapularis bursa was considered to be due to over-distension of a joint with a reduced capacity. The accuracy of the procedure and the reasons for false negative arthrograms and surgical exploration are discussed.

Adolescent↗
PubMed1985

Shoulder dislocation in skiing: choice of surgical method depending on the degree of humeral retrotorsion.

Shoulder dislocation is one of the typical upper extremity injuries in skiing, first following a violent accident but quite frequently recurring without new trauma. This article discusses the retrotorsional angle of the humerus as an etiological factor in the occurrence of an initial dislocation and as a triggering element for its recurrence. It focuses on the consequences to be drawn for the surgical treatment of recurrent shoulder dislocation. A technique for exact determination of the humeral angle of retrotorsion by X-ray is presented. In patients with recurrent anterior dislocations of the shoulder joint, the retrotorsional angle of the humerus is pathologically reduced as compared to the control group. The method of surgical therapy is determined by the individual deviance from the average value.

Athletic Injuries↗
PubMed1978

Migration of a kirschner wire in the body. A case report.

Foreign bodies may enter the body by various ways, yet migration in the body seldom occurs. A case is described where a Kirschner wire, which had been inserted in the shoulder joint, migrated through the pleural cavity and the diaphragm, apparently by force of gravity. It was subsequently easily removed by laparotomy.

Adult↗
PubMedDate not supplied

Clostridial myonecrosis following intra-articular steroid injection.

Fatal clostridial myonecrosis occurred in a 65-year-old man after intra-articular injection of steroids to the shoulder joint. Clinical evidence of the possibility of clostridial infection is sufficient reason to initiate treatment. The opportunity to save a life may be lost by waiting for paraclinical data for definitive diagnosis to initiate treatment. "Surgical skin prep" for every intra-articular injection is a preventive measure. Increasing joint pain after intraarticular injection should be considered a serious complaint and requires careful clinical follow-up observations.

Aged↗
PubMed1997

Relationship between pulse sequences and signal intensity of joint fluid in the gradient-echo MR imaging.

To depict the labrum and meniscus in terms of contrast to joint fluid by increasing its signal intensity, we examined in vitro and in a human subject the good imaging conditions of gradient-echo magnet resonance by using a 1.0 Tesla superconducting imager (Shimadzu). In our in vitro study, 3 types of joint fluid and physiological saline were imaged together with PVA gel (as the substitute for surrounding soft tissue), by using either the STAGE, SSFP, or STERF method, and with several TR's (repetition time); and mean signal intensity was obtained. In order to confirm the findings of the in vitro study, a human study was conducted: physiological saline was injected into a shoulder joint, and axial planes were depicted under the conditions equivalent to those of the in vitro study. With the STERF method, signal intensity of the fluid was high at any flip angle, but PVS gel and the surrounding soft tissues such as muscles were rarely depicted. With the STAGE and SSFP methods, depiction of the fluid, PVA gel, and the surrounding soft tissues were possible by setting an appropriate flip angle for TR: With the STAGE method (a spoiled gradient echo sequence), good imaging was possible by selecting small flip angle, regardless TR. Therefore, because of easiness in selecting conditions, the STAGE method is considered to be the best for diagnostic scanning.

Humans↗
PubMed2001

Arthroscopic debridement for dialysis shoulders.

PURPOSE: To arthroscopically treat "dialysis shoulder," severe shoulder pain in patients on long-term hemodialysis. This pain occurs only at rest such as during hemodialysis or while sleeping and is temporarily alleviated by assuming the sitting position or moving the shoulder joint. Limitations in range of motion and pain with overhead activity or the arm in the forward flexed position are not the patient's chief complaints. Although frozen shoulder and impingement syndrome may be observed as complications, pain at rest is the most characteristic. TYPE OF STUDY: Clinical research on arthroscopic debridement to treat dialysis shoulder. METHODS: We performed arthroscopic debridement of 36 dialysis shoulders in 29 patients. Only complete debridement in the glenohumeral joint and subacromial bursa was performed, without invasion to the bone and ligaments. RESULTS: The pain improved in 34 shoulders in 27 patients (94%) a mean of 29.8 months after surgery, showing satisfactory results. In this group, the mean Japan Orthopaedic Surgery Association shoulder score (maximum 100 points) was 66.4 points before surgery but increased to 86.6 points postoperatively, statistically significant by 2-group t test. CONCLUSIONS: We decided before beginning the study that no postoperative rehabilitation would be necessary. There were no complications and no need for further surgery, with all but 2 of the patients being satisfied with their postoperative condition.

Activities of Daily Living↗
PubMed1977

[Experiences with arthroplasty for tumors and metastases of the proximal femur and humerus (author's transl)].

This report describes the results of 17 arthroplasties of the hip joint for tumors or metastases in the proximal part of the femur and 3 arthroplasties of the shoulder joint because of tumors in the proximal humerus. Based on case reports the paper discusses the indication in the case of malignant, potentially malignant and benign primary bone tumors and in the case of metastases. In addition principles for the construction of suitable hip and shoulder prostheses are cited, whereby the partial joint replacement continues to retain its justification beside total replacement. While the results of the hip arthroplasty proved satisfactory, the results of the corresponding operation on the shoulder are less satisfactory and urge to exercise more restraint in the operative indication.

Adolescent↗
PubMed1993

Elbow joint restriction: effect on functional upper limb motion during performance of three feeding activities.

This study was conducted to quantify and compare changes in upper limb joint motion during different feeding tasks when the elbow joint was restricted. Ten male and nine female volunteer subjects age 18 to 50 years participated; all were healthy, right dominant, with no upper limb pathology. A splint was used to restrict elbow joint motion. Three feeding tasks under both unrestricted and restricted conditions were randomly assigned; motion was recorded by a video-based three-dimensional motion analysis system. Elbow restriction resulted in significantly (p < .05) larger arcs of motion in shoulder flexion and internal rotation. Differences between feeding types were similar during both unrestricted and restricted conditions. Increased shoulder joint motion resulting from elbow joint restriction may require greater activity of shoulder girdle muscles increasing the risk of soft tissue problems and degenerative joint disease. Decisions regarding elbow immobilization should take into consideration potential effects upon total upper limb motion.

Activities of Daily Living↗
PubMed1992

[Biomechanics of the shoulder--kinematics and intra-articular vacuum].

There being little skeletal stability, the shoulder joint must have a complex soft tissue anatomy in order to achieve sufficient stability in addition to good range of motion. The intra-articular vacuum provides some support for the joint structures in this function. Kinematic results obtained using a new spatial measuring systems (magnetic field system) have again quantified the clinical value of this vacuum phenomenon.

Biomechanical Phenomena↗