Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SHOULDER”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,405 records · Page 78Linked to original sources
PubMed2004

Activation of shoulder muscles in healthy men and women under isometric conditions.

PURPOSE: Due to the low osseous lead of the shoulder joint a large portion of the shoulder muscles, in addition to executing movements, deals with stabilising tasks. This requires a permanent readjustment of the intermuscular co-ordination of all involved muscles. The aim of the study was to verify the existence of gender dependent differences in intramuscular co-ordination patterns of shoulder muscles. METHOD: Fifteen healthy men and nine healthy women, who executed 24 isometric exercises in sagittal, frontal and horizontal planes with a loading of 50% of their individual isometric maximum force, were investigated. In every plane, four angular positions were chosen and both opposite force directions were measured, respectively. SEMG was taken from 13 muscles of the shoulder and the upper arm. Due to inter-individual differences SEMG amplitudes were normalised. RESULTS: Gender specific differences of functional intermuscular co-ordination patterns could be proven systematically. Women showed less activation of muscles acting in the main force direction. In addition, those muscles less necessary for the actual force production were more activated in women than in men. CONCLUSIONS: Functionally comparable shoulder function showed a gender dependency in terms of functional intermuscular co-ordination.

Adult↗
PubMedDate not supplied

Quantitative assessment of thinning of the subscapularis tendon in recurrent anterior dislocation of the shoulder by use of magnetic resonance imaging.

It is known that thinning and lengthening of the subscapularis tendon occur in shoulders with recurrent anterior dislocation. However, no studies have been performed to quantify the morphologic changes of the subscapularis tendon under such conditions. We retrospectively measured the thickness and cross-sectional area of the subscapularis tendon by use of magnetic resonance imaging in 22 shoulders in 11 patients with unilateral recurrent anterior dislocation of the shoulder. The contralateral shoulder in each patient served as a control. The thickness and cross-sectional area of the subscapularis on the affected side were smaller than those on the normal side (6.5 +/- 1.7 mm vs 8.0 +/- 1.9 mm, P = .001, and 388.6 +/- 120.0 mm 2 vs 547.9 +/- 128.5 mm 2 , P = .0001, respectively). We conclude that the subscapularis tendon undergoes an 18.7% decrease in thickness and a 29.1% decrease in cross-sectional area in shoulders with recurrent anterior dislocation.

Adolescent↗
PubMedDate not supplied

Biomechanical evaluation after five and ten millimeter anterior glenohumeral capsulorrhaphy using a novel shoulder model of increased laxity.

Anterior instability of the shoulder is classically treated with a capsulolabral repair, but in cases of capsular redundancy, shortening or shifting of the capsule is added. This study compared glenohumeral translations in intact shoulders after rotational stretching of the capsule and after progressive increasing of anterior-inferior capsular shifts. Seven cadaveric shoulders were mounted on a custom biomechanical testing apparatus. Rotational range of motion and glenohumeral translations were measured. To create laxity, the shoulders were rotationally stretched an additional 30% from the intact rotational range of motion about the axis of the humerus in external and internal rotation. Anterior-inferior capsular shifts of 5 and 10 mm were performed. Rotational stretching of the shoulder capsule created anterior laxity. A 5 mm capsular shift was ineffective, but a 10 mm shift restored anterior and total anteroposterior translation to the intact condition.

Aged↗
PubMedDate not supplied

Proximal humeral anatomy in shoulder arthroplasty: Implications for prosthetic design and surgical technique.

Resurfacing arthroplasty of the glenohumeral joint has been established for several decades as a means to restore comfort and function of the shoulder for many afflictions that derange the normal anatomy. Rigorous study of shoulder anatomy in terms relevant to prosthetic geometry, however, did not begin until the 1990s. It has become apparent that normal anatomy is highly variable from individual to individual and that it is aligned somewhat differently than the early modular prosthetic devices. Multiple studies have shown that retroversion is markedly variable, not only between individuals but also between the left and right sides of the same individual, ranging from 0 degrees to 55 degrees . The inclination of the proximal humeral articular surface relative to the shaft (head shaft angle) is also variable, ranging from 30 degrees to 55 degrees. The center of rotation is variably offset in 3 dimensions. The radius of curvature ranges from 20 to 30 mm and is smaller in women than in men. The thickness of the articular surface, head height, is equally variable but shows a striking proportionality to the radius of curvature. The last decade has seen a proliferation of humeral implants aiming to serve a better understanding of shoulder anatomy and function. A modern understanding of shoulder anatomy and contemporary design features is paramount for surgeons performing shoulder arthroplasty. Head size selection is dependent on multiple factors, the most important of these, other than the patient's original head size, are the osteotomy performed by the surgeon and the inclination angle(s) of the prosthetic system. Systems with variable inclination angles instruct the surgeon to resect the humeral head along the anatomic neck as best possible and then provide either adjustable or variable prosthetic geometries to match the resultant inclination angle. Other prosthetic systems have a fixed inclination angle somewhere within the normal range and instruct the surgeon to make an osteotomy at this inclination, adjusting the fit with additional preparation of the canal and revising the osteotomy as necessary. Over the last decade, most systems have offered heads that are offset by 3 to 4 mm, allowing the surgeon to dial in the most suitable position for the head on the stem. Component design and surgical technique are inextricably intertwined. Most surgeons with experience using modern systems feel a greater sense of predictability in achieving their surgical goals when using these systems as compared with earlier ones. How these developments impact implant longevity will only be known with time and further follow-up.

Arthroplasty, Replacement↗
PubMedDate not supplied

Rupture of the subscapularis tendon after shoulder arthroplasty: diagnosis, treatment, and outcome.

The purpose of this study was to document the diagnosis, surgical treatment, and functional outcome in patients with subscapularis ruptures after shoulder arthroplasty. Prospective objective and subjective data were collected on 7 patients with symptomatic rupture of the subscapularis tendon after shoulder arthroplasty. Presenting signs and symptoms included pain, weakness in internal rotation, increased external rotation, and anterior instability. All patients were treated with surgical repair of the ruptured tendon. Four required repair augmentation with a transfer of the pectoralis major tendon. After subscapularis repair and pectoralis transfer, 2 patients continued to have anterior instability and required an additional operation to address the instability. At a mean follow-up of 2.3 years (range, 18-55 months), the mean American Shoulder and Elbow Surgeons shoulder score in this study group was 63.2. The mean patient satisfaction rating, on a 10-point scale, was 6.2. Factors associated with post-arthroplasty subscapularis ruptures included subscapularis lengthening techniques used to address internal rotation contracture and previous surgery that violated the subscapularis tendon. Symptomatic subscapularis rupture after shoulder arthroplasty introduces the need for additional surgery and a period of protected or delayed rehabilitation after arthroplasty. Although symptoms were adequately addressed with appropriate surgical treatment, decreased functional outcomes were observed.

Adult↗
PubMedDate not supplied

Shoulder arthroplasty in Olmsted County, Minnesota, 1976-2000: a population-based study.

Because little information is currently available on the epidemiology of shoulder arthroplasty, this study was designed to evaluate the characteristics of patients undergoing this procedure and changes in practice patterns. Residents of Olmsted County, Minnesota, who underwent shoulder arthroplasty between 1976 and 2000 were identified (98 residents, 112 procedures). A relatively lower initial rate of shoulder arthroplasty was followed by a statistically significant steady increase (P < .0001), with an age- and sex-adjusted annual operative incidence rate of 1.4 per 100,000 person-years (1976-1980) to 10.1 per 100,000 person-years (1996-2000). Increased utilization of shoulder arthroplasty during the last decade was mainly a result of its application in osteoarthritis. A significant need exists for examination of utilization patterns for shoulder arthroplasty. An aging population and an increased demand and awareness by the public regarding interventions to improve quality of life will shape the future of arthroplasty, reinforcing the need for future studies of this nature.

Aged, 80 and over↗
PubMedDate not supplied

The effect of scapular protraction on isometric shoulder rotation strength in normal subjects.

To measure the effect of scapular protraction on isometric shoulder rotation strength, 20 normal subjects completed 2 maximal isometric internal and external rotation contractions in 2 scapular positions (scapula neutral [SN] and scapula protracted [SP]) from 3 arm positions (90 degrees internal rotation [IR], 45 degrees internal rotation [MR], and 90 degrees external rotation [ER]). Scapular protraction reduced shoulder rotation strength in 5 of 6 test positions (P < .0004), with significant interactions between scapular position and arm position (P < .001) and between scapular position and contraction type (P < .0001). Protraction significantly reduced IR strength by 13% to 24% relative to SN. The effect of SP on ER strength was more position-dependent, increasing strength by 6% in the IR position and decreasing it by 7% in the MR position and 20% in the ER position. In conclusion, acute changes in scapular position affect shoulder isometric IR and ER strength. The potential adverse effects of scapular protraction on shoulder rotation strength should be considered during the evaluation and treatment of shoulder pain.

Adolescent↗
PubMedDate not supplied

Revision shoulder arthroplasty with positive intraoperative cultures: the value of preoperative studies and intraoperative histology.

Currently, there are no reported results of patients without overt infection who had a positive intraoperative culture during revision shoulder arthroplasty. We therefore reviewed the intraoperative and preoperative investigations as well as the postoperative course of these patients who had positive intraoperative cultures. We reviewed the results of 75 shoulders without overt infection that underwent revision shoulder arthroplasty at our institution between January 1, 1974 and December 31, 2002 who had positive intraoperative cultures. Preoperatively, the results of 67 (93%) of 72 white-blood-cell counts were negative, 64 (91%) of 70 polymorphonuclear percentage distributions were negative, and 36 (86%) of 42 samples of erythrocyte sedimentation rate were negative. C-reactive protein concentration was measured in 16 patients, of which 12 (75%) had negative results. Results of intraoperative histologic evaluations were negative in 67 (92%) of 73 patients. The most common pathogen cultured was Propionibacterium acnes in 45 of 75, followed by Staphylococcus epidermidis in 10 of 75. Another operation was necessary in 10 (13%) of 75 shoulders to decrease pain or improve function. The mean time to re-revision was 2.5 years. The data from this study suggest that there are no good preoperative or intraoperative investigations to detect who will have a positive intraoperative culture at the time of revision shoulder arthroplasty.

Adult↗
PubMed2006

Determinants of patient satisfaction with outcome after shoulder arthroplasty.

The purpose of this investigation was to identify the determinants of patient satisfaction with outcome after hemiarthroplasty and total shoulder arthroplasty. Seventy patients who underwent shoulder arthroplasty were studied to determine predictors of patient satisfaction. Patient satisfaction was graded on an ordinal scale from 1 to 10. There was a significant association between patient satisfaction and age (P = .010) and between patient satisfaction and worker's compensation status (P = .018). There was no significant decrease in patient satisfaction for patients with rotator cuff tears. Patient satisfaction was significantly associated with all pain and function variables at follow-up (P < .05). The American Shoulder and Elbow Surgeons score was significantly correlated with patient satisfaction (P = 0.680, P < .05). Independent predictors of satisfaction included pain with activities of daily living, painless use of the arm above the shoulder, and difficulty with toileting (R(2) = 0.555). Subjective variables associated with pain were independent predictors of patient satisfaction. Thus, in assessing patient satisfaction after shoulder arthroplasty, we emphasize the importance of patient-derived subjective assessment of symptoms and function.

Adult↗
PubMedDate not supplied

Joint range of motion after total shoulder arthroplasty with and without a continuous interscalene nerve block: a retrospective, case-control study.

BACKGROUND AND OBJECTIVES: Although a continuous interscalene nerve block (CISB) has been shown to provide potent analgesia after major shoulder surgery, its potential effects on postoperative rehabilitation remain uninvestigated. Therefore, this retrospective case-control study was undertaken to determine the association between CISB and joint range-of-motion after total shoulder arthroplasty (TSA). METHODS: The medical records for patients who underwent TSA at our institution in the previous 3 years were examined. Each patient with a CISB (cases) was matched with a patient without a CISB (controls) for the following variables: age, gender, and TSA type (primary v revision). Data collected included maximum shoulder elevation and external rotation (primary endpoints), along with pre- and postoperative pain scores. RESULTS: Of 134 charts reviewed, 25 cases were matched with an equal number of controls. On postoperative day 1, patients with or without a CISB achieved a median (5th-95th percentiles) of 85% (51-100) and 33% (11-56) of their surgeon-defined goal for elevation (P = .048), respectively, and attained 100% (33-100) and 17% (-81-68) for external rotation (P < .001), respectively. The median numeric rating pain score (NRS) during shoulder movement for patients with CISB was 2.0 (0.0-8.7) versus 8.5 (1.8-10.0) for patients without CISB (P < .001). Least, median, and highest resting NRS for the 24 hours after surgery were 0.0 (0.0-5.8), 1.0 (0.0-6.4), and 3.0 (0.0-9.0) for patients with CISB, respectively, versus 2.0 (0.0-7.7), 6.0 (0.3-9.6), and 8.0 (0.0-10.0) for patients without CISB (P = .030, P < .001, and P < .001 between groups, respectively). CONCLUSIONS: The day after TSA, a CISB is associated with increased shoulder range of motion, most likely resulting from the potent analgesia these nerve blocks provide.

Adult↗
PubMed2000

Outcomes of care and resource utilization among patients with knee or shoulder disorders treated by general internists, rheumatologists, or orthopedic surgeons.

PURPOSE: Previous studies have suggested that specialists may achieve better clinical outcomes for patients, albeit often at greater cost. We sought to compare outcomes of care and resource utilization among patients with shoulder or knee problems who were treated by general internists, rheumatologists, and orthopedic surgeons. SUBJECTS AND METHODS: Outpatients with knee or shoulder complaints who were seen by general internists, rheumatologists, or orthopedic surgeons at an academic medical center were administered questionnaires at enrollment in the study and again 3 months later. The questionnaires included validated measures of satisfaction, functional status, and pain severity, as well as resource utilization. We compared baseline clinical characteristics, satisfaction with care, resource utilization, and changes in function and symptoms during 3 months of follow-up among patients who were cared for by the three different types of providers. RESULTS: A total of 534 patients responded to the baseline survey and 436 (82%) to the 3-month follow-up survey. About 60% (n = 323) had knee pain. Orthopedists cared for 40% (n = 211) of the patients, with the remainder treated in approximately equal numbers by general internists or rheumatologists. At baseline, patients of internists had less severe pain (differences of 0.3 to 0.6 points on a 1 to 5 scale, P <0.05) and functional limitations (differences of 0.4 to 0.6 points on a 1 to 5 scale, P <0.0006) than patients of rheumatologists and orthopedic surgeons. Adjusting for baseline differences, there were no significant differences among provider groups in pain relief or functional improvement during follow-up. However, in adjusted analyses, patients with shoulder pain who were cared for by orthopedic surgeons were least satisfied with the office environment [adjusted mean (+/- SD) satisfaction score of 1.6 +/- 0.8 on a 1 to 4 scale for orthopedic surgeons vs 1.3 +/- 0.8 for rheumatologists and 1.4 +/- 0.8 for internists, P = 0.004]. Among patients with knee pain, those treated by rheumatologists and orthopedic surgeons were more satisfied with the doctor-patient interaction (adjusted mean satisfaction scores of 1.1 +/- 0.9 for rheumatologists and 1.2 +/- 0.7 for orthopedic surgeons on a 1 to 4 scale vs 1.4 +/- 0.8 for general internists, P = 0.003). Orthopedic surgeons obtained significantly more radiographs of the knee or shoulder and more magnetic resonance imaging scans of the knee. Rheumatologists performed significantly more aspirations or injection procedures. Among all patients, those treated by rheumatologists were most satisfied with the physician interaction, and those treated by orthopedic surgeons were most satisfied with treatment results. CONCLUSION: The relative benefits of specialist compared with generalist care for patients with knee or shoulder pain depend on the importance attached to resource utilization, patient satisfaction, and health outcomes.

Academic Medical Centers↗
PubMed2000

The relation between lower extremity strength and shoulder overuse symptoms: a model based on polio survivors.

OBJECTIVE: To determine the relation between lower extremity weakness and shoulder overuse symptoms among polio survivors. We predicted that individuals with moderate weakness in their leg extensor muscles would use their arms to help compensate for this weakness and would be at high risk for developing symptoms of shoulder overuse. DESIGN: A cohort study of polio survivors recruited from the Einstein-Moss Postpolio Management Program (Philadelphia), the community, and the surrounding region. SETTING: A research laboratory at Moss Rehabilitation Research Institute, Philadelphia, PA. PARTICIPANTS: One hundred ninety-four polio survivors. Demographic and medical history data, symptom data, and strength data were obtained for each. MAIN OUTCOME MEASURES: Presence or absence of shoulder symptoms and ratings of pain by visual analogue scale were recorded. Strength was measured using a hand-held dynamometer and manual muscle testing. RESULTS: Shoulder symptoms could be grouped into two distinct clusters based on the type of testing used for assessment. Symptoms elicited by palpation were present in 26% of the subjects and were strongly related to knee extensor strength and weight. These symptoms were more common among women than men (42% and 10%, respectively). Symptoms elicited by resistance tests were present in 33% of the subjects and were seen with equal frequency in both sexes. These symptoms were also related to lower extremity strength, but the specific relationship was not as clear as for the palpation-related symptoms. CONCLUSIONS: Lower extremity weakness predisposes individuals to shoulder overuse symptoms. Sex and body weight are contributing factors. These results may be generalized to other populations with lower extremity weakness, including the elderly.

Adult↗
PubMed2000

Shoulder pain as an unusual presentation of pneumonia in a stroke patient: a case report.

Etiologies of shoulder pain in the hemiplegic population, such as glenohumeral subluxation, frozen shoulder, and reflex sympathetic dystrophy (RSD), have been described extensively. We present an 89-year-old woman with right hemiparesis secondary to ischemic lacunar infarction who developed sudden onset of right shoulder pain on the fifth day of inpatient rehabilitation. The pain was severe, limiting range of motion (ROM) and participation in therapy. Extensive investigations to rule out subluxation, fracture, connective tissue disease, RSD, and pulmonary embolism were negative. Ultimately, her shoulder pain and decreased ROM completely resolved with antibiotic treatment for right lower lobe pneumonia. We conclude that her symptoms were possibly referred pain from diaphragmatic irritation transmitted via right C4 sensory axons in the phrenic nerve, which shares the same dermatome as the right acromion area. This case was an unusual presentation of pneumonia in an elderly woman with hemiplegia. We recommend that pneumonia be considered in the differential diagnoses of shoulder pain.

Aged↗
PubMed1995

Shoulder complaints in patients with reflex sympathetic dystrophy of the upper extremity.

Five hundred forty-one patients with reflex sympathetic dystrophy (RSD) of the upper extremity were prospectively studied. One hundred fifteen patients complained of pain and/or limited range of motion in the shoulder. Shoulder complaints more often occurred in women (p = .01); age and etiology were not different from patients with RSD without shoulder complaints. Physical examination showed a tendinitis of one or both tendons of the biceps muscle in 109 patients. Seventy one patients were treated with local injection of bupivacaine followed by methylprednisolone. This resulted in permanent relief of complaints in 34 patients, temporary or moderate relief in 31, no difference in 3, increase of complaints in 1 patient, and in 2 patients results were not documented. We conclude that shoulder complaints in RSD occur in a minority of patients and more often in female patients. There are no predisposing factors. The pathophysiologic mechanism for developing shoulder complaints remains unknown. In most cases complaints can be attributed to a bicipital tendinitis for which local injection of bupivacaine followed by prednisolone are both diagnostic and therapeutic.

Adolescent↗
PubMed1997

Shoulder rotator torque and wheelchair dependence differences of National Wheelchair Basketball Association players.

OBJECTIVE: Shoulder rotator muscle imbalances can contribute to subacromial impingement. The forces and movement patterns of wheelchair locomotion may contribute to these imbalances. This study attempted to determine whether National Wheelchair Basketball Association players of differing classifications had significant differences (p < or = .05) in concentric isokinetic peak shoulder rotator torque and torque ratios, and wheelchair locomotion dependence. DESIGN: Fifty-seven (class 1 = 12, class 2 = 24, class 3 = 21) of 117 total tournament participants (class 1 = 25, class 2 = 49, class 3 = 43) served as the convenience sample of volunteers for the survey portion, and 33 of these subjects (class 1 = 11, class 2 = 12, class 3 = 10) also entered the isokinetic portion of this study. SETTING: National wheelchair basketball tournament. RESULTS: Class 1 and 2 players had greater wheelchair dependence than class 3 players (p < or = .05). Peak torque or torque ratios generally did not differ among player classifications or with other populations. Class 1 players had weaker nondominant shoulder external rotator torque production at 60 degrees/sec (p < or = .03) compared with other classes and at 180 degrees/sec compared with class 3 players (p = .02), suggesting an inability to develop the "attenuation of dominance" noted among other groups. Diminished torque-producing capacity at 60 degrees/sec related to greater wheelchair dependence among class 1 players (p = .034). CONCLUSIONS: Class 1 players failed to demonstrate the acquired shoulder external rotator torque symmetry evident among class 2 and 3 players (with specific weakness of the nondominant shoulder external rotators). This torque symmetry difference was related to their greater dependence on wheelchair locomotion.

Adult↗
PubMed1999

Shoulder pain in wheelchair users with tetraplegia and paraplegia.

OBJECTIVE: To compare the prevalence and intensity of shoulder pain experienced during daily functional activities in individuals with tetraplegia and individuals with paraplegia who use manual wheelchairs. DESIGN: Self-report survey. SETTING: General community. PARTICIPANTS: Fifty-five women and 140 men, 92 subjects with tetraplegia and 103 subjects with paraplegia who met inclusion criteria of 3 hours per week of manual wheelchair use and at least 1 year since onset of spinal cord injury. MAIN OUTCOME MEASURES: Respondents completed a demographic and medical history questionnaire and the Wheelchair User's Shoulder Pain Index (WUSPI), a measure of pain during typical daily activities. RESULTS: More than two thirds of the sample reported shoulder pain since beginning wheelchair use, with 59% of the subjects with tetraplegia and 42% of the subjects with paraplegia reporting current pain. Performance-corrected WUSPI scores were significantly higher in subjects with tetraplegia than in subjects with paraplegia. CONCLUSIONS: Both the prevalence and intensity of shoulder pain was significantly higher in subjects with tetraplegia than in subjects with paraplegia. Efforts to monitor and prevent shoulder pain should continue after rehabilitation.

Activities of Daily Living↗
PubMed2004

A behavioural treatment for chronic shoulder complaints: concepts, development, and study design.

This paper discusses the rationale for and content of a newly developed treatment for shoulder complaints, and describes a randomised study which is currently being conducted to test effectiveness of the treatment. In current practice, approximately 50% of all patients with shoulder complaints mention limitations in the performance of daily activities and persisting pain after six months. To improve the functional ability of patients with chronic shoulder complaints, despite their pain, we have developed an operant behavioural and time-contingent graded exercise therapy programme for use in a primary care setting. We present the theory and conceptual model underlying this programme, report on its development and content, and describe the design of a randomised clinical trial to evaluate the programme's effectiveness and cost-effectiveness. One hundred and thirty-two patients who suffer from shoulder complaints for at least 3 months are being recruited in general practice. After inclusion in the study, patients are allocated randomly to the graded exercise therapy programme or to usual care. Questionnaires will be used to measure factors like severity of the main complaint, functional limitations of daily activities, perceived recovery, global health status, shoulder pain, generic health-related quality of life, and costs. These factors will be assessed at baseline, during treatment (6 weeks), and after treatment (12, 26, and 52 weeks).

Behavior Therapy↗
PubMed1996

Perinatal outcome and the type and number of maneuvers in shoulder dystocia.

OBJECTIVES: To ascertain the type and order of maneuvers that should be used for the treatment of shoulder dystocia, and to determine its correlation with perinatal outcome. METHODS: We reviewed all consecutive cases of shoulder dystocia from January 1986 to August 1994 in our institution to obtain the type, order and number of maneuvers used for delivery. Patients were stratified by the number of maneuvers required for delivery. Outcome parameters included cord pH, Apgar score, neonatal trauma (Erb's palsy and fracture), and maternal trauma. RESULTS: The incidence of shoulder dystocia was 0.7% (39,280 total vaginal deliveries). Use of only two maneuvers, McRoberts and suprapubic pressure, resulted in resolution in 58% of cases. The addition of the Woods screw maneuver and/or delivery of the posterior arm was sufficient in all remaining cases. The rates of neonatal palsy and fracture, and maternal four-degree laceration, increased with the number of maneuvers. CONCLUSIONS: The McRoberts maneuver and suprapubic pressure should be first-line treatment for shoulder dystocia. More difficult and damaging maneuvers such as Woods screw and delivery of the posterior arm may be reserved for refractory cases. Additional maneuvers are rarely necessary for delivery. The number of maneuvers may serve as a measure of the severity of the shoulder dystocia.

Adult↗