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At least 1,423 records · Page 79Linked to original sources
PubMed1998

Assessment of outcome in shoulder arthroplasty.

This article discusses outcome measures for the patient requiring shoulder arthroplasty and the weakness and strengths of various assessment tools in current use. The optimal method to measure the outcome of patients with shoulder arthroplasty is yet to be defined; however, the ideal assessment should include measures of general health, a shoulder-specific assessment, and an assessment that is specific to the disease state for which shoulder arthroplasty is indicated. The authors also provide appendices with their recommended calculations for the elevation of the shoulder arthroplasty patient.

Arthroplasty, Replacement↗
PubMed2001

Shoulder rehabilitation strategies, guidelines, and practice.

This framework for rehabilitation is consistent with the proximal-to-distal kinetic chain biomechanical model and applies current concepts of motor control and closed chain exercises. This framework approaches the final goal--glenohumeral motion and function-through facilitation by scapular control, and scapular control through facilitation by hip and trunk activation. This article supplies guidelines for rehabilitation and practices to implement the guidelines that have proved effective in our hands. Other protocols may be effective, as long as they adhere to several basic concepts of kinetic chain-based shoulder rehabilitation: 1. Functional shoulder rehabilitation requires that the muscle activations and joint motions follow a proximal-to-distal pathway along the appropriate kinetic chain. 2. Muscles around the shoulder function in an integrated fashion and should be rehabilitated in integrated patterns. Specific muscles may need isolated activation, but this activation should be facilitated by placing the proximal segments in a facilitating function. 3. Scapular control and coupled rotator cuff activation is vital to normal shoulder function. 4. Closed chain axial loading exercises are the primary means of early shoulder rehabilitation and are the mainstays of functional rehabilitation protocols.

Anthropometry↗
PubMed2002

Sports-related injuries of the shoulder: instability.

With current technology a properly conceived imaging strategy can demonstrate instability lesions in the athlete. Plain radiographs can diagnose acute dislocations and assess successful reductions. In addition, plain radiographs can demonstrate Hill-Sachs and, more importantly for instability, osseous Bankart lesions. In the acute setting, conventional MRI nicely demonstrates labral Bankart, ligamentous. and tendonous injuries that result from dislocations and can lead to instability. In the setting of chronic instability, MR arthrography best evaluates these lesions. In the postoperative shoulder, muitislice CT arthrography may be the modality of choice, but further investigation is needed. If large series validate multislice CT arthrography for the evaluation of postoperative instability lesions, this technique may become widely used in athletes and in other populations where recurrent instability is a problem. Other imaging strategies may also find an increasing central role in evaluating shoulder instability lesions. Indirect MR arthrography, for example, may have a role in assessing these lesions in athletes . Another intriguing technology for this application is the development of high field (0.5 Tesla or greater) open magnets. In such a setting, physiological relationships in the shoulder with motion and stress may be evaluated. Such imaging may farther illuminate our understanding of the stable and unstable shoulder. Unfortunately, with all imaging modalities, whether widely used or experimental, outcomes data is Lacking. How do the various imaging modalities and strategies affect patient outcome? The answer is unknown and needs to be answered before a definitive patient work-up for shoulder instability can be established.

Athletic Injuries↗
PubMed2004

[Capsular shift for voluntary dislocation of the shoulder: results in children].

PURPOSE OF THE STUDY: Chronic shoulder instability is uncommon in patients with an immature skeleton. Some of these pediatric patients can produce their dislocation voluntarily raising the question of the traumatic or constitutional nature of the condition as well as its direction and tolerance. We report our experience with 29 patients. MATERIAL AND METHOD: Over a period of 28 years, 29 children aged 5 to 15 years were treated for voluntary shoulder dislocation. The dislocation was painful and poorly tolerated in 19, affecting daily life and sports activities. Posterior dislocation was observed in 15 patients and anterior dislocation in 4, but the direction was not always easy to establish, particularly in children with ligament laxity; multiple directions were not uncommon. Rehabilitation for at least eight months did not relieve pain in 11 patients who had a sensation of a blocked, unreliable shoulder which could not be controlled voluntarily. Posterior capsulorrhaphy was performed in 8 patients and anterior capsulorrhaphy in 3. RESULTS: Mean follow-up was 8 years. At last follow-up, all shoulders were stable and shoulder motion was normal with no loss of function. More than half of the children had resumed sports activities. Capsulorrhaphy was proposed when the pre-operative explorations did not reveal any bone or rim anomaly. The only preoperative finding in the operated patients was increased capsule volume, particularly in the inferior portion. Intraoperatively, ulceration of the humeral cartilage was found in two patients. Anatomic reconstruction of the capsuloligamentary structures enabled recovery of passive stability and active stability of the scapulohumeral joint, preventing further voluntary dislocation.

Adolescent↗
PubMed1976

Management of painful shoulder.

55 patients with 60 shoulders painful at rest, and with limitation of all ranges of movement, were treated with multiple injections of methylprednisolone acetate into the subacromial space and glenohumeral joint cavity. Pain was abolished in 80%, two weeks after starting therapy and 95% were pain-free four weeks after the first injection. Maximum functional recovery (at least 150 degrees abduction, 80 degrees internal rotation, and 45 degrees external rotation), was achieved in 90% of patients eight weeks after starting treatment. It is suggested that the "frozen" shoulder--i.e., pain-free shoulder with severe limitation of all movement--is the end result of a neglected painful shoulder and it is essential that painful shoulders be treated as early as possible if normal function is to be preserved.

Adult↗
PubMed2003

Stability of inter-joint coordination during circle drawing: effects of shoulder-joint articular properties.

The present study addressed the effect of articular conformity of the shoulder joint on the stability of inter-joint coordination during circular drawing movements. Twelve right-handed participants performed clockwise and counter-clockwise circular drawing movements at nine locations in the mid-sagittal plane. The task was paced acoustically at 1.0, 1.5 and 2.0 Hz and performed without visual control. Displacements of seven infrared light emitting diodes that were fixated at relevant joints were sampled at 100 Hz by means of a 3D-motion tracking system (Optotrak 3020). From these data, shoulder, elbow and wrist angular excursions were derived as well as the continuous relative phase of the proximal and distal joint pairs of the arm. The results confirmed earlier observations that the shoulder and elbow are more strongly coupled than the elbow and wrist in sagittal-plane movements. However, a typical characteristic of the architecture of the shoulder joint, that is, its built-in mechanical "joint play", was shown to induce a position-dependent variation in inter-joint coordination stability. We conclude that besides polyarticular-muscle induced synergies and inertial coupling, articular conformity of the shoulder joint constitutes an additional determinant of inter-joint coordination stability that, to date, has been neglected.

Adolescent↗
PubMed1992

Prospective evaluation of the scapular manipulation technique in reducing anterior shoulder dislocations.

STUDY OBJECTIVE: To evaluate the speed, efficacy, and safety of the scapular manipulation technique in reducing acute anterior shoulder dislocations. DESIGN: Prospective study. SETTING: Urban emergency department with an annual census of 65,000 patients. PARTICIPANTS: Forty-eight adult patients with acute anterior shoulder dislocation. INTERVENTIONS: Patients had an initial neurovascular and radiographic evaluation performed. They were sedated with IV fentanyl and midazolam. The shoulder was reduced using the scapular manipulation technique. The patient was re-evaluated for any evidence of complication. The total dose of analgesic required and time to reduction were recorded. RESULTS: The scapular manipulation technique was successful in 46 of 48 (96%) cases. The average time to reduction was 6.05 minutes, and no complications were detected. Average doses of 1.83 mg midazolam and 204 micrograms fentanyl were required for reduction. CONCLUSION: The scapular manipulation technique is a very fast, effective, safe method of reducing anterior shoulder dislocations in the ED. [Kothari RU, Dronen SC: Prospective evaluation of the scapular manipulation technique in reducing anterior shoulder dislocations.

Adolescent↗
PubMed2001

Mechanical load on the low back and shoulders during pushing and pulling of two-wheeled waste containers compared with lifting and carrying of bags and bins.

OBJECTIVE: Compare the mechanical load on the low back and shoulders during pushing and pulling a two-wheeled container with the load during lifting and carrying the same amount of waste. BACKGROUND: Only little is known about risk factors and mechanical loads during push/pull operations. DESIGN: A complete 2(3) factor push/pull experiment. A two-wheeled container with 25 or 50 kg was pushed in front of and pulled behind the body by seven waste collectors. Further, the same subjects lifted and carried a paper bag and a dustbin both loaded with 7 and 25 kg. METHOD: All operations were video recorded and the push/pull force was measured by means of a three-dimensional force transducer. Peak Motus and Watbak software were used for digitising and calculation of torque at L4/L5 and the shoulder joints and compression and shear forces at L4/L5. RESULTS: During pushing and pulling the compression at L4/L5 is from 605 to 1445 N. The extension torque at L4/L5 produced by the push/pull force is counteracted by the forward leaning of the upper body. The shear force is below 202 N in all situations. The torque at the shoulders is between 1 and 38 Nm. CONCLUSION: In the present experiments the torques at the low back and the shoulders are low during pushing and pulling. No relation exists between the size of the external force and the torque at the low back and the shoulder. RELEVANCE: Pushing and pulling are common in many workplaces and have often replaced lifting and carrying situations. This has emphasised the need for more knowledge of the internal mechanical load on the body during these activities.

Adult↗
PubMed2000

The relevance of the moment arm of shoulder muscles with respect to axial rotation of the glenohumeral joint in four positions.

OBJECTIVE: This study was undertaken to determine the efficiency of the shoulder girdle muscles during axial humeral rotation based on measurements of the moment arms. DESIGN: The instantaneous muscle moment arms of 10 shoulder muscles, including the three portions of the deltoid, the rotator cuff muscles, teres major, and the thoracohumeral muscle group, were measured during four specified glenohumeral rotations. BACKGROUND: Axial humeral rotation is a commonly performed movement during activities of daily living and is a targeted motion of shoulder rehabilitation, particularly in those protocols emphasizing rotator cuff strengthening. An understanding of the function of the movers and stabilizers of the shoulder requires such basic information of muscle moment arms. METHODS: The instantaneous moment arm values of the muscles were derived from the slope of the plot of tendon excursion versus glenohumeral joint rotation angle. Motion studied included axial rotation with the humerus elevated 90 degrees in the coronal, scapular, and sagittal planes, as well as in the neutral position with the arm at the side. RESULTS: Based on the findings, with the humerus in both neutral and elevated positions, the infraspinatus is potentially the most powerful external rotator, followed by teres minor and posterior deltoid. Subscapularis and possibly pectoralis major are the most effective internal rotators in this position. CONCLUSIONS: The moment arm in providing axial humeral rotation of 10 shoulder muscles in four planes were obtained. In general, the teres minor and infraspinatus had the largest moment arms in external rotation, and the subscapularis had the largest moment arm in internal rotation. The muscle function for axial humeral rotation was found to be modified by the plane of arm elevation. RELEVANCE: The data could be used for developing exercise programs in physical therapy.

Adult↗
PubMed2000

Posterior shoulder dislocation: avoiding a missed diagnosis.

Posterior shoulder dislocation is a relatively uncommon event, with an incidence of 1% to 4% of all shoulder dislocations. Because of the infrequency of this condition, the diagnosis is often missed, with significant consequences to the patient Injury in the athlete is usually from a direct blow or fall onto an outstretched arm. After such an injury, symptoms may be confused with a shoulder contusion or rotator cuff injury. Significant complications such as chronic posterior dislocation and degenerative disease of the shoulder can occur if the diagnosis is missed. A careful history and physical examination, complete radiographic evaluation, and a high level of suspicion are required to identify posterior shoulder dislocation. Treatment consists of prompt closed reduction, or operative repair if this is unsuccessful.

Accidental Falls↗
PubMed1999

Prereduction radiographs in clinically evident anterior shoulder dislocation.

The main study objective was to determine if experienced emergency physicians can accurately identify a subgroup of patients with anterior shoulder dislocation for whom prereduction radiographs do not alter patient management. Our prospective study evaluated 97 patients who presented to 2 ski-hill clinics and to our rural emergency department with possible shoulder dislocation between November 1996 and May 1997. Emergency physicians were certain of shoulder dislocation by clinical examination alone in 40 of 59 cases (67.8%) of possible dislocation. All 40 cases were found to have a dislocation (100%; 95% Cl, 91.19% to 100%), and the prereduction radiograph did not affect management of the injury. Prereduction radiographs added 29.6 +/- 12.68 minutes to treatment. We conclude that shoulder dislocation is often readily apparent from history and physical examination. When the experienced emergency physician is certain of the diagnosis of anterior shoulder dislocation, prereduction radiography delays treatment and does not alter management.

Adolescent↗
PubMed1994

Capsular elasticity and joint volume in recurrent anterior shoulder instability.

It is commonly claimed that unstable shoulders have an altered capsular elasticity and increased joint volume. To find out if there is a correlation between anterior instability and increased joint volume, 20 patients were examined while undergoing arthroscopic surgery of the shoulder. There were four anterior subluxators, 11 anterior dislocators, and five bilateral dislocators, and in all patients the contralateral shoulder was also examined. During continuous saline infusion, a pressure/volume curve was recorded within the range of 0-180 mm Hg. Joint volume was correlated with body surface area. Among the 15 patients with unilateral instability, there was no correlation between joint volume and body surface area. There were no differences in joint volume or capsular elasticity between the healthy and the unstable shoulder in any patient. It is concluded that capsular elasticity and joint volume contribute little to anterior shoulder instability and that instability probably depends more on damage to other stabilising structures in the joint.

Adolescent↗
PubMed1993

Intraarticular pressure of the shoulder.

Nine fresh frozen cadaveric shoulders were used to examine the changes in intraarticular pressure (IAP) of the shoulder joint and the position of the humeral head under various loads to determine the relationship between these parameters. All the soft tissues superficial to the rotator cuff were removed. The position of the humerus relative to the scapula was monitored using an electromagnetic tracking system before and after venting the capsule with 0, 0.5, and 1.0 kg of load applied to the humerus inferiorly in addition to the weight of the arm. Simultaneously, the IAP was monitored using a pressure transducer before venting the capsule. Venting had a significant effect on the position of the humeral head: the positions of the head after venting were significantly lowered in all loading conditions. The average IAP was -76 cm H2O without load, and the value decreased in a linear fashion with increased load; the correlations were significant in four of six shoulders without dislocation. The correlations were less significant between the pressure and the position, and there were no significant correlations between the load and the position. IAP, which is determined primarily by the load applied, is important to stabilize the shoulder inferiorly. Because IAP is intimately related to the external load and the response is specific to individuals, examination of IAP response to external load may be helpful in characterizing various instabilities of the shoulder.

Cadaver↗
PubMed1996

Interscalene anesthesia for shoulder arthroscopy in a community-sized military hospital.

The first 100 consecutive shoulder arthroscopic procedures performed under interscalene anesthesia at a small community-sized military hospital are the basis of this report. This method of anesthesia was compared with 100 shoulder arthroscopies performed in a previous 2-year time period under general anesthesia. A variety of arthroscopic and subsequent open reconstructive procedures about the shoulder were performed using both techniques. Using the interscalene method, 87 regional blocks were entirely successful. Thirteen patients required conversion to general anesthesia for adequate pain control; however, 4 of these had a complete block in the recovery room and required no postoperative narcotics. Seven patients required supplementation with local anesthetic when an open procedure became necessary. There were no major complications. Minor complications included 5 patients with transient Horner's syndrome, 4 patients who experienced anxiety, which was controlled with sedation, and 3 with nausea or pruritus. Interscalene anesthesia provided excellent intraoperative and postoperative analgesia with low morbidity. On a subsequent questionnaire, all patients with a successful block reported that they were extremely satisfied with their experience. Ten patients who had previous shoulder surgery under general anesthesia preferred the interscalene method. In summary, interscalene anesthesia proved to be an excellent method of anesthesia for shoulder arthroscopy. The technique is reproducible within the resources available in most community-level hospitals.

Adolescent↗
PubMed1998

Arthroscopic Bankart suture repair for traumatic anterior shoulder instability: analysis of the causes of a recurrence.

Eighty-two patients with traumatic anterior shoulder instability were treated with an arthroscopic transglenoid multiple suture technique (Caspari's method) and followed-up for more than 2 years. A retrospective analysis of the clinical outcome was performed to determine the factors related to poor results. The mean age at operation was 21 years (range, 13 to 50 years) and the mean follow-up period was 40 months (range, 24 to 70 months). According to the status of the ligament-labrum complex and the glenoid bone defect, the Bankart lesions were classified into five types arthroscopically. There were 21 shoulders of type 1, 33 shoulders of type 2, 22 shoulders of type 3, and 6 shoulders of type 5. Twenty-four of the patients played contact sports before the operation. The clinical outcome was assessed by Rowe's criteria (1978). To analyze the factors related to a poor outcome, a multivariate analysis was done to assess the influence of 12 clinical factors (age at operation, age at first dislocation, sex, dominant side, disease duration, number of dislocations, sporting activity before operation, inferior joint laxity, thickness of the ligament-labrum complex, type of Bankart lesion, number of sutures, and method of suture fixation). Fifty-five of 82 patients had an excellent outcome, 14 had a good result, and 13 had a poor result. According to postoperative instability, redislocation was seen in 13 patients (16%), resubluxation in 2 patients (2%), with a recurrence rate of 18%. The mean limitation of external rotation at 90 degrees abduction was 6.0 degrees (range, 0 degrees to 30 degrees), and there was a 10 degrees loss of external rotation in 10 patients. The factors significantly related to recurrence were a type 3 Bankart lesion, playing contact sports preoperatively, a thin ligament-labrum complex, and repair with less than four sutures. In conclusion, a 18% rate of recurrence is not acceptable. To obtain a better clinical outcome, very careful selection of patients for this technique is necessary. Our analysis of the factors related to a poor outcome may help to decide what the proper indications are for this technique.

Adolescent↗
PubMed2003

Shoulder arthroplasty in the young patient.

We reviewed the performance of 22 shoulder implant arthroplasties in 19 patients age 50 or younger at surgery. Patients were evaluated by telephone interview, written questionnaire, and radiographic examination. The average age at surgery was 38.6 years, and the average follow-up was 5.6 years. Patients were grouped by disease process (rheumatoid arthritis [RA], avascular necrosis [AVN], trauma, and hemophilic arthropathy [HA]) and type of prosthesis (total vs. hemiarthroplasty). The highest scores (best shoulder function) were seen in patients with hemiarthroplasty for HA. Patients with hemiarthroplasty for trauma and AVN scored similarly, whereas those with a hemiarthroplasty for RA scored lowest. Patients with RA who had a total shoulder arthroplasty scored higher than patients with hemiarthroplasty. When patients in our population with longer follow-up were compared with those with a shorter follow-up, no downward trends in shoulder function were seen. Accelerated deterioration of function of shoulder arthroplasties was not observed in our young patient population.

Activities of Daily Living↗
PubMed2003

Ninety-day mortality after shoulder arthroplasty.

Although mortality associated with knee and hip arthroplasty has been reported, there is no information about shoulder arthroplasty. The purpose of this study was to determine the incidence and risk factors associated with perioperative mortality after shoulder arthroplasty. Between 1970 and 2000, 2,953 patients underwent shoulder arthroplasty at our institution. A retrospective review identified all patients who died within 90 days of the procedure. The 90-day mortality incidence was 0.58% (17 of 2,953). Twelve hemiarthroplasties were performed for a pathologic fracture and one for rotator cuff arthropathy. Total shoulder arthroplasties were performed for the sequelae of trauma (2), rheumatoid arthritis (1), and avascular necrosis (1). Ninety-day mortality was closely associated with the underlying diagnosis. Perioperative mortality after shoulder arthroplasty for non-neoplastic conditions is low.

Aged↗
PubMed1990

Total shoulder arthroplasty versus hemiarthroplasty. Indications for glenoid resurfacing.

The results of total shoulder arthroplasty and hemiarthroplasty in a similar patient population were compared in an effort to define more clearly the indications for resurfacing the glenoid. The results of 64 Neer hemiarthroplasties in 59 patients were compared with 146 Neer total shoulder arthroplasties in 134 patients in a retrospective review of the period between 1974 and 1986. The average follow-up period was 44 months (range, 24-124 months). Hemiarthroplasty and total shoulder arthroplasty produced similar results in terms of functional improvement. Pain relief, range of motion, and patient satisfaction were better with total shoulder arthroplasty than hemiarthroplasty in the rheumatoid population. Progressive glenoid loosening was found in 12% of total should arthroplasties but no correlation with pain relief or range of motion was noted. Total shoulder arthroplasty is recommended for patients with inflammatory arthropathies, and hemiarthroplasty is recommended for patients with osteoarthritis, avascular necrosis, and four-part fractures with preservation of glenoid congruity and absent synovitis.

Adult↗