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PubMedDate not supplied

Nontraumatic clavicular osteolysis in weight lifters.

In a previous study, we found an overrepresentation of weight lifters in patients who had a resection of the lateral end of the clavicle. To further investigate a possible association between competitive weight lifting and the development of nontraumatic osteolysis of the lateral end of the clavicle, we studied a group of 25 Danish weight lifters. This group was compared to an age-matched control group of 25 men who had never engaged in weight training procedures. None of the subjects had any history of trauma to the shoulder girdle. All 50 subjects underwent radiographic examination of both shoulder joints. In the weight lifter group, seven cases (28%) demonstrated classical radiographic findings of clavicular osteolysis, with loss of subchondral bone detail, translucency, and cystic changes, while four subjects (16%) had subjective symptoms but no radiographic changes. None of the individuals from the control group revealed similar symptoms or radiographic signs. Thus, based on this limited material, the prevalence of the disorder is about 27%.

Adolescent↗
PubMedDate not supplied

[Cancellous metal implant in the surgical treatment of recurrent post-traumatic shoulder dislocation].

After a short abstract about history and principles in the operative treatment of recurrent dislocation of the shoulder joint and after an illustration of disadvantages and complications in the operative technique described by Eden-Hybinette-Lange, which is favoured in the German speaking area, we are introducing a modification of this technique by use of an implant made from cancellous metal "Lübeck" instead of a bone block. In addition to the introduction of this new technique, first results in 14 patients undergoing this operation are shown up.

Adolescent↗
PubMedDate not supplied

[Clavicula pro humero--a new surgical method for malignant tumors of the proximal humerus].

In the majority of cases with malignant tumors in the proximal part of the humerus a limb saving tumor resection is possible. Reconstruction of the defect is necessary to maintain the length of the arm and to create a fulcrum for elbow flexion and extension. Several methods of reconstruction have been described in the literature including the fixation of distal humerus to the second rib or to the clavicle by means of Küntscher-nails, the implantation of a proximal humerus prosthesis without or with accompanying bone transplantation, a bridging of the defect using an allograft or an arthrodesis of the shoulder joint using free or vascularized bone transplants. The following paper describes a new surgical procedure whereby the vascularization of the clavicle is preserved and the clavicle used to bridge the defect. Although the follow-up period of the patients operated on so far in this way is relatively short, the functional advantages of this operation over the other forms of reconstruction can already be observed.

Adult↗
PubMed2005

The use of activated recombinant coagulation factor VII during haemarthroses and synovectomy in a patient with congenital severe factor V deficiency.

Factor V deficiency is a rare hereditary bleeding disorder. Currently, FV concentrates are not available, and the treatment of spontaneous bleeding or bleeding associated with invasive procedures is transfusion of fresh frozen plasma (FFP). However, FFP transfusion can lead to the development of inhibitor to FV, and is associated with several potential transfusion reactions including allergic reactions. We report a patient with congenital severe FV deficiency with repeated haemarthroses of a shoulder joint, and progressively severe allergic reactions to FFP transfusions. In addition, the patient also developed acute pulmonary oedema. Activated recombinant coagulation factor VII (rFVIIa) was used as an alternative haemostatic agent to FFP. We describe the use of rFVIIa in this patient during haemarthroses, synovectomy, and physiotherapy.

Blood Coagulation Factors↗
PubMed1992

Superolateral erosions of the humeral head in chronic inflammatory arthropathies.

Erosive lesions on the superolateral aspect of the humeral head were studied in 127 patients with chronic inflammatory arthropathies including rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), ankylosing spondylitis (AS), and psoriatic arthropathy (PA), as well as in a control group of 53 patients with non-inflammatory shoulder joint disease. Superolateral erosions were found in 39 out of 127 patients (31%), comprising 11/56 RA cases (20%), 22/50 JRA cases (44%), 4/9 cases of AS (44%), and 2/12 cases of PA (17%), but were absent in non-inflammatory disorders. Two morphologically distinct types of erosions were observed, an extensive one, present in all of the inflammatory conditions studied, and a circumscribed one occurring predominantly in JRA patients.

Adolescent↗
PubMed1991

Nonhemophilic hemosiderotic synovitis of the shoulder. A case report.

In a nonhemophilic 72-year-old man, a persistent degenerative hemarthrosis of the shoulder joint was associated with a complete tear of the rotator cuff. Extensive, rusty synovial pigmentation and hyperplasia (hemosiderotic synovitis) mimicking pigmented villonodular synovitis (PVS) were noted at surgery. Spontaneous hemarthrosis of the shoulder includes rapid onset of severe pain, limitation of movement, subsequent appearance of a bruise on the affected shoulder and arm, and radiological evidence of joint degeneration. Hemosiderotic synovitis results from chronic intraarticular bleeding. With the breakdown of trapped hemoglobin, iron-containing hemosiderin is stored in synovial tissue producing rusty discoloration and proliferative reaction. The classic cytoarchitecture of PVS has additional subsynovial nodular proliferation of mononuclear cells. Hemarthrosis may produce significant structural alteration of joints. Its prompt recognition and the awareness of underlying causes should lead to earlier diagnosis, appropriate therapy, less joint destruction, and better outcomes.

Aged↗
PubMed2000

International research project to devise a protocol to test the effectiveness of acupuncture on painful shoulder.

OBJECTIVES: To describe in detail the questions and deliberations leading to the development of a methodologically rigorous protocol to test the effectiveness of acupuncture on painful shoulder. DESIGN: Randomized controlled trial using three groups, including one control group. SETTINGS/LOCATION: A hospital in the north of Italy treating at least 8-10 painful shoulders a day, with physician/acupuncturists, physiotherapists, and assessors available to participate in the study. SUBJECTS: Sixty patients with monolateral painful shoulder. A list of exclusion criteria is given. INTERVENTIONS: Acupuncture + mobilization; mobilization alone (control); ear acupuncture + mobilization. OUTCOME MEASURES: Severity of pain, scored on a visual analogue scale (VAS) and on the McGill Pain Questionnaire and restriction of range of motion (ROM) of the shoulder joint. Voluntary use of pain medication, Tenoxicam 20 mg, was added to the protocol. RESULTS: The research team developed a protocol and methodology that avoids the common flaws and difficulties of previous clinical trials on acupuncture. CONCLUSIONS: Physicians and acupuncture specialists will benefit from the advice and support of a project group consisting of experienced clinicians, researchers, and statisticians when designing and preparing clinical trials on acupuncture and other complementary and alternative therapies.

Acupuncture Therapy↗
PubMed1996

Perspective volume rendering of CT and MR images: applications for endoscopic imaging.

PURPOSE: To use perspective volume rendering (PVR) of computed tomographic (CT) and magnetic resonance (MR) imaging data sets to simulate endoscopic views of human organ systems. MATERIALS AND METHODS: Perspective views of helical CT and MR images were reconstructed from the data, and tissues were classified by assigning color and opacity based on their CT attenuation or MR signal intensity. "Flight paths" were constructed through anatomic regions by defining key views along a spline path. Twelve movies of the thoracic aorta (n=3), tracheobronchial tree (n=4), colon (n=3), paranasal sinuses (n=1), and shoulder joint (n=1) were generated to display images along the flight path. All abnormal results were confirmed at surgery. RESULTS: PVR fly-through enabled evaluation of the full range of tissue densities, signal intensities, and their three-dimensional spatial relationships. CONCLUSION: PVR is a novel way to present volumetric data and may enable noninvasive diagnostic endoscopy and provide an alternate method to analyze volumetric imaging data for primary diagnosis.

Aorta, Thoracic↗
PubMed1991

Relationship between the tendon of the long head of biceps brachii and the glenoidal labrum in humans.

The relationship between the tendon of the long head of the biceps brachii muscle and the glenoidal labrum was investigated in a large number of dissected human shoulder joints. In about 70% of the specimens examined, the labrum was deficient at the posterosuperior margin of the glenoid because the tendon of the biceps coursed over this margin to blend with the labrum. Because of this, a small crescentic accessory facet was observed at the posterosuperior margin of the glenoid. In the majority of cases, the tendon of the biceps blended with the glenoidal labrum, and only a small part of the tendon attached to the supraglenoid tubercle. However, in 25% of the specimens, the major portion of the tendon was attached to the supraglenoid tubercle.

Adult↗
PubMed1995

The rotator cuff.

The functional anatomy of the rotator cuff and its relationship to the mechanism of shoulder joint movements and control is now becoming more clearly understood. Common variations in the anatomy of the acromion and the subacromial region, particularly the coraco-acromial ligament, and its relationship to the tendon of the supraspinatus are now seen to be major determinants of degenerative changes in the rotator cuff. Changes in the matrix of the musculotendinous region, which may be related to mechanical interference with the vascular supply to the tendon are now a possible determinant of early degenerative changes (both primary, and those secondary to trauma) in the rotator cuff. The relationship of these findings to the management of lesions of the rotator cuff is discussed.

Humans↗
PubMed1993

Current concepts in the rehabilitation of the athletic shoulder.

The rehabilitative process of the overhead athlete represents a significant challenge to the clinician. Overhead athletes (thrower, tennis player, swimmer) repetitively subject their shoulder joints to high microtraumatic stresses that, due to the accumulative effects, may lead to a variety of shoulder injuries. This type of athletic patient exhibits uniquely specific physical characteristics, such as hypermobility of the anterior shoulder capsule, excessive external rotation, hypomobility of the posterior capsule, limited internal rotation, and generalized ligamentous laxity of the glenohumeral joint. However, the overhead athlete must exhibit functional stability for pain-free sports participation. Functional stability is accomplished through the proficient balance of static (passive) and dynamic (active) stabilizers. During the rehabilitation process, various concepts, such as neuromuscular control, proprioception, force couple efficiency, plyometrics, eccentrics, and scapular stability, can enhance dynamic functional stability for the overhead athlete. The evaluation and treatment of the shoulder patient is in perpetual change, and the purpose of this paper is to discuss several current concepts in the rehabilitative treatment of the athletic shoulder patient.

Athletic Injuries↗
PubMed1986

[Sonography as a new diagnostic procedure for resolving shoulder problems].

Eighty-one sonographic examinations of patients with complaints relating to the shoulder joint have shown that this is the method next in value to radiological examination. So far, lesions of the rotator cuff and of the long head of the biceps could only be demonstrated by invasive procedures such as arthrography or arthroscopy. In these situations, sonography attains a similar accuracy. Diffuse lesions can also be diagnosed correctly, making arthrography and arthroscopy unnecessary. In addition, sonography can demonstrate inflammatory and degenerative changes and incomplete sub-acromial and intermediary tears of the rotator cuff, unlike conventional diagnostic methods. In future, arthrography and arthroscopy will only be necessary as additional diagnostic methods if sonography remains inconclusive.

Adult↗
PubMed1987

Examinations of the pathology of the rotator cuff.

We performed autopsies on 195 shoulder joints in order to check the differing opinions as to the pathogenesis and incidence of tendinopathia calcarea and rupture of the rotator cuff that have been expressed in literature. There was a rupture rate of 11%. Intratendinous calcific deposits could be observed by radiology in 22% of the cases. The simultaneous presence of intratendinous calcification and rotator cuff rupture could be proved in 13 of 22 cases with a rupture of the rotator cuff. On the basis of our results we conclude that tendinopathia calcarea and rupture of the rotator cuff have an identical pathogenesis.

Adolescent↗
PubMed1995

[Compression of the subscapular nerve in the spino-glenoid tract by a synovial cyst].

We observed a case of synovial cyst in the shoulder joint leading to spino-glenoid symptomatology in a weight-lifter. Explorations included standard radiography, echography and magnetic resonance imaging. Differentiation between a true cyst and a pseudo-cyst was basedose presence of a synovial membrane. Mechanical contraints appear to be the most frequently suspected aetiology of spinoglenoid cysts. Echography cannot always confirm the liquid nature of the formation due to the close bone. Magnetic resonance imaging gives good tissue characterization and good topographic analysis. Gadolinium injection appears to be important for differential diagnosis with neurogenic tumours.

Humans↗
PubMed1991

[Postoperative results of arthrography following suturing of ruptured rotator cuff].

The authors examined 41 shoulder joints by arthrography after the patients had undergone surgery for rotator cuff tears. In 26 cases the arthrographic findings were negative; that is to say the region of the tendon suture was tightly closed. In 10 of these 26 cases the underside of the rotator cuff had a rather irregular border. The arthrograms were positive for 12 of the other 15 patients who had undergone surgery. In 3 cases contrast medium leakage into tendinous tissue on the joint side was seen. The postoperative results, ascertained with reference to the assessment guidelines proposed by Neer and Patte, were largely unrelated to the arthrographic findings. In patients with contrast medium leakage from the rotator cuff only the muscular strength was slightly reduced. There was no correlation with the clinical symptoms. In the comparison of all patients who had undergone postoperative arthrography with the total study population a lower number in the index was striking. It may be that patients with symptoms persisting after surgery were more prepared to undergo control arthrography.

Adult↗
PubMed2004

Preliminary analysis of Nacholapithecus scapula and clavicle from Nachola, Kenya.

The Miocene ape Nacholapithecus is known from rather complete skeletons; some of them preserve the shoulder joint, identified by three scapulae and one clavicle. Comparisons made with other Miocene and living apes ( Proconsul, Equatorius, Ugandapithecus) suggest that the mobility of the scapulohumeral joint was important, and scapular features such as the morphology and position of the spine and the morphology of the acromion and axillary border resemble those of climbing arboreal primates except for chimpanzees, gorillas, or orang-utans. From the size of the scapula (male Nasalis size), it is clear that the animal is smaller than an adult chimpanzee, but the clavicle is almost as relatively long as those of chimpanzees. Some features closer to colobine morphology reinforce the hypothesis that Nacholapithecus was probably a good climber and was definitely adapted for an arboreal life.

Animals↗
PubMed2005

[Biomechanical analysis of dynamics and statics of the moving arm in musical instrumentalists].

BACKGROUND: Biomechanical measurements of the motion organ in musicians are a separate issue of studies because of specific conditioning of complex motion functions which can be observed during playing an instrument. MATERIALS AND METHODS: The study was carried out in a group of 368 instrumentalists, taking into consideration the measurement of biomechanical parameters before, during and after musical performance. RESULTS: An analysis of adduction in the shoulder joint during playing an instrument showed that the largest average abduction angle appears in cellists, bassists, pianists and flutists, and it is larger in the left arm in the case of the double bass, and in the right arm in the case of the flute. The lowest average values are lowest in violinists and violists, but the static adduction of their right arm is remarkably larger. CONCLUSIONS: The study proves that playing an instrument causes specific load of the motion organ, both static and dynamic.

Adult↗
PubMed1986

[Morphologico-functional study of the locomotor system of penguins as a principle of the general motor model of "underwater flight." II].

Based on the statements in part I according to the evolution of the underwater flight, its biophysical consequences and summarizing our knowledge on swimming performances of Penguins, the active and passive apparatus of movement was studied by dissection of 26 individuals of Pygoscelis papua, P. antarctica, P. adeliae, Eudyptes chrysolophus, and Aptenodytes forsteri. Besides the functional explanation of the Articulatio sternocoracoidea (diverging considerably from the usual type in birds), a new interpretation is given for the structures of the Articulatio humeri. In this context, the role of the Ligamentum acrocoracohumerale as an important element for co-ordination of the motion processes in the shoulder joint is elucidated. The essential curvature of the Caput humeri is found to be satisfactorily approximated by a logarithmic spiral. The understanding of the mechanics of bones and tendons leads to a reinterpretation of the role of several groups of muscles which is described in detail. Besides of the preponderant thrust producing (flapping) muscles working mainly in the isotonic manner, muscles can be distinguished which are managing the transfer of the produced forces to the body operating thereby in the isometric way. Another group of muscles has to control the position of the humerus adjusting in this way, the hydrodynamic angle of attack corresponding to the respective flow conditions.

Animals↗