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At least 145 records · Page 8Linked to original sources
PubMed2006

Postoperative shoulder surgery initiative (POSSI): an interim report of major shoulder surgery as a day case procedure.

BACKGROUND: There are logistical and financial advantages to undertaking shoulder surgery in a day case setting. However, this approach is limited by postoperative pain being inadequately controlled by oral medication alone. We describe a pilot study investigating the feasibility and acceptance of community based continuous interscalene brachial plexus blockade (CIBPB) to provide effective analgesia for day case shoulder surgery. METHODS: Phase 1 consisted of five patients who received CIBPB for shoulder surgery. Following an overnight hospital stay they were assessed for discharge home with the interscalene catheter in situ. Once the safety and feasibility of the approach was documented, five more patients were recruited to Phase 2. These patients had the adequacy of analgesia assessed in the postoperative period and were discharged home on the same day as surgery. A district nurse visited twice daily and removed the catheter on the third day. Patient satisfaction was assessed using a discovery interview. RESULTS: Nine of the 10 patients experienced good analgesia. One patient was re-admitted because the catheter fell out. No patient experienced complications and the discovery interviews showed that the patients were satisfied with their management and pleased to be treated as a day case. CONCLUSIONS: POSSI proved that it was feasible to manage these patients in the community with support and training of the district nurses. Although extra community nursing hours are required, this technique has the potential for significant cost benefits with at least three bed days saved per patient.

Adult↗
PubMed1986

Statistical data base for the biomechanical properties of the human shoulder complex--I: Kinematics of the shoulder complex.

In the last two decades, several multi-segmented mathematical models of the total-human-body have appeared in the literature. While these models can handle very sophisticated load-motion situations, their effectiveness depends heavily on the proper biomechanical description and simulation of the major articulating joints of the human body. Among these joints, the most complicated and the least successfully modeled one has been the shoulder complex mainly due to the lack of an appropriate biomechanical data base as well as the anatomical complexity of the shoulder region. In 1984, the senior author and his associates proposed a new kinematic data collection methodology by means of sonic emitters and associated data analysis technique. Based on this data collection methodology, Part I of this paper establishes a statistical data base for the shoulder complex sinus of the male population of ages 18-32. Estimates for the population mean and standard deviation as well as their confidence intervals are presented. The results are expressed in functional expansion form relative to a locally defined joint axis system as well as relative to the torso-fixed coordinate system in the form of globographic representation.

Adolescent↗
PubMedDate not supplied

Shoulder function in patients with unoperated anterior shoulder instability.

A functional analysis, including Rowe score and measurements of isokinetic peak torque and range of motion of the shoulder, and a subjective assessment were performed in 26 consecutive patients (23 males and 3 females) with unoperated anterior shoulder instability. Patients experienced the initial dislocation at an average age of 23 +/- 8 years and 58% occurred during sports activity. No patient had gone through any controlled rehabilitation program. In this study, an average of 7 years (range, 1 to 28) had passed since the initial dislocation. Fifty-nine percent of the patients complained of markedly reduced ability to perform in sports because of instability, impaired strength, decreased range of motion, and pain induced by activity. The majority (65%) of the patients reported instability only during physical activity. The average Rowe score was 68 +/- 14 on a scale of 100. In comparison with the healthy side, the injured shoulder had a significantly lower isokinetic peak torque during abduction and internal rotation, as well as a reduced range of motion in extension, abduction, and external rotation, but not in flexion. The severity of impairment (Rowe score, deficit in range of motion, and peak torque) was not related to the number of dislocations sustained or to the duration of instability.

Adult↗
PubMed2004

Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders.

We reviewed 80 shoulders (77 patients) at a mean follow-up of 44 months after insertion of a Grammont inverted shoulder prosthesis. Three implants had failed and had been revised. The mean Constant score had increased from 22.6 points pre-operatively to 65.6 points at review. In 96% of these shoulders there was no or only minimal pain. The mean active forward elevation increased from 73 degrees to 138 degrees. The integrity of teres minor is essential for the recovery of external rotation and significantly influenced the Constant score. Five cases of aseptic loosening of the glenoid and seven of dissociation of the glenoid component were noted. This study confirms the promising early results obtained with the inverted prosthesis in the treatment of a cuff-tear arthropathy. It should be considered in the treatment of osteoarthritis with a massive tear of the cuff but should be reserved for elderly patients.

Aged↗
PubMed1999

Geographic variations in the rates of operative procedures involving the shoulder, including total shoulder replacement, humeral head replacement, and rotator cuff repair.

BACKGROUND: Although geographic variations in the rates of orthopaedic procedures have been well documented, considerable controversy remains regarding the factors that drive these variations, particularly the role of the availability of orthopaedic surgeons. Moreover, little attention has been specifically focused on variations in the rates of commonly performed shoulder procedures. METHODS: The current study documents state-to-state variations in the rates of total shoulder replacement, humeral head replacement, and rotator cuff repair and examines factors that might account for these variations. The regional incidences of these three procedures were analyzed with use of the Health Care Financing Administration Medicare database (MEDPAR, 1992). The rates were age-adjusted, and variations were measured with use of high:low ratios, variation coefficients, and systematic components of variation. Potential causes of variation were analyzed with use of Spearman and partial correlations as well as with Poisson regression. RESULTS: Rates for the three procedures that were studied varied from one state to another by as much as tenfold. Humeral head replacement had the lowest rate of variation according to all three measures. All three procedures were performed less often in states that were more densely populated. With the numbers available for study, no consistent, significant relationship was found between the density of orthopaedists and shoulder surgeons and the rates of any procedure. CONCLUSIONS: The striking variations that were noted for these commonly performed procedures showed that there is a clear need for well designed clinical research to further define the factors that account for the variations and to examine the effectiveness and appropriate indications for the procedures.

Aged↗
PubMed1988

Archer's shoulder. Recurrent posterior subluxation and dislocation of the shoulder in two archers.

Two right-handed archers presented with posterior instability of the shoulder. A 19-year-old Japanese and a 26-year-old white male archer developed pain and instability of the shoulder of 6 months' duration. Both had engaged in archery for several years. Both exhibited a positive apprehension test and recurrent posterior subluxation and dislocation by flexing the arm to 80 degrees with internal rotation. Both could reduce the instability with a snap by extending the arm. For the subluxation, Neer's inferior capsular shift procedure via a posterior approach was performed. For the dislocation, a posterior bone block was added to the inferior capsular shift. The posterior capsular redundancy was marked in both cases. At 5 and 9-years follow up respectively, both were doing archery and full activities without pain. These cases are thought to be examples of how a repetitive force can cause shoulder instability.

Adult↗
PubMed1975

Soft tissue disorders of the shoulder. Frozen shoulder, calcific tendintis, and bicipital tendinitis.

The painful periarticular conditions about the shoulder joint-calcific tendinitis, bicipital tendinitis, and frozen shoulder syndrome-are seen commonly in the general practice of medicine or in the practice of orthopedic surgery. Their etiologies are unknown. Their treatment is relatively simple and depends upon a knowledge of the anatomic structures involved and the proper use of rest and exercise. Operative intervention is rarely necessary in any of these conditions. The frozen shoulder syndrome, however, in our experience is best treated in the subacute or chronic stages by infiltration brisement under general anesthesia.

Bursitis↗
PubMed1989

Shoulder arthroscopy for shoulder instability.

The arthroscope is a valuable adjunct in the diagnosis and treatment of shoulder instability. Throwing athletes with shoulder pain, and those with subluxation in particular, may require diagnostic arthroscopy to clarify the instability pattern. Labral debridement, if confined to the portion above the equator of the glenoid, can provide symptomatic relief. Arthroscopic stabilization of the shoulder is still in an evolutionary phase. No long-term data exist as to which technique or material provides the most secure fixation. All of these techniques are technically demanding and require a skilled arthroscopist.

Arthroscopy↗
PubMed1985

Shoulder function following early mobilization of the shoulder after mastectomy and axillary dissection.

A prospective clinical trial was conducted to determine the effect of axillary node dissection for breast carcinoma on shoulder function and seroma production. 59 Operations were carried out in 57 patients. The patients were divided into two groups. In group A, shoulder exercises were started, under the guidance of a physiotherapist, immediately following surgery, and in group B the exercises were begun on the seventh postoperative day. A full range of motion within six months was achieved in 25 patients of group A (81%) and in 22 of group B (79%). There was no significant difference in wound drainage between the two groups. Restricted shoulder movement was often seen after local wound complications following axillary radiotherapy or after seriously disturbed wound healing.

Adolescent↗
PubMed1981

A prospective study of adhesive capsulitis of the shoulder ("frozen shoulder') in a high risk population.

In order to evaluate risk factors for adhesive capsulitis of the shoulder ("frozen shoulder') a prospective study was carried out in neurosurgical patients, in whom there is a high incidence of capsulitis. Ninety-nine patients were admitted into the study, most of whom had surgical treatment for sub-arachnoid haemorrhage. Ninety-one patients (92 per cent) were followed up at six months, and of these 23 (25.3 per cent) had developed adhesive capsulitis, which was bilateral in three. Three patients developed the shoulder-hand syndrome. By comparing the patients with capsulitis at six months with those in whom no capsulitis was found, we were able to evaluate 28 possible risk factors (Appendix I). The subsequent development of adhesive capsulitis in our patients was associated with, (1) impairment of consciousness, (2) hemiparesis, (3) duration of post-operative intravenous infusion, (4) age, and (5) depressive personality. These five associations were statistically significant. Associations with phenobarbitine therapy and hysterical personality were suggested, but these did not reach statistical significance. Routine treatment with corticosteroids post-operatively did not prevent capsulitis.

Adult↗
PubMed1996

Isolated subacromial decompression for the treatment of chronic shoulder pain with rotator cuff calcification. A review of twenty-seven shoulders, including eighteen evaluated by magnetic resonance imaging after surgery.

We conducted a retrospective study of functional results and imaging study changes after isolated anterosuperior decompression of 27 chronically painful shoulders with calcification of the supraspinatus tendon at the time of surgery (n = 22) or at an earlier date (n = 5). Mean duration of pain at surgery was 4.5 years. Mean time between surgery and evaluation of results was three years. Absence of pain and full range of motion were noted in most cases (70%), usually after four to six months. There were no postoperative exacerbations of pain. The best results were obtained in those patients with a heterogeneous supraspinatus calcification. Most calcifications (18/22) disappeared within one year of surgery. Magnetic resonance imaging findings at last follow-up are reported for 18 shoulders. Functional results were nearly as good as those reported after calcification removal. In patients with shoulder pain and rotator cuff tendon calcifications who fail to respond to conservative therapy and aspiration with lavage, anterosuperior decompression may be the treatment of choice when the calcification is either heterogeneous and located within the tendon or no longer visible. In contrast, curettage may be the best treatment for superficial homogeneous calcifications that can be removed without damaging the rotator cuff.

Adult↗
PubMed2005

Outcome following Bankart repair for shoulder instability 1998-2002 using a subjective patient based shoulder questionnaire (Oxford).

Bankart repair for shoulder instability has been performed by the senior author since 1998. We employ a modification of the technique as described by Rowe et al., using suture anchors but without a coracoid osteotomy. If inferior instability was present this procedure was combined with a capsular shift. We performed a retrospective case note review and postal questionnaire incorporating the Oxford Instability Score (OIS) on all patients. Fifty Bankart repairs were performed in the study period, three patients had further dislocations and three patients had ongoing symptoms of instability. Response rate to the questionnaire was 62%. Mean OIS following primary stabilisation was 21.7 (possible scores from 12-excellent to 60-poor). OIS following Bankart stabilisation of the shoulder has not been previously reported. These results compare favourably to original scores published by Dawson et al. (1999) who included both patients treated by surgery or physiotherapy.

Adult↗
PubMed1999

The experience of pain from the shoulder-neck area related to the total body pain, self-experienced health and mental distress. The Malmö Shoulder-Neck Study group.

The present paper presents the relationship between the total body-pain (TBP) score, defined as the total number of areas shaded on a pain drawing, and the pain from one area, the Shoulder-Neck (SN), among subjects in or out of full-time gainful work respectively. Furthermore, relationships between pain-score, self-experienced health (SEH) and level of mental distress, measured with the General Health Questionnaire (GHQ) were investigated. The analyses is based on a general population sample of 8,116 men and women, 45-60 years of age, completing a questionnaire in the Malmö Shoulder Neck Study. The TBP-score was higher with increasing pain from the SN area, being out of full-time work and among women. Independently of working status, the SEH decreased with increasing pain in the SN area, which was enhanced, by increasing TBP-score. The proportion of women out of full-time gainful work was twice as high as for men. Women showed the same SEH levels with regard to their pain status, independently of their working status while men working full-time scored higher than women did. Oppositely, men out of full-time work had the lowest SEH in relation to their pain status. The GHQ scores of mental distress varied essentially in the same way as the SEH did. The results emphasize the need for an assessment of the number of pain locations and which one that first gave symptoms when studying possible causal relationships between low force musculoskeletal load and development of localized pain. If such data are not collected in epidemiological studies on causes for musculoskeletal pain it will at best lead to unnoticed effect modifications. At worst a potential confounding situation may occur. The relationship between the self-experienced health, mental distress and chronic pain identifies chronic pain as a major public-health problem and suggests a multidisciplinary approach in the treatment and rehabilitation already before work capacity is lost.

Adaptation, Psychological↗
PubMedDate not supplied

Cutaneous nerve lesions of the shoulder and arm after arthroscopic shoulder surgery.

Increasing use of shoulder arthroscopy has caused developing awareness of the associated complications. A consecutive series of patients who had undergone arthroscopic surgery of the shoulder was reviewed. The overall incidence of a sensory deficit was 21 (7%) in 304 patients at 2 weeks after operation, and in approximately half (3.3%) of these patients this condition was still present at 8 months' average follow-up. These deficits fell into three distinct patterns, suggesting that damage was occurring to three different nerve branches. Most of these areas of hypesthesia corresponded to lesions of cutaneous branches of the axillary nerve; the most likely cause was direct injury at the portal sites, particularly the lateral portal.

Adult↗
PubMed2004

Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial.

OBJECTIVE: To determine whether a short course of prednisolone is superior to placebo for improving pain, function, and range of motion in adhesive capsulitis. DESIGN: Double blind, randomised, placebo controlled trial. SETTING: Community based rheumatology practice in Australia. PARTICIPANTS: 50 participants (24 active, 26 placebo); 46 completed the 12 week protocol. Entry criteria were age > or =18 years, pain and stiffness in predominantly one shoulder for > or =3 weeks, and restriction of passive motion by >30 degrees in two or more planes. INTERVENTIONS: 30 mg oral prednisolone/day for three weeks or placebo. MAIN OUTCOME MEASURES: Overall, night, and activity related pain, SPADI, Croft shoulder disability questionnaire, DASH, HAQ, SF-36, participant rated improvement, and range of active motion measured at baseline and at 3, 6, and 12 weeks. RESULTS: At 3 weeks, there was greater improvement in overall pain in the prednisolone group than in the placebo group (mean (SD) change from baseline, 4.1 (2.3) v 1.4 (2.3); adjusted difference in mean change between the two groups, 2.4 (95% CI, 1.1 to 3.8)). There was also greater improvement in disability, range of active motion, and participant rated improvement (marked or moderate overall improvement in 22/23 v 11/23; RR = 2 (1.3 to 3.1), p = 0.001). At 6 weeks the analysis favoured the prednisolone group for most outcomes but none of the differences was significant. At 12 weeks, the analysis tended to favour the placebo group. CONCLUSIONS: A three week course of 30 mg prednisolone daily is of significant short term benefit in adhesive capsulitis but benefits are not maintained beyond six weeks.

Anti-Inflammatory Agents↗
PubMed1996

[A dynamic shoulder model for biomechanical measurements of shoulder specimen].

The article discusses a dynamic shoulder model capable of simulating the forces generated by the rotator cuff and the deltoid muscle, and elevation movements of the glenohumeral joint using, a computer-aided servohydraulic unit. In 10 cadaver shoulder specimen, the effects of the loss of function of the supraspinatus muscle on maximum elevation was determined with an ultrasound system. Changes in the so-called impingement pressure below the coracoacromial arch were determined with the aid of capacitive pressure sensors. With the supraspinatus muscle inactive/ absent, the maximum elevation of the humerus showed a decrease of 6% (p < 0.05), which, however, was overcome by an increase in deltoid power of only one-third of the supraspinatus muscle power loss. For a simulated isolated supraspinatus defect, the subacromial pressure below the coracoacromial arch decreased by 8% (p > 0.05). These results confirm clinical investigations showing that isolated lesions affecting the supraspinatus tendon often fail to produce symptoms and thus require no surgical reconstruction.

Adult↗
PubMed1981

[Shoulder radiographic evaluation. Radiographic examination of shoulder and scapular girdle trauma (author's transl)].

The Shoulder Radiographic Evaluation ("Complet Radiologique de l'Epaule") is completed by four positions: Standard A-P, Axillary axial view, Profil of the scapula, A-P in arm abduction. This paper focuses on the radiographic examination of the components of scapular girdle and shoulder articular complex. Several positions are described as routine positions in trauma. This radiographic procedure is of helpful interest for clinical, therapeutic and forensic applications.

Acromioclavicular Joint↗