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At least 145 records · Page 8Linked to original sources
PubMed1985

Stability of the shoulder joint. Cadaver study of stabilizing structures.

In 10 cadaver shoulder joints, the increments in external rotation were measured after successive cutting of the anterior stabilizing structures while a constant external torque was applied to the humerus, abducted in the scapula plane. The subscapularis muscle prevented anterior subluxation in the lower range of abduction. As abduction increased, the lower part of the capsule was the most important stabilizing structure. The findings suggest that it may be possible to perform more selective repairs in the treatment of recurrent anterior instability.

Biomechanical Phenomena↗
PubMed1990

Effectiveness of push/pull hemodiafiltration using large-pore membrane for shoulder joint pain in long-term dialysis patients.

Long-term hemodialysis (HD) patients complaining of shoulder joint pain were treated by HD and by push/pull HDF using high-flux synthetic membranes with large pores (Asahi PAN 20CX2) for 2 weeks. The results showed no significant difference in Kt/Vurea between HD and push/pull HDF. Nevertheless, reduction of the plasma beta 2-microglobulin was greater during push/pull HDF than during HD. These findings can be explained by far more convective flux in push/pull HDF than in HD: nearly 30 L during push/pull HDF vs. 3 L during HD. In the present study, there was no alleviation of the shoulder joint pain during HD treatment, whereas marked relief of the symptom was found during push/pull HDF treatment. Since the two treatment modalities differ simply in their efficiency in removing larger molecular weight substances, the joint pain alleviation effected by push/pull HDF could well be ascribed to elimination of an unknown larger molecular weight substance causing this symptom. However, a considerable amount of beta 2-microglobulin was removed both by HD and push/pull HDF. Therefore, the substance causing the joint pain might be larger than beta 2-microglobulin.

Female↗
PubMed2001

Medical devices; reclassification of the shoulder joint metal/polymer/metal nonconstrained or semi-constrained porous-coated uncemented prosthesis. Food and Drug Administration, HHS. Final rule.

The Food and Drug Administration (FDA) is announcing that it is reclassifying the shoulder joint metal/polymer/metal nonconstrained or semi-constrained porous-coated uncemented prosthesis intended to replace a shoulder joint from class III to class II (special controls). The agency is also announcing that it has issued an order in the form of a letter to the Orthopedic Surgical Manufacturers Association (OSMA) reclassifying the device. The special control that will apply is a guidance document entitled "Class II Special Controls Guidance: Shoulder Joint Metal/Polymer/Metal Nonconstrained or Semi-Constrained Porous-Coated Uncemented Prosthesis." The agency is classifying this device into class II because special controls, in addition to general controls, would provide reasonable assurance of the safety and effectiveness of the device, and there is sufficient information to establish special controls.

Device Approval↗
PubMed1992

[The differential diagnosis of lesions of the rotator cuff and of neurological disorders in the shoulder joint area].

Lesions of the rotating cuff is a most frequent cause of disorders in the shoulder joint. However, they are frequently misdiagnosed and their manifestations use to be considered as those of scapulohumeral periarthritis, cervical osteochondrosis, or even brachial plexus palsy. The paper deals with symptoms and signs of rotating cuff lesions that are fairly different from those of the conditions above cited. It is emphasized that the deltoid muscle palsy cannot result in a permanent loss or restriction of active elevation of the arm when the function of the rotating cuff remains undisturbed. 16 patients with ruptures of the rotating cuff and simultaneous axillary palsy (11 cases) or Erb-Duchenne paralysis (5 cases) were successfully operated on by the author. Experience gained with treating lesions of the rotating cuff including surgical repair of the cuff in the above-mentioned cases permitted drawing a table of the differential diagnosis of rotatory cuff lesions and certain neurological and neurodystrophic lesions in the shoulder joint as well as specifying the identification of the level of brachial plexus lesion.

Adult↗
PubMed1988

Persistent hemarthrosis of the shoulder joint with a rotator-cuff tear in the elderly.

Three elderly patients developed persistent hemarthrosis of the shoulder joint without having suffered injury. Complete tears of the rotator cuff, attrition of the undersurface of the acromion, and instability were noted in the affected shoulders. Synovial fluids examined from two patients contained many alizarin red S-positive microspheroids. The synovium obtained at surgery from two patients showed hypervascularity, vasodilatation, and severe degenerative changes of collagenous tissues. The tendon of the m. supraspinatus showed infiltrations of multinucleated giant cells around calcified deposits consisting of hydroxyapatite crystals. Anatomical and mechanical derangements, and possible biological reactions following phagocytosis of hydroxyapatite crystals, may have contributed to the persistent hemorrhage in the shoulder joints.

Acromion↗
PubMed1984

[Significance of the limbus glenoidalis for the stability of the shoulder joint].

Besides the osseous structures and the muscular elements, the capsular and ligamentous apparatus, including the limbus genoidalis, is of utmost importance for the stability of the shoulder-joint. In the literature the limbus glenoidalis (L.G.) is generally described as a fibrocartilagineous structure comparable to the menisci of the knee-joint. Basically, the cause of a primary foreful shoulder-dislocation may be either a direct or an indirect trauma. The lesions during luxation concern the joint's capsula, the L.G. and the head of the humerus. However, in the literature one finds many different explanations as to which of those lesions is responsible for the subsequent development of recurring shoulder dislocation. The variability of concepts is reflected by the large number of operative procedures that are advised as treatment of a recurring dislocation. Assuming that the L.G. substantially contributes to the stability of the shoulder joint, we have investigated structure, blood-perfusion and anatomical connections of the L.G. The mechanism of the primary shoulder dislocation was simulated in mechanical strain-experiments, carried out on human corpse specimens. The occurring lesions were analysed. The following investigations were undertaken in alltogether 182 fresh specimens of human shoulder joints: measurement and calculation of the joint-surfaces of scapula and humeral head, dye-injection of the arteria axillaris, in order to demonstrate the vascular supply of the limbus glenoidalis, histological examination of the structure of the limbus glenoidalis, mechanical strain-experiments, that simulate the dislocation mechanism of the shoulder-joint. The calculations of joint-surfaces showed a relative decrease of the scapular joint-surface with growing age. The relation of the scapular joint-surface (always plus limbus glenoidalis) to the joint-surface of the humeral head is 1: 2.25 +/- 0.38 in men and 1: 2.20 +/- 0.11 in women (age-group: 20 to 49 years). In the age-group of 70 to 89 years the respective numbers are 1: 2.90 +/- 0.35 and 1: 2.99 +/- 1.04. The differences in the relations of surfaces between the different age-groups are statistically significant for both sexes (p less than 0.01; Student-t-test). The dye-injection showed that the main artery supplying the limbus glenoidalis is a branch of the arteria circumflexa scapulae. This branch is connected by several anastomoses with the arteriae circumflexa humeri anterior and posterior. These macroscopical observations were confirmed by histological and microangiographic examinations.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1986

Nonprogressive abduction contracture of the shoulder joint. A case report.

Nonprogressive abduction contracture of the shoulder joint in a 32-year-old woman became clinically obvious only when the shoulder became painful following minor trauma. The tether in the deltoid muscle appears to have been present from an early age, but had been well compensated by abnormal scapular posture. No etiological factors could be discovered, but there was an unsubstantiated family history of similar problems. Only one comparable case has been found in the literature, and this unusual presentation seems not to have been described previously. The patient responded well to conservative treatment.

Adult↗
PubMed1999

[Preferential direction of collagen fibrils in the sub-chondral bone bone and the hip and shoulder joint].

We hypothesised that--due to bending and tension--there should exist a preferential direction of the collagen fibrils in the subchondral bone of the concave components of the hip and shoulder joint that results from bicentric or eccentric loading, but there should be no preferential direction in the convex joint partners. We therefore examined 25 human hip and 27 shoulder joints, these being decalcified after maceration. To analyse the preferential direction of the collagen fibrils, we used the split line method. The subchondral plate was pierced at regular intervals with needles that had been previously dipped in diluted ink. In the acetabulum, we found a predominantly transverse direction of the split lines in the ventral and dorsal horn of the lunatic surface, and these usually continued through the acetabular fossa. In the ventral part of the acetabular roof, arch-like orientations of the split lines were observed. In the glenoid cavity, a clearly preferential orientation was found in anterior-posterior direction, usually in the middle third of the articular surface. In the femoral and humeral heads, no preferential direction of the split lines was observed in any of the specimens. We interpret the split-line patterns in the acetabulum as an expression of the tensile stress that is encountered during a "spreading open" of the socket upon bicentric (ventral-dorsal) loading in the physiologically incongruous joint. In the glenoid, the relatively weak bony support in the ventral and dorsal part of the articular surface may be responsible for bending and tensile stress, particularly in view of eccentric loading during dynamic activity, and this could explain the observed anterio-posterior split line pattern. The results support the idea that the subchondral bone of concave joint partners encounters tension, leading to a preferential direction of the collagen fibrils. This can be considered as a functional adaptation of the subchondral bone on a microstructural level.

Aged↗
PubMed1993

[Infection of the shoulder joint. Etiology, diagnosis and therapy].

Acute infections of the shoulder joint have to be considered as an emergency and must be treated immediately. The significance of an infected glenohumeral joint is demonstrated by the functional results, which are poorer than other in joint infections. Irreversible cartilage damage is already observable after one week, and impairment of motion resulting in invalidity may result. Early functional physiotherapy is necessary to avoid shoulder ankylosis. The etiology, characteristic clinical findings, radiologic examinations and different forms of therapy are summarized. By early diagnosis, with immediate and adequate therapy, it is possible to avoid devastating results.

Arthritis, Infectious↗
PubMed2003

Rheumatoid arthritis of the shoulder joint: comparison of conventional radiography, ultrasound, and dynamic contrast-enhanced magnetic resonance imaging.

OBJECTIVE: To determine the role of ultrasound and magnetic resonance imaging (MRI) compared with conventional radiography in the detection of chronic and acute inflammatory manifestations of rheumatoid arthritis (RA) of the shoulder joint. METHODS: Forty-three consecutive patients with known RA prospectively underwent clinical examination, radiography, ultrasound, and MRI of the shoulder joints. Each patient was assigned a clinical/laboratory score consisting of 7 parameters, including measurements of shoulder mobility, the erythrocyte sedimentation rate, and C-reactive protein level. Conventional radiography was standardized and performed in 2 planes. Ultrasound was performed in 10 predefined planes using a 7.5-MHz linear transducer. MRI at 1.5T comprised transverse and oblique coronal T1- and T2*-weighted fast spin-echo, gradient-echo (GRE), and inversion-recovery sequences with a matrix size of up to 512 pixels. A dynamic T1-weighted GRE sequence was acquired with intravenous administration of contrast medium. Erosions were assessed using all 3 imaging techniques on a 4-point scale. Soft-tissue involvement was evaluated according to the presence of synovitis, tenosynovitis, and bursitis on ultrasound and MRI. The results in the study group were compared with those obtained in a control group of 10 patients with shoulder pain. RESULTS: In the study group, erosions of the humeroscapular joint were detected by conventional radiography in 26 patients, by ultrasound in 30 patients, and by MRI in 39 patients; the differences were statistically significant for the comparisons of conventional radiography with MRI and for ultrasound versus MRI (P < 0.0001). Conventional radiography detected 12 erosions of the scapula and MRI detected 15. Synovitis was demonstrated in 12 patients by ultrasound and in 27 patients by MRI (P = 0.0003). Tenosynovitis was observed in 15 patients by ultrasound and in 28 patients by MRI (P = 0.0064). Bursitis was detected in 13 patients by ultrasound and in 18 patients by MRI. The findings on dynamic contrast-enhanced MRI correlated significantly with the detection of synovitis by ultrasound and erosions by static MRI (P < 0.05). CONCLUSION: Ultrasound and MRI supplement conventional radiography in assessing the shoulder joint. Although conventional radiography can be used as the sole method of following up known joint destruction in RA, ultrasound and, preferably, MRI are recommended as additional techniques in the initial diagnostic evaluation when radiography yields negative results.

Adult↗
PubMed1997

Variations in composition of cartilage from the shoulder joints of young adult dogs at risk for developing canine hip dysplasia.

OBJECTIVE: To determine whether the composition of cartilage from the shoulder joints of dogs varied with the risk of developing canine hip dysplasia (CHD). DESIGN: Observational study. ANIMALS: 12 skeletally mature (approx 1 year old) Labrador Retrievers. PROCEDURE: Dogs were classified as having a low, moderate, or high risk of developing CHD on the basis of distraction indices. Cartilage was harvested from the craniolateral and weight-bearing regions of the humeral heads, and wet weight per unit area and dry, glycosaminoglycan, and fibronectin contents were determined. RESULTS: Glycosaminoglycan and dry contents did not vary among risk groups. For cartilage from the craniolateral region of the humeral head, wet weight per unit area and fibronectin content increased as risk of developing CHD increased. Wet weight and fibronectin content of cartilage from the weight-bearing region of the humeral head did not vary among risk groups. CLINICAL IMPLICATIONS: Dogs that have a high risk of developing CHD are also more likely to develop osteoarthritis of the shoulder joint. The observed increases in wet weight per unit area and fibronectin content in cartilage from the craniolateral region of the humeral head in dogs at a high risk of developing CHD may be early sings of incipient osteoarthritis.

Animals↗
PubMed1994

[Stress-related clinical and ultrasound changes in shoulder joints of handball players].

This prospective clinical and ultrasound study was performed to show specific overuse injuries or changes in the periarticular structures of shoulder joints. Therefore, 11 male handball players with an average age of 23 years and 6 months were evaluated via a standardised shoulder exam sheet and an ultrasound examination before, one hour after, 10-12 hours after, 16-20 hours after and 22-24 hours after specific handball training. Characteristic changes were found in respect of bursitis subacromialis and tendinitis of biceps tendon up to 16-20 hours after training, which were fully reversible 22-24 hours after the stress. The effusion was visible for more than 24 hours after the training but was reversible 60 hours after stress. This study shows characteristic pariarticular changes in the shoulder joint of handball players without any clinical finding in physical examination, so that the ultrasound changes seem to be a physiological reaction to the specific stress. These changes should therefore not be misinterpreted especially if there are no clinical symptoms.

Adolescent↗
PubMed1997

[Arthroscopic surgical measures in the shoulder joint].

Arthroscopic and open surgery have to be combined for successful surgical therapy of the shoulder joint. A surgeon performing open surgery alone or just using arthroscopic measures cannot cover the full spectrum of modern shoulder surgery. Isolated diagnostic arthroscopy is rarely indicated. Far more common, diagnostic arthroscopy is combined with an operative procedure both to confirm preoperative assessment of pathology and to uncover associated lesions. The results of arthroscopic stabilization of chronic anterior post-traumatic dislocations fail to compare with the high success rates of open procedures. Better patient selection will probably be the key to improving results. In cases of acute traumatic first-time dislocation in young, highly athletic people, arthroscopic repair of the isolated Bankart-Perthes lesion offers the attractive advantage of anatomic reconstruction with minimal soft-tissue dissection. Further indications for arthroscopic measurements of pathologies of the glenohumeral joint are synovectomy in rheumatoid arthritis, capsulotomy in frozen shoulder and tenodesis for lesions of the long head of the biceps. Arthroscopic subacromial decompression according to Ellman is the procedure performed most often and most successfully in the shoulder joint and has overcome the classic Neer open acromioplasty. For smaller tears of the supraspinatus tendon, arthroscopic acromioplasty can be combined with an all arthroscopic suture repair or with mini-open repair. Larger tears of the rotator cuff are still the domain for open reconstructive procedures. In associated or isolated AC joint arthritis, an arthroscopic Mumford procedure can be performed. For chronic calcific tendinitis, isolated arthroscopic excision of the calcium deposit is of great value. Additionally, acromioplasty is needed for true mechanical obstruction of the subacromial space.

Arthritis, Rheumatoid↗
PubMed1993

Shoulder joint movement and its relationship to disability in the elderly.

One hundred healthy subjects over the age of 65 years were interviewed and examined. The range of movement of their shoulder joints was recorded. Assessment of the prevalence of symptomatic shoulder joint disorders and their nature was also made. The impact of the presence and severity of such disorders on their functional independence was evaluated by means of the Katz Scale of Index of Independence in the Activities of Daily Living. Ranges of all movements were considerably reduced in this age group compared to figures for a younger population. The prevalence of symptomatic shoulder disorders was 34% of which a rotator cuff lesion was the most common. Disability related to these disorders was found in 30% of the study population and was significantly associated with reduced movement. It is suggested that treatment of these disorders might improve quality of life and that routine examination of the shoulder in the aging population would identify those at risk of losing their independence.

Activities of Daily Living↗
PubMed1998

Reconstruction of the shoulder joint using an acetabular allograft. A report of two cases.

Wide resection of tumors involving the glenoid region of the scapula compromises a center of motion in the shoulder joint and can cause significant loss of function. Two patients with aggressive tumor of the scapula were treated with wide resection and reconstruction using an osteoarticular acetabular allograft. The ball and socket geometry of the newly reconstructed joint and secure reattachment of soft tissues in the allograft provided a stable shoulder joint. The functional results of the two patients were 87% and 93%, respectively according to the Musculoskeletal Tumor Society system. In a select group of patients with locally aggressive lesions of the scapula, a surgical reconstruction with an osteoarticular allograft would yield satisfactory functional and cosmetic results.

Acetabulum↗
PubMed1993

[Arthroscopy of the shoulder joint. Technique, indications, surgery and complications].

Diagnostic and operative arthroscopy of the shoulder joint has gained considerable importance in traumatology and orthopedic surgery over the last years. Injuries of the limbus glenoidalis, in particular traumatic shoulder luxation, injuries of the rotator cuff, infection of the glenohumeral joint and unclear posttraumatic pain are indications for diagnostic and operative arthroscopy. Arthroscopy of the shoulder is a procedure, which offers exact diagnosis and the possibility of immediate surgery at the same time. The technique of the shoulder joint arthroscopy has to be carried out carefully and according to a standard protocol. The complication rate of around 5% of shoulder arthroscopy has not to be neglected.

Arthroscopy↗
PubMed1980

[Results of arthrodesis and arthroplasty on the shoulder joint (author's transl)].

In a follow-up study the results of four arthrodeses, twenty allo-arthroplasties and ten resection-arthroplasties of the shoulder joint are reported. Arthrodeses were done after severe posttraumatic arthrosis or after injuries to the brachial plexus. Allo-arthroplasties resection-arthroplasties were predominantly applied in cases of compound fractures or in tumours. Such operations were indicated rarely and only in cases where the shoulder joint could not be preserved. After allo-arthropaties a high rate of complications was seen. The use of this method should be restricted in cases of tumour; it is only exceptionally indicated in fractures. The resection-arthroplasties showed good or moderate results, if the insertions of the muscles could be preserved.

Adult↗
PubMed1989

Collagen fiber arrangement of the human shoulder joint capsule--an anatomical study.

The polariscopic examination of isolated shoulder joint capsules shows that the entire capsule does not have a homogeneous collagen structure. Most of the capsule is characterized by regular collagen fibers which cross at an obtuse angle in the area of the musculus supraspinatus and at an acute angle in the area of the m. infraspinatus. The density of the collagen network increases from the medial to the lateral part. Deviating from this basic pattern of the joint capsule, there is a different collagen texture in the area between the m. supraspinatus and the m. subscapularis. This texture has dissociated, rarefied and irregular collagen fibers. This means that the area--in comparison with the remainder of the capsule--is characterized not only by missing reinforcing ligaments but also by a deviating pattern of the collagen fibers. This different collagen structure is already existent in the fetus.

Adult↗