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PubMed2001

Ultrasound of the shoulder joint: non "rotator cuff" lesions.

Most of the papers in the literature are on rotator cuff lesions. This paper will deal with a somewhat forgotten part of the shoulder, the joint and the nontendinous structures around the joint. Since 1985, we have performed ultrasound examinations of the shoulder. We have collected many cases and some of them will be performed. The shoulder joint can be partly examined by ultrasound. We can get some information about joint effusions, humeral head cartilage, some part of the labrum, loose bodies, ganglions and fractures around the joint. The acromio-clavicular joint is also part of the examination, leading to diagnosis of sprains, osteoarthritis and dislocations. Non rotator cuff examination of the shoulder must be a routine part of the ultrasound examination of the shoulder.

Cartilage, Articular↗
PubMedDate not supplied

Shoulder impingement syndrome: preoperative health status.

Eighty-one patients with chronic shoulder impingement resistant to conservative treatment completed a generic quality-of-life questionnaire (SF-36) and shoulder-specific questionnaire (Simple Shoulder Test [SST]). SF-36 data were compared with those of an Australian normative data set. Patients with chronic shoulder impingement were found to be significantly lower in all health dimensions of the SF-36 than the normal population. Results from the SST test indicated that patients were functionally very limited, particularly in being unable to work full time at their usual job and being unable to lift a weight above the head. Our results indicate that chronic shoulder impingement results in significant functional disability and a reduction in quality of life. Baseline descriptive data of this nature are important, because they provide a point of comparison for the effect of different conditions and for determining the effect of surgical treatment.

Adolescent↗
PubMedDate not supplied

A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young: a five-year follow-up study.

A prospective arthroscopic study was conducted on 31 patients with an acute first-time anterior shoulder dislocation (AFASD). The patients were aged between 16 and 39 years. The mean age was 24 years. None had a history of shoulder problems. All were evaluated after 1, 2, and 5 years. The Constant score, Rowe score, recurrence rate, and instability rate were evaluated, as well as patient satisfaction and sports participation. We conclude that after a prolonged follow-up, an increase in the instability rate in young patients with AFASD may become apparent. The overall instability rate was 55% (17/31) after 5-year follow-up. In patients aged younger than 18 years the instability rate was 71% (5/7). Age was the only predictive factor in shoulder instability. The mean Rowe score was 87 (range, 57-100; SD, 14). Three patients had undergone a stabilization operation at the 5-year follow-up. The intraarticular pathology found at arthroscopy was not predictive of shoulder instability. We could not find a correlation between sporting activities and shoulder instability. On the basis of our results, it appears unlikely that arthroscopic lavage reduces redislocation rates after AFASD in the young patient.

Adolescent↗
PubMedDate not supplied

The efficacy of cryotherapy in the postoperative shoulder.

We report the results of an outcome study that used visual analog scales to evaluate the efficacy of cryotherapy in the postoperative shoulder. This prospective study included 50 consecutive patients admitted to the hospital for at least one night after anterior shoulder stabilization, rotator cuff repair, or total shoulder replacement. The patients were randomized: 25 were fitted with a cryotherapy device in the operating room, and 25 were not. Otherwise, postoperative treatment was identical for the two groups, including types of analgesic agents given. Visual analog responses were converted to numeric values by simple measurement techniques. The scales assessed pain, comfort, sleep, analgesic use, and overall satisfaction. On the night of the operation the pain was less severe and occurred less often in the cryotherapy group. Those in the cryotherapy group slept better on the night of the operation and perceived the need to use pain medicine less often in comparison with those in the noncryotherapy group. By postoperative day 10 patients in the cryotherapy group reported their shoulders hurt less often and with less severity. Swelling was less, and shoulder movement hurt less during rehabilitation, enhancing the rehabilitative effort. Cryotherapy offers a number of benefits for care of patients in the immediate postoperative period.

Adolescent↗
PubMedDate not supplied

A prevalence study of recurrent shoulder dislocations in young adults.

The computerized database of the Israeli Defence Forces Medical Corps monitors recurrent shoulder dislocations before citizens are eligible for military induction, during the years of regular military service, and during the time of eligibility for reserve army service. With the computerized database of the Israeli Defence Forces Medical Corps, between the years of 1978 to 1995 the prevalence rate of subjects with recurrent shoulder dislocations less than or equal to 21 years of age was found to be 19.7 of 10,000 for men and 5.01 of 10,000 for women. The prevalence rate of subjects with a history of shoulder dislocations in the male population between the ages of 22 and 33 years was 42.4 of 10,000. Forty-four percent were judged to be sufficiently unstable to warrant surgery, but only 55% of these actually underwent surgery. These epidemiologic data may be important if arthroscopic shoulder surgery is being considered after a first shoulder dislocation.

Adult↗
PubMedDate not supplied

Open and arthroscopic techniques for the treatment of traumatic anterior shoulder instability in Australian rules football players.

Australian Rules football (ARF) is a potentially violent, overhead, body-contact sport. We reviewed 56 shoulders in patients who sustained their initial traumatic anterior subluxation or dislocation during ARF and who underwent reconstructive surgery for traumatic anterior instability, whether by arthroscopic or by open techniques. Patients were followed up for a mean of 29.4 months after operation, and clinical evaluation was performed with the Rowe grading system. Three types of surgical procedures were performed: arthroscopic suture repair, arthroscopic Bankart repair with an absorbable polyglyconate tack, and open capsular shift with repair of the Bankart lesion. Shoulders treated with arthroscopic suture repair had a 70% rate of recurrent subluxation or dislocation on return to ARF Dislocations treated arthroscopically with the biodegradable tack had a 38% rate of recurrence of instability; three fourths of the recurrences were after minimal to moderate trauma. Shoulders treated with an open capsular shift and Bankart procedure had a 30% rate of recurrent instability, with half of the recurrences caused by violent trauma. In the open group there were no failures in patients who did not return to ARF. We suggest that arthroscopic repair in shoulders with anterior instability and recurrent dislocation does not adequately address the plastic deformation of the anterior capsule that may occur after repeated episodes of dislocation. We advocate open shoulder procedures in ARF athletes to address all areas of the capsulolabral pathologic condition and to provide the most secure repair possible with minimal chance of recurrence.

Adolescent↗
PubMedDate not supplied

Restraining patients and shoulder dislocations during seizures.

We describe 3 patients whose shoulders dislocated as the movements of the arm were restricted during a generalized tonic clonic seizure over an 18-month period. The first patient had both shoulders dislocated when observers sat on his arms during the convulsion. The second patient had a convulsion while in a forced lateral decubitus position and dislocated the shoulder on that side. The third patient dislocated the shoulder and fractured the acromion as she was held by her arms in a chair during a convulsion. Despite the large number of patients with refractory epilepsy under our care, no cases of spontaneous shoulder dislocation occurred during that period of time.

Adult↗
PubMed2001

Assessment and management of the painful shoulder.

The shoulder joint is a complex structure composed of intricate bony architecture and an ornate system of muscles, tendons, and ligaments. What many refer to as the "shoulder joint" is actually a combination of 4 articulations--the glenohumeral joint, acromioclavicular joint, sternoclavicular joint, and the scapulothoracic articulation. These structures work together to provide the shoulder complex with multiple degrees of freedom, which allow the upper extremity to be abducted, adducted, rotated, flexed, and extended. Although this flexibility is vital for positioning the arm in space, it can make the evaluation of pathology difficult. Furthermore, neck pathology can refer pain to the shoulder, which may require a screening evaluation of the neck. This article reviews the relevant anatomy and discusses an approach to the differential diagnosis of shoulder pain.

Algorithms↗
PubMedDate not supplied

Shoulder dislocation after infraclavicular coracoid block.

OBJECTIVE: We report a case of shoulder dislocation after a brachial plexus block with a double-injection technique using the infraclavicular coracoid approach. CASE REPORT: An obese woman with no previous episodes of joint dislocation developed an anterior dislocation of the head of the humerus after an infraclavicular coracoid block performed for hand surgery. Dislocation was probably because of a combination of unrecognized glenohumeral instability, paralysis of some muscles of the shoulder, and positioning of her arm on a board below her torso. Shoulder dislocation was recognized after surgical positioning of her arm, and painless reduction was achieved. There were no sequelae after 10-day follow-up. CONCLUSIONS: When motor block of the muscles of the shoulder occurs after brachial plexus anesthesia, special care must be taken in patient positioning to avoid shoulder dislocation.

Carpal Tunnel Syndrome↗
PubMed2006

What factors are associated with neonatal injury following shoulder dystocia?

OBJECTIVE: To identify factors associated with the development of neonatal injury in the setting of shoulder dystocia. STUDY DESIGN: Medical record ICD-9 codes and a computerized perinatal database were reviewed to identify cases of shoulder dystocia from January 1996 to January 2001 in a tertiary care center. For confirmation of the diagnosis and collection of data, both maternal and neonatal charts were then reviewed and neonatal injuries categorized as either neurological (brachial plexus injury) or skeletal (clavicular fracture, humeral fracture). Shoulder dystocia cases were divided into groups based on the presence of neonatal injury at delivery or at discharge (with or without Erb's palsy). The group with neonatal injury was compared for demographic and obstetrical factors to the group without injury (control). chi (2) test, Mann-Whitney test and logistic regression were used as appropriate. RESULTS: During this 5-year period, there were 25,995 deliveries and 206 (0.8%) confirmed cases of shoulder dystocia. Of these cases, 36 (17.5%) had neonatal injury diagnosed at delivery and 25 (12%) remained with significant residual injury at discharge. Of these there were 19 cases of Erb's palsy and six cases of clavicular fracture. No association was found between neonatal injury and maternal age, ethnicity, diabetes, operative vaginal delivery or number of obstetrical maneuvers. However, maternal body mass index >30 kg/m2, a second stage of labor >20 min and a birth weight >4500 g were all associated with an increased risk of neonatal injury at delivery and at discharge, including Erb's palsy. After logistic regression analysis, only a second stage of delivery >20 min remained significantly associated with neonatal injury at discharge. CONCLUSION: In our population, maternal obesity was associated with an increased risk of neonatal injury after shoulder dystocia. In addition, a short second stage of labor (<20 min) was associated with a lower rate of neonatal injury.

Adult↗
PubMed2000

Restoration of shoulder abduction in brachial plexus injury with phrenic nerve transfer.

BACKGROUND: Shoulder abduction is one of the most essential functions in reconstruction of the brachial plexus following injury. In the literature there are few reports on phrenic nerve transfer, especially in relation to restoration of shoulder function. The purpose of the present study was to evaluate the clinical effectiveness and safety of phrenic nerve transfer. METHODS: A study was made of 10 cases of phrenic nerve transfer to the suprascapular nerve. RESULTS: The average shoulder abduction was 41 degrees (range: 20-60 degrees). The average degree of shoulder abduction in patients with C5 or C6 root avulsions was slightly more than that in the patients with total root avulsions. There was no clinically significant respiratory insufficiency in any patient. CONCLUSIONS: Phrenic nerve transfer to the suprascapular nerve is an effective, reliable and safe method of shoulder abduction restoration in brachial plexus injury.

Adult↗
PubMed2003

Hydrodilatation in the management of shoulder capsulitis.

The aim of this study was to research the benefit of hydraulic arthrographic capsular distension (hydrodilatation) in the management of adhesive capsulitis of the shoulder. One hundred and nine shoulders with primary adhesive capsulitis were treated with hydrodilatation. Prior to the procedure, 93 shoulders were painful. Two months following the procedure, 31 continued to have some pain. In the 109 shoulders, the measured range of passive glenohumeral movement improved by approximately 30 degrees in all directions. The procedure was of similar benefit if carried out early or late in the disease process. The absolute improvement in movement range was similar in severe and mild cases. The severe cases in the long term, although improved, still had more restriction in movement and tended to have more pain than the other cases. There was considerable improvement in all the non-diabetic patients. The patients with diabetes responded less well in the long term to hydrodilatation and had an increased requirement for arthroscopic surgery. Effective treatment of adhesive capsulitis can be achieved in the majority of cases with an immediate hydrodilatation of the shoulder. Technically, it is important to achieve maximum distension, preferably with capsular rupture, and to utilize cortisone in the fluid injected.

Anesthetics, Local↗
PubMed2002

Effect of scapular protraction and retraction on isometric shoulder elevation strength.

OBJECTIVES: To examine the effect of scapular protraction (SP) and scapular retraction (SR) on isometric shoulder elevation strength measured in the sagittal plane and to test the hypothesis that strength would be significantly reduced when tested in the SP position relative to the neutral resting scapular position (SN). DESIGN: Prospective before-after trial. SETTING: Multidisciplinary sports medicine center. PARTICIPANTS: Ten healthy volunteers (5 men, 5 women) ages 26 to 43 years recruited from the Mayo Clinic, Rochester, MN. INTERVENTIONS: Subjects completed 3 maximal isometric shoulder elevation contractions at 90 degrees of sagittal plane elevation in the SN, SP, and SR positions. The order of scapular positions was varied to minimize fatigue effects. Mean isometric strength values were compared by using Student t tests. MAIN OUTCOME MEASURES: Isometric shoulder elevation strength for the 3 scapular positions. RESULTS: Isometric strength was significantly lower for the SP position compared with the SN position (8.5 +/- 3.4 kg vs 11.1 +/- 4.0 kg, P <.0005) and for the SR position relative to the SN position (7.8 +/- 3.3 kg vs 11.1 +/- 4.0 kg, P <.00003). Strength values did not differ between the SP and SR positions (P =.38). CONCLUSIONS: Movement of the scapula into a protracted or retracted position results in a statistically significant reduction in isometric shoulder elevation strength as measured in this study. Further research is warranted to examine the relationship between scapular position and shoulder muscle function.

Adult↗
PubMed2000

Classification of impairment of shoulder abduction in obstetric brachial plexus palsy and its clinical significance.

Shoulder abduction was studied in 25 cases of obstetric brachial plexus palsy (OBPP). According to muscle function, electromyographic features and X-ray examination, impairment of shoulder abduction could be classified into dynamic, resistant or combined types. Five cases were the dynamic type, which was characterized by paralysis of the shoulder abductors. Fifteen cases were categorized as the resistant type, with contracture of the subscapularis muscle, co-contraction of latissimus dorsi and teres major muscles and secondary disorders of the shoulder joint. Five cases were classified as the combined type in which there were both dynamic and resistant factors. Appropriate management and surgical procedures in the shoulder affected by OBPP depend on the pathological classification.

Adolescent↗
PubMed2001

Shoulder-girdle strength after standard and lateral muscle-sparing thoracotomy.

BACKGROUND: There is no objective data in the literature to support the statement that shoulder-girdle strength can be preserved better after muscle-sparing thoracotomy compared with standard thoracotomy. The aim of this study is to determine the decrease on muscle strength with objective criteria by measuring the peak torque value produced by the shoulder girdle. METHOD: Peak torque values on abduction and adduction of entire shoulder range at the velocity of 60 and 120 degree per second were measured with an isokinetik dynomometer which was attached to a computer. The measurements were performed in 20 cases, all candidates for thoracotomy. Patients were randomised into 2 groups; muscle sparing thoracotomy was undertaken in group A, and standard thoracotomy in group B. The same measurements were repeated 3 months after the surgery. RESULTS: The decrease in postoperative PT values between group A and B was statistically significant (p<0.003). The decrease on shoulder abduction and adduction was insignificant in group A (p = 0.33 and p=0.13) and statistically significant in group B (p<0.0001 and p<0.001). CONCLUSION: These results confirm the statement that shoulder girdle strength is better preserved with muscle-sparing thoracotomy.

Adult↗
PubMedDate not supplied

[Postoperatively recurring instability of the shoulder--a fault analysis in 46 cases].

AIM: The successful operative stabilization of the shoulder joint is a demanding surgical procedure. The causality of shoulder instability is complex with in some cases multiple lesions in different anatomical structures. The surgeon has to understand the complexity of factors causing instability in order to be therapeutically successful. The aim of the study was to document the intraoperative pathology in revision instability surgery. METHOD: 46 patients with recurrent postoperative instability were included (8 female, 38 male, follow-up > 12 months). After diagnostic arthroscopy an open revision surgery was performed in all cases. RESULTS: In 19 cases (40%) an insufficient surgical procedure was performed (inadequate capsular shift with worn out labral tissue). Selection of an incorrect surgical technique was the reason for revision in 12 patients (25%). Anamnestically 5 patients reported a re-injury, whereas objectively only one patient described an adequate trauma. The most frequent finding was an open rotator interval (persisting Foramen Weitbrecht), which was seen in 22 cases (46%). CONCLUSION: A stable range of motion of the shoulder is achieved by a variety of different factors, which leads in most instances to a combination of pathological changes in case of a dislocated shoulder. To understand the contributing factors of an instable shoulder joint is a necessity to carry out a successful surgical procedure.

Adult↗
PubMed1990

[The value of arthroscopic labrum stapling in anterior shoulder dislocation].

Shoulder luxations are common injuries in relation to sports. Isokinetic strength was evaluated in 24 patients on the average 1 year after performing arthroscopic stabilisation of an anterior shoulder luxation. Using the Merac (Universal Gym Equip., Cedar Rapids, Iowa, USA), test data were gathered on both shoulders in flexion-extension, abduction-adduction and in the supine 90 degrees abducted test position in external-internal rotation. Tests were performed at 60, 180 and 500 deg/sec. Means and standard deviations for peak torque, total work, peak torque to body weight ratios and agonist/antagonist ratios are presented. Our one year follow-up showed, that 82% of all patients were free from complaints and had almost the same data as on the non-operated shoulders. Arthroscopic stabilisation of anterior shoulder luxations in combination with intensive physiotherapy gave excellent results in most cases.

Adult↗
PubMed2000

Necessity of radiographs in the emergency department management of shoulder dislocations.

STUDY OBJECTIVE: To determine the necessity of radiographs in the emergency department management of patients with suspected shoulder dislocation. METHODS: A prospective, observational study was conducted at a university-affiliated, Level I trauma center ED with an emergency medicine residency program. Physicians entered all patients with a suspected shoulder dislocation and reported whether they were certain that the patient's shoulder was dislocated or reduced, before obtaining radiographs. Outcome measures were the assessments of joint position and the radiology reports of prereduction and postreduction films. RESULTS: One hundred four patients were enrolled in the study, including 98 with shoulder dislocations, and 191 physician assessments were performed (96 prereduction, 95 postreduction). Twenty-eight patients had recurrent dislocations with an atraumatic mechanism (group 1), and 76 had no prior dislocation or a blunt mechanism of injury (group 2). There were no fractures in group 1 patients; the accuracy of confident assessments was 100% (95% confidence interval 92% to 100%). In group 2, the accuracy of confident assessments was 98% (95% confidence interval 94% to 100%). Incorrect assessments occurred only in patients with fractures. A derived algorithm would have reduced radiographs by 51%. CONCLUSION: Physicians are highly accurate in the clinical determination of shoulder dislocation and relocation. Radiographs should be obtained when the physician is uncertain of dislocation or reduction. Prereduction films should be obtained for patients with a blunt traumatic mechanism of injury, and postreduction for those found to have a fracture-dislocation. However, postreduction films add little in patients without fractures, and neither prereduction nor postreduction films are likely to affect the ED management of patients with recurrent dislocation by an atraumatic mechanism. Prospective validation of the derived algorithm is suggested.

California↗