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PubMedDate not supplied

[Reconstruction technics for ruptured rotator cuff].

The principal signs for the diagnosis of a ruptured rotator sheath are a painful arch and painful, restricted movement of the shoulder joint. The diagnosis is confirmed by arthrography. Surgical reconstruction is indicated only if prior conservative treatment has been unsuccessful. A variety of approaches to the rotator sheath are advocated. Of these, the posterior-superior incision described by Debeyre et al. is particularly worthy of consideration. This approach is especially suitable for more extensive ruptures. It is described here with modifications, including the various fixation methods used for rupture of the rotator sheaths in the authors' own patients. The results obtained by the authors are classified and compared with opinions expressed in the literature. It is emphasized that the procedure described is particularly suitable for reconstruction of ruptured rotator sheaths.

Adult↗

PubMed1991

[Sonographic findings in radiologically non-displaced proximal humerus fractures].

UNLABELLED: In 5 patients with radiological nondisplaced fracture of the proximal humerus and persistent pain of the involved shoulder joint, ultrasonic evaluation was performed statically and dynamically. All patients suffered from a nondisplaced two-part fracture of the greater tuberosity. In four cases we found a significant cranialisation of the greater tuberosity between 1 and 8 mm. Furthermore, we identified a ventral cleft on the fracture side as well as a dorsal dislocation of the fragment. During dynamic examination we observed an impingement of the supraspinatus tendon between the acromion and the greater tuberosity. CLINICAL RELEVANCE: In primary diagnosis of cases with a questionable dislocated fragment and in patients with persistent pain after proximal humeral head fractures, diagnostic ultrasound investigation may yield additional information. This may influence further treatment.

Adult↗

PubMedDate not supplied

Shoulder strength and range of motion in symptomatic and pain-free elite swimmers.

To evaluate differences in shoulder strength and range of motion between painful and pain-free shoulders we examined two matched groups of athletes. Fifteen competitive swimmers were allocated to two groups. Group 1 consisted of seven swimmers with unilateral shoulder pain related to swimming (Neer and Welsh phase I to II). The control group (Group 2) consisted of eight swimmers with no present or previous history of shoulder pain. Concentric and eccentric internal rotational torques were reduced in painful shoulders in between-group comparisons as well as in side-to-side comparisons. The decrease in internal rotational torque resulted in significantly greater concentric and eccentric external-to-internal rotational strength ratios of the painful shoulder in Group 1 swimmers compared with the controls. Furthermore, the functional ratio (eccentric external rotation:concentric internal rotation) was significantly greater in the painful shoulder in both between-group and side-to-side comparisons. Both groups of swimmers exhibited increased external range of motion and reduced internal range of motion compared with normalized data, but no between-group or side-to-side differences were detected. Our findings suggest that prevention or rehabilitation of swimmer's shoulder might not solely involve strengthening of the external rotators of the shoulder joint. Attention might also be drawn toward correction of a possible deficit in internal rotational strength. Changes in shoulder range of motion seem unrelated to the occurrence of shoulder pain.

Adolescent↗

PubMed2006

Chronic shoulder osteoarthritis in a loggerhead turtle (Caretta caretta).

This report describes the lesions seen in an extremely weak and emaciated adult male loggerhead turtle (Caretta caretta) found stranded near Perth, Western Australia. Blood collected from a dorsal cervical sinus immediately prior to euthanasia demonstrated severe anaemia, markedly elevated plasma concentrations of creatinine kinase (2263 U/L), alkaline phosphatase (58 U/L), urea (18.1 mmol/L) and hypoglycaemia (glucose 0.7 mmol/L). Necropsy examination demonstrated a severe chronic osteoarthritis of the right shoulder joint with marked remodelling of the glenoid fossa, coracoid, scapula and humerus. There was marked synovial effusion and periarticular fibrosis. Cytological examination and culture of synovial fluid failed to demonstrate an infectious agent. Other findings were low numbers of trypanorhynch cysts present on the surface of the liver and numerous spirorchid eggs in the attached mesentery. Several large and small spirorchid flukes were present in the heart and there was a localised endarteritis in the left aortic arch associated with this infection. Numerous nematode eggs and at least three species of spirorchid eggs were seen microscopically in faeces collected from the terminal colon. The pathogenesis and significance of these lesions is discussed.

Alkaline Phosphatase↗

PubMed1993

Cholesterol crystals in synovial and bursal fluid.

Cholesterol crystals were found in two patients with classic rheumatoid arthritis (RA). In one patient, cholesterol crystals were found in synovial fluid from both shoulder joints, and in the second they were in an olecranon bursa. To examine the possible systemic etiology of cholesterol crystals in synovial and bursal fluid, lipid concentrations and the presence of serum antilipoprotein antibodies were measured. Antilipoprotein antibodies were not found. The concentration of lipid and lipoproteins, as well as the normal pattern of lipoprotein on agarose gel, eliminates the possibility of hyperlipoproteinemia. Results seemed to exclude a systemic etiology for the formation of cholesterol crystals in synovial and bursal fluid in the RA patients. It appears that several local factors such as defective drainage, local destruction, increased permeability of synovial membrane, and intraarticular (bursal) bleeding are possible etiologies.

Arthritis, Rheumatoid↗

PubMed2004

Position of the humeral head and rotator cuff tear: an anatomical observation in cadavers.

BACKGROUND: The relationship between the humeral head position and rotator cuff tears is not well described. MATERIAL AND METHODS: We performed an anatomical study of 22 cadaveric shoulders to find out the relationship between the normal anatomical position of the humeral head and tears of the rotator cuff. After dissection, the rotator cuff pathology was documented. The position of the humeral head was noted in relation to the acromion. The humeral head with intact acromion and articulated shoulder joint was photographed from the superior aspect of the joint and the area of the humeral head outside the acromion was measured, i.e. the part of the humeral head lateral to the lateral border of the acromion process. The relationship between rotator cuff pathology and uncovering of the humeral head was determined. RESULTS: 9 specimens had a partial cuff tear, while 4 had a complete tear. Those specimens with a rotator cuff tear had a mean area of 83% of the humeral head under the acromion. The specimens that did not show a rotator cuff tear had a mean area of 61% of the humeral head under the acromion. INTERPRETATION: We suggest that there is individual variation in anatomical position of the humeral head in relation to the acromion and that this position correlates with the occurrence of rotator cuff pathology.

Cadaver↗

PubMed2002

The targeting accuracy of subacromial injection to the shoulder: an arthrographic evaluation.

PURPOSE: The study goal was to examine the targeting accuracy of subacromial injection to the shoulder and the influence of the location of the injected structure. TYPE OF STUDY: A prospective nonrandomized study. METHODS: Fifty-three patients (56 shoulders; 34 women and 19 men; mean age, 74.5 years; range, 49 to 91) with impingement signs (Neer, Hawkins) of at least 2 months' duration received a subacromial injection of a mixture of 0.5 mL (2.5 mg) betamethasone acetate and 3 mL of radiographic contrast material (iotrolan) and 7 mL of 1% lidocaine using a lateral approach. Radiographs of the shoulder joint were taken immediately after the injection to determine the structure reached by the injection. Details of pain expressed as Neer and Hawkins impingement signs were obtained before and 15 minutes after the injection, and subjectively assessed using a 4-point self-administered pain score. Pain reduction resulting from subacromial and intradeltoid injection was compared. RESULTS: Thirty-nine of the 56 injections (70%) were judged to have reached the subacromial bursa. Twelve (21%) were seen to have entered the deltoid muscle; 2 (4%) were in the glenohumeral joint; and 3 (5%) were subcutaneous. A comparison of subacromial bursal with intradeltoid injection showed no significant differences in pain reduction expressed as impingement signs (1.5 vs 1.7 in the Neer impingement sign and 1.6 vs 1.6 in the Hawkins impingement sign, respectively). CONCLUSIONS: This study showed that subacromial injection was a relatively difficult procedure. A high incidence of injections that missed the subacromial bursa would be a sufficient reason to refrain from repeated usage of corticosteroids. These results also suggest that pain relief could be attained whether the injected material reached the subacromial bursa or the deltoid muscle. Successful pain relief after intradeltoid injection seems to call into question the diagnostic value of a positive Neer impingement test.

Aged↗

PubMed1989

Ultrasonography of the tendons of the shoulder.

The purpose of the present study was to compare ultrasonographic signs with macroscopic and histological findings in lesions of the rotator cuff and the biceps tendon. Twenty-six shoulder joints from 10 male and 3 female cadavers, ranging in age from 40 to 89 years (mean 65.9), were examined with a linear array real-time ultrasonographic scanner provided with a 7.5 MHz transducer. Arthrotomy and histological preparations were made after ultrasonography. Thinning and discontinuity of echogenic homogenicity of the tendons of the rotator cuff were the most reliable ultrasonographic signs of a total tear of the tendon, but focal hyper- and hypo-echogenic changes of the tendons of the rotator cuff were unreliable criteria. Partial tears of the rotator cuff were difficult to determine with static ultrasonograms. Ultrasonography readily revealed discontinuity of echogenic homogenicity of the biceps tendon as a sign of a rupture of the tendon, which was commonly associated with rotator cuff tears.

Adult↗

PubMedDate not supplied

The effects of beveling the margins of articular cartilage defects in immature dogs.

Eight 4 month old crossbred puppies underwent surgery simulating treatment of osteochondritis dissecans. Both humeral heads were exposed by a caudal approach to the shoulder joint. In one, an 8 mm circular, full-thickness cartilage defect was created so that the remnant cartilage margin was perpendicular to the joint surface. In the other, a similar 8 mm defect was created with the chondral margins beveled at approximately 45 degrees. There was no clinical lameness in any of the dogs. At necropsy after 16 weeks, the cartilage defects with beveled edges were significantly larger (11.0 +/- 0.6 mm SD) than those with perpendicular edges (8.0 +/- 0.1 mm SD), because of the beveling (p = 0.0039). Fibrocartilage was present but did not always completely fill the defects. Articular surfaces of the glenoid cavities suffered erosion and fibrillation more frequently opposite beveled defects than opposite defects with vertical walls (p = 0.0312). This was presumably due to the larger apposing defect. It was concluded that the cartilage margins surrounding a chondral defect should not be beveled.

Animals↗

PubMed1992

Late effects of radiotherapy in the treatment of breast cancer.

Late effects after radiotherapy for breast cancer include radiation induced malignancy and changes in irradiated tissues leading to e.g. edema of the arm, decreased mobility of the shoulder joint, brachial plexus neuropathy, pulmonary fibrosis, telangiectasia or atrophic ulceration of the skin. While radiation-induced malignancy depends on the volume of tissue irradiated and the total dose, other late effects are also fractionation dependent. Several reports have shown increased rates of such late effects after changes of the fractionation schedule which should be isoeffective according to the mathematical models commonly used to predict early effects. Although knowledge of the relation between total dose, number of fractions and radiation effects in late responding tissues has increased, extrapolations from the models should be used cautiously. The dose-response curve seems to be steeper for late effects than for tumour control. The possibility of late effects should be included in the decision as to when and how to treat breast cancer with radiotherapy.

Brachial Plexus↗

PubMed1983

Neurologic painful conditions affecting the shoulder.

Radiating pain accompanied by motor or sensory change, particularly below the elbow, strongly suggests a neurologic etiology of shoulder pain. The patient's description of the pain often is misleading because the shoulder joint has a movable fulcrum, which may be the site of a secondary irritant rather than a primary site. The pain may originate medially in the spinal cord or as far distal as the axillary border of the scapula. Precise identification usually requires myelography or discography in addition to a routine careful investigation. Included in this group are spinal cord tumors, extruded intervertebral discs, foraminal root compression syndromes, scalene and cervical rib syndromes, and various clavipectoral compression syndromes. The most confusing clinical picture results from nerve and vascular involvement, such as with cervical ribs, first rib abnormalities, or scalene muscle disturbances. Identification of specific characteristics of neural and vascular pain may help in the differential diagnosis of these lesions. Persistent neurologic deficit usually requires surgical treatment. Traumatic lesions of the plexus and individual nerves represent obvious causes and also may require surgical measures.

Chronic Disease↗

PubMed1989

Canine serum keratan sulfate and hyaluronate concentrations. Relationship to age and osteoarthritis.

Elevated serum levels of keratan sulfate (KS) and hyaluronate (HA) in patients with osteoarthritis (OA) have been reported. We measured KS and HA in dogs to determine if there was an elevation of these serum glycosaminoglycans in a canine model of OA. A single intraarticular injection of 1 mg of chymopapain into a shoulder joint increased serum KS by tenfold, and HA by less than twofold, in 24 hours. Serum KS and HA levels were 3-5-fold higher in dogs younger than 2 months of age than in older dogs. Serum KS and HA concentrations and synovial fluid KS concentrations were unrelated to spontaneous cartilage degeneration in 1-year-old dogs. Higher KS levels in synovial fluid correlated with higher KS levels in serum (r = 0.54, P less than 0.025). The mean KS concentration in sera of older dogs (greater than 3 years old) with OA was 37% higher than that in disease-free controls, but the difference between the groups was not statistically significant. Thus, elevated levels of serum KS and HA do not appear to have clinical significance in this model of OA.

Aging↗

PubMed1986

Neuromuscular electrical stimulation of the muscles surrounding the shoulder.

Neuromuscular electrical stimulation (NMES) can be used to augment range-of-motion, strengthening, and facilitation treatment programs of the muscles surrounding the shoulder. The purposes of this article are 1) to describe the uses of NMES around the shoulder joint as developed through our clinical use and 2) to detail the effects of an NMES program on chronic shoulder subluxation as determined by a clinical study. Because of the complexities of this multiarticular joint, NMES is most useful in the initial phase of the ROM, and stimulated contractions are compromised, relatively, as the humerus moves above the 90-degree horizontal plane. The use of NMES to provide scapular stabilization often entails unwanted alteration of the pressures on the spinal column, occasionally making the treatment program unusable. Electrical stimulation to prevent or correct shoulder subluxation, especially in the neurologically involved patient, provides the therapist with a powerful new treatment technique. In a group of stroke patients, shoulder subluxation was reduced significantly (p less than .05) at the completion of a six-week NMES program. Some of the problems, and possible solutions, unique to the development of electrical stimulation programs for the shoulder muscles are discussed.

Adult↗

PubMed2004

Muscle forces analysis in the shoulder mechanism during wheelchair propulsion.

This study combines an ergometric wheelchair, a six-camera video motion capture system and a prototype computer graphics based musculoskeletal model (CGMM) to predict shoulder joint loading, muscle contraction force per muscle and the sequence of muscular actions during wheelchair propulsion, and also to provide an animated computer graphics model of the relative interactions. Five healthy male subjects with no history of upper extremity injury participated. A conventional manual wheelchair was equipped with a six-component load cell to collect three-dimensional forces and moments experienced by the wheel, allowing real-time measurement of hand/rim force applied by subjects during normal wheelchair operation. An ExpertVision six-camera video motion capture system collected trajectory data of markers attached on anatomical positions. The CGMM was used to simulate and animate muscle action by using an optimization technique combining observed muscular motions with physiological constraints to estimate muscle contraction forces during wheelchair propulsion. The CGMM provides results that satisfactorily match the predictions of previous work, disregarding minor differences which presumably result from differing experimental conditions, measurement technologies and subjects. Specifically, the CGMM shows that the supraspinatus, infraspinatus, anterior deltoid, pectoralis major and biceps long head are the prime movers during the propulsion phase. The middle and posterior deltoid and supraspinatus muscles are responsible for arm return during the recovery phase. CGMM modelling shows that the rotator cuff and pectoralis major play an important role during wheelchair propulsion, confirming the known risk of injury for these muscles during wheelchair propulsion. The CGMM successfully transforms six-camera video motion capture data into a technically useful and visually interesting animated video model of the shoulder musculoskeletal system. The CGMM further yields accurate estimates of muscular forces during motion, indicating that this prototype modelling and analysis technique will aid in study, analysis and therapy of the mechanics and underlying pathomechanics involved in various musculoskeletal overuse syndromes.

Adult↗

PubMed1996

[Ultrasound diagnosis of the shoulder].

Sonography of the shoulder joint is a well-established technique in the hands of the experienced examiner, when using a standardized protocol. It has proved invaluable in assessing pathological soft tissue changes, especially after trauma. The static evaluation of anatomy and dynamic assessment of function are especially helpful in both preoperative staging and postoperative follow-up. The normal anatomy, examination techniques, including our own variations, and pathological conditions are discussed. The findings and various classifications of impingement syndrome, rotator cuff injuries, biceps tendon lesions and inflammatory changes are examined. Review of the major articles in the literature shows excellent correlation with our results, the overall sensitivity in the case of rotator cuff lesions being over 90%. A well-performed ultrasound examination in most cases obviates the need for the more invasive arthroscopy and the more cumbersome and expensive MRI examinations.

Adolescent↗

PubMed2004

Inter-arm asymmetry in bone mineral content and bone area in postmenopausal recreational tennis players.

OBJECTIVE: To determine whether long-term recreational tennis participation is associated with increased bone and muscle mass in the dominant compared to the non-dominant arm, in postmenopausal tennis players. METHODS: Dual-energy X-ray whole body scans were performed in 10 postmenopausal tennis players (mean +/- S.D.; 59.7 +/- 4.8 years) and 12 postmenopausal non-active women (62.8 +/- 7.2 years) matched for age and height. Tennis players started in this sport at 31.4 +/- 8.8 years, and had been playing for 26.8 +/- 6.8 years, at least 3 h per week. In addition, shoulder isokinetic muscular strength was also evaluated. RESULTS: Tennis participation resulted in a lower whole mass and fat mass in both arms (P < 0.05). Dominant arm muscle mass and shoulder joint isokinetic strength were essentially similar in both groups, however, the tennis players showed 8% greater bone mineral content and 7% greater osseous area in the dominant than in the non-dominant arm (P < 0.05). No inter-arm differences were found in bone mineral density. A relationship was observed between the length of tennis participation and the degree of inter-arm asymmetry in bone mineral content (r = 0.81, P < 0.01) and bone area (r = 0.78, P < 0.01). However, the BMD of the arms was essentially similar in both groups. No differences were observed in femoral and lumbar bone mass and density between groups. CONCLUSIONS: Long-term tennis participation is associated with increased bone mass, but not BMD, in the dominant arm of postmenopausal tennis players. The magnitude of the inter-arm asymmetry of postmenopausal tennis players is proportional to the length of tennis participation.

Absorptiometry, Photon↗

PubMedDate not supplied

Origin of cartilage laminae in MRI.

To understand the origin of the laminated appearance of cartilage in MRI (the magic angle effect), microscopic MRI (mu MRI) experiments were performed at 14-microns pixel resolution on normal canine articular cartilage from the shoulder joints. Two-dimensional images of the spin-spin relaxation time (T2) of the cartilage-bone plug at two angles (0 degree and 55 degrees) were calculated quantitatively. A distinct T2 anisotropy was observed as a function of the cartilage tissue depth. The surface and the deep regions exhibit strong orientational dependence of T2, whereas the upper-middle region exhibits little orientational dependence of T2. These three mu MRI regions correspond approximately to the three histologic zones in cartilage tissue. The results from the bulk T2 measurements agreed with these mu MRI results. Our studies show that the laminated appearance of cartilage in MRI is caused by T2 anisotropy of the tissue. We further suggest that the molecular origin of the T2 anisotropy is the nuclear dipolar interaction. The structure of the cartilage tissue indicates that the collagen meshwork defines this T2 anisotropy. The results show that the T2 anisotropy provides an indirect but sensitive indicator for the orientation of macromolecular structures in cartilage. The clinical implications of this anisotropy are discussed.

Animals↗

PubMed2006

Central resetting of neuromuscular steady states may underlie rhythmical arm movements.

Changing the steady-state configuration of the body or its segments may be an important function of central pattern generators for locomotion and other rhythmical movements. Thereby, muscle activation, forces, and movement may emerge following a natural tendency of the neuromuscular system to achieve the current steady-state configuration. To verify that transitions between different steady states occur during rhythmical movements, we asked standing subjects to swing one or both arms synchronously or reciprocally at approximately 0.8 Hz from the shoulder joints. In randomly selected cycles, one arm was transiently arrested by an electromagnetic device. Swinging resumed after some delay and phase resetting. During bilateral swinging, the nonperturbed arm often stopped before resuming swinging at a position that was close to either the extreme forward or the extreme backward arm position observed before the perturbation. Oscillations usually resumed when both arms arrived at similar extreme positions when a synchronous bilateral pattern was initially produced or at the opposite positions if the initial pattern was reciprocal. Results suggest that a central generator controls both arms as a coherent unit by producing transitions between its steady state (equilibrium) positions. By controlling these positions, the system may define the spatial boundaries of movement. At these positions, the system may halt the oscillations, resume them at a new phase (as observed in the present study), or initiate a new motor action. Our findings are relevant to locomotion and suggest that walking may also be generated by transitions between several equilibrium configurations of the body, possibly accomplished by modulation and gating of proprioceptive reflexes.

Acoustic Stimulation↗