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PubMedDate not supplied

Semiconstrained total shoulder arthroplasty for glenohumeral arthritis and massive rotator cuff tearing.

Each of 6 patients (7 shoulders) underwent semiconstrained total shoulder arthroplasty for glenohumeral arthritis, subluxation, and extensive rotator cuff tearing to obtain a more balanced joint and achieve consistent pain relief. A hooded glenoid component (Neer 600%) was used to contain the humeral head within the joint. Patients were followed for an average of 69 months (range, 26-125 months) or to revision surgery and were assessed clinically and radiographically. All patients experienced improvement with respect to pain; on average, active elevation and external rotation decreased to 44 degrees and 43 degrees. On radiographic evaluation, 3 of the glenoid components were seen to have complete radiolucent lines and 1 case showed a shift in component position. Five shoulders had anterior-superior joint subluxation. According to the shoulder score rating system of Neer, all but 1 of the shoulders were rated as unsatisfactory or unsuccessful at final follow-up. Two patients have undergone revision surgery for subluxation or glenoid loosening. We cannot recommend this method of treatment.

Aged↗
PubMedDate not supplied

Bone grafting for glenoid deficiency in total shoulder replacement.

Twenty-eight patients had glenoid bone grafting for segmental glenoid wear as a part of total shoulder arthroplasty. Nineteen of these patients had osteoarthritis and 5 had arthritis associated with shoulder instability. Follow-up evaluation averaged 5.3 years (range, 2 to 11 years). Autogenous humeral head grafts were used in 27 patients. In 25 patients, 3.5-mm cortical screws were used for fixation. Postoperatively, there was no or slight pain in 25 patients and moderate pain in 3 patients. Postoperative motion averaged 126 degrees in abduction, 39 degrees in external rotation, and T12 in internal rotation. According to Neer's result rating, 13 shoulders were excellent, 10 satisfactory, and 5 unsatisfactory (symptomatic glenoid loosening in 2, reoperation for instability in 2, and persistent pain in 1). Radiographically, 13 shoulders had no lucencies, 11 had incomplete lucencies, and 4 had complete lucencies. In 3 of these, the lucencies were at least 1.5 mm wide. These glenoids were considered radiographically loose; however, only 2 were symptomatic. When this technique is used to restore glenoid bone and joint alignment, clinical and radiographic results are similar to those for total shoulder arthroplasty overall.

Adult↗
PubMedDate not supplied

Function of the long head of the biceps at the shoulder: electromyographic analysis.

The purpose of this study was to delineate, through electromyographic analysis, the function of the long head of the biceps at the shoulder. Ten shoulders were examined with dynamic electromyography. The long head of the biceps was instrumented with thin wire electrodes. The supraspinatus, infraspinatus, deltoid, brachialis, and brachioradialis were instrumented as controls. Because the biceps functions primarily as a forearm supinator and elbow flexor, a long arm brace was used to lock the elbow in extension with the forearm in neutral pronation/supination. Each motion was tested in a full arc at fast (170 degrees per second) and slow (36 degrees per second) speeds and repeated with and without a 5-pound weight attached to the distal end of the brace. No electrical activity was identified in the long head of the biceps muscle in response to isolated shoulder motion with the elbow and forearm position controlled. The data demonstrate that the long head of the biceps is not active in isolated shoulder motion when the elbow and forearm are controlled. Thus, any hypothesis on bicipital function at the shoulder must be based on either a passive role of the tendon or tension in association with elbow and forearm activity.

Adult↗
PubMedDate not supplied

Radiographic assessment of cemented humeral components in shoulder arthroplasty.

Forty-three shoulder arthroplasties performed with the use of cemented Neer II humeral components and followed radiographically for a mean of 6.6 years (range, 2-20 years) were analyzed. A humeral component was considered radiographically "at risk" for clinical loosening when a radiolucent line 2 mm or greater in width was present in 3 or more zones or tilt or subsidence was identified on sequential radiographs by 2 or 3 of the 3 independent observers. None of the components was considered to have tilted or subsided. Radiolucent lines of any size were present in 16 shoulders and were wider than 2 mm in 9 shoulders. They were limited to 1 zone in 8 shoulders and to 2 zones in 7 shoulders. Only 1 component (2%) with a 2-mm radiolucent line in 3 zones was judged to be "at risk." The incidence, extent, and thickness of humeral radiolucent lines were significantly higher in total arthroplasties than in hemiarthroplasties (P <.05). Clinically important changes around cemented Neer II humeral components are uncommon. Humeral radiolucent lines develop more frequently in the presence of a glenoid component. Data from this study can be used as one benchmark to compare with alternate methods of humeral component fixation.

Aged↗
PubMedDate not supplied

The effect of instability and subsequent anterior shoulder repair on proprioceptive ability.

Proprioceptive ability was prospectively evaluated in patients with recurrent traumatic anterior instability who subsequently underwent anterior shoulder repair. Thirty consecutive patients were evaluated for passive position sense and detection of motion with the shoulder in flexion, abduction, and external rotation 1 week before surgery. They were then retested at 6 and 12 months postoperatively. A significant deficit in proprioception was found when the unstable side was compared with the uninvolved side before surgery. Six months after surgical repair, position sense showed an improvement of approximately 50% but was still found to be significantly different on the involved side; detection of motion was no longer significantly different from the uninvolved shoulder. One year after open anterior shoulder repair, both position sense and detection of motion were equivalent to those of the uninvolved shoulder.

Adolescent↗
PubMed2003

Kinesthetic sense of the shoulder in patients with impingement syndrome.

A proprioceptive deficit is an important determinant of disability in various shoulder disorders, such as instability and osteoarthrosis. In 15 patients with impingement syndrome stage II (Neer 1983), who were treated by arthroscopic subacromial decompression, we measured movement sense by determining threshold levels for the perception of motion of the shoulder. The patients were placed in a specially designed chair allowing continuous passive motion of the shoulder joint, while avoiding cutaneous, auditory and visual stimuli. To assess movement detection thresholds, passive abduction movements of the shoulder were performed at a starting angle of 60 degrees, an amplitude of 10 degrees and an angular velocity of 1.3 degrees/s. Before surgery, all patients had higher threshold levels for the perception of motion in their affected shoulders then in the other side. After decompression, proprioception had improved on the decompressed side, but was unchanged on the other side.

Adult↗
PubMed2003

Effect of a redesigned two-wheeled container for refuse collecting on mechanical loading of low back and shoulders.

The objective of this study was to compare the mechanical and perceived workload when working with a redesigned two-wheeled container and working with a standard two-wheeled container for refuse collecting. The three changes in the design of the container were a displacement of the position of the centre of mass in the direction of the axis of the wheels, a slight increase in the height of the handle and a slight increase in the horizontal distance between the handle and the wheel-axis, and an increase in the diameter of the wheels. The volume of the container remained 0.240 m3. Nine refuse collectors performed some of their most frequent daily activities with both types of containers in the laboratory. Kinematics and exerted hand forces were assessed as input for detailed 3D biomechanical models of the low back and shoulder to estimate net moments at the low back and shoulders, compressive forces at the low back and contact forces at the glenohumeral joint. Also, the refuse collectors rated the ease of handling the two-wheeled containers on a five point scale. The use of the redesigned container resulted in a decrease of the exerted hand forces of 27%, decreases in the net moments at the low back and shoulders of 8% and 20%, respectively, and a decrease of 32% of the contact force at the glenohumeral joint when compared to the standard container. However, pulling an empty redesigned container on to the pavement resulted in an increase of the shoulder moment of more than 100%. No differences between container types were found for the compressive forces at the low back. Pushing and pulling with the redesigned container was rated as easier than pushing and pulling with the standard container. No differences in subjective ratings were found for the tasks of turning the container or pulling an empty container onto the pavement. It is concluded that, provided that empty containers are placed back onto the pavement as infrequently as possible, the introduction of the redesigned container could result in a reduction of the low back and shoulder load for refuse collectors.

Adult↗
PubMed2006

The relationship between shoulder torques and the perception of muscular effort in loaded reaches.

The objective of this study was to define the quantitative relationship between external dynamic shoulder torques and calibrated perceived muscular effort levels for load delivery tasks, for application in job analyses. Subjects performed a series of loaded reaches and, following each exertion, rated their perceived shoulder muscular effort. Motion and task physical requirements data were processed with a biomechanical upper extremity model to calculate external dynamic shoulder torques. Calculated torque values were then statistically compared to reported calibrated perceived muscular effort scores. Individual subject torque profiles were significantly positively correlated with perceived effort scores (r2 = 0.45-0.77), with good population agreement (r2 = 0.50). The accuracy of the general regression model improved (r2 = 0.72) with inclusion of factors specific to task geometry and individual subjects. This suggests two major conclusions: 1) that the perception of muscular shoulder effort integrates several factors and this interplay should be considered when evaluating tasks for their impact on the shoulder region; 2) the torque/perception relationship may be usefully leveraged in job design and analysis.

Biomechanical Phenomena↗
PubMed2001

Hemiplegic shoulder pain: defining the problem and its management.

PURPOSE: Hemiplegic shoulder pain can affect up to 70% of stroke patients and can have an adverse impact on rehabilitation outcomes. This article aims to review the literature on the suggested causes of hemiplegic shoulder pain and the therapeutic techniques that can be used to prevent or treat it. On the basis of this review, the components of an optimal management programme for hemiplegic shoulder pain are explored. METHOD: English language articles in the CINAHL and MEDLINE databases between 1990 and 2000 were reviewed. These were supplemented by citation tracking and manual searches. RESULTS: A management programme for hemiplegic shoulder pain could comprise the following components: provision of an external support for the affected upper limb when the patient is seated, careful positioning in bed, daily static positional stretches, motor retraining and strapping of the scapula to maintain postural tone and symmetry. CONCLUSIONS: Research is required to evaluate the effectiveness of the components of the proposed management programme for the prevention and treatment of hemiplegic shoulder pain and to determine in what combination they achieve the best outcomes.

Braces↗
PubMed2006

Assessment of shoulder pain in hemiplegia: sensitivity of the ShoulderQ.

BACKGROUND: The ShoulderQ is a structured questionnaire designed to assess timing and severity of hemiplegic shoulder pain (HSP), in order to target pain relief effectively. It includes both verbal and visual graphic rating scale questions, simply presented for patients with language/visuo-spatial deficits following stroke. OBJECTIVE: To assess the sensitivity of the ShoulderQ to clinical improvement in shoulder pain following multi-disciplinary intervention. Design and setting. Retrospective analysis of serial questionnaires collected in the course of clinical treatment in an in-patient neurological rehabilitation unit. Subjects and interventions. Thirty consecutive adults with cognitive and communicative deficits, presenting with hemiplegic shoulder pain following acquired brain injury. Multi-disciplinary treatment was delivered through an integrated care pathway, and ShoulderQs recorded fortnightly, including at baseline and end of treatment. RESULTS: Changes on visual graphic rating scale (VGRS) were associated with verbal reports of improvement (rho 0.665, p < 0.001). Patients were divided retrospectively on the basis of their overall clinical response into responders (n = 18) and non-responders (n = 12). Responders showed significant change in both VGRS and verbal scores, whereas the non-responder group did not. A change in summed VGRS score of =3 showed 77% sensitivity and 91.3% specificity for identifying the responders, with a positive predictive value of 93.3%. Summed VGRS scores of =2 had a negative predictive value of 73.3%. CONCLUSION: In this preliminary evaluation of clinical data, the ShoulderQ appears to provide a sensitive measure of shoulder pain which is responsive to change in pain experience for those able to complete the questionnaire, despite the difficulties that many of this group of patients may have in reporting their symptoms. Set alongside previously reported test-retest reliability, the results support the utility of the ShoulderQ as a simple and practical tool for evaluation of shoulder pain in patients with severe complex disabilities.

Adult↗
PubMed2006

A scoring system for detection of macrosomia and prediction of shoulder dystocia: a disappointment.

OBJECTIVE: To develop a scoring system for the detection of a macrosomic fetus (birth weight (BW) >or= 4000 g) and predict shoulder dystocia among large for gestational age fetuses. STUDY DESIGN: We retrospectively identified all singletons with accurate gestational age (GA) that were large for GA (abdominal circumference (AC) or estimated fetal weight (EFW) >or= 90% for GA) at >or=37 weeks with delivery within three weeks. The scoring system was: 2 points for biparietal diameter, head circumference, AC, or femur length >or=90% for GA, or if the amniotic fluid index (AFI) was >or=24 cm; for biometric parameters <90% or with AFI <24 cm, 0 points. The predictive values for detection of shoulder dystocia were calculated. RESULTS: Of the 225 cohorts that met the inclusion criteria the rate of macrosomia was 39% and among vaginal deliveries (n = 120) shoulder dystocia occurred in 12% (15/120; 95% confidence interval (CI) 7-20%). The sensitivity of EFW >or=4500 g to identify a newborn with shoulder dystocia was 0% (95% CI 0-21%), positive predictive values 0% (95% CI 0-46%), and likelihood ratio of 0. For a macrosomia score >6, the corresponding values were 20% (4-48%), 25% (5-57%) and 2.3. CONCLUSION: Though the scoring system can identify macrosomia, it offers no advantage over EFW. The scoring system and EFW are poor predictors of shoulder dystocia.

Dystocia↗
PubMed1998

The effect of CO2 insufflation rate on the postlaparoscopic shoulder pain.

Shoulder pain (SP) is frequently mentioned in recent literature following laparoscopic operations. In the literature, many causes have been declared to explain shoulder pain after CO2 insufflation, such as direct peritoneal irritation of the CO2 gas, excessive traction of the triangular ligament, and overstretching of the diaphragmatic muscle fibers due to the high rate of insufflation. This study was planned as multicentric, and 76 patients, aged between 35 to 45, were entered into the study. They were all selected by a randomized sampling method, with equal numbers of men and women, to achieve true evaluation. The low flow-rate (LFR) group was insufflated with 2.5 L/min and the high flow-rate (HFR) group with 7.5 L/min. All cases were evaluated by subjective pain classification on postoperative day 3. According to the subjective pain scale method, shoulder pain average was 23.9+/-3.1 in the LFR group and 55.4+/-6.5 in the HFR group. The difference between these groups was significant (p > 0.01). There is no significant difference for the operation time (LFR%: 64+/-15 minutes, HFR: 61+/-20 minutes, p > 0.05). Our results suggest that there is a significant statistical relation between the postoperative shoulder pain levels and increased insufflation rates. For this reason, low insufflation rate significantly reduces the shoulder pain but does not increase the operation time. Therefore, a low insufflation rate should be applied in all cases for patients' comfort and safety.

Adult↗
PubMed1986

Hemiplegic shoulder pain.

This article reviews the literature relevant to the possible causes, prevention, and treatment of hemiplegic shoulder pain. Shoulder pain and stiffness impede the rehabilitation of patients with hemiplegia. The cause of this complication is unknown, but it may be related to the severity of neurological deficits, preexisting or posthemiplegic soft tissue injury, subluxation, brachial plexus injury, or shoulder-hand syndrome. Shoulder pain may be preventable if risk factors can be identified and appropriate prophylaxis applied. Resolution of the condition depends on diagnosis and effective treatment at the onset of the symptoms. More clinical research is needed to clarify the cause of hemiplegic shoulder pain and to document the efficacy of prophylactic and treatment methods.

Brachial Plexus↗
PubMed1986

Analysis of shoulder rotation accompanying a proprioceptive neuromuscular facilitation approach.

The purpose of this study was to determine whether the medial rotation that accompanies flexion of the shoulder took place during the performance of the flexion-abduction-lateral-rotation proprioceptive neuromuscular facilitation pattern (D2F) with the forearm moving in supination and the elbow remaining in extension. The dominant shoulders of 10 volunteer subjects (8 men and 2 women) between 18 and 30 years of age and with no known pathological conditions of the dominant upper extremity were examined. The amount of shoulder flexion was determined by using a gravity-activated angle finder placed on the superior surface of the humerus at the beginning and ending phases of motion. The amount of shoulder rotation was determined by using a universal goniometer, a square ruler, and a gravity-activated angle finder with its base resting on the surface of an adjustable wooden bracket aligned over the humeral epicondyles. The results for all subjects showed that, as the D2F pattern was performed, lateral rotation occurred during the initial phase of motion that was followed by a palpable change to medial rotation. The analysis of variance and Scheffé tests demonstrated significant differences (p less than .01) between the amount of medial rotation at the beginning of the pattern and the point at which the rotational direction changed and between this point and the end of the pattern. Physical therapists should be aware that the flexion-abduction-lateral-rotation pattern should end with the shoulder in medial rotation when they guide and apply resistance to patients performing this PNF pattern.

Adolescent↗
PubMed1992

Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects.

The purposes of this study were to identify the incidence of postural abnormalities of the thoracic, cervical, and shoulder regions in two age groups of healthy subjects and to explore whether these abnormalities were associated with pain. Eighty-eight healthy subjects, aged 20 to 50 years, were asked to answer a pain questionnaire and to stand by a plumb line for postural assessment of forward head, rounded shoulders, and kyphosis. Subjects were divided into two age groups: a 20- to 35-year-old group (mean = 25, SD = 63) and a 36- to 50-year-old group (mean = 47, SD = 2.6). Interrater and intrarater reliability (Cohen's Kappa coefficients) for postural assessment were established at .611 and .825, respectively. Frequency counts revealed postural abnormalities were prevalent (forward head = 66%, kyphosis = 38%, right rounded shoulder = 73%, left rounded shoulder = 66%). No relationship was found between the severity of postural abnormality and the severity and frequency of pain. Subjects with more severe postural abnormalities, however, had a significantly increased incidence of pain, as determined by chi-square analysis (critical chi 2 = 6, df = 2, P less than .05). Subjects with kyphosis and rounded shoulders had an increased incidence of interscapular pain, and those with a forward-head posture had an increased incidence of cervical, interscapular, and headache pain.

Adult↗
PubMed1990

Lesions of the mid-shaft of the humerus presenting as shoulder capsulitis.

We describe three patients who presented with pain and restriction of movement at the shoulder suggestive of capsulitis, but proved to have lesions of the mid-shaft of the humerus. It is important to be aware of the possibility of this cause of a 'frozen shoulder', since radiographs of the shoulder are usually cropped at the mid-humerus and lesions at this level may easily be missed. A radiograph of the entire humerus, or an isotope bone scan, may be more useful than repeated shoulder radiographs in patients whose shoulder symptoms do not respond to standard treatment.

Adult↗
PubMed2000

The reliability of the three-dimensional FASTRAK measurement system in measuring cervical spine and shoulder range of motion in healthy subjects.

OBJECTIVES: To assess the inter-observer and intra-observer reliability of a new three-dimensional measurement system, the FASTRAK, in measuring cervical spine flexion/extension, lateral flexion and rotation and shoulder flexion/extension, abduction and external rotation in healthy subjects. METHODS: The study was conducted in two parts. One part assessed inter-observer reliability with two observers measuring 40 subjects. The other part assessed intra-observer reliability with one observer measuring 32 subjects on three occasions. All subjects had unrestricted, pain-free cervical spine and shoulder movement. Reliability was measured by the intraclass correlation coefficient [ICC(2,1)]. RESULTS: The inter-observer ICCs for the cervical spine ranged from 0.61 to 0.89 and for the shoulder from 0.68 to 0.75. After removal of outliers, all ICCs were above 0.70. Intra-observer ICCs for the cervical spine ranged from 0.54 to 0.82 and for the shoulder from 0.62 to 0.81. After removal of outliers, all ICCs were above 0.70 except for shoulder abduction (0.62). CONCLUSIONS: Whilst all movements measured by the FASTRAK showed good reliability, the reliability of the whole movement in a plane (e.g. left plus right lateral flexion) was better than for the separate movements (e.g. left and right lateral flexion taken separately). Inter-observer reliability was generally better than intra-observer reliability for most cervical spine movements, suggesting that variability of movement within subjects (e.g. over a period of days) for these movements was greater than variability between measures on the same occasion.

Adult↗
PubMed2005

A cost consequences analysis of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care.

OBJECTIVE: Local steroid injections and community-based physiotherapy have been shown to be of similar benefit for treating shoulder pain presenting to primary care. This paper presents a cost consequences analysis of a prospective economic evaluation, conducted alongside a randomized clinical trial (RCT) of corticosteroid injections versus physiotherapy for new episodes of unilateral shoulder pain, to determine the economic implications of injection versus physiotherapy. METHODS: A pragmatic RCT with 207 patients randomized to either physiotherapy (n = 103) or local steroid injection (n = 104) was conducted. The resource inputs required were identified for each treatment arm in terms of capital, staff and consumables. These were measured for the period up to 6 months post-randomization. Outcome measures included shoulder disability, shoulder pain, global assessment of health change and the EQ5D, all at 6 months. A sensitivity analysis was performed around the general practitioner minor surgical fee. RESULTS: Analysis is presented on the 199 patients for which the general practice record review (101 physiotherapy, 98 injection) was available. The total mean costs, per patient, were 71.28 pound sterling for the injection group and 114.60 pound sterling for the physiotherapy group. The difference in average total cost per patient was 43.32 pound sterling (95% bootstrap confidence interval: 16.21 pound sterling, 68.03 pound sterling ). This is a statistically significant difference in cost. Outcome was similar in both groups across all measures following intervention. Smaller mean differences in cost were observed between the treatment groups in the sensitivity analysis, but the difference remained in favour of injection over physiotherapy. CONCLUSIONS: This study has shown, given similar clinical outcomes across the treatment groups, that corticosteroid injections were the cost-effective option for patients presenting with new episodes of unilateral shoulder pain in primary care.

Adult↗