Charcot joint disease of the shoulders in a patient who had familial sensory neuropathy with anhidrosis. A case report.
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Adult↗
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[Surgical treatment of bone and joint injuries of the shoulder--a limited indication (author's transl)].
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Clavicle↗
[Migration of shoulder prosthesis as a consequence of hemi- or total arthroplasty].
BACKGROUND: Migration after shoulder arthroplasty can induce muscular dysbalance and instability of the shoulder joint. The aim of this study was to analyse the frequency, causes and consequences of secondary migration after shoulder arthroplasty. METHODS: 107 shoulder arthroplasties in patients with primary osteoarthritis (OA, n = 83) or avascular necrosis of the humeral head (AVN, n = 24), were followed clinically and radiographically over a period of 1 to 10 years. RESULTS: 17 Patients (16 %) developed secondary migration of the prosthesis. These were determined after a mean period of 33 months after shoulder arthroplasty. Patients with secondary migration of the prosthesis showed a worse function with a mean Constant score (CS) of 52.3 points in comparison to the patient group without migrated shoulder arthroplasties (62 points) (p = 0.038). In patients with total shoulder arthroplasty (TSA, n = 75), migration was observed in 13 % of cases during follow-up. Lucent lines at the glenoid were found in radiographs in 55 % of migrated shoulders and in 52 % of non-migrated shoulders (p = 0.633). The Constant score showed no significant difference between the groups (non-migrated shoulders 63 points, migrated shoulders 61 points, p > 0.5). Migration was seen in 22 % (7/32 patients) after hemiarthroplasty, however, no significant difference could be found between the respective Constant scores for migrated (47.7 points) or non-migrated (55.1 points) shoulders (p = 0.447). In patients with OA there was no significant difference in Constant score between migrated and non-migrated shoulders (p = 0.331), whereas patients with AVN showed significantly worse function after migrated shoulder arthroplasty (p = 0.007). CONCLUSION: Migration after total shoulder arthroplasty leads in the medium term neither to an increased frequency of lucent lines at the glenoid nor to a worsening of the functional score in comparison to non-migrated prosthesis. In patients with AVN, migration is accompanied by a worsening of the functional score and can consequently be regarded as a negative prognostic factor.
Arthroplasty, Replacement↗
[The diagnostic accuracy and therapeutic relevance of CT arthrography and MR arthrography of the shoulder].
PURPOSE: In glenohumeral instability, CT arthrography and MR arthrography of the shoulder joint were compared to assess accuracy in diagnosis of labral lesions and other internal derangements of the joint, and to evaluate relevance of both imaging methods for therapy. METHODS: 38 patients with symptoms of shoulder instability were examined clinically, arthrographically with CT and MRI, and arthroscopically. Arthrography with CT and MRI was performed in a double-contrast technique after single puncture and simultaneous injection of the contrast agents for both imaging methods. Type and extent of lesions on arthrographic imaging were criteria for planning therapy to a conservative, sole arthroscopic, or open surgical approach. RESULTS: Sensitivity in diagnosis of labral lesion (26 defects) was 85% in CT, 88% in MRI and 100% if both methods were used. Full-thickness tears of the rotator cuff were visualised in CT in 73%, and in MRI in 100%. Diagnostic accuracy increased from partial to complete to total defects. An open surgical approach was correctly predicted on MRI in 90% and on CT in 71%. A sole arthroscopic therapy was correctly foreseen on both arthrographic techniques in only 38% due to difficulties to assess glenohumeral ligaments. CONCLUSIONS: CT arthrography and MR arthrography were excellent for diagnosing labral lesions. MRI is superior to CT in the imaging of all joint structures. Surgical approach can be accurately predicted with both imaging methods but special surgical techniques cannot be effectively planned to replace diagnostic arthroscopy in all cases.
Adult↗
Development and prevention of frozen shoulder after acute aneurysm surgery.
BACKGROUND: We conducted a study on periarthritis humeroscapularis or "frozen shoulder," a postoperative complication of aneurysm surgery. The purpose of this study was to seek the cause of this complication and the methods of preventing it in patients who undergo aneurysm surgery. METHODS: The diagnosis of frozen shoulder was based on the clinical presence of shoulder pain and difficulty in raising arms that developed within 3 months of surgery. Sixty-four patients who underwent aneurysm surgery with no motor deficit were examined and classified into three groups: (1) early surgery (29 patients in the acute stage after subarachnoid hemorrhage); (2) delayed surgery (19 patients in the chronic stage); and (3) elective surgery (16 patients with unruptured aneurysms). RESULTS: The incidence of frozen shoulder was 41% in the early surgery group, 16% in the delayed surgery group, and 13% in the elective surgery group. The highest incidence of frozen shoulder was found to occur in the early surgery group and was attributed to the immobility of their upper extremities during postoperative treatment. Since patients who undergo surgery in the acute stage are often delirious and confused for several days after surgery, their arms are tied down by their sides in order to prevent them from inadvertently removing catheters such as the one for ventricular drainage. It seems that this manner of immobilizing the patient's arms is the cause of the development of frozen shoulder: Our study showed that if each arm was passively raised by turns above the patient's shoulder, the patient was able to maintain the range of motion of the upper arms and was less likely to develop frozen shoulder. CONCLUSION: Inactivity of the shoulder joints due to immobilizing the upper extremities of patients after acute aneurysm surgery seemed to cause the development of frozen shoulder. The incidence of this complication was greatly reduced by keeping the patient's upper arms raised alternately to maintain their range of motion after acute aneurysm surgery.
Craniotomy↗
The shoulder in sports.
Many sports activities that involve the upper extremity entail similar patterns of movement. Analysis of these activities, a better understanding of the throwing motion, and an awareness of shoulder diseases or injuries have led to a rational plan for investigation and management of shoulder problems. Evaluation often extends beyond the usual medical boundaries and must be based on information obtained from an analysis of sports mechanics, a review of training methods, and a physical examination directed at determination of flexibility, strength, endurance, and the presence of inflammation. Three common sports injuries are damage to the acromioclavicular joint (shoulder separation), instability of the glenohumeral joint, and a spectrum of pathologic changes in the rotator cuff. Sports that are commonly associated with shoulder problems include swimming, baseball, tennis, football, and gymnastics. Treatment may comprise rest, changes in training methods, an alteration of technique, and a physical rehabilitation program. Surgical treatment has a well-defined role, but it is usually optional.
Acromioclavicular Joint↗
Immediate effect of thermal capsulorrhaphy on glenohumeral joint mobility.
OBJECTIVES: To evaluate the effects of anterior thermal capsulorrhaphy of the glenohumeral joint by monitoring changes of magnitudes of the anterior and posterior displacements of the humeral head and ranges of motion of abduction and rotation in fresh cadaver shoulders. DESIGN: Single session repeated-measures design. BACKGROUND: Following thermal shrinkage anterior and posterior displacements of the head of humerus were decreased. However, no studies were focused on the ranges of motion of abduction and rotation of the shoulder joint immediately. The mobility of abduction and rotation are also important indexes for glenohumeral function. METHODS AND MEASURES: Nine fresh frozen shoulder specimens were used. The dorsal and ventral displacements of humeral head and ranges of motion of abduction and rotation of glenohumeral joint before and after thermal capsulorrhaphy were performed and monitored. Changes after thermal treatment in these linear and angular displacement variables were calculated as outcome measures. RESULTS: After anterior thermal capsulorrhaphy, significant (P < 0.001) decreases were found in displacements (-1.80 mm in dorsal direction and -1.24 mm in ventral direction), rotation range of motion (-3.93 degrees in lateral rotation and -2.60 degrees in medial rotation), and abduction range of motion (-3.15 degrees ). CONCLUSIONS: The results from cadaveric experiments showed that anterior thermal capsulorrhaphy immediately reduced the dorsal and ventral displacements and ranges of abduction and rotation of glenohumeral joint by a small amount. RELEVANCE: Radiofrequency electrosurgical system combined with arthroscopy has the potential to decrease the translations of the humeral head as well as the rotational range of motion of the glenohumeral joint.
Aged↗
Clinical and radiographic assessment of a non-constrained total shoulder.
This paper presents the early post-operative results of a nonconstrained total shoulder joint prosthesis of the UCLA design in ten patients. Substantial relief of pain was achieved in eight patients. Half the patients showed and increased range of shoulder movement and ony one prosthesis was unstable requiring reoperation. Radiolucent zones at the cement-bone interface of the glenoid developed in several patients. The significance of these with regard to joint mobility, resultant forces and incipient loosening of the polyethylene component are discussed. No clinical signs of loosening occurred in the observation period.
Adult↗
Sports injuries of the shoulder.
Much strain is placed on the shoulder joint in all sports. Sports injuries may be caused by a single, violent incident. Fractures of the clavicle, acromioclavicular and sternoclavicular traumas, isolated fractures of the greater tuberosity and shoulder dislocations are frequent clinical pictures which today can be managed by well established procedures. Other sports injuries, however, involve over-use of the shoulder which, through repetitive harmful movements, can bring about microtraumatic lesions of the rotator cuff, glenoid labrum, acromioclavicular joint and certain peripheral nerves around the suprascapularis. In all cases, a programmed, comparative, clinical examination and complementary, sequential examinations will indicate suitable curative and preventive treatment.
Acromioclavicular Joint↗
Effect of trunk restraint on the recovery of reaching movements in hemiparetic patients.
BACKGROUND AND PURPOSE: Reaching movements made with the affected arm in hemiparetic patients are often accompanied by compensatory trunk or shoulder girdle movements, which extend the reach of the arm. We investigated the effects of the suppression of these compensatory movements on reaching ability in hemiparetic individuals. METHODS: Eleven healthy and 11 hemiparetic individuals participated. Three-dimensional kinematic analysis was used to quantify reaches made to a close and a distant target (near the limit of arm's length). Unrestrained reaches were compared with those in which shoulder girdle and trunk movements were restrained by a harness. RESULTS: During unrestrained reaching, abnormal trunk recruitment and limitations in elbow and shoulder movements were correlated with the degree of clinical stroke severity (r=-0.91 to -0.96) in hemiparetic patients. During trunk restraint, ranges of elbow and shoulder joint movement increased in both groups. In addition, elbow and shoulder interjoint coordination improved. This was caused by increases in the range of joint motion as well as by a better dynamic temporal relation between joints. CONCLUSIONS: Trunk restraint allowed patients with hemiparetic stroke to make use of arm joint ranges that are present but not normally recruited during unrestrained arm-reaching tasks. Thus, the underlying "normal" patterns of movement coordination may not be entirely lost after stroke. Appropriate treatments, such as trunk restraint, may be effective in uncovering latent movement patterns to maximize arm recovery in hemiparetic patients.
Abdomen↗
Shoulder kinematics in 25 patients with impingement and 12 controls.
UNLABELLED: We used dynamic radiostereometry to study the three-dimensional kinematics of the shoulder joint during active abduction. Twenty-five patients experiencing shoulder symptoms (Neer Stage 2) for more than 18 months, without total rotator cuff tears, participated. Eight men and four women without shoulder symptoms constituted controls. The rotation of the humeral head relative to a fixed scapula and the absolute rotation of the humerus (caused by humeral, scapular, and trunk motion) were measured. The rotations were calculated in the order of abduction/adduction (anteroposterior axis), internal/external rotation (longitudinal axis), and flexion/extension (transverse axis). The absolute abduction of the humerus in our patients did not differ from controls, nor did the abduction in the glenohumeral joint. During abduction, the humeral centre displaced medially, proximally, and anteriorly. In the patient group, slightly more (1-1.5 mm) proximal translation was observed. Presence of impingement syndrome was associated with increased proximal translation of the humeral head center, which occurred in the early phase of the arc of motion. LEVEL OF EVIDENCE: Diagnostic Level I. See Guidelines for Authors for a complete description of Levels of Evidence.
Adult↗
The 11th nerve syndrome in functional neck dissection.
OBJECTIVES: Assessment of the incidence of shoulder joint disability and evaluation of the role of a personal postoperative physical rehabilitative protocol therapy in reducing pain and shoulder dysfunction and improving the quality of life (QOL) of patients who have undergone functional neck dissection (FND) associated with total laryngectomy. SETTING, DESIGN, AND OUTCOME MEASURES: Sixty laryngectomees who had undergone FND were divided into two groups (A and B). Group A received physical therapy after surgery. Clinical evaluation was done according to the Constant modified questionnaire, including physical assessment of passive and active shoulder movement and information regarding patients' QOL. Bilateral quantitative electromyography (Q-EMG) of scapulohumeral muscles was carried out on all patients. Results were evaluated by Student t test and multivariate analysis to find out which variables were important in predicting pain and return to work. RESULTS: Six months after surgery, the patients in group A had better results concerning passive forward elevation (P = 0), shoulder active motility (P = 0), pain (P <.001), working and recreational activity (P = 0), and score of Constant (P = 0) compared with the patients in group B. From a multivariate analysis of clinical parameters important in predicting pain, significant predictors (P <.01) were shown to be global shoulder active motility, active forward elevation, abduction, active external rotation, internal rotation hand to back, working and recreational activity, and score of Constant. Regarding return to work, a significant predictor (P <.01) was the score of Constant. Electromyography work-up showed deterioration in early postoperative periods and improvements in late postoperative periods. CONCLUSION: The post-surgical variable clinical picture of shoulder disability is related not only to the accessory nerve injury, but also to the secondary glenohumeral stiffness resulting from the scapulohumeral girdle muscles weakness and postoperative forced immobility. Physical therapy aimed to early recover passive motion and to avoid the occurrence of joint fibrosis has been shown to have a real contributory role in decreasing shoulder complaints and improving the patients' QOL.
Accessory Nerve Diseases↗
Ipsilateral dislocation of the shoulder and elbow joints with contralateral comminuted humeral fracture.
Ipsilateral dislocation of the shoulder and elbow joints is a rare and complex injury. During the last 25 years, only 3 cases have been reported in the literature. We report a 50-year-old woman who suffered ipsilateral elbow and shoulder dislocation with contralateral comminuted humeral fracture. Both shoulder and elbow joints were reduced, but the elbow was dislocated subsequently at follow-up. The reduction in the elbow was stabilized by a Kirschner wire that was removed at 3 weeks, and the elbow was then stable. A U-shaped coaptation splint was applied for the contralateral comminuted humeral fracture. At 6 months, she had acquired a nearly full range of motion of both shoulder and elbow with complete healing in the contralateral humerus. Although rare and complex, ipsilateral shoulder and elbow dislocation, which is the result of a high-energy trauma, can be treated conservatively.
Elbow Joint↗
Electrothermally-assisted capsulorrhaphy (ETAC): a new surgical method for glenohumeral instability and its rehabilitation considerations.
Knowledge of current surgical procedures and the effect they have on healing tissue is important when developing rehabilitation guidelines. Recently, clinicians have been asked to treat patients who have undergone Electrothermally-Assisted Capsulorrhaphy (ETAC) for shoulder instability. The ultimate tensile strength of the tightened capsule is unknown during various timeframes following surgery. The use of thermal energy to shrink the shoulder joint capsule initially causes weakness of the collagen ultrastructure. Rehabilitation following ETAC includes a period of relative immobilization, followed by controlled range of motion exercises. Exercises to strengthen shoulder muscles must be done in a manner that minimizes stress on the surgically treated capsule. This article provides a brief review of capsuloligamentous repair; describes the surgical procedure, its indications, contraindications, and the effect ETAC has on the healing tissue; and provides guidelines for rehabilitation following ETAC based on the evidence available and the authors clinical experience.
Hot Temperature↗
Locked nailing for displaced surgical neck fractures of the humerus.
OBJECTIVE: To report experience with a newly devised humeral locked nail for treating surgical neck fractures of the humerus. This device has the advantages of a small diameter for minimal tissue trauma and transfixing locking screws for reliable fixation. METHODS: From 1993 to 1996, 21 consecutive severely displaced surgical neck fractures of the humerus were antegrade nailed with humeral locked nails; 2 fractures were associated with dislocation and 1 fracture was a comminuted metaphyseal fracture with a failed plating. The average age of patients was 65.8 years; average follow-up time was 19.2 months. The proximal screws were applied upward in 5 patients and downward in 16 patients. Static locking was performed in 8 patients, dynamic locking in 13 others. RESULTS: The average operation time was 55 minutes. No patients needed blood transfusion. All fractures eventually achieved union with an average time to union of 14.8 weeks. On the basis of Neer criteria for outcome analysis, excellent or satisfactory results were obtained for 86% of the patients (18 of 21 patients). No patients had deep infection, implant failure, malunion, osteonecrosis, or nail migration that interfered with joint motion. Due to technique errors, one patient had shoulder joint impingement caused by protrusion of the proximal nail tip. CONCLUSION: The operative method reported here has the advantages of minimal tissue trauma, minimal hardware application, sufficient fixation, and easy operative technique, and it can be a worthy alternative for the treatment of severely displaced surgical neck fractures of the humerus.
Adult↗
Kinematics of four methods of stabbing: a preliminary study.
Despite considerable research and development into stab-resistant clothing, no data exists which provides valid data for knife-body contact speeds which may be used to ensure that an appropriate and standard protection level is provided. Such data can only be obtained by a quantitative kinematic analysis of the stabbing movement. Two-dimensional video techniques (50 Hz) were used to record images of subjects (n = 10) performing each of four stabbing actions; Long Over (LO), Long Under (LU), Short Over (SO), Short Under (SU). Images were digitised from a minimum of ten frames pre-, to at least six frames post-blade entry. A two-way analysis of variance applied to selected kinematic parameters revealed significantly higher (P < 0.01) blade entry speeds for LO and LU as compared to SO and SU, respectively. This was due to the extra distance over which knife speed could be increased in the former conditions. Significantly greater shoulder joint angular velocities were found for LU and SU conditions, whilst for the elbow joint, conditions LO and SO were significantly greater (P = 0.000008). This suggests that the entry speeds during LO and SO are derived from a greater contribution from elbow extensor muscles, whilst those for LU and SU are derived from a greater contribution from the shoulder flexors. It was concluded that two separate kinematic strategies were employed by subjects, and that the maximum speed which may be generated during stabbing is influenced by the manner in which the knife is held.
Adult↗
Upper limb loadings of gait with crutches.
Long-term crutch users and patients with arthritis are particularly susceptible to upper limb joint degeneration during aided gait. The function of the walking aid for stability, support, and restraint/propulsion must be optimized with the upper limb loadings caused by the aids. Post-operative total hip replacement (THR) patients, tibial fracture, and paraplegic subjects using sticks and elbow crutches were analyzed in this study. Elbow and shoulder joint centers and aid orientations were monitored simultaneously in three dimensions and combined with aid forces to determine upper limb moment loadings. Three loading effects were observed: tendency for the aids to cause 1) the elbow to flex and shoulder to extend, 2) the elbow and shoulder to extend, and 3) the shoulder to abduct. Moment values of up to 0.10 Nm per body weight (BW) causing the shoulder to extend were measured, i.e., of similar magnitude to the moments at the hip in unaided gait. A modification of the elbow crutch, designed to improve medial-lateral stability, was unsuccessful in use due to wrist instability. This reinforced the requirement that crutch designs integrate the aid's function in gait with the ability of the upper limb joints to balance the applied loads.
Arm↗
Reciprocal aided gait in paraplegia.
A group of 9 male paraplegics, experienced in the use of walking aids for ambulation, were tested using an alternate four-point gait. Data were collected pertaining to the axial load transmitted through the crutches, the upper limb joint displacements and the moments about the elbow and shoulder joints during the period of contact of the walking aid with the ground. This gait was found to be slow with long periods of load transmission through the walking aids. Comparatively high values were calculated for the moments about the joints of the upper limb.
Adult↗