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PubMed2005

Development of a Spanish-language version of the Shoulder Disability Questionnaire.

BACKGROUND: The Shoulder Disability Questionnaire (SDQ) is a validated shoulder functional scale that has not yet been translated into Spanish. OBJECTIVE: The objective of this study was to develop and test the consistency of a Spanish translation of The Netherlands version of the SDQ (NSDQ). METHODS: A backtranslation process was used to generate a Spanish version of the NSDQ, called the S-SDQ. Subsequently, both the NSDQ and S-SDQ were administered to 30 bilingual (English/Spanish) subjects. Finally, the S-SDQ was administered to 35 monolingual Spanish-speaking subjects with shoulder pain on 2 occasions. External consistency between NSDQ and S-SDQ scores in the bilingual subjects, and between scores for the 2 S-SDQ applications in the monolingual subjects was assessed using the intraclass correlation coefficient (Ri). Internal consistency of the S-SDQ was assessed with Cronbach's alpha coefficient. RESULTS: In the bilingual subjects, the Ri between the NSDQ and S-SDQ scores was 0.991 (95% confidence interval [CI], 0.981-0.995). In the monolingual Spanish-speaking patients with shoulder pain, the Ri between the 2 S-SDQ scores was 0.99 (95% CI, 0.997-0.999). The Cronbach's alpha coefficient for the S-SDQ was 0.99. CONCLUSIONS: A highly consistent Spanish version of the NSDQ, the S-SDQ, was developed. This can be confidently used in clinical care and research settings for measurement of the functional status of shoulder joint disorders in Spanish-speaking subjects.

Adult↗
PubMed1996

Four radiological measures to estimate shoulder balance in scoliosis.

We studied four indirect radiological measures of shoulder balance, their correlation with true shoulder balance, and measurement error of each method. Thirty-three consecutive patients with idiopathic scoliosis requiring surgical treatment were selected. Actual shoulder level was determined from a line in the top margin of the acromion clearly visualized in the wide chart. Indirect references used to assess shoulder balance were tilting of cephalic end-plate of T1, inclination of a line through superior border of both first ribs, the level of top margin of coracoid processes, and the level of two specific points where the clavicle intersects the rib cage. All radiographs were assessed by three independent observers. Correlation coefficients between each measurement and true shoulder level were 0.54 for T1 tilting (p = 0.001), 0.63 for first rib inclination (p < 0.001), 0.96 for coracoid process (p = 0.0001), and 0.93 for clavicle-rib cage intersection (p = 0.0001).

Adolescent↗
PubMed2000

EMG-based prediction of shoulder and elbow kinematics in able-bodied and spinal cord injured individuals.

We have evaluated the ability of a time-delayed artificial neural network (TDANN) to predict shoulder and elbow motions using only electromyographic (EMG) signals recorded from six shoulder and elbow muscles as inputs, both in able-bodied subjects and in subjects with tetraplegia arising from C5 spinal cord injury. For able-bodied subjects, all four joint angles (elbow flexion-extension and shoulder horizontal flexion-extension, elevation-depression, and internal-external rotation) were predicted with average root-mean-square (rms) errors of less than 20 degrees during movements of widely different complexities performed at different speeds and with different hand loads. The corresponding angular velocities and angular accelerations were predicted with even lower relative errors. For individuals with C5 tetraplegia, the absolute rms errors of the joint angles, velocities, and accelerations were actually smaller than for able-bodied subjects, but the relative errors were similar when the smaller movement ranges of the C5 subjects were taken into account. These results indicate that the EMG signals from shoulder and elbow muscles contain a significant amount of information about arm moVement kinematics that could be exploited to develop advanced control systems for augmenting or restoring shoulder and elbow movements to individuals with tetraplegia using functional neuromuscular stimulation of paralyzed muscles.

Adult↗
PubMed2006

Correlation between Bankart and Hill-Sachs lesions in anterior shoulder dislocation.

BACKGROUND: Bankart lesions and Hill-Sachs lesions are commonly associated with anterior shoulder dislocations. The presence of Bankart lesion indicates the need for surgical repair. Magnetic resonance imaging (MRI) has been shown to be sensitive in detecting these two lesions. The aim of this study is to investigate the correlation between Bankart lesions and Hill-Sachs lesions on MRI for patients with traumatic anterior shoulder dislocations. METHODS: Between 2003 and 2005, 61 patients from Alfred and Sandringham Hospitals had an MRI as part of the investigation for traumatic anterior shoulder dislocations. The MRI scans were reviewed and subsequently confirmed by a radiologist to show the presence or absence of Bankart and Hill-Sachs lesions. The data were then analysed by a statistician. RESULTS: Although patients with one of these lesions were more than two-and-a-half times as likely to have the other, small study numbers precluded this result from achieving statistical significance. (odds ratio, 2.67 (0.83-8.61), P = 0.10). Younger age was a strong predictor of a recurrence of shoulder dislocation (odds ratio, 0.93 (0.89-0.98), P = 0.005). The presence of Bankart or Hill-Sachs lesions on MRI for the primary shoulder dislocation group was similar to the recurrent group (73% vs. 72% for Bankart lesion and 67% vs. 70% for Hill-Sachs lesion). CONCLUSION: There is a strong correlation between both lesions. This apparent trend can be useful in predicting the presence of a Bankart lesion when a Hill-Sachs lesion is identified on a plain radiograph. This study suggests the consideration of surgical repair after identification of a Hill-Sachs lesion on plain radiographs, especially for younger patients where the rate of re-dislocation is high.

Adolescent↗
PubMed1998

Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy.

OBJECTIVE: To use information collected by the Confidential Enquiry into Stillbirths and Deaths in Infancy to help obstetric, midwifery and paediatric practice in the management of shoulder dystocia. DESIGN: Review of casenotes by a multidisciplinary focus group. SAMPLE: All 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy from England, Wales and Northern Ireland in 1994 and 1995, where stillbirth or neonatal death was attributed to shoulder dystocia. MAIN OUTCOME MEASURES: Case notes were reviewed with respect to a range of perinatal variables. Comparisons were made with normative data from other studies when appropriate. RESULTS: Maternal obesity and big babies were over-represented in pregnancies complicated by fatal shoulder dystocia. Fetal compromise was recorded in 26% of labours. The median time interval between delivery of the head and the rest of the body was only five minutes. The lead professional at the time the head was delivered was a midwife in 65% of cases. Middle grade or senior obstetric staff were supervising 47% of cases by the time the body was delivered. CONCLUSIONS: Antenatal prediction of shoulder dystocia is imprecise, and the majority of deliveries are attended by midwives. A relatively brief delay in delivery of the shoulders may be associated with a fatal outcome.

Autopsy↗
PubMedDate not supplied

Diagnostic and surgical arthroscopy of the equine shoulder joint.

An arthroscopic technique for examination and surgical treatment of conditions of the shoulder joint was evaluated in eight normal horses and two horses with osteochondrosis lesions. A single arthroscope entry point caudal to the infraspinatus tendon allowed inspection of the cranial, lateral, and caudal surfaces of the shoulder joint. With the humeral head and glenoid cavity distracted by a curved forceps, the entire cartilage surface of the shoulder could be examined. The caudomedial portion of the humeral head was seen better with a 70 degree angled arthroscope. Instruments for intra-articular manipulation were introduced through a separate skin incision 2 to 4 cm caudal to the arthroscope entry point. Two horses with osteochondrosis lesions of the shoulder were examined arthroscopically and debrided with instrument triangulation. Five normal horses and both horses with osteochondrosis lesions were euthanized immediately after the procedure and a necropsy was performed. Minor iatrogenic damage to the cartilage surfaces and joint capsule resulted from the technique. Three horses recovered from anesthesia and were killed 3, 30, or 60 days after surgery. Subcutaneous fluid that accumulated during surgery had resorbed by 3 days and lameness was evident for 12 to 24 hours. Gross examination and histopathologic findings of specimens collected at 30 and 60 days showed several small nonhealing partial-thickness cartilage defects attributed to instrument insertion. Arthroscopy is a satisfactory method to examine the joint surfaces and to evaluate and treat osteochondrosis lesions of the shoulder joint in horses.

Animals↗
PubMed2006

Influence of shoulder abduction and lateral trunk tilt on peak elbow varus torque for college baseball pitchers during simulated pitching.

Elbow varus torque is a primary factor in the risk of elbow injury during pitching. To examine the effects of shoulder abduction and lateral trunk tilt angles on elbow varus torque, we conducted simulation and regression analyses on 33 college baseball pitchers. Motion data were used for computer simulations in which two angles-shoulder abduction and lateral trunk tilt-were systematically altered. Forty-two simulated motions were generated for each pitcher, and the peak elbow varus torque for each simulated motion was calculated. A two-way analysis of variance was performed to analyze the effects of shoulder abduction and trunk tilt on elbow varus torque. Regression analyses of a simple regression model, second-order regression model, and multiple regression model were also performed. Although regression analyses did not show any significant relationship, computer simulation indicated that the peak elbow varus torque was affected by both angles, and the interaction of those angles was also significant. As trunk tilt to the contralateral side increased, the shoulder abduction angle producing the minimum peak elbow varus torque decreased. It is suggested that shoulder abduction and lateral trunk tilt may be only two of several determinants of peak elbow varus torque.

Abdomen↗
PubMed2004

Suprascapular nerve block in chronic shoulder pain: are the radiologists better?

BACKGROUND: Suprascapular nerve block is a safe and effective treatment for chronic shoulder pain in arthritis, which can be performed either by direct imaging (CT guided) or in the clinic using anatomical landmarks to determine needle placement. OBJECTIVE: To compare a CT guided versus an anatomical landmark approach in a randomised, single blind trial examining the efficacy of suprascapular nerve block for shoulder pain in patients with degenerative joint/rotator cuff disease. METHODS: 67 patients with chronic shoulder pain from degenerative disease participated in the trial. 77 shoulders were randomised. The group randomised to receive the block through the anatomical landmark approach received a single suprascapular nerve block. Those in the CT guided group received an injection of methylprednisolone acetate and a smaller volume of bupivacaine around the suprascapular nerve. The patients were followed up for 12 weeks by a "blinded" observer and reviewed at weeks 1, 4, and 12 after the injection. RESULTS: Significant improvements were seen in all pain scores and disability in the shoulders receiving both types of nerve block, with no significant differences in the improvement in pain and disability between the two approaches at any time. Improvements in pain and disability scores were clinically and statistically significant. No significant adverse effects occurred in either group. Patient satisfaction scores for pain relief using either approach were high. CONCLUSION: The CT guided control and landmark approaches to performing suprascapular nerve blocks result in similar significant and prolonged pain and disability reductions; both approaches are safe.

Aged↗
PubMed2006

Do psychological factors predict outcome in both low-back pain and shoulder pain?

BACKGROUND AND OBJECTIVE: Psychological factors are assumed to predict persistent or recurrent musculoskeletal pain. The influence of psychological factors in patients with low-back pain (LBP) or shoulder pain was explored to study whether there is similarity regarding the factors that predict persisting pain and disability. METHODS: Patients presenting in primary care with a new episode of shoulder pain or non-specific (sub)acute low back pain (LBP) were enrolled in a prospective study. In both patient groups, pain catastrophising, distress, somatisation and fear-avoidance beliefs were measured at baseline. Primary outcome measures at 3 months were (1) persistent symptoms, and (2) <30% reduction in functional disability. Multivariate logistic regression analysis was used to study the associations between psychological factors and outcome. RESULTS: A total of 587 patients with shoulder pain and 171 patients with LBP were enrolled in the study. In patients with shoulder pain, most associations of psychological factors with outcome were weak and not significant. Only in patients with longer symptom duration at baseline (>or=3 months) were higher scores on catastrophising significantly associated with persistent symptoms (p = 0.04). In patients with LBP, psychological factors were more strongly associated with poor outcome, although most associations were not significant. CONCLUSION: Psychological factors, with the exception of fear-avoidance beliefs, are more strongly associated with persistent pain and disability in patients with LBP than in those with shoulder pain. This seems to indicate that in a primary care population the influence of psychological factors on outcome may vary across patients with different types of pain.

Adult↗
PubMed1989

Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: a controlled study.

Two groups, one of 824 adult diabetics and one of 320 age and sex matched non-diabetics, were examined for abnormal glucose metabolism and calcifications on anteroposterior shoulder x rays. Two hundred and sixty two (31.8%) of the diabetics had shoulder calcification compared with 33 (10.3%) of the control group, with a preponderant localisation in the right shoulder. Diabetes of long duration treated with insulin for a long time was associated with a larger percentage of shoulder calcifications. These data and previous laboratory findings suggest a possible pathogenetic correlation between the prevalence of calcific shoulder tendinitis and diabetes.

Adult↗
PubMed2002

Painful shoulder: comparison of physical examination and ultrasonographic findings.

BACKGROUND: High frequency ultrasonography is an accurate non-invasive imaging technique for evaluating patients with painful shoulder. OBJECTIVE: To compare the clinical diagnosis established by a physical examination with high frequency ultrasonographic findings in patients with painful shoulder. METHODS: Thirty one consecutive patients with a first flare of shoulder pain were prospectively included in the study. All had a physical examination performed by two blinded rheumatologists. Ultrasonographic examination was carried out within one week of the physical examination by a third rheumatologist experienced in this technique who had no knowledge of the clinical findings. Ultrasonography was considered the optimal diagnostic technique. RESULTS: Clinical assessment showed low accuracy in the diagnosis of periarticular shoulder lesions. CONCLUSION: Ultrasonography should be used wherever possible to improve diagnosis and treatment of painful shoulder.

Adult↗
PubMed2003

Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study.

OBJECTIVE: To evaluate the clinical and radiological response of chronic calcific tendinitis of the shoulder to extracorporeal shock wave therapy (ESWT) in a single blind study. METHODS: 70 patients showing chronic, symptomatic, calcifying tendinitis of the shoulder were examined. A single blind randomised study was performed with 35 patients undergoing a regular treatment (group 1) and 35 a simulated one (group 2). Pain and functional assessment was carried out according to Constant and Murley. Variations in the dimension of the calcification were evaluated by anteroposterior x ray films. RESULTS: A significant decrease of pain and a significant increase in shoulder function was seen in group 1. Examination by x ray showed partial resorption of the calcium deposits in 40% of cases and complete resorption in 31% of cases in group 1. In the control group no significant decrease of pain and no significant increase in shoulder function was seen. No modifications were observed by x ray examination. CONCLUSION: Because of its good tolerance, safety, and clinical radiological response, ESWT can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder.

Activities of Daily Living↗
PubMed2003

A pragmatic randomised controlled trial of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care.

OBJECTIVES: To compare the long term effectiveness of local steroid injections administered by general practitioners with practice based physiotherapy for treating patients presenting in primary care with new episodes of unilateral shoulder pain. METHODS: Adults consulting with shoulder pain were recruited by their general practitioner. Patients were randomly allocated to receive either corticosteroid injections or community based physiotherapy. Primary outcome was self reported disability from shoulder problems at six months. Secondary outcomes included participant's global assessment of change; pain; function; "main complaint"; range of shoulder movement; co-interventions. A study nurse unaware of the treatment allocation performed baseline and follow up assessments. Analysis was by intention to treat. RESULTS: Over 22 months 207 participants were randomised, 103 to physiotherapy and 104 to injection. Prognostic variables were similar between the two groups at baseline. Mean (SD) improvements in disability scores at six weeks were 2.56 (5.4) for physiotherapy and 3.03 (6.3) for injection (mean difference=-0.5, 95% confidence interval (95% CI): -2.1 to 1.2) and at six months were 5.97 (5.4) for physiotherapy and 4.55 (5.9) for injection (mean difference=1.4, 95% CI -0.2 to 3.0). A "successful outcome" (a minimum 50% drop in the disability score from baseline) at six months was achieved by 59/99 (60%) in the physiotherapy group and 51/97 (53%) in the injection group (percentage difference=7%, 95% CI -6.8% to 20.4%). Co-interventions were more common in the injection group during follow up. CONCLUSION: Community physiotherapy and local steroid injections were of similar effectiveness for treating new episodes of unilateral shoulder pain in primary care, but those receiving physiotherapy had fewer co-interventions.

Administration, Topical↗
PubMed2002

Inferior capsular shift operation for multidirectional instability of the shoulder in players of contact sports.

OBJECTIVES: To assess the results of inferior capsular shift for multidirectional instability of the shoulder in athletes. METHODS: Multidirectional instability was surgically corrected in 53 shoulders in 47 athletes who engaged in contact sports. A history of major trauma was found in eight patients, the others having had minor episodes. Before surgery, all patients had complex combinations of instabilities. The surgical approach was selected according to the predominant direction of instability. RESULTS: Anterior inferior capsular shift was carried out in 37 shoulders, and anterior dislocation recurred in three. In one of these, it was anterior alone, one was anterior and inferior, and one was unstable in all three directions. After posterior inferior capsular shift in 16 shoulders, one dislocation occurred anteriorly and one posteriorly. With the anterior approach, four athletes could not return to sport. Two patients treated with the posterior approach could not return to sport. Of these six failures, five patients had had bilateral repairs. Successful repair based on the criteria of the American Shoulder and Elbow Association was achieved in 92% of anterior repairs and 81% of posterior repairs. Successful return to sport was noted in 82% of patients with anterior repairs, 75% with posterior repairs, and 17% with bilateral repairs. Overall, there were five subsequent dislocations, three in the anterior repair group (8%), and two in the posterior repair group (12%). CONCLUSIONS: Inferior capsular shift can successfully correct multidirectional instability in most players of contact sports, but the results in bilateral cases are poor.

Adolescent↗
PubMed1991

Intra-articular distension and steroids in the management of capsulitis of the shoulder.

OBJECTIVE: To determine whether there is any synergistic effect in the administration of intraarticular steroids with distension in the management of early capsulitis of the shoulder. DESIGN: Prospective randomised trial of three treatments--namely distension only, steroid only, and steroid with distension. SETTING: Academic department of orthopaedic and accident surgery at Queen's Medical Centre, Nottingham. SUBJECTS: 47 patients (30 women) with capsulitis affecting 50 shoulders. INTERVENTIONS: Three intra-articular injections into the shoulder given at six week intervals by the same technique. MAIN OUTCOME MEASURES: Passive range of abduction, forward flexion, and external rotation; results of shoulder dynamometry measuring work done and torque produced; pain levels at rest and with resisted movement. RESULTS: All patients reported improvement during the study. Analysis of the mean improvements in abduction and forward flexion showed these to be significantly greater in the steroid with distension and steroid only groups than in the distension only group (mean improvements in abduction (degrees/week (95% confidence interval)) 4.3 (3.4 to 5.2), 3.4 (2.4 to 4.5), and 1.0 (-0.8 to 2.8) in the three groups respectively; mean improvements in flexion (degrees/week (95% confidence interval)) 3.6 (3.2 to 4.0), 3.3 (2.3 to 4.3), and 1.5 (0.5 to 2.5) respectively). Shoulder dynamometry failed to show a significant difference among the treatment groups. No severe complications occurred as a result of the injections, but two patients reported facial flushing related to the use of steroids. CONCLUSION: Intra-articular steroid injections have a useful role in the outpatient management of early capsulitis.

Air↗
PubMed2002

Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys.

OBJECTIVES: To study changes in pain of the back and neck in adolescents between 1985 and 2001 and pain of the neck, shoulder, and lower back between 1991 and 2001. DESIGN: Biennial nationwide postal surveys, 1985-2001, and annual classroom surveys, 1996-2001. SETTING: Finland. PARTICIPANTS: 62 677 12, 14, 16, and 18 year olds and 127 217 14-16 year olds. MAIN OUTCOME MEASURES: Pain in the back and neck, neck and shoulder, or lower back, at least weekly. RESULTS: Prevalence of pain in the back and neck was greater in the 1990s than in the 1980s and increased steadily from 1993 to 1997. Pain of the neck and shoulder and pain of the lower back was much more common in 1999 than in 1991 and in 2001 than in 1999. Pain was more common among girls and older groups: pain of the neck and shoulder affected 24% of girls and 12% of boys in 14 year olds, 38% of girls and 16% of boys in 16 year olds, and 45% of girls and 19% of boys in 18 year olds; pain in the lower back affected 8% of girls and 7% of boys in 14 year olds, 14% of girls and 11% of boys in 16 year olds, and 17% of boys and 13% of girls in 18 year olds. CONCLUSION: Pain in the neck, shoulder, and lower back is becoming more common in Finnish adolescents. This pain suggests a new disease burden of degenerative musculoskeletal disorders in future adults.

Adolescent↗
PubMed2001

An easy method to reduce anterior shoulder dislocation: the Spaso technique.

OBJECTIVE: To introduce the Spaso technique for reducing anterior shoulder dislocation by reporting the success rate of the Spaso technique performed by junior emergency medicine residents. DESIGN: Retrospective case series. SETTING: Urban accident and emergency department. PARTICIPANTS: Patients with anterior shoulder dislocations. INTERVENTIONS: The Spaso technique was applied by the emergency medicine residents to reduce anterior shoulder dislocation. RESULTS: The emergency medicine residents applied the Spaso technique to reduce 16 cases of anterior dislocated shoulder during the study period. The Spaso technique was successful in 14 of 16 cases. The overall success rate was 87.5% (95% CI 60.4, 97.8%). No complications were noted. CONCLUSION: A new method has been introduced for reduction of anterior shoulder dislocation by reporting the experience of junior residents. The Spaso technique is simple, effective and able to be performed by single operator. Although the sample size was small, the result of the study could provide background information for planning a properly designed randomised controlled trial to evaluate the Spaso technique.

Adult↗
PubMed2005

Scapular manipulation technique for reduction of traumatic anterior shoulder dislocations: experiences of an academic emergency department.

BACKGROUND: Shoulder dislocations account for almost 50% of all joint dislocations, which are most commonly anterior (90-98%) and occur due to trauma. This prospective study was conducted to report our experiences of using the scapular manipulation technique (SMT) to reduce traumatic anterior shoulder dislocations. METHODS: Between March 2002 and March 2003, SMT was applied to 41 patients who presented with traumatic anterior shoulder dislocation to the Gulhane Military Medical Academy, Department of Emergency Medicine, Ankara, Turkey, which is a level 1 trauma centre with an annual attendance of 85,000 patients. The technique was applied to patients in the prone position by a single operator. Where necessary, a procedural sedation/analgesia (PSA) protocol was followed. RESULTS: The study population consisted of 26 (63.4%) male patients aged between 17 and 76 years (SD 15.6). History of recurrent shoulder dislocations at the same site were taken from seven (17.1%) of the patients. Mean (SD) trauma to reduction time was approximately 61.5 (72) minutes (range 10-480). Five patients (12%) had a greater tuberosity fracture. SMT was attempted twice to only four (9.8%) patients by a standard PSA protocol. We experienced a success rate of 90.2% at the first attempt and 100% overall. None of the patients encountered any complication. CONCLUSIONS: We report the successful use of SMT in the prone position for the reduction of traumatic anterior shoulder dislocations, mainly without requirement of any sedatives or opiate analgesics. We believe that SMT may also be applied by inexperienced physicians, as it is simple, applicable, and easily understood. As no single method has a 100% success rate, SMT is a useful one to know.

Adolescent↗