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At least 1,495 records · Page 83Linked to original sources
PubMed1996

Development of an upper extremity FES system for individuals with C4 tetraplegia.

The application of functional electrical stimulation (FES) to provide upper extremity function for individuals with C4 tetraplegia is under investigation. In this study, a FES system was designed that allowed one individual with complete C4 tetraplegia to coordinate stimulated lateral or palmar prehension with stimulated arm movements using contralateral shoulder position. The system consisted of percutaneous intramuscular electrodes implanted to muscles for hand grasp and release, supination, elbow flexion, and extension and arm adduction. Due to peripheral denervation, transposition and subsequent stimulation of the paralyzed latissimus dorsi muscle provided elbow flexion and transfer and stimulation of the paralyzed extensor carpi ulnaris muscle provided forearm supination. A suspended sling provided shoulder joint stability. The subject controlled stimulation proportionally using contralateral shoulder motion sensed by a position transducer. Control of stimulated hand grasp and release were coupled with stimulated arm motions so that hand-to-mouth activities could be accomplished with one motion of the contralateral shoulder. With this system, the subject was able to grasp a milk carton placed in the hand and lift and lower it from his mouth to drink from a short straw. He could also scoop a semisolid substance with an adapted spoon and lift and lower it from the work surface to his mouth to eat. The subject required assistance to place the milk carton or spoon in his hand and position the plate for scooping. Further investigation is needed to generate the necessary arm movements to make completion of these tasks possible without assistance and to expand the range of activities possible with the FES system.

Accidents, Traffic↗
PubMed2001

Changes in molecular expression of aggrecan and collagen types I, II, and X, insulin-like growth factor-I, and transforming growth factor-beta1 in articular cartilage obtained from horses with naturally acquired osteochondrosis.

OBJECTIVE: To determine molecular changes in the expression of insulin-like growth factor-I (IGF-I) and transforming growth factor-beta1 (TGF-beta1) in horses with osteochondrosis, and to characterize expression of matrix aggrecan and collagen types I, II, and X in articular cartilage of affected joints. SAMPLE POPULATION: Articular cartilage from affected stifle or shoulder joints of 11 horses with naturally acquired osteochondrosis and corresponding joints of 11 clinically normal horses. PROCEDURE: Harvested specimens were snap frozen in liquid nitrogen, and total RNA was isolated. Specimens were fixed in 4% paraformaldehyde for histologic examinations. Expression of matrix molecules was assessed by analysis of northern blots and in situ hybridization, using equine-specific cDNA probes and riboprobes, respectively. Expression of IGF-I and TGF-beta1 was assessed by use of noncompetitive quantitative polymerase chain reaction, in situ hybridization, and immunohistochemical analysis. RESULTS: Cartilage obtained from osteochondrosis lesions had significantly greater expression of IGF-I, compared with normal cartilage. Expression of TGF-beta1 and collagen type I were higher, but not significantly so, in affected tissues. Expression of aggrecan or collagen types II and X did not differ between affected and clinically normal cartilage. CONCLUSIONS AND CLINICAL RELEVANCE: Increased expression of growth factors and collagen type I was found in cartilage from osteochondrosis lesions. However, this probably reflects a healing response to injured tissue rather than a primary alteration. Therefore, methods aimed at altering concentrations of growth factors in cartilage of growing horses would be unlikely to alter the incidence or progress of the disease.

Aggrecans↗
PubMed2003

Two-dimensional link-segment model of the forelimb of dogs at a walk.

OBJECTIVE: To calculate normative joint angle, intersegmental forces, moment of force, and mechanical power at elbow, antebrachiocarpal, and metacarpophalangeal joints of dogs at a walk. ANIMALS: 6 clinically normal mixed-breed dogs. PROCEDURE: Kinetic data were collected via a force platform, and kinematic data were collected from forelimbs by use of 3-dimensional videography. Length, location of the center of mass, total mass, and mass moment of inertia about the center of mass were determined for each of 4 segments of the forelimb. Kinematic data and inertial properties were combined with vertical and craniocaudal ground reaction forces to calculate sagittal plane forces and moments across joints of interest throughout stance phase. Mechanical power was calculated as the product of net joint moment and the angular velocity. Joint angles were calculated directly from kinematic data. RESULTS: All joint intersegmental forces were similar to ground reaction forces, with a decrease in magnitude the more proximal the location of each joint. Flexor moments were observed at metacarpophalangeal and antebrachiocarpal joints, and extensor moments were observed at elbow and shoulder joints, which provided a net extensor support moment for the forelimb. Typical profiles of work existed for each joint. CONCLUSIONS AND CLINICAL RELEVANCE: For clinically normal dogs of a similar size at a walk, inverse dynamic calculation of intersegmental forces, moments of force, and mechanical power for forelimb joints yielded values of consistent patterns and magnitudes. These values may be used for comparison in evaluations of gait in other studies and in treatment of dogs with forelimb musculoskeletal disease.

Animals↗
PubMed2006

[A new thinking of acupuncture and moxibustion treatment of shoulder pain after hemiplegia].

Analysis from anatomy and physiology indicates that causes of shoulder pain are (1) decline and after-constriction of the scapula;(2) the adduction and intorsion of the humerus; (3) the spasm of the upper limb flexor. The acupuncture and moxibustion prescriptions stipulated for prevention and treatment of shoulder pain are Jianjing (GB 21), Jianzhongshu (SI 15), Jugu (LI 16), Tianzong (SI 11), Jianliao (SJ 14), Jiquan (HT 1) at the flaccid hemiplegia, and Jugu (LI 16), Jianyu (LI 15), Tianzong (SI 11), Jianliao (SJ 14), Xiaoluo (SJ 12), Shanglian (LI 9), Wenliu (LI 7) at the spastic hemiplegia , in combination with cupping at the Urinary Bladder Meridian on the back and around shoulder. Thus, it is indicated that shoulder pain not only is involved in the shoulder joint but also in all muscle groups of the shoulder girdle and the upper limb extensor at the affected side.

Acupuncture Therapy↗
PubMedDate not supplied

[Joint involvement in polymyalgia rheumatica/temporal arteritis].

The coincidence of arthritis with polymyalgia rheumatica (PMR) or temporal arteritis (TA) is not well established. After reviewing the literature we found that 22% of patients suffering from PMR/TA present with additional signs of inflammatory joint involvement. Joints predominantly affected are the sternal junctions, knee and shoulder joints, and the wrists, involvement of the latter frequently resulting in carpal tunnel syndrome. With the exception of sternal junctions, bony erosions are rarely seen. In most cases, synovitis is mild, pauciarticular, asymmetrical, transient and not destructive. Little evidence for inflammatory involvement of spine or sacroiliac joints was found, thus, back pain in these patients should be considered as caused by osteoporosis of the spinal column, mostly due to prolonged corticosteroid treatment.

Arthritis↗
PubMed1996

Common disorders of the shoulder.

The shoulder joint is a complex articulation requiring coordinated interaction of bone and soft-tissue structures for normal function of the upper extremity. Trauma or overuse of the shoulder may lead to dysfunction requiring medical evaluation. Most shoulder problems may be treated without surgery by the primary care physician. Appropriate conservative management depends on an accurate diagnosis of the underlying pathology.

Acromioclavicular Joint↗
PubMed1979

Arthrography in acute shoulder dislocations.

Arthrography of the shoulder was performed on 50 patients with acute traumatic shoulder dislocations. The mean interval between injury and arthrogram was 2.3 days, with a median interval of one day. Anterior dislocations occurred in 96% of patients, and posterior dislocations in 4%. Initial dislocations were present in 74%, and recurrent dislocations in 26%. The most frequent abnormality identified or arthrograms was an enlarged but intact shoulder capsule (58%), most commonly seen in shoulders subject to recurrent dislocations (77%). Shoulder joint capsular tears or disruptions were seen in 48% of the patients. The next most common lesion was fracture (52%), identified on standard roentgenograms. These included Hill-Sachs lesions (28%), greater tuberosity fractures (22%), and coracoid fractures (2%). Ruptures of the rotator cuff, present in 28% of the cases (14 patients), occurred more frequently in initial dislocations (62%) than in recurrent ones (36%). The high frequency of enlarged intact shoulder capsules, even after an acute initial joint dislocation (58%), suggests that the humeral head does not routinely rupture the capsule during dislocation, but rather tears the glenoid labrum at its bony attachment and dislocates subperiosteally, dissecting a false pouch below the periosteum and under the subscapularis.

Acute Disease↗
PubMed1995

[Clinical examination of the shoulder].

If the treatment of shoulder problems is to be successful, an accurate diagnosis is required. To achieve this, it is necessary to pay attention to some peculiarities of the shoulder joint. Because of the great importance of the soft tissues in dynamic and static stabilization, bony lesions will occur late when massive dysfunction of the shoulder has maybe just occurred. Imaging techniques as CT or X-ray will not give a diagnosis in the early phases. Therefore, an exact clinical evaluation with a history and assessment of motion and special muscle testing will permit an early diagnosis.

Acromioclavicular Joint↗
PubMed1989

Prosthetic replacement due to giant-cell tumor in the proximal humerus. A case report.

A 45-year-old woman with an extensive giant-cell tumor of the right proximal humerus was treated by segmental resection and shoulder reconstruction. A Neer prosthesis and allogeneic bone grafts were used to reconstruct the shoulder joint. Autogeneic iliac bone was placed at the host-graft junction. The rotator cuff was reattached to the bone after making a semicircular trough. The long head of the biceps was reattached with stay sutures after making a trough between reattachments of the supraspinatus and the subscapularis. The patient regained almost full range of motion and excellent muscle power of the shoulder 60 months after operation. She did not have any difficulty with daily tasks of living. The prosthesis articulated with the glenoid well. There has been no evidence of tumor recurrence or metastasis.

Bone Neoplasms↗
PubMed2004

Effect of fixation of shoulder and elbow joint movement on the precision of laparoscopic instrument manipulations.

BACKGROUND: Motion analysis of the upper limb and the surgical instruments is used for objective assessment of endoscopic manipulations. The aim of this study was to investigate the effect of fixation of shoulder and elbow joint movement on the precision of laparoscopic instrument manipulations. METHODS: Two experiments were conducted to correlate hand movement with instrument tip during free and restricted movement of the shoulder and elbow joints. A three-dimensional infrared optical tracking system has been used. Five subjects participated in the study, and each completed the range of movements twice. End points were velocity (m/s), angular velocity (r/s) and acceleration (m/s2). RESULTS: There was a weak correlation for all end points between the instrument tip and individual joint movement during free upper limb movement (r < 0.4). With restricted movement of the shoulder and elbow joints, the correlation between hand movement and instrument tip was found to be good for the velocity (r = 0.66 for flexion; r = 0.72 for abduction; r = 0.56 for supination) and angular velocity (r = -0.83 for flexion; r = -0.48 for abduction; r = -0.70 for supination), but weak for the acceleration (r < 0.4). CONCLUSIONS: The characteristics of hand movements do not correlate with movement of the laparoscopic instrument tip when the upper limb is unsupported. The precision of laparoscopic surgical manipulations is increased if both joints (shoulder and elbow) are supported.

Elbow Joint↗
PubMed1989

Glenohumeral instability.

Glenohumeral instability is an important cause of shoulder pain and disability in an active population. An awareness of the prevalence of recurrent instability, either in the form of dislocation or subluxation, is particularly useful in the assessment of the young athlete presenting with shoulder pain. Young adults presenting with rotator cuff tendinitis may have an underlying instability as the primary cause of their problem. A careful clinical examination should determine whether the instability is voluntary or involuntary, of traumatic or atraumatic onset, and the primary direction of the instability, as these factors have important implications with regard to treatment. Anterior glenohumeral instability is most common and the incidence of recurrent instability following on from an initial dislocation is high in the young active patient. An intensive rehabilitation programme is indicated for all initial dislocations or subluxations but surgery may become necessary after failure of conservative treatment. Care must be taken to determine accurately those patients with voluntary or multi-directional instability and a longer trial of conservative treatment is indicated here, as results of operative treatment in those cases are less favourable. Conservative treatment should be directed at strengthening the dynamic stabilizers of the shoulder joint, notably the rotator cuff muscles. Additional X-ray views are needed to demonstrate all the radiological changes associated with recurrent instability and further evaluation with examination under anaesthesia and arthroscopy is beneficial in the assessment of these patients. Arthroscopic surgery also has a role in the treatment of patients with symptomatic labral pathology and is now being used to perform stabilization procedures in selected cases. Many operative procedures have been described for stabilization of the shoulder and these should be directed at correcting the pathology present. Restoration of the patient's flexibility and strength postoperatively is essential, especially in the athlete in order to allow a full return to sporting activity.

Combined Modality Therapy↗
PubMed2004

Absolute and relative cell counts for synovial fluid from clinically normal shoulder and stifle joints in cats.

OBJECTIVE: To determine absolute and relative cell counts for synovial fluid from grossly, radiographically, and histologically normal shoulder and stifle joints in healthy cats. DESIGN: Clinical study. ANIMALS: 52 cats scheduled to be euthanatized for unrelated reasons. PROCEDURE: Arthrocentesis of the shoulder and stifle joints was performed bilaterally, and synovial fluid was analyzed for absolute WBC count, WBC morphology, and percentages of neutrophils and mononuclear cells. Joints were examined grossly and radiographically, and synovial membrane specimens were submitted for histologic examination. Synovial fluid samples that were contaminated with blood and samples from joints with any gross, radiographic, or histologic abnormalities were excluded. RESULTS: 82 of the 208 synovial fluid samples were excluded because abnormalities were identified during physical examination; the volume of fluid obtained was insufficient for analysis; there was evidence of blood contamination; or the joint had gross, radiographic, or histologic abnormalities. Median WBC count for the remaining 126 synovial fluid samples was 91 cells/microL (96.4% mononuclear cells and 3.6% neutrophils); WBC count was not significantly different between left and right joint samples or between shoulder and stifle joint samples. Body weight was associated with synovial fluid WBC count, with WBC count increasing as body weight increased. Sixteen of the 52 (30%) cats had radiographic evidence of osteoarthritis involving at least 1 joint. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that synovial fluid can be obtained reliably from shoulder and stifle joints in cats.

Animals↗
PubMed1986

Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin-dependent diabetes mellitus.

Limited joint mobility and shoulder capsulitis were evaluated in 109 consecutive diabetic patients attending an out-patient diabetic clinic. Forty-nine had insulin-dependent diabetes mellitus (IDDM) and 60 had non-insulin-dependent diabetes mellitus (NIDDM). Seventy-five normal subjects were also examined. Limitation of joint mobility was detected in 24 (49%) patients with IDDM and in 31 (52%) patients with NIDDM but in only 17 (20%) normal subjects (p less than 0.001). There were no significant differences between diabetic patients with and without joint limitation with regard to age, sex, type of DM, mean daily insulin dosage and overall diabetic control as assessed by estimation of glycosylated haemoglobin concentration. However, patients with impaired joint mobility had a longer duration of diabetes (p = 0.01) and a significantly increased frequency of retinopathy compared to patients without joint limitation (p less than 0.05). Normal subjects with restricted joint mobility were older than those without restriction (p = 0.05). Shoulder capsulitis was present in 19% of patients with diabetes mellitus and 5% of normal subjects. However, there was no significant association between limited joint mobility and shoulder capsulitis in the diabetics.

Adolescent↗
PubMed2006

Long term effects of intra-articular botulinum toxin A for refractory joint pain.

UNLABELLED: The purpose of this case series review is to describe our 12 month clinical experience with intra-articular injections of Botulinum toxin Type A (BoNT/A) for refractory joint pain. Eleven patients with chronic arthritis who had failed treatment with oral and/or intra-articular medications and were not surgical candidates were referred to us for management of moderate to severe refractory joint pain in 15 joints. The use of BoNT/A to treat joint pain is a non-FDA approved "off label" treatment with potential side effects. After a detailed explanation of the joint injection procedure, signed informed consent was obtained for the procedure. Fifteen joints were injected with BoNT/A (Allergan, Inc): six lower extremity joints (3 knees, 3 ankles) with 25-50 units and nine shoulders with 50-100 units. Patients were followed for one year or longer. Maximum relief of pain was measured by comparing baseline pain on a numeric rating scale (0-10) to pain at the time of maximum relief (paired t-test). Maximum improvement in function was assessed using paired t-tests for improvement in active flexion and abduction for the shoulder joint, and by the time to perform sit to stand ten times (the timed stands test, TST) for the lower extremity joints. RESULTS: Two patients were female and nine were male, aged 42-82 years. Five had osteoarthritis (OA), five had rheumatoid arthritis (RA) and one had psoriatic arthritis. All patients were on analgesic and/or anti-inflammatory medications and all joints had previous intra-articular steroid or viscosupplement injections with inadequate or unsatisfactory benefit. A clinically and statistically significant improvement was noted after IA-BoNT/A injections. The mean maximum decrease in lower extremity joint pain was 55% (p =0.02) and the 36% (p =0.044) improvement in the Timed Stands Test was noted at four to ten weeks after injection. There was a 71% mean maximum reduction in shoulder pain severity from 8.2 +/- 1.1 to 2.4 +/- 1.9 (p <0.001). Active range of motion increased 67% in flexion (from 67.8 +/- 27.6 to 113.3 +/- 46.6 degrees, p =0.001) and 42% in abduction (from 50 +/- 18.5 degrees to 71.1 +/- 23.1 degrees p =0.01). No immediate or delayed adverse effects related to BoNT/A were noted after the injection. Duration of pain relief was variable and ranged from 3 to 12 months. Five joints were re-injected with IA-Bont/A and had a similar decrease in joint pain that lasted 3 to 12 months. CONCLUSIONS: This is the first report of the long term effects of intra-articular BoNT/A injections to treat chronic joint pain and the efficacy of repeated injections. Although this study was small, and uncontrolled the results suggest that IA-BoNT/A injections are an effective and safe treatment for chronic joint pain disorders.

Adult↗
PubMed2005

[Risedronate: a possible treatment for extraosseous calcification].

A case report of 51 year-old female, diagnosed as CREST syndrome, presenting with an ectopic calcification in the left shoulder joint, which disappeared soon after the start of risedronate. She had been taking steroid and NSAIDs for the past four years, but the pain and the range of motion of her shoulder became worse and restricted progressively during the last three years only to form extraosseous calcification. Laboratory data showed normal renal function, no inflammatory changes, and no abnormalities in calcium and and phosphate metabolism including parathyroid hormone. Risedronate was administered for glucocorticoid-induced osteoporosis. Although the bone turnover markers, such as serum NTX (N-terminal telopeptides of type I collagen) and BSAP (bone specific alkaline phosphate), did not show remarkable changes, the pain disappeared a week later and the range of motion recovered a month later. The X-ray at 6 months risedronate treatment revealed a complete disappearance of the ectopic calcification. Risedronate, probably through a different process from etidronate, could prevent extraosseous calcification.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1987

The role of hyaluronic acid in joint stability--a hypothesis for hip dysplasia and allied disorders.

The concentration of hyaluronic acid (HA) and proteins in synovial fluids of hip and shoulder joints of a variety of canine breeds has been investigated. In the Australian Kelpie, a working dog with a low incidence of hip dysplasia, shoulder synovial fluid viscosity and HA concentration were higher than in similar joints of Alsatians in which hip dysplasia is relatively common. Moreover, the HA levels and viscosity in shoulder fluids of animals with clinically defined hip dysplasia were substantially lower than in all other breeds studied. On the basis of these findings, we propose that hip dysplasia and other joint abnormalities may arise as a consequence of a deficiency in the levels of HA in synovial fluids.

Animals↗
PubMed2004

Comprehensive assessment of clinical outcome and quality of life after total shoulder arthroplasty: usefulness and validity of subjective outcome measures.

OBJECTIVE: To explore the physiometric and psychometric properties of clinical, generic, and condition-specific assessment instruments. To describe patients' outcome after total shoulder arthroplasty. METHODS: Forty-three patients were assessed in a 5-6-year cross-sectional catamnesis. RESULTS: With regard to shoulder joint stability, pain, general physical health, and mental health, the patients showed scores comparative to normative scores. Significant functional limitation was evidenced by low mean scores on the specific function scales (e.g., Disability of the Arm, Shoulder and Hand questionnaire score = 64.0, normative score = 86.6). There were high correlations among the joint-specific scales (up to 0.93) and moderate correlations between these and the generic and clinical scales. Factor analysis identified 3 different assessment domains. CONCLUSION: The patients' quality of life (QOL) was high and not affected by impairment in some specific functional abilities. Physical QOL, mental QOL, clinical assessment, condition-specific measures, and generic measures were identified as separate domains, all of which are required for a comprehensive and sophisticated assessment in practical clinical routine.

Adult↗
PubMed1996

Joint center longitudinal positions computed from a selected subset of Chandler's data.

Mathematical models of the human body are indispensable tools for studying the biomechanics of human movement. The geometrical centers of the 12 main joints (shoulders, elbows, wrists, hips, knees ankles), modeled as simple mechanical joints, are widely used as reference points for building mathematical models of the human body. These reference points, typically defined as "joint centers", are assumed to maintain a fixed 3D position relative to both the segments forming the joint, throughout the range of joint motion. No single point in a human joint perfectly meets this assumption, and no simple method is available for locating the points that are closest to meet it. Researchers often have recourse to subjective methods, based on their knowledge of anatomy. Objective estimates are easily attainable if the positions of a few bony landmarks can be measured on the subject, and the longitudinal distances of the joint centers from these landmarks are known. A subset of the anthropometric measurements performed by Chandler et al. (NTIS No. AD 710-622, 1975) on six cadavers was critically selected and utilized to compute the percent longitudinal distances of the 12 main joint centers from neighboring bony landmarks, relative to the lengths of the respective proximal and/or distal segments. Three-dimensional positions are attainable as well, by assuming joint centers lay on the respective segment longitudinal axes. The use of a method for accurately locating joint centers is recommended, particularly when they are used as reference points for defining a personalized geometrical model of a subject's body.

Anthropometry↗