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At least 1,513 records · Page 84Linked to original sources
PubMed2006

Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: a randomised, double blind, placebo controlled study of botulinum toxin A.

OBJECTIVE: This randomised, double blind, placebo controlled, two parallel group study was conducted to assess the beneficial effect of injection of botulinum toxin A (Dysport) into the subscapularis muscle on shoulder pain in stroke patients with spastic hemiplegia. METHODS: A single dose of botulinum toxin A (500 Speywood units) or placebo was injected into the subcapularis muscle. Pain was assessed using a 10 point verbal scale. Subscapularis spasticity was assessed by the change in passive shoulder lateral rotation and abduction. Upper limb spasticity was assessed using the Modified Ashworth Scale for shoulder medial rotators, and elbow, wrist and finger flexors. Assessments were carried out at baseline and at weeks 1, 2 and 4. RESULTS: Twenty patients (10 patients per group), 11 with ischaemic stroke and 9 with haemorrhagic stroke, completed the study. Pain improvement with botulinum toxin A was observed from week 1; score difference from baseline at week 4 was 4 points versus 1 point with placebo (p = 0.025). Lateral rotation was also improved, with a statistically significant difference compared with placebo at week 2 (p = 0.05) and week 4 (p = 0.018). A general improvement in upper limb spasticity was observed; it was significant for finger flexors at week 4 (p = 0.025). CONCLUSIONS: Subscapularis injection of botulinum toxin A appears to be of value in the management of shoulder pain in spastic hemiplegic patients. The results confirm the role of spasticity in post-stroke shoulder pain.

Botulinum Toxins, Type A↗
PubMed2004

Work related shoulder disorders: quantitative exposure-response relations with reference to arm posture.

AIMS: To determine quantitative exposure-response relations between work with highly elevated arms and supraspinatus tendinitis, shoulder pain with disability, and shoulder pain without disability. METHODS: A cross sectional study was conducted in a historical cohort of 1886 males from three occupational groups. Exposure measurements were performed for four consecutive working days in a random sample of 72 currently employed subjects. Individual work histories were obtained by questionnaire and register data. Health status was ascertained by physical examination blinded towards exposure and symptoms. Data were analysed by generalised estimating equation and multiple logistic regression with adjustment for potential confounders. RESULTS: For current upper arm elevation above 90 degrees, a duration increment of 1% of the daily working hours was associated with odds ratios of 1.23 (95% CI 1.10 to 1.39) for supraspinatus tendinitis, 1.16 (95% CI 1.08 to 1.24) for shoulder pain with disability, and 1.08 (95% CI 1.04 to 1.13) for shoulder pain without disability. The outcomes were not related to duration of employment in one of the three trades. CONCLUSIONS: Quantitative exposure-response relations were established between current work with highly elevated arms and clinically verified shoulder disorders. Substantial long term cumulative effects were not shown. A potential for primary prevention was revealed.

Adult↗
PubMed2000

Occupational risk factors for shoulder pain: a systematic review.

OBJECTIVES: To systematically evaluate the available evidence on occupational risk factors of shoulder pain. METHODS: Relevant reports were identified by a systematic search of Medline, Embase, Psychlit, Cinahl, and Current Contents. The quality of the methods of all selected publications was assessed by two independent reviewers using a standardised checklist. Details were extracted on the study population, exposures (physical load and psychosocial work environment), and results for the association between exposure variables and shoulder pain. RESULTS: 29 Studies were included in the review; three case-control studies and 26 cross sectional designs. The median method score was 60% of the maximum attainable score. Potential risk factors related to physical load and included heavy work load, awkward postures, repetitive movements, vibration, and duration of employment. Consistent findings were found for repetitive movements, vibration, and duration of employment (odds ratio (OR) 1.4-46 in studies with method scores >/= 60%). Nearly all studies that assessed psychosocial risk factors reported at least one positive association with shoulder pain, but the results were not consistent across studies for either high psychological demands, poor control at work, poor social support, or job dissatisfaction. Studies with a method score >/=60% reported ORs between 1.3 and 4.0. Substantial heterogeneity across studies for methods used for exposure assessment and data analysis impeded statistical pooling of results. CONCLUSIONS: It seems likely that shoulder pain is the result of many factors, including physical load and the psychosocial work environment. The available evidence was not consistent across studies, however, and the associations were generally not strong. Future longitudinal research should evaluate the relative importance of each individual risk factor and the role of potential confounding variables-such as exposure during leisure time-to set priorities for the prevention of shoulder pain in occupational settings.

Bias↗
PubMed2002

MR arthrography of shoulders after suture-anchor Bankart repair.

PURPOSE: To determine the ability of magnetic resonance (MR) arthrography to depict the anatomic reestablishment of the capsulolabral complex after suture-anchor Bankart repair. MATERIALS AND METHODS: Thirty patients (25 men, five women; mean age, 28 years) who had undergone suture-anchor Bankart repair of one shoulder underwent MR arthrography before second-look arthroscopy. Ninety-eight anchors were used for the sutures. MR arthrographic diagnosis of anatomic reestablishment of the capsulolabral complex was correlated with arthroscopic findings. Contingency table analysis was performed to determine the relationship between MR arthrographic findings and arthroscopic findings. RESULTS: MR findings of reattachment of the capsulolabral complex were in agreement with arthroscopic findings in 93 anchor points (accuracy, 93 of 98 anchor points; 95%). In 28 shoulders, oblique transverse images obtained with the shoulder in the abduction and external rotation position showed that the anterior band of the inferior glenohumeral ligament (AIGHL) abutted the humeral head and that reattachment of the AIGHL to the glenoid rim was seamless. Arthroscopy revealed satisfactory reestablishment of the capsulolabral complex in these shoulders. In the remaining two shoulders, a pool of contrast material was seen between the AIGHL and humeral head and a "divot" was detected at the point of reattachment of the AIGHL to the glenoid rim. Arthroscopy revealed unsatisfactory reestablishment of the capsulolabral complex. MR arthrographic findings of reattachment of the AIGHL were significantly associated with arthroscopic findings of reestablishment of the capsulolabral complex (P <.01). CONCLUSION: MR arthrography can be reliably used for the postoperative assessment of suture-anchor Bankart repair.

Adolescent↗
PubMed1986

Shoulder instability: impact of glenohumeral arthrotomography on treatment.

We used arthrotomography to study the glenoid labrum in 114 patients. Sixty-nine of the patients had anatomic instability of the shoulder (including recurrent dislocation and subluxation of the shoulder), and 45 patients had functional instability of the shoulder (denoted by chronic pain, clicking of the joint, and the sensation that an unstable condition exists without the objective signs of it). Labral tears were revealed arthrotomographically in 86% of the patients with anatomic instability, while only 40% of the patients with functional instability had labral abnormalities, and these were primarily of minor severity. Fifty-six patients (44 of whom had anatomic instability; 12, functional instability) required surgery. The surgical findings were correlated with the arthrotomographic findings, and no false-positive results were revealed. However, arthrotomography demonstrated only part of the pathologic condition of two patients. These results confirm that there is a strong correlation between labral pathologic conditions and anatomic instability of the shoulder. Arthrotomographic studies have a great impact on the selection of therapy in cases of both anatomic and functional instability of the shoulder.

Adolescent↗
PubMed2003

Neck dissection shoulder syndrome: quantification and three-dimensional evaluation with an optoelectronic tracking system.

Objective 3-dimensional biomechanical changes of the shoulder at rest or during arm elevation were measured by means of a new specific method using an optoelectronic detection system that was developed for computer-aided surgery. Additionally, the shoulder syndrome following neck dissection was evaluated by the recognized orthopedic shoulder Constant score. The statistical evaluation encompassed 12 patients with unilateral radical neck dissection (RND), 12 patients with unilateral modified radical neck dissection (MRND) with preservation of the accessory nerve, and 10 healthy subjects. The healthy shoulders showed normal kinematic behavior, the so-called "scapulohumeral rhythm" (SHR). After MRND, the static scapular position and SHR showed no significant 3-dimensional variations. In contrast, RND produced a highly significant scapular displacement at rest (p < .01) and a near-total abolition of SHR. The Constant scores were significantly lower after RND than after MRND (p < .01). Three-dimensional evaluation of the shoulder syndrome supports the Constant score, quantifying what can be measured objectively.

Accessory Nerve↗
PubMed1999

Biomechanical analysis of four supports for the subluxed hemiparetic shoulder.

External support systems, such as slings and lapboards, may reduce shoulder subluxation in individuals with hemiplegia. However there is controversy among occupational therapists concerning the most appropriate method to support the affected arm. The purpose of the present paper is to report the biomechanical analysis of four support systems; two shoulder support systems, a Bobath axillary roll, and a laptray. Two dimensional static biomechanical analyses determine the mechanical characteristics of each of these four support systems. The results of the analyses demonstrate the magnitude of the shoulder loading and the effectiveness of the various components of each of the systems. The effect of changing some of the characteristics of the slings is demonstrated. Slings with straps over the unaffected shoulder provide continuous support for the flaccid extremity. The Bobath axillary roll may introduce an unwanted lateral force. Lapboards must be maintained at an appropriate distance from the subluxed shoulder to be effective. This theoretical analysis of supports systems will provide therapists information to help them understand effective supports for subluxation.

Anthropometry↗
PubMedDate not supplied

Prospective evaluation of thermal capsulorrhaphy for shoulder instability: indications and results, two- to five-year follow-up.

BACKGROUND: Thermal shrinkage of capsular tissue has recently been proposed as a means to address the capsular redundancy associated with shoulder instability. Although this procedure has become very popular, minimal peer-reviewed literature is available to justify its widespread use. PURPOSE: To prospectively evaluate the efficacy of arthroscopic electrothermal capsulorrhaphy for the treatment of shoulder instability. STUDY DESIGN: This nonrandomized prospective study evaluated the indications and results of thermal capsulorrhaphy in 84 shoulders with an average follow-up of 38 months. METHODS: Patients were divided into three clinical subgroups: traumatic anterior dislocation (acute or recurrent), recurrent anterior anterior/inferior subluxation without prior dislocation, and multidirectional instability. Patients underwent arthroscopic thermal capsulorrhaphy after initial assessment, radiographs, and failure of a minimum of 3 months of nonoperative rehabilitation. RESULTS: Outcome measures included pain, recurrent instability, return to work/sports, and the American Shoulder and Elbow Surgeons (ASES) Shoulder Assessment score. Overall results were excellent in 33 participants (39%), satisfactory in 20 (24%), and unsatisfactory in 31 (37%). CONCLUSIONS: The high rate of unsatisfactory overall results (37%), documented with longer follow-up, is of great concern. The authors conclude that enthusiasm for thermal capsulorrhaphy should be tempered until further studies document its efficacy.

Adolescent↗
PubMed1989

Use of laser Doppler flowmetry and transcutaneous oxygen tension electrodes to assess local autonomic dysfunction in patients with frozen shoulder.

The laser Doppler flowmeter (LDF), which measures changes in cutaneous blood flow, and the transcutaneous oxygen electrode which measures cutaneous perfusion, were used to study reflex changes in the microcirculation of the shoulder in 38 patients with frozen shoulder and 10 normal controls. In all controls and 22 patients with frozen shoulder, a normal LDF response to inspiration/expiration was observed. In 16 patients with frozen shoulder, LDF responses were either unilaterally or bilaterally absent. Comparison between the two patient groups showed a significant association (chi 2 = 6.43, P less than 0.02) between abnormality of response and the persistence of pain. TcPO2 was in the normal range in all patients and controls. These findings suggest that the LDF together with the TcPO2 may be a useful method of studying the skin microcirculation over the shoulder.

Adult↗
PubMedDate not supplied

The pathophysiology of shoulder instability.

Over the last several decades there has been an improved understanding of the intricate anatomy that provides stability to the glenohumeral joint. In addition, significant advances in identifying the pathologic etiology of the unstable shoulder have occurred because of basic science glenohumeral ligament cutting studies, clinical evaluation, and the advent of arthroscopic evaluation and treatment of the unstable shoulder. This article will review the pertinent anatomy of the normal glenohumeral joint and will carefully review the pathoanatomy found in the unstable shoulder. Sports medicine specialists who treat athletes with unstable shoulders should have a firm understanding of both the normal and pathologic shoulder conditions to be able to provide the best care for these athletes.

Humans↗
PubMedDate not supplied

Relationships between throwing mechanics and shoulder distraction in professional baseball pitchers.

The extreme forces and torques and the high speeds and excessive ranges of motion of baseball pitching place tremendous stress on the soft tissues of the throwing shoulder. Little is known about the relationship between pitching mechanics and shoulder joint stress, especially in professional athletes. The purpose of this study was to quantify joint loads and kinematic parameters of pitching mechanics at the major league level and to study their relationships. Three-dimensional, high-speed video data were collected on 40 professional pitchers during the 1998 Cactus League spring training. A clinically significant distraction force was calculated at the shoulder joint, which reached an average peak value of 947 +/- 162 N (108% +/- 16% body weight). Descriptive statistics and a multiple linear regression analysis were used to relate shoulder distraction to kinematic and kinetic parameters of pitching mechanics. This study was undertaken not only to investigate the peak forces and torques on the shoulder, but also to identify potential areas of intervention that might prevent throwing injuries. Knowledge of joint ranges of motion, angular velocities, and joint-reaction forces can provide a scientific basis for improved preventive and rehabilitative protocols for baseball pitchers.

Adult↗
PubMedDate not supplied

Prospective evaluation of arthroscopic stabilization of acute, initial anterior shoulder dislocations in young athletes. Two- to five-year follow-up.

From March 1992 to November 1998, 57 patients sustained 58 acute, initial, traumatic anterior shoulder dislocations at the United States Military Academy. Six patients selected nonoperative treatment. Three patients underwent primary open repair after diagnostic arthroscopy revealed no Bankart lesion amenable to repair with the bioabsorbable tissue tack. The remaining 48 patients with 49 anterior dislocations were treated with arthroscopic primary repair. There were 45 men and 3 women with an average age of 20 years (range, 17 to 23) and an average follow-up of 37 months (range, 24 to 60). The average Rowe score was 92 (range, 30 to 100). The average single assessment numeric evaluation patient rating was 95.5% (range, 50% to 100%). The average Short Form-36 score (physical function) for the stable shoulders was 99 (range, 95 to 100). Forty-three shoulders remained stable (88%). There were six failures (12%). Factors associated with failure included a history of bilateral shoulder instability, a 2+ sulcus sign, and poor capsulolabral tissue at the time of repair. All patients with stable shoulders returned to their preinjury levels of athletic activity. With follow-up of 5 years, we have observed significantly better results compared with nonoperative treatment in young, active adults at the United States Military Academy.

Acute Disease↗
PubMedDate not supplied

Retroversion of the humerus in the throwing shoulder of college baseball pitchers.

BACKGROUND: Increased external rotation and decreased internal rotation have been noted to occur progressively in the throwing shoulder of baseball pitchers. HYPOTHESIS: Proximal remodeling of the humerus contributes to the rotational asymmetry between shoulders in pitchers. STUDY DESIGN: Descriptive anatomic study. METHODS: Both shoulders of 19 male college baseball pitchers were evaluated and retroversion of the humerus calculated by using the technique of Söderlund et al. Measurements were taken of passive glenohumeral external rotation at 0 degrees and 90 degrees of abduction and internal rotation at 90 degrees of abduction under a 3.5-kg load. Subjects completed a questionnaire on the amount and duration of overhead throwing performed during the ages 8 through 16 years. RESULTS: All of the subjects had greater external rotation at 0 degrees and 90 degrees of abduction, decreased internal rotation at 90 degrees of abduction, and greater retroversion of the humerus in their dominant compared with nondominant shoulders. A significant difference was found between dominant and nondominant external rotation at 0 degrees and 90 degrees of abduction, internal rotation at 90 degrees of abduction, and retroversion of the humerus. In the dominant arm, there was a significant correlation between retroversion of the humerus and external rotation at 0 degrees and 90 degrees of abduction. There was also a significant correlation between the side-to-side difference in retroversion of the humerus compared with the side-to-side difference in external rotation at 90 degrees of abduction. CONCLUSIONS: Rotational changes in the throwing shoulder are due to bony as well as soft tissue adaptations.

Adolescent↗
PubMedDate not supplied

A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations.

BACKGROUND: Nonoperative treatment of traumatic shoulder dislocations leads to a high rate of recurrent dislocations. HYPOTHESIS: Early arthroscopic treatment for shoulder dislocation will result in a lower recurrence rate than nonoperative treatment. STUDY DESIGN: Prospective, randomized clinical trial. METHODS: Two groups of patients were studied to compare nonoperative treatment with arthroscopic Bankart repair for acute, traumatic shoulder dislocations in young athletes. Fourteen nonoperatively treated patients underwent 4 weeks of immobilization followed by a supervised rehabilitation program. Ten operatively treated patients underwent arthroscopic Bankart repair with a bioabsorbable tack followed by the same rehabilitation protocol as the nonoperatively treated patients. The average follow-up was 36 months. RESULTS: Three patients were lost to follow-up. Twelve nonoperatively treated patients remained for follow-up. Nine of these (75%) developed recurrent instability. Six of the nine have required subsequent open Bankart repair for recurrent instability. Of the nine operatively treated patients available for follow-up, only one (11.1%) developed recurrent instability. CONCLUSIONS: Arthroscopic stabilization of traumatic, first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional, nonoperative treatment.

Accidental Falls↗
PubMed2004

Excessive humeral external rotation results in increased shoulder laxity.

BACKGROUND: The quantitative relationship between increased anterior shoulder laxity and increased humeral external rotation observed in throwers remains unclear. HYPOTHESIS: An elongated anterior capsule, especially the anterior band of the inferior glenohumeral ligament, produced by excessive humeral external rotation will result in increased anterior shoulder laxity and increased humeral external rotation. STUDY DESIGN: Controlled laboratory study. METHODS: Seven cadaveric shoulders were tested to measure the humeral rotational range of motion, glenohumeral translations, and length of the anterior band of the inferior glenohumeral ligament. Data were collected for the intact shoulders and after nondestructive stretching of 10%, 20%, and 30% beyond maximum humeral external rotation. RESULTS: Nondestructive excessive external rotational stretching resulted in a significant increase in superior (30%, 3.3 mm) and inferior (30%, 2.3 mm) length of the anterior band of the inferior glenohumeral ligament, external rotation (30%, 35 degrees), and anterior (30%, 2.4 mm), inferior (30%, 2.2 mm), and anterior-posterior (30%, 5.1 mm) translations. There were significant positive linear correlations between the length of the anterior band of the inferior glenohumeral ligament, external rotation, and anterior translation. CONCLUSIONS: Excessive humeral external rotation results in an elongation of the anterior band of the inferior glenohumeral ligament and an increase in anterior and inferior glenohumeral translations and humeral external rotation. CLINICAL RELEVANCE: Repetitive excessive humeral external rotation observed in throwers may be one of the biomechanical causes for increased shoulder laxity and increased humeral external rotation.

Adult↗
PubMed2005

Arthroscopic anterior shoulder stabilization of collision and contact athletes.

BACKGROUND: Repair of the anterior labrum (Bankart lesion) with tightening of the ligaments (capsulorrhaphy) is the recommended treatment for recurrent anterior glenohumeral dislocations. Current evidence suggests that arthroscopic anterior stabilization methods yield similar failure rates for resubluxation and redislocation when compared to open techniques. STUDY DESIGN: Case series; Level of evidence, 4 PURPOSE: To examine the results of arthroscopic anterior shoulder stabilization of high-demand collision and contact athletes. METHODS: Thirteen collision and 5 contact athletes were identified from the senior surgeon's case registry. Analysis was limited to patients younger than 20 years who were involved in collision (football) or contact (wrestling, soccer) athletics. Objective testing included preoperative and postoperative range of motion and stability. Outcome measures included the American Shoulder and Elbow Society shoulder score, Simple Shoulder Test, SF-36, and Rowe scores. The surgical procedure was performed in a consistent manner: suture anchor repair of the displaced labrum, capsulorrhaphy with suture placement supplemented with thermal treatment of the capsule when indicated, and occasional rotator interval closure. Average follow-up was 37 months (range, 24-66 months). RESULTS: Two of 18 contact and collision athletes (11%) experienced recurrent dislocations after the procedure; both were collision athletes. One returned to play 3 years of high school football but failed after diving into a pool. One patient failed in his second season after his stabilization (>2 years) when making a tackle. None of the contact athletes experienced a recurrent dislocation, with all of them returning to high school or college athletics. CONCLUSIONS: One hundred percent of all collision and contact athletes returned to organized high school or college sports. Fifteen percent of those collision athletes had a recurrence, which has not required treatment. Participation in collision and contact athletics is not a contraindication for arthroscopic anterior shoulder stabilization using suture anchors, proper suture placement, capsulorrhaphy, and occasional rotator interval plication.

Adolescent↗
PubMed2005

A modified capsular shift for atraumatic anterior-inferior shoulder instability.

PURPOSE: To evaluate the long-term outcome of a modified inferior capsular shift procedure in patients with atraumatic anterior-inferior shoulder instability by analyzing a consecutive series of patients who had undergone a modified inferior capsular shift for this specific type of shoulder instability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1992 and 1997, 38 shoulders of 35 patients with atraumatic anterior-inferior shoulder instability that were unresponsive to nonoperative management were operated on using a modified capsular shift procedure with longitudinal incision of the capsule medially and a bony fixation of the inferior flap to the glenoid and labrum in the 1 o'clock to 3 o'clock position. The patient study group consisted of 9 men and 26 women with a mean age of 25.4 years (range, 15-55 years) at the time of surgery. The mean follow-up was 7.4 years (range, 4.0-11.4 years); 1 patient was lost to follow-up directly after surgery. The study group was evaluated according to the Rowe score. RESULTS: After 7.4 years, 2 patients experienced a single redislocation or resubluxation, 1 patient had recurrent dislocations, and 1 patient had a positive apprehension sign, which is an overall redislocation rate of 10.5%. The average Rowe score increased to 90.6 (SD = 19.7) points from 36.2 (SD = 13.5) points before surgery. Seventy-two percent of the patients participating in sports returned to their preoperative level of competition. CONCLUSIONS: Results in this series demonstrate the efficacy and durability of a modified capsular shift procedure for the treatment of atraumatic anterior-inferior shoulder instability.

Adolescent↗
PubMed2006

The effect of the inferior capsular shift on shoulder intra-articular pressure: a cadaveric study.

BACKGROUND: The inferior capsular shift procedure is commonly performed for multidirectional instability of the shoulder with excellent clinical results. HYPOTHESIS: The mechanism of this procedure is to increase shoulder stability by changing the responsiveness of intra-articular pressure to downward loading. STUDY DESIGN: Controlled laboratory study. METHODS: In 7 fresh-frozen cadaveric shoulders, inferior capsular shift was simulated by imbricating the anterior and posterior capsule using clamps. The position was monitored using an electromagnetic tracking device with the glenohumeral joint capsule intact, imbricated anteriorly, or imbricated anteriorly and posteriorly and with the inferior load of 0, 0.5, or 1.0 kg. Simultaneously, intra-articular pressure was monitored using a pressure transducer. Saline was injected into the glenohumeral joint to measure capsular volume. The capsule was vented, and the position was again measured. RESULTS: Intra-articular pressure was -71 +/- 19, -221 +/- 70, and -366 +/- 73 cm H(2)O with 0, 0.5, and 1.0 kg of load, respectively, with the capsule intact. With anterior imbrication, intra-articular pressure decreased to -79 +/- 10, -274 +/- 103, and -460 +/- 135 cm H(2)O, respectively, and with anterior and posterior imbrication, intra-articular pressure further decreased to -87 +/- 16, -308 +/- 74, and -548 +/- 39 cm H(2)O, respectively. The volume of the intact shoulder (36 +/- 9 mL) significantly decreased to 27 +/- 7 mL (75%) with anterior imbrication and to 15 +/- 5 mL (42%) with anterior and posterior imbrications (P = .0001). Before venting the capsule, inferior displacement was 5% of the vertical length of the glenoid, even with 1.0 kg of load with any capsular conditions. After venting, the humeral head dislocated inferiorly in all shoulders, even after imbrications. CONCLUSION: The inferior capsular shift procedure decreases joint volume and increases responsiveness of intra-articular pressure to downward loading. CLINICAL RELEVANCE: Biomechanical data provide scientific background to the commonly performed procedures of inferior capsular shift and thermal capsular shrinkage.

Adult↗