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At least 1,513 records · Page 84Linked to original sources
PubMed1991

Residual sensorimotor functions in a patient after right-sided hemispherectomy.

Sensorimotor functions were examined in a patient with left-sided infantile hemiparesis who underwent hemispherectomy (HS) on the right side at age 18 for intractable epilepsy. Pathological examination of the removed hemisphere showed a porencephalic cyst of the temporal lobe and of the frontoparietal operculum. On examination, the patient had hemianopia to the left and sensorimotor deficits only of the distal limbs contralateral to the HS. She walked with a barely perceptible limp. Axial and proximal movements were quasi normal, so that the patient could fully elevate both arms, flex and extend the forearm with nearly normal power and execute small, isolated precision movements of the arm around the shoulder joint. This astonishing proximal motor repertoire was mimicked on the somatosensory side where cutaneous sensation and kinesthesia were normal above the elbow and knee and contrasted the pronounced distal sensorimotor dysfunctions. Movement analysis by means of an optoelectronic two-camera position analysis system (Selspot II) showed normal flexion-extension synergies during gait, but abnormal synergic coupling between the shoulder and elbow joint during reaching and prehension. Distal movements were still possible but could only be performed as rigidly coupled movement synergies, such as closing and opening of the fist along with arm adduction/flexion or abduction/extension. She could engage these synergies for grasping and holding large objects. The performance of individual, fractionated finger movements was impossible. Involuntary mirror movements were elicited in both the affected and the normal arm, but with distinctly different phase relationships, indicating that different circuitries contribute to their generation. The case study reveals the existence of a bilaterally organized sensorimotor system that has the potential to provide quasi normal performance of the axial-proximal body parts on both sides. This raises the question why this potential cannot be better used in cases with only partial unilateral brain damage and persistent hemiplegia.

Arachnoid Cysts↗
PubMed2005

Histopathological studies of experimental lyme disease in the dog.

Experimental borrelia infection was induced in 62 specific--pathogen-free beagle dogs by exposure to Ixodes scapularis ticks harbouring the spirochaete Borrelia burgdorferi. Clinical signs of Lyme disease occurred in 39/62 dogs, the remaining 23 being subclinically infected. Clinical signs consisted of one to six episodes of transitory lameness with joint swelling and pain, most commonly affecting the elbow or shoulder joints. The polymerase chain reaction and culture demonstrated that the dogs remained infected for up to 581 days. At necropsy, gross findings consisted of lymphadenopathy in the area of tick attachment. Microscopical changes consisted of effusive fibrinosuppurative inflammation or nonsuppurative inflammation, or both, affecting synovial membranes, joint capsules and associated tendon sheaths. Plasma cells dominated areas of chronic inflammation, with CD3(+) T cells being present in lesser numbers. Microscopical signs of arthritis were polyarticular and more widespread than indicated by clinical signs, and most of the subclinically affected animals also had synovitis. In areas of tick attachment to the skin, hyperkeratosis and a mixture of suppurative and nonsuppurative dermatitis were encountered. Lymphadenopathy in superficial lymph nodes resulted from follicular and parafollicular hyperplasia. In 14/62 dogs, lymphoplasmacytic periarteritis and perineuritis were noted, resembling lesions found in human Lyme disease and syphilis, in which an underlying microangiopathy has been proposed.

Animals↗
PubMedDate not supplied

[Focal osteochondral necrosis of the femoral head of an adult after Legg-Calve-Perthes disease in childhood].

In the treatment of circumscribed osteochondral lesions of the knee and the ankle joint autologous osteochondral transplantation (AOT) has been established as one of the possible operative therapies. However, there is less experience with the use of AOT on other joints (shoulder, elbow). The care of osteochondral defects of the hip joint with autologous osteochondral transplantation can still be regarded as an absolute rarity. Facing a focal osteochondral necrosis in a young female adult after LCP disease in childhood, we report about an autologous osteochondral transplantation at the femoral head using the diamond bone cutting system.

Adult↗
PubMed1996

[Osteolysis of the lateral clavicle after Tossy II injury in ice hockey players].

Injuries of the acromioclavicular joint in hockey mainly occur after trauma directly to the shoulder joint. E.g. at a fall against the border, onto the ground or in case of a body check. Tossy-III-lesions lead directly to surgery meanwhile type Tossy-II-lesions are mainly treated conservatively. Despite healing of the acromioclavicular ligaments often acromioclavicular joint pain remains despite conservative treatment because of discuss lesions or a osteolysis of the lateral end of the clavicle. The resection of the lateral end of the clavicle with certain pain relief, very good functional results and quick full level participation in hockey has been shown as the method of choice in our patients.

Acromioclavicular Joint↗
PubMed1997

Hemodialysis-related arthropathy. A prospective MR study with SE and GRE sequences.

PURPOSE: A prospective examination of hemodialysis-related arthropathy by MR imaging with SE and GRE sequences was undertaken to verify whether the low signal intensity on T2-weighted SE images is caused by a paramagnetic susceptibility effect derived from amyloid or from hemosiderin. MATERIAL AND METHODS: Twenty-seven joints (19 hip joints, 6 discovertebral joints of 5 lumbosacral spines and 1 cervical spine, 2 shoulder joints) in 14 patients undergoing long-term hemodialysis (duration 10-22 years, mean 17) were examined with SE T1-weighted, T2-weighted and GRE T2*-weighted sequences. RESULTS: The signal intensity of the intraarticular and periarticular masses of the involved joints was basically isointense to the muscle in all 3 pulse sequences. No significantly low signal area was found on GRE T2*-weighted images. CONCLUSION: The low signal areas in the hemodialysis-related arthropathy on SE T2-weighted images are not caused by a paramagnetic susceptibility effect, but probably by the hypocellular and fibrous nature of amyloid-containing tissues. Therefore the GRE sequence can be helpful for differentiating hemodialysis-related amyloid arthropathy from chronic hemarthrosis or juxta-articular brown tumor.

Adult↗
PubMed2005

Lessons learnt from the painful shoulder; a case series of malignant shoulder girdle tumours misdiagnosed as frozen shoulder.

Adhesive capsulitis or frozen shoulder is a common condition characterized by shoulder pain and stiffness. In patients in whom conservative measures have failed, more invasive interventions such as arthrographic or arthroscopic distension can be very effective in relieving symptoms and improving range of movement. However, absolute contraindications to these procedures include the presence of neoplasia around the shoulder girdle. We present five cases referred to our institution where the diagnosis of shoulder joint malignancy was delayed, following prolonged, ineffective treatment for frozen shoulder. These cases highlight the importance of careful review of the radiology and the need for reconsideration of the diagnosis in refractory "frozen shoulder".

Journal Article↗
PubMed2006

Gait abnormalities caused by selective anesthesia of the suprascapular nerve in horses.

OBJECTIVE: To assess gait abnormalities associated with selective anesthesia of the suprascapular nerve (SSN) achieved by use of perineural catheterization and thereby determine the function of that nerve as it relates to gait in horses. ANIMALS: 3 adult horses with no preexisting clinically apparent lameness at a walk. PROCEDURE: Each horse was anesthetized; the right SSN was exposed surgically for placement of a perineural catheter to permit delivery of 1 mL of 2% mepivacaine hydrochloride. Six hours after recovery from anesthesia, each horse was videotaped while walking (50-step data acquisition period) before and after administration of mepivacaine. Videotapes were reviewed and the proportion of abnormal steps before and after selective SSN anesthesia was assessed. A step was considered abnormal if a marked amount of scapulohumeral joint instability (ie, lateral luxation of the proximal portion of the humerus) was observed during the weight-bearing phase of the stride. RESULTS: Clinically apparent gait dysfunction was detected in all 3 horses following perineural administration of the local anesthetic agent. Anesthesia of the SSN resulted in scapulohumeral joint instability as evidenced by consistent lateral excursion of the shoulder region during the weight-bearing phase of gait at a walk. The proportion of abnormal steps before and after SSN anesthesia was significantly different in all 3 horses. CONCLUSIONS AND CLINICAL RELEVANCE: These data support the role of the SSN in shoulder joint stability in horses and define SSN dysfunction as 1 mechanism by which the syndrome and gait dysfunction clinically referred to as sweeny may develop.

Anesthesia, Local↗
PubMed2000

Operative treatment of medial rotation contracture of the shoulder caused by obstetric brachial plexus palsy.

OBJECTIVE: To introduce an operation of subscapularis slide from its origin and anterior release from its insertion for treatment of medial rotation contracture, subluxation and dislocation of the shoulder caused by obstetric brachial plexus palsy (OBPP). METHODS: Thirty-six cases with medial rotation contracture of the shoulder were diagnosed by measurement of the inferior glenohumeral angle, passive lateral rotation of the shoulder and plain radiographs. Subscapularis slide was performed in 24 cases with simple medial rotation contracture, and anterior release in 12 cases with complex contracture-medial rotation contracture combined with subluxation, dislocation, or other deformities of the shoulder joint. Systems of Mallet scoring and Gilbert grading for the shoulder were used to evaluate the postoperative shoulder function. RESULTS: With follow up for a minimum of six months, 32 cases got apparent gains from operations, accounting for 88.8% of the total operated on. The younger the child was, the better the result. Of 4 cases with no operative effects, 3 had no flexion of the elbow preoperatively, suggesting a poor recovery of the upper trunk of the brachial plexus; the rest one had no repair of the severed subscapularis tendon. CONCLUSIONS: Subscapularis slide and anterior release of the shoulder are effective for treatment of medial rotation contracture as well as its consequence of subluxation and dislocation of the shoulder in OBPP. The operative effect is related to children's age and the recovery extent of the upper trunk of the brachial plexus.

Journal Article↗
PubMed1987

The relationship between dead arm syndrome and thoracic outlet syndrome.

A relationship exists between anterior shoulder subluxation and thoracic outlet syndrome that is responsible for the more florid symptoms of dead arm syndrome (DAS) in some patients. This relationship was demonstrated in eight of 27 patients (30%) in a consecutive series of Bankart operations for treatment of subluxation. The mechanism is associated with a disturbance in the kinesiology of the shoulder-joint complex that alters the position of the scapula relative to the rib cage and neurovascular supply to the upper limb. Therapy is directed toward restoration of the stability of the glenohumeral joint so that normal biomechanics can be reestablished. In advanced stages of thoracic outlet syndrome, however, DAS may initially require surgical decompression of the nerves and vessels. Careful attention to postural mechanics is essential for rational diagnosis and treatment of DAS.

Adult↗
PubMed1993

Treatment of rheumatoid arthritis with radionuclide combination.

Radiation synovectomy (RSIN) with radionuclide combination (N) was performed in 135 patients with rheumatoid arthritis or 417 joints: 155 knee joints (90Y), 230 MCF or PIF joints (169Er), 17 ankle, 7 wrist, 6 elbow and 2 shoulder joints (186Re). Therapeutic effect was followed up during 8 year period. After 3 years positive effect of the treatment was achieved in 70-80% of cases and complete treatment in 50-60% of cases, while 8 years later the same effects were maintained in 55-60%, i.e. 35-40% of the treated joints. The best effect was achieved in the treatment of the knee and the worst in the treatment of the wrist joint. At simultaneous application of one or several different RN, the total dose for one patient did not exceed 259 MBq while the maximum dose was 695 MBq during the long-term treatment.

Adult↗
PubMed1998

[Indications for shoulder prosthetics in degenerative and inflammatory diseases].

Shoulder arthroplasty has since it's more widespread introduction in the early seventies found a general acceptance as an excellent tool for treating late stage arthritis of the shoulder joint. The indications will vary from primary osteoarthritic disease to inflammatory diseases such as rheumatoid arthritis, or psoriatric arthritis. It is also used as a primary tool in multifragmented shoulder fractures, which can not be restored anatomically, or are felt at risk for avascular necrosis. The surgeon setting out for this procedure has to decide whether a total arthroplasty is required in cases with glenoid destruction, or at risk of developing secondary degenerative changes in the glenoid early on. A hemiarthroplasty will only replace the humeral side of the joint, but while well accepted in the fracture patient, the arthritic patients tend to fare better with a total joint replacement for pain relief.

Arthritis, Psoriatic↗
PubMed2002

[Current concepts in treatment of rotator cuff tears].

The expectation of a functional shoulder joint, even in advanced age, the growing experience and success in shoulder surgery have brought the operative treatment another step further. The goal of any advanced knowledge should be a proper treatment of the patients and the pathology. Complex rotator cuff tears can be repaired by means of muscle transfer and partial reconstruction. In cases of irreparable rotator cuff tear arthropathy prosthetic replacement of the gleno-humeral joint can be performed. In this article a review on the different techniques and indications for rotator cuff repair is given.

Arthroscopy↗
PubMed1999

Challenges of rehabilitation after shoulder surgery.

The shoulder joint is a complex structure that requires intricate precision to function purposefully, with full motion, synchronous patterns, and high endurance. Injury and trauma hamper this process, and surgery represents significant traumatic stress for any joint. Any surgical procedure may be accompanied by consequences that, left untreated, can develop into problems that result in dysfunctional performance of daily living and sports activities. This article addresses common challenges resulting from shoulder surgery and some of the treatments that can be administered to minimize problems.

Activities of Daily Living↗
PubMed2003

Interjoint coordination dynamics during reaching in stroke.

A technique is described that characterizes the dynamics of the interjoint coordination of arm reaching movements in healthy subjects (n=10) and in patients who had sustained a left-sided cerebrovascular accident (n=18). All participants were right-handed. Data from the affected right arm of patients with stroke were compared with those from the right arm of healthy subjects. Seated subjects made 25 pointing movements in a single session. Movements were made from an initial target located ipsilaterally to the right arm beside the body, to a final target located in front of the subject in the contralateral arm workspace. Kinematic data from the finger, wrist, elbow, both shoulders and sternum were recorded in three dimensions at 200 Hz with an optical tracking system. Analysis of interjoint coordination was based on the patterns of temporal delay between rotations at two adjacent joints (shoulder and elbow). The data were reduced to a single graph (Temporal Coordination or TC index) integrating the essential temporal characteristics of joint movement (the angular displacements, velocities and timing). TC segments, duration and amplitude, were analysed. The analysis was sensitive to the differences in interjoint coordination between healthy subjects and patients with arm motor deficits. In patients, the temporal coordination between elbow and shoulder movements was disrupted from the middle to the end of the reach. More specifically, in mid-reach, all patients had difficulty coordinating elbow flexion with shoulder horizontal adduction. In addition, patients with severe arm hemiparesis had difficulty changing elbow movement direction from flexion to extension and in coordinating this change with shoulder movement. At the end of the reach, patients with severe hemiparesis had deficits in the execution of elbow extension while all patients had impaired coordination of elbow extension and shoulder horizontal adduction. In addition, active ranges of joint motions were significantly decreased in the stroke compared to the healthy subjects. Finally, TC analysis revealed significant relationships between specific aspects of disrupted interjoint coordination and the level of motor impairment, suggesting that it may be a useful tool in the identification of specific movement coordination deficits in neurological impaired populations that can be targeted in treatment for arm motor recovery.

Adult↗
PubMed1981

"Milwaukee shoulder"--association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. I. Clinical aspects.

Four women, aged 63 to 90 years old, presented with mildly painful shoulders of decreased mobility or stability. Radiographic evidence of a complete tear of the fibrous rotator cuff was present in 7 of 8 shoulder joints. Microspheroids containing hydroxyapatite crystals were seen by scanning electronmicroscopy in 12 of 13 synovial fluid samples. All synovial fluids showed activated collagenase and neutral protease activity. This constellation of findings represents a heretofore undescribed syndrome which we have designated "Milwaukee shoulder."

Aged↗
PubMedDate not supplied

A new kind of rehabilitation after Neer capsuloplasty: results.

The shoulder joint constitutes a sophisticated compromise between stability and movement: trauma such as dislocation and the surgery that follows to restore anatomical integrity, may cause a change in this balance, resulting in myofascial retraction, neuromotorial inhibition, and a deviation in motorial programming with the appearance of compensation. It is the purpose of this study to report the results obtained with a specific rehabilitation program in 18 patients submitted to Neer capsuloplasty to treat anterior shoulder instability. An objective and subjective study with pre-established stages, and a 12-month follow-up was done, to evaluate the results obtained based on the Rowe scale.

Adolescent↗
PubMed1990

Normal functional range of motion of upper limb joints during performance of three feeding activities.

This study was designed to quantify the range of upper limb joint motion required during the performance of a specific type of functional activity. Ten able-bodied men were studied as they performed three feeding tasks--eating with a spoon, eating with a fork, and drinking from a handled cup. Three shoulder joint rotations, one elbow joint rotation, one forearm joint rotation, and three wrist joint rotations were quantified simultaneously using a three-dimensional measurement system. It was found that the required ranges of motion for the feeding tasks were 5 degrees to 45 degrees shoulder flexion, 5 degrees to 35 degrees shoulder abduction, 5 degrees to 25 degrees shoulder internal rotation, 70 degrees to 130 degrees elbow flexion, from 40 degrees forearm pronation to 60 degrees forearm supination, from 10 degrees wrist flexion to 25 degrees wrist extension, and from 20 degrees wrist ulnar deviation to 5 degrees wrist radial deviation. Wrist rotation was also measured, but it was found to be negligible.

Adult↗
PubMedDate not supplied

[Distribution pattern of subchondral mineralization in the glenoid cavity in normal subjects, athletes and patients].

To get information on the stresses acting on the shoulder joint, the distribution of subchondral mineralisation was examined by means of CT-Osteo-absorptiometry in the glenoid cavity in healthy people, athletes and patients. In young persons two density maxima are found ventrally and dorsally older persons, however, show a centrally located maximum which suggests a different joint mechanics in different ages depending on the decreasing physiological incongruence. In gymnasts the overall mineralisation is significantly higher, maxima are found centrally or shifted dorsally. In patients with recurrent dislocation of the shoulder or instability the zone of highest density is shifted to the edges of the glenoid cavity indicating that the prevailing position of the resultant force is excentric. By means of CT-Osteo-absorptiometry these individual patterns of mineralisation can be displayed in the living and can give information on the individual mechanical situation ("loading history") of a joint.

Absorptiometry, Photon↗