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At least 1,549 records · Page 86Linked to original sources
PubMed1993

Intraarticular pressure of the shoulder.

Nine fresh frozen cadaveric shoulders were used to examine the changes in intraarticular pressure (IAP) of the shoulder joint and the position of the humeral head under various loads to determine the relationship between these parameters. All the soft tissues superficial to the rotator cuff were removed. The position of the humerus relative to the scapula was monitored using an electromagnetic tracking system before and after venting the capsule with 0, 0.5, and 1.0 kg of load applied to the humerus inferiorly in addition to the weight of the arm. Simultaneously, the IAP was monitored using a pressure transducer before venting the capsule. Venting had a significant effect on the position of the humeral head: the positions of the head after venting were significantly lowered in all loading conditions. The average IAP was -76 cm H2O without load, and the value decreased in a linear fashion with increased load; the correlations were significant in four of six shoulders without dislocation. The correlations were less significant between the pressure and the position, and there were no significant correlations between the load and the position. IAP, which is determined primarily by the load applied, is important to stabilize the shoulder inferiorly. Because IAP is intimately related to the external load and the response is specific to individuals, examination of IAP response to external load may be helpful in characterizing various instabilities of the shoulder.

Cadaver↗
PubMedDate not supplied

Strength of the glenoid labrum and adjacent shoulder capsule.

This study evaluates the role of the glenoid labrum and capsule in the prevention of shoulder dislocation. Fifteen shoulder joints from nine fresh cadavers were used. The labrum and capsule were cut into sections 5 mm wide, and the strength of each slice to rupture was measured. The rupture site was observed microscopically. The anterior-inferior portion was the weakest, with a mean force necessary to cause rupture of 3.84 +/- 1.00 kg/5 mm. The rupture site was the portion of the labrum close to the cartilage of the glenoid. Histologic structure and degenerative changes of the labrum did not differ in the anterior to posterior portions. These results show that the anterior-inferior portion of the labrum is relatively weak. This finding may explain the lesion commonly identified in anterior shoulder dislocation.

Aged↗
PubMed2002

Ultrasound-guided, high-energy extracorporeal - shock-wave treatment of symptomatic calcareous tendinopathy of the shoulder.

BACKGROUND: The objective of the present study was to test the effectiveness of ultrasound-guided high-energy extracorporeal shock-wave treatment in symptomatic chronic calcareous tendinopathy of the shoulder rotator cuff, and to assess the morphology of the hydroxyapatite deposits before and after this treatment. METHODS: The study involved 80 patients who suffered from calcification of the rotator cuff. These patients were treated with an instrument with electromagnetic induction of shock-waves (Doli-Lithotripter, Dornier, Munich, Germany) under continuous ultrasound location of the treatment focus. The treatments were carried out in one to five sessions at an interval of 4-6 weeks. Each patient received a total of 1800 shock waves in each therapy. The flow density of the energy in the therapy focus was 0.08-0.42 mJ/mm2. RESULTS: Sixty-eight patients (85%) attained complete freedom from symptoms or only had minimal residual symptoms when stressing their shoulder joint. The calcification suffered by 57 (71.2%) patients was completely resorbed after treatment and partially resorbed in 16 patients (20%). Complete resorption of the calcareous deposits led to freedom from symptoms. In all patients with amorphous calcareous deposits, there was complete resorption of the calcification. Mixed calcareous foci were eliminated in 64.7-77% of the cases, depending on the extent of amorphous structures. Complete resorption was achieved in 44.4% of patients where homogeneous calcareous deposits were >1 cm in size. CONCLUSION: Shock-wave treatment in periarthritis of the shoulder is a new and very effective method for symptomatic calcareous tendinopathy. Extracorporeal shock-wave treatment has good prospects of success in any type of calcification. As a non-invasive technique with a high success rate, shock-wave treatment is an alternative to surgical operations in patients who remain symptomatic after exhaustive conservative treatment.

Adult↗
PubMed1993

[Nerve lesions after acute anterior dislocation of the humero-scapular joint--electrodiagnostic study].

We present a pilot seria of 18 patients with acute anterior dislocation of the shoulder joint following simple trauma. All the patients underwent conservative treatment using a standard Kocher technique. In the majority of cases muscular spasm and pain rendered through neurological examination difficult to perform. All patients were, therefore, submitted to extensive electrodiagnostic procedure which revealed a nerve injury on half of them. Such high incidence was, probably, due to the increased age (17 out 18 patients were over 40 years old), and rather traumatic reduction procedure. The axillary nerve was the most frequently affected (38.8%), either alone or in combination with musculocutaneus nerve. Comparing to previous reports in the literature, we found musculocutaneus nerve lesion in a rather high number of patients (22%). Extensive electrodiagnostic study is therefore recommended when further treatment and prognosis of anterior dislocation of the shoulder are taken in consideration.

Acute Disease↗
PubMed2006

Innervation patterns of the inferior glenohumeral ligament: anatomical and biomechanical relevance.

Although the Inferior Glenohumeral Ligament (IGHL) has a well known mechanical and proprioceptive relevance in shoulder stability, the interrelation of the ligament's anatomical disposition/innervation has not actually been described previously. The purpose of the study was to determine the IGHL innervation patterns and relate them to dislocation. Forty-five embalmed and 16 fresh-frozen human cadaveric shoulders were studied. Masson's Trichrome staining detailed the intraligamentous nerve fiber arrangements. The effect on the articular nerves of an anteroinferior dislocation of the shoulder joint and the position of 60 degrees abduction and 45 degrees external rotation was studied dynamically. The axillary nerve provided IGHL innervation in 95.08% of the cases. We saw two distinct innervation patterns originating from the axillary nerve. In Type 1, one or two collaterals diverged later from the main trunk to enter the ligament. Type 2 showed innervation to the ligament provided by the posterior branch for three to four neural branches. In both cases, these branches enter the ligament near the glenoid rim and at the 7 o'clock position (right shoulder). The radial nerve (Type 3 innervation pattern) provided IGHL innervation in 3.28% of the cases. Microscopic analysis revealed wavy intraligamentous neural branches. The articular branches relaxed and separated from the capsule at the apprehension position and stayed intact after dislocation. These results showed a special predisposition to avoid possible denervation and suggested that the neural arch probably remains unaffected after most dislocations. Knowledge of the neural anatomy of the shoulder will clearly help in avoiding its injury in surgical procedures.

Aged↗
PubMed1993

[Shoulder instability and pain. Computerized arthro-tomography assessment].

The growing interest in shoulder joint imaging comes from the ever-increasing demand for such an examination in orthopedics. Since more complete and detailed imaging of bone, capsuloligamentous and musculotendinous compartments is always needed, CT arthrography has necessarily become a widely used method. In this study, 282 patients were investigated with CT arthrography. Seventy per cent of them had anatomical instability, 17.3% had functional instability and the extant 12.7% had shoulder pain. In traumatic instability, the most often injured structures were the glenoid labra (91%) and the capsule (82%). Lesions in the two structures were nearly always associated. Moreover, high incidence (65.8%) of Hill-Sachs lesions of the humeral head was observed. In atraumatic instability, abnormal anteversion of the scapular glenoid was always detected. In the patients with shoulder pain, the most common causes were the impingement syndrome (30.5%), superior labrum lesions (16.7%), adhesive capsulitis (16.7%) and synovial osteochondromatosis (13.7%). With CT arthrography, labial abnormalities (detachments, tears, amputations, eversions and degeneration) can be identified, as well as capsular lesions (insertional detachment and laxity), rotator cuff conditions (bursitis, tendinitis and partial/complete tears), biceps tendon abnormalities and glenoid rim and humeral head fractures. Moreover, CT arthrography is minimally invasive and well tolerated. It exhibits 97.7% specificity, 91% sensitivity and 96% accuracy. Furthermore, it has been proven to be extremely useful in treatment and surgical planning.

Adolescent↗
PubMed1982

[The post-traumatic frozen shoulder].

The post-traumatic frozen shoulder is a sickness which develops relatively frequently following even small injuries of the shoulder joint. The particular anatomic conditions of this joint are the cause of its frequent lesions. After an injury typical pathological changes in function are observed. Most common injuries are distorsions, contusions, luxations and especially in increasing age the subcapital fractures of the humerus. Other injuries as there are rupture of the acromio-clavicular joint, fractures of the clavicle or scapula may also cause a frozen shoulder. The clinical examination is most important as it is the basis of the therapy. The current procedure consists of intensive physical therapy. If this treatment is not successful other ways must be discussed, e.g. mobilisation under anaesthesia. Operative treatment has a very strict indication. Medico-legal points of view of the frozen shoulder are difficult but a connection between injury and degenerative changes ought not to be denied in clear cases.

Adult↗
PubMed1998

Axillary nerve injuries in contact sports: recommendations for treatment and rehabilitation.

Axillary nerve injuries are some of the most common peripheral nerve injuries in athletes who participate in contact sports. Resulting deltoid muscle paralysis is secondary to nerve trauma which occurs following shoulder dislocation or a direct blow to the deltoid muscle. Compression neuropathy has been reported to occur in quadrilateral space syndrome as the axillary nerve exits this anatomic compartment. The axillary nerve is also extremely vulnerable during any operative procedure involving the inferior aspect of the shoulder, and iatrogenic injury to the axillary nerve remains a serious complication of shoulder surgery. Accurate diagnosis of axillary nerve injury is based on a careful history and physical examination as well as an understanding of the anatomy of the shoulder and the axillary nerve in particular. Inspection, palpation and neurological testing provide the bases for diagnosis. A clinically suspected axillary nerve injury should be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. During the acute phase of injury, the athlete should be rested and any ligamentous or bony injury should be treated as indicated. Patients should undergo an extensive rehabilitation programme emphasising active and passive range of motion as well as strengthening of the rotator cuff, deltoid and periscapular musculature. Shoulder joint contracture should be avoided at all costs as a loss of shoulder mobility may ultimately affect functional outcome despite a return of axillary nerve function. If no axillary nerve recovery is observed by 3 to 4 months following injury, surgical exploration is indicated. Athletes who sustain injury to the axillary nerve have a variable prognosis for nerve recovery, although the return of function of the involved shoulder is typically good to excellent. We recommend that athletes who sustain axillary nerve injury may return to contact sport participation when they achieve full active range of motion of the shoulder and when shoulder strength is documented to be good to excellent by isometric or manual muscle testing.

Athletic Injuries↗
PubMed2005

Psoriatic arthritis: a retrospective study of 162 patients.

AIM: The aim of our study was to determine the prevalence of psoriatic arthritis in the patients with psoriasis and to analyze retrospectively the results of a 34-year multidisciplinary management of the patients with psoriatic arthritis. METHODS: The study included 162 out of 183 treated patients with psoriatic arthritis, aged 48 +/- 15 years. All the patients satisfied the current diagnostic criteria for psoriasis and psoriatic arthritis according to the American College of Rheumatology. RESULTS: Psoriatic arthritis developed in 183 (9.3%) out of 1976 patients with psoriasis. Time interval for establishing the diagnosis was 4 years. A positive family history of the disease had 15.0% of the studied patients. Its onset was most often at 42 years of age in 70.4% of the cases, and 2 months to 59 years after the appearance of psoriasis. Psoriatic arthritis without psoriasis appeared in 1.8% of the patients. A severe form of arthritis had 64.2% of the patients, mainly the patients with scalp psoriasis (chi2 = 3.2; p < 0.05). Nail changes had 35% of the patients. Distal interphalangeal joints were involved in 63.6%, axial skeleton in 36.4%, oligoarthritis in 45.0%, polyarthritis in 55.0%, and mutilating form in 6.8% of the patients. Elevated Erythrocyte Sedimentation Rate was reveald in 61.7% of the patients. Immunoglobulin M (IgM) rheumatoid factor was altered in 4.3% of the patients. The human leukocyte antigen (HLA) typing in the 28 patients were: A2 32.0%, A3 18.0%, Al and A9 14.0%, A28 and A29 3.5%, B8 and B16 14.0%, B5 and B12 11.0%, B13, B15, B18, B27 and B35 7.0%. Radiologic changes were most often in hand and foot joints, less frequently in the knees and quite infrequently in hips and shoulders joints. Sacroiliitis was found in 46.4% of the patients. Psoriasis was treated with topical corticosteroids and salicylic ointments in all the patients, ultraviolet (PUVA therapy) in 5.6% and retinoids in 4.3% of them. Artrithis was treated with nonsteroidal anti-inflammatory drugs, with systemic corticosteroids 41.3% and with disease modified antirheumatic drugs, most frequently methotrexate, 59.9% of the patients. Radionuclide synovectomy was performed in 6.8%, surgery in 6.2% and physical therapy in all the patients. CONCLUSION: Psoriatic arthritis developed in 9.3% of the psoriatic patients. Time interval for establishing the diagnosis was long, and there were no specific laboratory findings. All the synovial joints could be involved in the psoriatic process. Scintigraphy should be used only in case of early suspected sacroiliitis. The treatment of psoriatic arthritis was the teamwork between the dermatologist, rheumatologist, physiatrist and orthopedic surgeon.

Adolescent↗
PubMed1996

Multicentric reticulohistiocytosis. A report of 3 cases and review of literature.

Multicentric reticulohistiocytosis (MR) is a rare systemic disease of unknown cause. The disease is characterized by tissue infiltration of lipid-laden histiocytes and multinucleated giant cells. Destructive polyarthritis and skin lesions are the most common findings. The disease becomes apparent in adult life. We report on 3 patients and discuss the specific radiographic characteristics of bone and joint involvement. The radiologic feature is a bilateral, symmetric joint involvement with predilection for the interphalangeal and metacarpophalangeal joints. In all of our cases we found an early involvement of shoulder joints. Erosive arthritis begins at the margins of the joints, progressing to osseous defects and to severe joint destruction. In contrast to rheumatoid arthritis, periarticular osteoporosis and early joint space loss are absent in MR. In addition, significant erosions of distal interphalangeal joints are not common in rheumatoid arthritis.

Adult↗
PubMed1976

[Total replacement of humerus including shoulder and elbow joints].

A case of total alloplastic replacement of the humerus, including the neighboring joints, is reported. The method may be used for treatment of large defects of the humerus due to tumor, osteomyelitis, or trauma. The alloplastic replacement seems superior to autoplastic fibula transplantation.

Bone Neoplasms↗
PubMed1988

Arthrotomography of the unstable shoulder.

Thirty-seven patients suffering from clinically verified subluxation of the shoulder joint underwent double-contrast arthrotomography. Sixteen of these patients were operated on, 4 of whom after arthroscopy, and 1 patient had only arthroscopy. Arthrotomography readily revealed lesions of the glenoid labrum, most of them small, and also redundancy of the anterior joint capsule. The method can be recommended in the examination of the glenoid labrum in patients suffering from anterior subluxation of the shoulder.

Adolescent↗
PubMedDate not supplied

Computed tomography (CT) arthrography of shoulder instabilities in athletes.

Sixty professional and recreational athletes underwent CT arthrography of the shoulder for evaluation of suspected shoulder joint derangement. These athletes, 46 males and 14 females ranging in age from 15 to 60 years (mean, 32 years), all had persistent pain that interfered with their sports activity and was resistant to conservative treatment. Seventeen patients had shoulder instability based on clinical manifestations and CT arthrographic findings. An additional five patients, also based on clinical manifestations and CT arthrographic findings, were considered to have an unobtrusive degree of anterior joint laxity. Patients with anterior instability (20 cases) all had an anteroinferior tear or detachment of the glenoid labrum, as well as some violation of the insertion of the joint capsule onto the scapula. Those with posterior instability (two cases) had a combination of labral and capsular tears. Two other major patterns of labral tears, both unaffiliated with shoulder instability, were identified. These included total or partial detachment of superior segments of the labrum, and anterior labral tears at the midglenoid level. Moreover, various degrees of labral attenuation (or, less often, enlargement), osteophyte formation, and alterations in articular cartilage were observed. Surgical correlation was obtained in 25 patients, with 95% accuracy of CT arthrographic findings. CT arthrography is a minimally invasive and highly accurate technique for investigation of glenohumeral derangement. Specifically, the extent of pathologic changes associated with instability can be determined and differentiated from other intraarticular causes of incapacity, such as labral tears caused by throwing, or degenerative changes.

Adolescent↗
PubMed1999

Apparatus for measuring and perturbing shoulder and elbow joint positions and torques during reaching.

Visually guided reaching movements by monkeys has become an important paradigm for examining the function of various sensory and motor areas of the brain. However, a major problem with interpreting neural discharge during this motor task has been the difficulty to quantify and manipulate the mechanics of movement. To address this problem, a new experimental facility has been developed to allow neural recordings in a monkey while it makes movements with a mechanical linkage attached to its arm. The device (KINARM) has hinge joints aligned with the monkey's shoulder and elbow and allows the monkey to make arm movements in the horizontal plane. Custom-made fibreglass braces attach the linkage to the monkey's forearm and arm. Motors attached to the mechanical linkage provide angular position of the joints and apply torques either to the shoulder or elbow, or both. The KINARM is used in concert with a computer projection system that provides virtual targets in the plane of the arm. Preliminary results illustrate the ability of a monkey to perform a variety of multi-joint motor tasks under various static and dynamic loads.

Animals↗