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PubMedDate not supplied

[Development and assessment of so-called rotator cuff ruptures].

The following conclusions can be drawn from our investigations: We could not find out isolated ruptures of the supraspinatus tendon, which were caused exclusively by injury. Mostly ruptures of the rotatory cuff develop spontaneously, the basic degenerative changes involve also the shoulder joint and the acromioclavicular joint. The term rupture of rotatory cuff is misleading, because it signals to the patient the existence of aftermath of injuries and for the most part the rupture is not found in the tendons of the rotatory muscles but in the supraspinatus tendon. The degenerative cuff defects with spontaneous ruptures must be differentiated in medical certificate from the rare rotatory cuff ruptures, which are caused by injury alone. Seldom exogenous mechanical stress may lead to an enlargement of a preexistent rupture with symptoms and clinical signs, which occur for the first time. On the promises, that an adequate injury has occurred, that roentgenographic changes deteriorated within 3 months after the injury and a degenerative defect of rotatory cuff with clinical relevance can be excluded for the time before the injury, the damage of the shoulder has to be accepted by the insurance as an injury after accident. In the most times occasional causes with inadequate injuries to the shoulder are brought up, to assert an old degenerative defect of the shoulder as an aftermath of injury. There are no interrelations between intraoperative findings and mechanism of injury. The anamnestic statement of the patient concerning earlier diseases and injuries are often unreliable.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗
PubMed1999

CT imaging and three-dimensional reconstructions of shoulders with anterior glenohumeral instability.

Glenohumeral instability is a common occurrence following anterior dislocation of the shoulder joint, particularly in young men. The bony abnormalities encountered in patients with glenohumeral instability can be difficult to detect with conventional radiography, even with special views. The aim of our study was to evaluate the bony abnormalities associated with glenohumeral instability using CT imaging with 3-D reconstruction images. We scanned 11 patients with glenohumeral instability, one with bilateral symptoms; 10 were male, one female, and their ages ranged from 18-66 years. Contiguous 3 mm axial slices of the glenohumeral joint were taken at 2 mm intervals using a Siemens Somatom CT scanner. In the 12 shoulders imaged, we identified four main abnormalities. A humeral-head defect or Hill-Sachs deformity was seen in 83% cases, fractures of the anterior glenoid rim in 50%, periosteal new bone formation secondary to capsular stripping in 42%, and loose bone fragments in 25%. Manipulation of the 3-D images enabled the abnormalities to be well seen in all cases, giving a graphic visualization of the joint, and only two 3-D images were needed to demonstrate all the necessary information. We feel that CT is the imaging modality most likely to show all the bone abnormalities associated with glenohumeral instability. These bony changes may lead to the correct inference of soft tissue abnormalities making more invasive examinations such as arthrography unnecessary.

Adolescent↗
PubMed1988

Light resistance and stretching exercise in elderly women: effect upon flexibility.

Decreased range of motion (ROM) due to disuse limits the older adult's ability to perform daily activities. The flexibility of five joints of 46 women (aged 65 to 89 years) was measured by goniometer before and after a 25-week exercise program. Three groups were formed: a control group who did no exercise (C) (n = 13), a group who exercised with light weights (EW) (n = 17), and a group who exercised with no weights (EN) (n = 16). Subjects who exercised (EN and EW) gained significantly greater ROM in ankle plantar flexion, shoulder flexion, shoulder abduction, and left neck rotation than C subjects. No significant differences were found between groups in hip flexion, right neck rotation, wrist flexion or extension, or ankle dorsiflexion. The only difference between exercise treatments was that the EN group gained significantly more ROM in shoulder abduction than the EW. The use of arm weights may have limited shoulder ROM during exercise, resulting in less improvement for shoulder abduction. Comparison with data from other studies suggests age-related loss in flexibility at the shoulder joint. Exercise generally increased shoulder ROM and may be capable of reversing loss in flexibility due to disuse.

Aged↗
PubMed2006

[Conventional x-ray after shoulder prosthesis].

Three types of shoulder prostheses are commonly used to cover the different indications of shoulder joint replacements: classical modular, inverse and cup. The modular prosthesis can replace the glenoid as well as the humeral head components. Exact visualization of the interface between the glenoid component and bone (or cement-bone interface) is necessary to detect osteolysis, which is relatively common. Therefore, it is mandatory to make true AP and axial projections. When describing the humeral component, the interface between bone and implant must again be considered. Additionally, the position of the humeral head in relation to the glenoid has to be noted. The glenoid component is usually fixed by screws to the bone and an osteolysis is often present at the inferior pole of the glenoid component due to prosthesis bone notching. If the implants are modular devices (classic modular prosthesis, inverse shoulder prosthesis) there is the possibility of dissociation of components and any suspicion of this should be reported. In case of reporting the conventional x-ray of cup prosthesis, the bone implant interface should be mentioned. Again the position of the humeral head to the glenoid requires attention. In all types of prostheses, dislocation of the glenohumeral joint is obvious and has to be addressed in the medical report.

Arthroplasty, Replacement↗
PubMedDate not supplied

[Ultrasonography of the shoulder: the acromioclavicular joint].

In 95% of the patients complaining of shoulder pain, pain is consequent to mechanical impingement of the coraco-acromial arch on the rotator cuff. Acromioclavicular joint conditions play a major role (well over 50%) in initiating the process. This study was aimed at assessing the value of acromioclavicular investigations during shoulder US studies. September 1992 to September 1993, a hundred and seventy-four patients with shoulder pain underwent US exams of both shoulders and acromioclavicular joints. In 62% of patients rotator cuff tears (from less to more severe) were demonstrated, in 48% biceps tendon conditions (effusion, tendonitis, dislocation or tear) and in 31% aspecific degenerative changes of the rotator cuff. Three acromioclavicular joint cysts, a clavicular fracture and an acromioclavicular dislocation were also observed. The patients with US patterns of acromioclavicular conditions were 105 (60%); in 38% of cases, only capsular hypertrophy due to joint degeneration was observed. In 22% of cases the latter was associated with arthrosis-like changes of the articular rim. In 63% of cases rotator cuff tears were associated and in 37% of cases there were aspecific degenerative cuff changes. The authors believe that, especially in the latter cases, acromioclavicular joint US can be a useful approach to diagnosis and treatment.

Acromioclavicular Joint↗
PubMed2000

[Clinical features of patients with osteoarthritic knees followed by development of rheumatoid arthritis].

We investigated clinical features of patients with osteoarthritic knees followed by development of rheumatoid arthritis (RA) after several year's interval. The subjects were 16 knees of 8 patients with osteoarthritis (OA) including one man and 7 women. The mean age at development of OA knee was 62.8 years (range; 45-73). The mean age at later development of RA was 66.0 years (range; 52-79). The mean follow-up period was 96.4 months (range; 28-191). We evaluated clinical features using the 1987 revised Criteria of the American College of Rheumatology (ACR), laboratory dates including RF, CRP, ESR, the number of joints with RA, and femorotibial angle (FTA). The mean number of features of patients which was fulfilled with the ACR criteria was 3.3 +/- 1.6 at the onset of RA. Only four patients were seropositive through the total follow-up period. The serum level of RF, CRP, and ESR were reduced at the follow-up period. The mean number of the joints involved in RA was 11.0 +/- 5.1 (range; 4-22) and wrist and shoulder joints were involved more frequently than other joints except knees. High tibial osteotomy (HTO) was performed on 5 knees of 3 patients and the mean degree of FTA was 168.8 +/- 1.9 degrees just after surgery. However, 36 months after development of RA, joint destruction and valgus deformity occurred on 3 knees and the mean degree of FTA of 5 knees was ended up to 159.6 +/- 11.3 degrees. Our experiences suggested that RF, CRP, ESR and lesions of other joints should be carefully evaluated in the OA patients with seropositivity or knee hydrarthrosis and that histological analysis for synovium should be assessed by the biopsy at time of HTO or arthroscopic surgery to improve accuracy of diagnosis.

Aged↗
PubMed1995

Septic arthritis: Arthroscopic management with local antibiotic treatment.

In a retrospective study, the results of arthroscopic treatment of septic arthritis were evaluated in 12 patients. Ages ranged from 4 to 57 years. The knee joint was affected in 9 cases, the elbow in 2 cases, and the shoulder joint in one case. In 3 patients the infection was hematogenous. Four patients had a postoperative infection and in 5 patients the infection followed an intraarticular injection. The indication for arthroscopic treatment was based on clinical findings, an increased ESR and/or CRP, an increase in leukocyte count in the joint fluid and no bone involvement on x-ray. Arthroscopic management was performed according to the intraoperative findings (lavage, debridement, synovectomy). The procedure was completed by intraarticular placement of an antibiotic collagenous fleece. Additionally systemic antibiotics, active against staphylococcus aureus, were used for perioperative therapy before starting a specific antibiotic treatment according to the cultured organism. In 10 out of 12 cases the infection was cured by one operation. Because of the advantages of arthroscopic treatment, it should be performed as soon as joint infection is confirmed.

Adult↗
PubMed1991

Glenoid labrum: evaluation with MR imaging.

Fifteen patients with shoulder instability and nine asymptomatic volunteers were studied with magnetic resonance (MR) imaging. The shoulder joint was visualized by means of arthroscopy or surgery in all patients. Ten patients had abnormalities of the glenoid labrum. Two musculoskeletal radiologists interpreted the MR images of the patients and volunteers without knowledge of the clinical history or surgical results. The surgical and arthroscopic results were used as the standard of reference in symptomatic patients. Observer A achieved a sensitivity of 44.4% and a specificity of 66.7%; observer B had a sensitivity of 77.8% and a specificity of 66.7%. In addition to the poor sensitivities and specificities, there was substantial intra- and interobserver variability. Assuming that the shoulders of the asymptomatic volunteers were normal, the specificities were 100.0% and 88.9% for observers A and B respectively. In this small study, axial MR imaging was relatively insensitive and nonspecific in the evaluation of labral lesions. Further study will be necessary to determine the utility and limits of MR imaging in this regard.

Adolescent↗
PubMed2004

Essentials of shoulder MR arthrography: a practical guide for the general radiologist.

Lesions of the glenoid labrum and ligamentous structures commonly occur secondary to shoulder trauma and are a frequent cause of shoulder joint instability. Numerous eponyms, acronyms and subclassifications are used to describe the often confusing array of bony and labro-ligamentous abnormalities of the shoulder. This aim of this review is to illustrate the relevant features of these lesions and to provide a systematic and practical approach to imaging of the shoulder using MR arthrography.

Humans↗
PubMed1993

[Chronology of the postnatal ossification of the shoulder and elbow joints in the Siamese cat (Felis catus L.)].

A study was done by radiological techniques to show the chronology of ossification of the shoulder and cubit joints in the Siam cat, from birth up to the 25th week of postnatal development. For this experiment we used 40 little cats (19 males and 21 females) belonging to 11 litters subjected to different controls: pattern race, healthy, feeding, growing up and radioactivity. The time of the appearance and the evolution of the ossification centers is determined as well as the phenomenon of fusion during this time. The postnatal ossification from both joints of the Siam cat is compared with that of the common cat.

Animals↗
PubMedDate not supplied

Intraoperative measurement of shoulder translation.

Assessing laxity of the shoulder joint in patients who are under anesthesia is a standard procedure before arthroscopy. The aim of this study was to evaluate a novel instrument for quick and reliable intraoperative measurement of glenohumeral translation. Previous testing of various designs has resulted in a device secured by 1 pin in the acromion and 1 pin in the proximal humerus. These pins are interconnected by a sliding ruler that gives translation values in millimeter increments as the laxity tests are performed. Comparison between manual arbitrary approximation of laxity and instrumented translation measurements showed that manual testing is reasonably good for assessment of anterior and posterior translation, without, however, providing values of translation in millimeter increments. The low correlation between manual assessment and instrumented inferior translation measurements indicates that inferior translation is more difficult to approximate manually. The shoulder translation tester was used in 102 patients. The mean values for clinically stable shoulders (n = 58) were 5 mm for anterior translation, 5 mm for posterior translation, and 4 mm for inferior translation. The corresponding values in unstable shoulders were significantly higher than in the stable shoulders, especially in patients with multidirectional instability. We conclude that the shoulder translation tester is easy and quick to use. It provides quantitative values of translation and will thus contribute information for correct diagnosis, therapy, and documentation.

Adult↗
PubMed1989

The prevention and treatment of injuries to the shoulder in swimming.

The biomechanics of swimming cause considerable stress on the shoulder joint which may be accentuated by improper stretching or training techniques. The rotator cuff, and particularly the supraspinatus tendon, is at risk in repetitive overhead stroke activity. Arthritis in the shoulder is primarily centered at the acromioclavicular joint; degeneration may occur as a result of overuse or leverage of the scapuloclavicular mechanism, or from motion related to upward pressure at the undersurface of the acromion due to subluxation or instability of the glenohumeral joint. Instability of the glenohumeral joint is a major problem which may occur in itself or in combination with rotator cuff tendinitis. The glenohumeral joint is stabilised superiorly by a posterior superior sling consisting of the long biceps tendon, the superior joint capsule, and the coracoacromial and coracohumeral ligaments. An anterior inferior sling mechanism consisting of the inferior glenohumeral ligament and subscapularis musculotendinous unit provides significant stability if uninjured. Fragments of labral tissue may mechanically wedge into the joint also leading to symptoms of subluxation. If the humeral head is wedged or allowed to slip out of joint due to capsular incompetency, secondary rotator cuff 'impingement' may occur; this is particularly difficult to manage. Prevention of injury is best accomplished through a programme of flexibility and strengthening avoiding overuse.

Athletic Injuries↗
PubMed2003

[Septic arthritis of the shoulder and hip joint in cattle: diagnosis and therapy].

During eight years, in 17 cattle a septic arthritis of the shoulder or hip joint was diagnosed at the Veterinary Surgery Department, University of Munich. The diagnosis was based on the results of the synoviocentesis and confirmed by ultrasound and radiographic examination. The average number of leucocytes in the synovia was 65,137/microliter (median 43.344/microliter), with 97% neutrophils (median 96%). Of the 17 animals, 13 were treated. In two patients arthrotomy, and in 11 repeated joint lavage was performed. As a lavage solution, 500 to 1000 ml of Ringer's solution, with 800 to 1600 mg Gentamicin added, was used. Four animals were not treated because of advanced radiographic changes (1), purulent arthritis and phlegmon (1) or economic reasons (2). Ten patients could be cured long-term (follow up time 10.5 months on average, median 6.5 months), three remained lame and were slaughtered. As a conclusion, septic arthritis of the shoulder or the hip joint in cattle has a good prognosis when diagnosed and treated early.

Animals↗
PubMed1989

Computed tomography-osteoabsorptiometry for assessing the density distribution of subchondral bone as a measure of long-term mechanical adaptation in individual joints.

To estimate subchondral mineralisation patterns which represent the long-term loading history of individual joints, a method has been developed employing computed tomography (CT) which permits repeated examination of living joints. The method was tested on 5 knee, 3 sacroiliac, 3 ankle and 5 shoulder joints and then investigated with X-ray densitometry. A CT absorptiometric presentation and maps of the area distribution of the subchondral bone density areas were derived using an image analyser. Comparison of the results from both X-ray densitometry and CT-absorptiometry revealed almost identical pictures of distribution of the subchondral bone density. The method may be used to examine subchondral mineralisation as a measure of the mechanical adaptability of joints in the living subject.

Absorptiometry, Photon↗
PubMed1992

Computed tomography in traumatology with special regard to the advances of three-dimensional display.

There is a variety of methods to aid in the diagnosis of fractures requiring operative treatment. A computer program that produces pseudo-three-dimensional (3D) images from sets of axial computed tomograms is used for examining fractures in areas of complex skeletal anatomy. The resulting reconstructions, representing the surface in a form similar to that of anatomic preparations, can facilitate the process of diagnosis. They are also valuable for planning operations. The 3D information can be used to define the size, shape, and location of the various fracture types. We have used the technique in more than 500 patients with injuries to the skull, spine, acetabulum, sternoclavicular joint, shoulder, knee, and calcaneus and are able to demonstrate the benefit of special investigation protocols.

Calcaneus↗
PubMed1994

[Limbus diagnosis by computerized tomography after initial traumatologic dislocation of the shoulder].

This paper shows a retrospective analysis of 98 shoulder joint CT scans after traumatic primary anterior dislocation in the period of 1988 till December 1991. The intraoperative findings and the X-ray characteristics beside arthrographic and MRI examinations led us to a classification of four types by pathomorphologic aspects, the type of the tear correlated to the degree of instability. For anterior limbus tear and lesions, a CT scan gives a diagnostic sensitivity of more than 90% (own rate 94.6%). Concerning our patients, the total lesions rate of 77.6% following first traumatic dislocation justifies a progressive examination and evaluation of the joint structures, that enhance further dislocations. Hereby, inspite of its invasivity, joint CT scan have, in comparison to other diagnostic procedures, proved to be routinely useful.

Adult↗
PubMedDate not supplied

Anthropometry of the scapula: clinical and surgical considerations.

Anthropometric measurements were taken on 266 scapulas from the "G. Marro" Egyptian skeletal collection of the Department of Anthropology of the University of Turin in Italy to study the orthopaedic pathologic condition of the shoulder joints. Data were taken on the size and shape of the acromial arch in relation to the inclination and anatomic variants of the acromion. The rarity of the "hooked" form was confirmed, and two variants of the acromial vault (i.e., one predominantly osseous and the other predominantly fibrous) were recognized. The spatial location and biomechanical importance of the coracoid process were considered. Orientation of the glenoid fossa furnishes an osseous base for the stability of the scapulohumeral joint both anteroposteriorly and vertically. Observations on current practices of surgical intervention on the shoulder as reported in the literature and some anatomic skeletal basis of surgical access are discussed.

Acromion↗