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PubMedDate not supplied

Open surgical treatment for dialysis-related arthropathy in the shoulder.

The clinical results of open surgical treatment for hemodialysis-related arthropathy in the shoulder were evaluated, and the pathology was investigated. Fifteen shoulders of 11 patients (6 female and 5 male) were treated during the past 6 years. The average age was 56.7 years. The duration of hemodialysis averaged 17.5 years. Simple curettage was performed in 7 shoulders, and curettage and bone graft were performed in 5 shoulders. Repair of the rotator cuff was performed in 3 shoulders. Pathologic foci always existed in the intertubercular sulcus and the greater tuberosity of the humerus. Marked proliferations of the bursa and multiple cystic bone lesions were found, and amyloid depositions were observed on histologic evaluation in all cases. Open surgical treatment was quite effective, and relief from the clinical symptoms was maintained for a satisfactory period of time. Enthesopathy induced by the amyloid deposition is considered the main pathology.

Adult↗
PubMed2000

[Posterior shoulder instability in athletes: surgical treatment with iliac bone block. Apropos of 6 case reports].

PURPOSE OF THE STUDY: Sports activities requiring antepulsion, adduction and medial rotation can favor the development of posterior instability of the shoulder. Conservative treatment is indicated, but many techniques have been proposed in case of failure. All do not allow recovery of the same sports level. We report our experience with six cases of posterior shoulder instability treated with a Gosset posterior bone block. MATERIAL AND METHODS: We retrospectively reviewed cases treated between 1974 and 1995. Six athletes, aged 17 to 34 years (mean 25 years) underwent posterior bone block surgery using the Gosset procedure on their dominant shoulder. Three of the patients had experienced involuntary dislocation and three others involuntary and voluntary dislocation. One patient had a multidirectional hyperlaxity. Five patients had participated in rehabilitation programs for at least five months. Two patients had undergone unsuccessful bone block surgery in another unit. RESULTS: Stability and pain relief were achieved in all cases. Three patients recovered complete mobility. In the three others, mean limitation of mobility for the different sectors was 15 degrees. There has been no sign of osteoarthrosis at three years follow-up. All patients have resumed their sports activities, three at the same level. DISCUSSION: In our experience, most surgical techniques proposed for the treatment of posterior shoulder instability are unsuccessful. The Gosset iliac bone block prolongs the articular surface. After consolidation, it allows sports activities requiring shoulder force and provides satisfactory mobility.

Adolescent↗
PubMed2001

Shoulder ultrasonography in the diagnosis of polymyalgia rheumatica: a case-control study.

OBJECTIVE: Magnetic resonance imaging (MRI) showed that subacromial/subdeltoid bursitis is the most frequent shoulder lesion in polymyalgia rheumatica (PMR). We evaluated whether shoulder ultrasonography (US) was as effective as MRI in the detection of this lesion and assessed the sensitivity and specificity of bilateral subacromial/subdeltoid bursitis in the diagnosis of PMR. METHODS: A case-control study of 57 consecutive case patients with untreated PMR and 114 controls seen over a 6 month period in 3 secondary referral rheumatology centers. Control patients consisted of the next 2 consecutive patients with bilateral shoulder aching and stiffness observed after the case patient. In all case and control patients the glenohumeral joint space, bursae, and long head biceps tendon were assessed by bilateral shoulder US. The first 24 case patients were also examined by bilateral shoulder MRI. RESULTS: US showed subacromial/subdeltoid bursitis in 55/57 (96%) patients with PMR and in 25/114 (22%) controls (p < 0.001). The lesion was bilateral in 53/55 (96%) case patients and in 1/25 (4%) controls (p < 0.001). The frequency of glenohumeral joint synovitis and biceps tenosynovitis did not differ significantly between case patients and controls. In 100% of case patients MRI showed subacromial/subdeltoid bursitis confirming US findings. The sonographic evidence of bilateral bursitis had a sensitivity of 92.9%, specificity of 99. 1%, and positive predictive value of 98. 1% for the diagnosis of PMR. CONCLUSION: US and MRI were equally effective in confirming bilateral subacromial and subdeltoid bursitis in PMR. This finding, in view of its high sensitivity and specificity, could be used as a new diagnostic criterion for PMR.

Aged↗
PubMed2001

Which primary shoulder and elbow replacement? A review of the results of prostheses available in the UK.

To assist surgeons select a suitable prosthesis, we have undertaken a detailed review of all shoulder and elbow replacements currently marketed in the UK. Twenty shoulder and 8 elbow implants, manufactured by 16 companies, have been identified. Twelve of the shoulder and one of the elbow implants have been introduced or modified in the last 8 years and have no clinical results published in peer-reviewed journals. Only the Biomodular, Bipolar, Copeland, Isoelastic, Neer hemi, Neer II, Roper-Day and Select shoulders accounting for less than 40% of the UK shoulder market, possess published results. The Capitello-condylar, Coonrad-Morrey, GSB III, Kudo, Liverpool, Roper-Tuke and Souter-Strathclyde elbows all have published results. These account for over 95% of all UK elbow replacements. The implications of these findings in an era of evidence-based medicine is discussed. Reviewing the clinical results should be of primary importance in the selection of a suitable prosthesis. Implants with a proven long-term record must represent the 'gold standard'. New or modified implants should only be used if they are part of a properly conducted clinical trial.

Arthroplasty, Replacement↗
PubMed2001

Expanded shoulder flap in burn sequela.

The expanded shoulder flap is presented as an alternative for the treatment of cervical retraction secondary to burning. The flap has an axial pattern, mainly based on the transverse cervical artery. The anterior limit of the flap is a line that goes from ear lobule, towards the shoulder, to the deltoid muscle. The incision for inclusion of the tissue expander is made at the shoulder, and on that line, with extension and posterior, lateral and medial detachments broad enough to slightly exceed the expander dimensions, with the valve being placed in infraclavicular position. In the immediate postoperative period, a volume around 15% to 20% of the tissue expander's total capacity was infiltrated, which was followed by weekly infiltrations until the expanded area reached a circumference approximately 2 to 3 times larger than the supposed wound after creating the resection of the retraction. The expanded shoulder flap allows coverage of large extensions, by using a single donor shoulder, as it permits not only release of retraction, but also replacement of associated cervical scars by leaner skin, better adjusted to the region's anatomy. Twelve patients were treated with this method, with good results in all cases, and there being no flap delay. Closing of the donor area happened without any stress, which resulted in scars of good quality.

Adolescent↗
PubMedDate not supplied

0.25% levo-bupivacaine for interscalene block during shoulder surgery. A survey on 20 patients.

BACKGROUND: Interscalene brachial plexus block (ISB) is an alternative procedure to general anaesthesia for shoulder surgery, and consents the anaesthetist to easily control postoperative pain that, indeed, is known to be intense and often requires strong analgesic administration. The introduction of regional anaesthesia for this type of surgery, contributed to the relief of acute postoperative pain occurring in the recovery room since the analgesic effects of block persist for several hours after surgery depending upon the selected drug. The aim of this study was to determine the effects of 40 ml of 0.25% levo-bupivacaine, a local anaesthetic derived from the racemic mixture of bupivacaine, on the speed of onset, quality and duration of ISB. METHODS: Twenty adult ASA I-II patients, undergoing shoulder surgery for various pathologies, were enrolled in this study. All patients were examined before surgery and were given a full explanation; written informed consent was asked for and obtained. ISB was placed with the classic Winnie approach and the plexus was localised by means of a 40 mm, 22G Teflon(R) coated needle connected to an electro neural stimulator distributing 0.5 mA at 2 Hz. Once twitching was observed, 16 ml of 0.25% levo-bupivacaine were injected on shoulder lift, 12 ml on forearm abduction and 12 ml on forearm adduction. Monitoring: the time elapsing from last injection to loss of sensibility of pin-prick on the shoulder area, degree of motor block expressed on a 4 points scale, surgery time, as well as total time of analgesia were recorded for statistical analysis. STATISTICS: data were analysed at the STATISTICS Department of the University of Messina (Italy) and results are expressed as means and standard deviations. RESULTS: Eighteen patients were operated under ISB and light sedation while 2 patients were scheduled for interscalene block plus deep sedation, the position being very discomforting and surgery supposed to last more than 60 min (shoulder arthroscopy). Less than 9 min were required for the block to be complete with satisfactory muscle relaxation, optimal intraoperative anaesthetic condition and more than 13 hours of postoperative analgesia occurred. CONCLUSIONS: Levobupivacaine is a newly developed local anaesthetic derived from a bupivacaine racemic mixture from which the right isomer has been eliminated. Levo-bupivacaine, compared to racemic mixture, is acknowledged to be less cardiotoxic, faster at equal dosage, and ensures a longer analgesic interval. Zero point twenty-five percent concentration was preferred in this study in order to inject large volumes (40 ml) with a minimal anaesthetic amount (100 mg), resulting in short time for obtaining loss of sensibility, optimal intraoperative conditions and long lasting block with adequate postoperative analgesia.

Adult↗
PubMed2002

Effect of linear polarized near-infrared light irradiation on flexibility of shoulder and ankle joints.

BACKGROUND: There is a possibility that heat stimulus by linear polarized near-infrared light irradiation (PL: Super Lizer HA-30, Tokyo Medical Laboratory) improves the range of joint motion, because the flexibility of soft-part tissues, such as a muscle or a tendon, is improved by increasing the muscle temperature. The purpose of this study was to examine the influence of PL-irradiation on the ranges of shoulder and ankle motions. METHODS EXPERIMENTAL DESIGN: 30 healthy young adults (15 males: mean+/-SD, age 19.1+/-0.8 yrs, height 173.3+/-4.6 cm, body mass 68.5+/-8.0 kg and 15 females: mean+/-SD, age 19.2+/-0.7 yrs, height 162.3+/-4.5 cm, body mass 58.1+/-6.6 kg) participated in the experiment under PL-irradiation and no-irradiation (placebo) conditions. MEASURES: the angles of shoulder and ankle joint motions were measured twice, before and after the PL- and placebo-irradiations. The angle of a motion was defined as the angle connecting 3 points at linearity as follows: for the shoulder, the greater trochanter, acromion, and caput ulnare, and for the ankle, the knee joint, fassa of lateral malleolus and metacarpal bone. Each angle was measured when a subject extended or flexed maximally without support. RESULTS: The trial-to-trial reliability of each range of joint motion was very high. All parameters in PL-irradiation were significantly larger in postirradiation than pre-irradiation, and the value of postirradiation in PL-irradiation was significantly greater than that for placebo. The ranges of shoulder and ankle motions in placebo-irradiation were also significantly greater in postirradiation than pre-irradiation. Moreover, the change rate for each range of joint motion between pre- and postirradiations was significantly greater in PL-irradiation in both joints. In PL-irradiation, most subject's motions were greater in postirradiation than pre-irradiation, but not in the placebo-irradiation. The effect of PL-irradiation tended to be greater on subjects with a small range of a joint motion. CONCLUSIONS: It is considered from the present results that the ranges of shoulder and ankle motions became greater with PL-irradiation, and is effective as a warming-up method.

Adult↗
PubMed2002

[A case of shoulder pain following right basilic vein catheterization].

We have experienced a case of total laryngectomy with graft of the rectus abdominis muscle skin flap because of the recurrent lingual cancer. Just before the operation, we used right basilic vein for introduction of a central venous catheter. Right shoulder pain occurred on the first postoperative day. After the operation, we found that the catheter from the right basilic vein was inserted to the right jugular vein. We pulled out it and inserted another catheter from the left subclavian vein. Shoulder pain diminished and then pyrexia and symptom of infection diminished. After recatheterization, shoulder pain was suspected to be the result of frozen shoulder. We should be aware that shoulder pain could occur by immobility of upper extremities when basilic venous catheter is in place.

Adult↗
PubMedDate not supplied

Arthroscopic monopolar radiofrequency thermal capsulorrhaphy for the treatment of shoulder instability: a prospective outcome study with mean 2-year follow-up.

PURPOSE: This study describes the experience with arthroscopic monopolar thermal capsulorrhaphy for painful multi-directional shoulder instability in a community-based practice. TYPE OF STUDY: Prospective outcome study of consecutive patients. MATERIALS AND METHODS: Thirty-two shoulders in 30 patients were prospectively evaluated using the twelve-question Simple Shoulder Test (SST). This questionnaire assesses shoulder pain and function in a variety of everyday tasks. The duration of symptoms prior to surgery averaged 26.1 +/- 41.0 months (range 2 months-20 years). Patients were evaluated at baseline and then again at various follow-up time points (mean follow-up of 27.7 +/- 8.6 months post-surgery, range, 4-41 months). Patients completed at least 4-6 weeks of physical therapy prior to surgery. All patients were determined to have multi-directional instability during examination under anesthesia and there were no Bankart lesions in the series. When thermal capsulorrhaphy alone was determined to not be adequate to achieve a stable shoulder, the procedure was augmented with additional tuck sutures in whatever direction necessary. Twenty-one of the 32 surgeries (62%) used suture capsulorraphy in addition to the thermal treatment. Following surgery patients were immobilized in a sling for a minimum of 4 weeks and were not allowed to return to sports or strenuous activity until 12 weeks postoperatively. RESULTS: Mean pre-operative SST score was 5.5 +/- 3.5. Post-operative mean SST score was 9.0 +/- 3.3. This difference was significant (p < 0.0001). Five patients in the series were unable to return to activities of daily living and were considered failures. Two of these patients received a second operation that was then successful. CONCLUSIONS: Arthroscopic monopolar radiofrequency thermal capsulorrhaphy alone in or addition to suture capsular tightening procedures is a successful means of treating patients with painful, symptomatic, multi-directional instability.

Adolescent↗
PubMed2003

Shoulder and elbow function following Marchetti-Vicenzi humeral nail fixation.

Humeral nailing has been associated with reduction of shoulder and elbow function. We present the results of fixation of 15 diaphyseal humeral fractures with Marchetti-Vicenzi nails (B Braun Medical Aesculap). Shoulder and elbow functions were assessed by the Constant shoulder and Mayo elbow scoring systems. The average Constant Shoulder score was good (82.5/100) and the average Mayo Elbow Score was excellent (95.4/100). The indications for surgery included nonunion, pathological fractures and poor fracture position. The mean follow-up was 67 weeks with an average interval to surgery of 19 weeks. The mean time to union was 19 weeks. All the fractures united without any patient requiring any further procedure. There were two postoperative radial nerve palsies and one median nerve palsy, however two patients had complete recovery and one had partial recovery of the radial nerve. There was one deep infection requiring removal of the implant. There were no implant failures. Based on our experience, the Marchetti-Vicenzi humeral nail appears as a relatively safe implant and its use has been associated with preservation of good shoulder and elbow functions.

Adult↗
PubMed1992

Isokinetic and isometric measurement of strength of external rotation and abduction of the shoulder.

The strength of active external rotation and of abduction of the shoulder when the humerus was in the plane of the scapula (30 degrees of horizontal flexion anterior to the coronal plane) was measured isokinetically and isometrically in thirty-nine normal volunteers, who were stratified by age and sex. The angles at which peak torque was produced were similar when tested isokinetically and isometrically; these angles were similar for external rotation (at 60 and 30 degrees of internal rotation) and for abduction (at 30 and 60 degrees of abduction). Isometric peak torque was greater than slow-speed (90 degrees per second) isokinetic peak torque, which in turn was greater than fast-speed (210 degrees per second) isokinetic peak torque. There were highly significant differences in strength, measured isokinetically and isometrically, between younger and older men and between older men and older women. The variability of normal values for torque was similar in each group. Repeat testing demonstrated a high reliability of isokinetic measurements and of isometric measurements at angles within the range of the production of peak torque. Complete testing was performed in four normal volunteers before and after a block of the suprascapular nerve. The supraspinatus and infraspinatus components of the rotator cuff contributed a variable proportion to the total strength of abduction (25 to 50 per cent) and external rotation (50 to 75 per cent) throughout the range of motion. This study demonstrated that both isokinetic and isometric testing in the scapular plane are valid methods for measurement of the strength of external rotation and abduction of the shoulder. The data support standardization of the positions for testing the strength of motions of the shoulder: isometric strength of external rotation should be measured in the scapular plane with the shoulder in 45 degrees of abduction and 45 degrees of internal rotation; isometric strength of abduction, in the scapular plane with the shoulder in 45 degrees of abduction; and isokinetic strength of external rotation and abduction, in the scapular plane at 90 degrees per second.

Adult↗
PubMed2003

[Painful shoulder syndrome].

Painful shoulder syndrome was described by S.E. Duplay 1872. showing the patient with pain and stiffness of the shoulder after trauma. Codman et. al. at the beginning of 20th century expanded the syndrome on several causes of shoulder pain. Syndrome is characterized by pain and limitation of joint movements. One of the most common nontraumatic causes of shoulder pain is periarticular disorder. The potential sources of local or referred pain may be muscle, tendon, bursa or neurovascular structures. Secondary referral pain to the shoulder may be due to coronary artery disease, hepatic or splenic disease.

Diagnosis, Differential↗
PubMed2004

Surface electromyography of nine shoulder muscles in two iron cross conditions in gymnastics.

AIM: The rules of gymnastics impose an element of static strength such as an iron cross (IC) on the rings. For IC training, coaches use a custom made device -- the herdos -- to simulate the conditions of competition. The purpose was to compare muscle activity and coordination during IC performed both on the rings and using herdos. Secondly, we tried to determine whether herdos usage induced functional adaptations of the shoulder muscles. METHODS: Six male gymnasts performed 10 IC in each condition. Surface electromyogram of muscles pectoralis major, latissimus dorsi, teres major, infraspinatus, rhomboideus, trapezius, serratus anterior, biceps brachii, and triceps brachii in the right shoulder were analysed using root-mean-square (RMS), and muscle part's in each condition. Muscle part represents the contribution of each of the 9 shoulder muscles studied in each condition. Total muscle activity (SUM) was also used to compare the 2 conditions. RESULTS: Except for the muscle teres major, the RMS decreases (p<0.05) when using the herdos. The SUM also decreases (p<0.05) when using this device. The muscle parts indicate that the contribution of the muscle latissimus dorsi decreases (p<0.05) when using the herdos. These results suggest that the herdos modified shoulder coordination. But their usage does not seem to induce any functional adaptations of these muscles. CONCLUSIONS: The herdos do not seem to provide a valid method to reproduce the same shoulder coordination as on the rings. Therefore IC training with this special device could be called in question.

Adult↗
PubMed2005

[Effects of functional electric stimulation on shoulder subluxation and upper limb motor function recovery of patients with hemiplegia resulting from stroke].

OBJECTIVE: To observe the effects of functional electric stimulation (FES) on shoulder subluxation and motor function recovery of the upper extremities of patients with hemiplegia resulting from stroke. METHODS: Forty-eight hemiplegic patients were randomly divided into two groups for treatment with FES and shoulder pads, respectively. The recovery of the patient's shoulder subluxation and movement function of upper extremities were evaluated 6 weeks after treatment and the effects of two therapies were compared. RESULTS: The shoulder subluxation and movement function of the upper extremities were improved after treatment with both therapies (P<0.01, and FES showed better effect (P<0.01). CONCLUSIONS: FES can improve shoulder subluxation and motor function of the upper extremities affected by hemiplegia resulting from stroke.

Electric Stimulation Therapy↗
PubMed2005

Whiplash injury of the shoulder: is it a distinct clinical entity?

The pathophysiology of shoulder pain after whiplash injury remains uncertain. Patients with shoulder pain after a whiplash injury were recruited from the accident and emergency department in a prospective study to determine the nature of indirect shoulder trauma after a whiplash injury. Twenty patients fulfilled the inclusion criteria. Magnetic resonance imaging (MRI) was obtained in 18 patients. Three MRI scans confirmed acute shoulder injuries. Two patients underwent arthroscopic subacromial decompression after failure of non- operative treatment. In conclusion, whiplash injuries can result in indirect acute shoulder trauma, possibly through an acceleration-deceleration mechanism, and may be a distinct entity.

Adult↗
PubMed2006

[Functional outcome following shoulder tumor resection and reconstruction].

OBJECTIVE: To analyze the long-term limb sparing outcomes of various reconstructive procedures and complications associated with extensive excision in bone tumours of the shoulder girdle. METHODS: Shoulder reconstruction following resection of bone tumors of the shoulder girdle was reviewed retrospectively for 32 patients at the Wesley Hospital or Princess Alexandra Hospital. The reconstructions were including arthrodesis (8 cases), allograft-prosthetic composite (7 cases), spacer (6 cases), no bone reconstruction (5 cases), prosthesis (3 cases), vascular fibular graft (2 cases) and allograft (1 case). RESULTS: The average duration of follow-up was 81 months for the 23 patients who were still alive at the time of the latest follow-up examination. Functional results were related to the type of resection and the method of shoulder reconstruction. After intra-articular resection of the proximal humerus with loss of the abductor mechanism, arthrodesis resulted in 87% functional score and more strength was found after reconstruction with prosthesis or allograft-prosthetic composite. Allograft-prosthetic composite had better function (Score 79%) than prosthesis alone after intra-articular resection of the humerus because reconstruction of the deltoid and the rotator cuff could be performed without increased prevalence of complication related to the allograft. After extra-articular resection of the glenoid cavity and the proximal humerus with abductor mechanism, reconstruction with a functional spacer frequently resulted in superior subluxation of the implant and only fair function (Score 66%) of the shoulder. With two teen-aged patients, a free fibular graft inserted after intra-articular resection of the proximal humerus led to fair function (Score 73%), to be followed by secondary arthrodesis when growth was complete. CONCLUSIONS: Indications for the method of reconstruction depend on type of resection, age, gender, occupation, the expected functional level and restriction of activity. After resection of the abductor mechanism, arthrodesis results in more strength and is the preferred option for the young active demanding patients. If the abductor mechanism is preserved, allograft-prosthetic composite gives good results.

Adolescent↗
PubMed2006

Postural differences in the shoulder girdle during normal locomotion in treadmill vs. over ground walking.

In a clinical setting, most musculoskeletal assessment related to gait is undertaken using a treadmill which is additionally widely used during gait and neurological rehabilitation. Although previous studies have reported the range of motion of gait characteristics during running, there is a paucity of information on normative walking data applicable to clinical assessment. Movements and posture of the shoulder girdle is an important indication of back and upper extremity function. While studies indicate that shoulder girdle kinematics are changed during shoulder dysfunction there is little information on the postural relationship between the shoulder and pelvis. The present investigation aims to create a normative database for kinematics during treadmill walking by examining the differences between the treadmill and over ground walking patterns. Additionally, the research will also assess shoulder girdle posture and to establish its relationship with the pelvic complex which will contribute to further understanding scoliotic posture and movement. 14 normal subjects walked over ground at a self-selected speed followed by walking on the treadmill at a speed matched to each subject's respective average over-ground speed. Three-dimensional kinematic data was captured using a passive marker based motion analysis system (Vicon Peak, UK). Angular and temporal kinematic parameters were estimated. The results indicate differences in angular kinematics between over-ground and treadmill locomotion. These differences should be considered when treadmill kinematics are used for clinical evaluation as opposed to over ground ambulation is scoliosis and other conditions.

Adult↗
PubMed2006

Ipsilateral dislocation of the shoulder and elbow joints with contralateral comminuted humeral fracture.

Ipsilateral dislocation of the shoulder and elbow joints is a rare and complex injury. During the last 25 years, only 3 cases have been reported in the literature. We report a 50-year-old woman who suffered ipsilateral elbow and shoulder dislocation with contralateral comminuted humeral fracture. Both shoulder and elbow joints were reduced, but the elbow was dislocated subsequently at follow-up. The reduction in the elbow was stabilized by a Kirschner wire that was removed at 3 weeks, and the elbow was then stable. A U-shaped coaptation splint was applied for the contralateral comminuted humeral fracture. At 6 months, she had acquired a nearly full range of motion of both shoulder and elbow with complete healing in the contralateral humerus. Although rare and complex, ipsilateral shoulder and elbow dislocation, which is the result of a high-energy trauma, can be treated conservatively.

Elbow Joint↗