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PubMed1997

[The comparative clinico-laboratory characteristics of Lyme arthritis and reactive arthritis].

The paper presents comparative clinical and laboratory characteristics of 17 cases of Lyme-arthritis (LA) and 28 cases of reactive arthritis (RA). LA and RA patients differed by age and sex. LA arose after the tick bite followed by erythema migrans or infection symptoms. In RA patients the above symptoms were absent. In LA patients arthritis was associated with typical symptoms of neuroborreliosis. The articular syndrome manifested similarly in LA and RA: arthritis was preceded by arthralgias, low limb joints and periarticular tissues were involved most frequently. The differences were: monoarthritis, elbow and shoulder joints, muscles lesions occurred more frequently in LA; polyarthritis, arthritis of hand and foot joints, talalgia were more common in RA. RA ran more actively, joint syndrome more frequently gave rise to fever. Prevalence of chlamydial infection in LA was close to that in RA. LA may run as RA, is frequently combined with Chlamydia trachomatis infection.

Aged↗
PubMed1999

Resistance properties of Thera-Band tubing during shoulder abduction exercise.

STUDY DESIGN: Single-group, repeated measures. OBJECTIVES: To investigate the relationship between tubing length and tubing tension for 6 colors of Thera-Band tubing (each color representing a different level of resistance) and to estimate the resistive shoulder torque provided during shoulder abduction exercise. BACKGROUND: Thera-Band tubing is popular for providing resistance in rehabilitation strengthening programs. Unfortunately, it is difficult to compare use of elastic tubing with other resistance training methods because no published data exist on how much resistance is being provided during exercise. METHODS AND MEASURES: Nine male and 6 female subjects (age, 25.9 +/- 3.6 years; height, 173 +/- 10 cm) performed shoulder abduction, using 6 colors of tubing. A strain gauge attached at the fixed end of the tubing directly measured the tension generated during stretch. For each color of tubing, each subject momentarily held a position at 30 degrees, 60 degrees, 90 degrees, 120 degrees, and 150 degrees of abduction. Shoulder joint abduction, limb segment position, and tubing length were analyzed by means of the Peak Motion Measurement System. Simple linear regression equations predicted tubing tension from percent change in tubing length at the joint angle positions. A 2-way (5 x 6) repeated-measures ANOVA determined the mean differences in tubing tension across tubing colors at the shoulder abduction positions. RESULTS: Strong linear relationships were found for each tubing tension when referenced according to changes in tubing length. Significant differences in tension were found for the various colors of tubing. The resistive torque curves for each color tubing were similar to isotonic exercise. CONCLUSIONS: Thera-Band tubing provides linear resistance during shoulder abduction, but the resistive torque provided by the tubing mimics isotonic exercise.

Adult↗
PubMed1991

[Routine ultrasound diagnosis of the shoulder. A simplified examination procedure].

With increasing use of ultrasonography at the shoulder, a confusing number of transducer positions have been recommended. At the shoulder, however, dynamic examination yields more information than fixed transducer orientations. In our examination routine, the transducer is guided across the shoulder following the shape of a triangle. Orientation is secured by palpable, bony structures. The clinically relevant parts of the rotator cuff and the long biceps tendon are investigated, first medially and laterally in a transverse projection and then longitudinally. Dynamic examination is provided by moving the transducer as well as the shoulder joint. In a time-saving examination routine, all important soft tissue structures of the shoulder are visualized.

Humans↗
PubMed2002

Work and fatigue characteristics of unsuited and suited humans during isolated isokinetic joint motions.

The effects of a pressurized suit on human performance were investigated. The suit is known as an Extra-Vehicular Mobility Unit (EMU) and is worn by astronauts while working outside their spacecraft in a low earth orbit. Isolated isokinetic joint torques of three female and three male subjects (all experienced users of the suit in 1G gravity) were measured while working at 100% and 80% of their maximum voluntary torque (MVT, which is synonymous with maximum voluntary contraction (MVC)). It was found that the average decrease in the total amount of work (the sum of the work in each repetition until fatigue) done when the subjects were wearing the EMU were 48% and 41% while working at 100% and 80% MVT, respectively. There is a clear relationship between the MVT and the time and amount of work done until fatigue. Here, the time to fatigue is defined as the ending time of the repetition for which the computed work done during that repetition dropped below 50% of the work done during the first repetition. In general the stronger joints took longer to fatigue and did more work than the weaker joints. It was found that the EMU decreases the work output at the wrist and shoulder joints the most, due to the EMU joint geometry. The EMU also decreased the joint range of motion. The average total amount of work done by the test subjects increased by 5.2% (20.4%) for the unsuited (suited) case, when the test subjects decreased the level of effort from 100% to 80% MVT. Also, the average time to fatigue increased by 9.2% (25.6%) for the unsuited (suited) case, when the test subjects decreased the level of effort from 100% to 80% MVT. It was also found that the experimentally measured torque decay could be predicted by a logarithmic equation. The absolute average errors in the predictions were found to be 18.3% and 18.9% for the unsuited and suited subjects, respectively, when working at 100% MVT, and 22.5% and 18.8% for the unsuited and suited subjects, respectively, when working at 80% MVT. These results could be very useful in the design of future EMU suits and the planning of Extra-Vehicular Activity (EVA) for the future International Space Station assembly operations.

Female↗
PubMed2006

Joint symptoms: a practical problem of anastrozole.

BACKGROUND: Anastrozole and tamoxifen have mild toxicity. However, we noticed that more patients treated with anastrozole complained of joint symptoms than expected. In particular, digital stiffness as is seen with rheumatoid arthritis is a problem. Some clinical trials of anastrozole in Europe and the United States reported musculoskeletal disorders as adverse events, however, joint symptoms were not described in detail. PATIENTS AND METHODS: At our clinic from August 2001 to March 2005, 53 postmenopausal women with estrogen receptor-positive breast cancer were treated with anastrozole. We calculated the incidence and classified the grade of joint symptoms by interviewing patients. We also investigated the patients' characteristics and their relevance to joint symptoms. RESULTS: Of 53 patients, 14 patients (26%) had joint symptoms (13 patients with digital stiffness and 3 patients with arthralgias of wrist and shoulders). Joint symptoms tended to occur in the patients who had previously undergone chemotherapy; however, there has no relationship between prior hormonal therapy and joint symptoms. Seven patients who discontinued anastrozole treatment showed improved symptoms. Five patients with grade 1 digital stiffness continued anastrozole treatment without additional treatment. Two patients with grade 1 digital stiffness, who took a Chinese herbal medicine showed improved symptoms and continued anastrozole treatment. CONCLUSION: Benefits to the patients may possibly be lost by discontinuation of anastrozole or changing to tamoxifen since the clinical superiority of anastrozole to tamoxifen has been reported. We should continue anastrozole in patients with low grade symptoms, while ensuring that patients are aware of the toxicity of anastrozole.

Adult↗
PubMed2002

[Nerve conduction studies of suprascapular nerve for site-of-lesion diagnosis].

Shoulder pain is a common symptom, resulting not only from bone and shoulder joint diseases, but also from neurogenic lesions. Entrapment neuropathy of the suprascapular nerve also causes shoulder symptoms. Conduction of the suprascapular nerve was studied in 12 healthy control subjects and 25 patients suffering from shoulder pain and/or dysfunction. Surface stimulation was performed at Erb's point, and compound muscle action potentials(M waves) were recorded from the supraspinatus and the infraspinatus muscles with concentric needle electrodes. To determine the optimal site for recording M waves from the infraspinatus muscle, simultaneous multi-channel recordings of M waves using pairs of surface electrodes were obtained from different sites over the infraspinatus muscle. In two patients, latency of the M waves to the infraspinatus muscle was prolonged, whereas that to the supraspinatus muscle was normal. These findings indicate entrapment neuropathy at the spinoglenoid notch. In three patients, the latency to the infraspinatus and supraspinatus muscles was prolonged. These findings are compatible with entrapment neuropathy at the suprascapular notch. The latency to the supraspinatus and infraspinatus muscles was prolonged in patients with brachial plexus injury and in those with suprascapular nerve injury. In patients with myopathy, those with neuralgic amyotrophy and those with cervical radiculopathy, the latency was normal. Thus, conduction studies of the suprascapular nerve using multiple-channel recordings are useful, especially for the diagnosis of entrapment neuropathy of the suprascapular nerve.

Adult↗
PubMed2005

Traumatic shoulder dislocation in the adolescent athlete: advances in surgical treatment.

PURPOSE OF REVIEW: The shoulder joint has the greatest range of motion of any joint in the body and as a result is particularly susceptible to dislocation and subluxation. Recurrent instability is a common complication after traumatic shoulder dislocation in young people, with rates as high as 100% in skeletally immature patients and 96% in for adolescents. Treatment for shoulder dislocation has traditionally involved immobilization followed by a rehabilitation program. Recent studies have reported decreased rates of recurrent instability and improved outcomes in patients treated with surgical stabilization of acute, traumatic shoulder dislocation. The purpose of this review is to review recent publications concerning the treatment of traumatic shoulder dislocations in adolescents. RECENT FINDINGS: Lawton et al. retrospectively reviewed 70 shoulders in 66 patients 16 years old or younger treated for shoulder instability with follow-up more than 2 years. Forty-two shoulders were successfully treated with physical therapy, whereas 28 eventually required surgery. Subsequently, Deitch et al. retrospectively identified 32 patients between 11 and 18 years of age with radiographically documented traumatic anterior shoulder dislocation. Instability recurred in 75% of patients and 50% eventually required surgical stabilization. Bottoni et al. reported results of a prospective randomized trial comparing arthroscopic stabilization to nonoperative treatment of acute, traumatic shoulder dislocations in patients aged 18 to 26 years. Recurrent instability developed in 75% of patients treated conservatively versus 11% in those treated with surgery. DeBerardino et al. prospectively evaluated arthroscopic stabilization of acute shoulder dislocations in 48 young athletes with an average follow-up of 37 months and reported a 12% rate of recurrent instability. All patients with stable shoulders were able to return to their previous levels of activity. SUMMARY: Conservative management of traumatic shoulder dislocations in young patients is associated with high rates of recurrent instability. Recent studies have demonstrated improved results and significant reduction in recurrent instability in patients treated with surgical stabilization when compared with nonoperative treatment.

Adolescent↗
PubMed2002

Longitudinal development of kinematics in shetland ponies and the influence of feeding and training regimes.

Nowadays, ponies are used more and more for competitive equine sports, driving and racing. The locomotor performance of ponies, however, has been evaluated in only a few kinematic and kinetic studies. To compare the longitudinal development of locomotor characteristics in the pony to the same process in the horse, the kinematics of 23 Shetland ponies were recorded at the trot on a treadmill (3 m/s) at ages 4 and 30 months using a modified CODA-3 apparatus. Furthermore, the influence of specific feeding and training regimes on this development was evaluated. It appeared that stride and stance duration increased with age, but the swing duration and pro/retraction range were similar at foal and mature age. Fore- and hindlimb maximal joint flexion at swing was larger in the mature ponies compared to foals. The elbow and shoulder joint were kept in a more extended position and the stifle joint more flexed, while scapula and pelvis were kept in a more vertical position. These effects are similar to those found in horses. The majority of both temporal and angular kinematic variables correlated significantly between foals and mature ponies. Ponies that were restricted in their feeding, resulting in a low body condition score, demonstrated a flatter gait than ponies fed ad lib (4 cm more height, 60 kg more weight), which trotted at the same velocity with significantly more joint flexion. Extra sprint training on top of free paddock exercise did not significantly influence the longitudinal development of kinematics. From these data, it can be concluded that the longitudinal development of locomotor characteristics in ponies is similar to that in horses. Fatter animals show a more animated gait, while extra sprint training added to free paddock exercise has no detectable effect on the development of kinematics. Aside from training or feeding regimes, in the Shetland pony breed, it appears possible to recognise 'good movers' at a young age.

Age Factors↗
PubMed1999

Injuries presenting to Army physiotherapy in north Queensland, Australia.

OBJECTIVE: To analyze archival physiotherapy records at a major military base in North Queensland, Australia, to investigate the epidemiology of injuries associated with sports and training, examining for possible risk factors for military training injury. METHODS: A retrospective study was undertaken during a 62-month period, from 1987 to 1992, at Lavarack Barracks, Townsville, Australia, which services a dynamic population base of some 5,000 uniformed staff. Sociodemographic basic data, as well as treatment-related data (treatment area, number and type, interval between onset and initial treatment, reported cause), were used. Admission records were recoded according to the Orchard Sports Injury Classification System (version 2.0) standard. RESULTS: During the 62-month period from 1987 to 1992, 4,993 personnel, 96.2% (4,803/4,993) males and 3.7% (190/4,993) females, were referred for 5,025 physiotherapy treatments. The incidence of injuries requiring physiotherapy was 80.4 new patients per 5,000 personnel per month, and the incidence rate of injury was 19.3% per year or 0.19 injuries per person per year. The mean age of patients was 25.7 +/- 6.2 (SD) years, and the median age was 24 years, with a range of 17 to 59 years. Injuries were related to military training (29.3%, 1,471/5,025), diverse causes (21.2%, 1,072/5,025), sports (13.8%, 694/5,025), insidious onset (11.8%, 589/5,025), football (11.7%, 586/5,025), manual handling (4.2%, 211/5,025), motor vehicle crashes (4.1%, 206/5,025), and surgery (3.9%, 196/5,025). The four major body areas treated by physiotherapists were the knee joint (37.0%, 1,321/3,612), lumbar spine (29.8%, 1,075/3,612), ankle (19.9%, 719/3,612), and shoulder joints (13.8%, 497/3,612), which accounted for nearly three-quarters of all admissions. Of these, most were referred without definitive diagnosis (71.1%, 2,572/3,612), with the remainder comprising joint injuries (17.5%, 634/3,612), other types of pathology such as chest infections or neurological involvement, soft-tissue injuries (3.5%, 128/3,612), and bone damage (1.0%, 38/3,612). Most injuries (59.0%, 2,959/5,019) occurred during the 6 months between April and September referred to as the winter season, during which 71.8% of all football and 66.8% of all sports-related referrals were made. Significant associations were found between gender and injury cause (p < 0.001), gender and injury type (p < 0.01), body area affected and injury type (p < 0.00001), body area affected and injury cause (p < 0.00001), injury cause and injury type (p < 0.00001), and season and injury cause (p < 0.00001). Pretreatment interval was significantly associated with cause of injury (p < 0.00001), body area affected (p < 0.0001), and type of injury (p < 0.0001). Total number of consecutive treatments provided was significantly associated with both body area affected (p < 0.05) and injury type (p < 0.001). CONCLUSIONS: This study has used archival physiotherapy records for the purpose of exploring injury reporting patterns associated with a military population. The incidence profile for injuries using physiotherapy admissions is likely to be conservative because the patients are a group of injured military personnel selected by medical officers for physiotherapy treatment. This selection process needs further study, particularly because the majority of injuries referred for physiotherapy treatment are undiagnosed. This may be attributable in part to the cumulative and diverse nature of some injuries. Injury prevention needs to focus on activities relating to military training and football and other sports. Improved systems for recording detailed and accurate physiotherapy admission, treatment, and follow-up information are needed.

Adolescent↗
PubMed1987

Shoulder injury caused by electric shock.

Shoulder injury and more in particular bilateral dislocation of the shoulder joint after electric shock is rare. Three patients are presented with dislocation and fracture of the shoulder and serious muscle contraction. After an accident involving electric current potential shoulder injuries should be considered. Early diagnosis improves the functional results of adequate treatment.

Adult↗
PubMed1999

MR imaging of the subcoracoid bursa.

OBJECTIVE: The subcoracoid bursa, a bursa anterior to the shoulder joint, can be identified on MR images. Awareness of the MR appearance and location of this bursa, which can connect with the subacromial-subdeltoid bursa, enables appropriate diagnosis in patients with shoulder pain. MATERIALS AND METHODS: Dictated reports involving all MR imaging of the shoulder (n = 1545) performed at our institution from June 1993 to February 1998 were reviewed from computer archives. Films were reviewed in 16 cases describing a subcoracoid bursa; in nine MR imaging correctly revealed this bursa, whereas in seven MR imaging revealed the subscapular recess, an outpouching of the glenohumeral joint often confused with the subcoracoid bursa. RESULTS: Of the 1545 shoulders examined, MR imaging revealed the subcoracoid bursa in nine (0.6%) patients. Two cases from a teaching file were also included, for a total of 11 cases. In five (45%) of the 11 cases, the subcoracoid bursa contained a small amount of fluid (<1 cm in largest diameter on sagittal images). In the remaining six cases (55%), the subcoracoid bursa contained a moderate (1-2 cm in largest diameter) or a large amount (>2 cm in largest diameter) of fluid. Of the 11 cases, six (55%) also showed connection with the subacromial-subdeltoid bursa. CONCLUSION: It is important to correctly identify the subcoracoid bursa on MR imaging because it is believed to cause isolated shoulder pain. Fluid in the subcoracoid bursa can also communicate with the subacromial-subdeltoid bursa.

Adolescent↗
PubMed2006

Arthroscopic treatment of acute traumatic posterior glenohumeral dislocation and anatomic neck fracture.

We describe a simple method of arthroscopic-assisted reduction of a posterior fracture dislocation of the proximal humerus, the principle of which could be used as a method of reduction for all fracture dislocations of the proximal humerus for which percutaneous reduction is beneficial. With the patient in the beach-chair position and using a posterior portal 2 cm medial and 2 cm inferior to the posterolateral corner of the acromion on the medial edge of the displaced head, a 4.5-mm blunt trocar is introduced, directed medial to the head fragment toward the posterior lateral scapular neck, translating the distal tip laterally to enter the shoulder joint. The trocar is then redirected medially onto the articular surface of the glenoid and the head is levered into the joint atraumatically. The standard technique of percutaneous reduction of the proximal humerus follows. Arthroscopic evaluation of the shoulder with gravity-assisted flow is performed to improve the articular reduction and document any associated capsular, ligamentous, labral, or tendon damage. Similarly, anterior fracture dislocations can be reduced atraumatically using lateral and anterior portals, after which percutaneous reduction could be effective when indicated.

Adult↗
PubMedDate not supplied

Glenohumeral articular cartilage changes in rotator cuff disease.

This study aims to clarify the natural history of glenohumeral articular cartilage changes in rotator cuff disease. We assessed 33 cadaveric shoulder joints, examining the rotator cuffs for macroscopic tears and the articular surfaces for degenerative changes. Ten specimens had tears of the rotator cuff. Articular degenerative changes were noted in 23 joints. Articular cartilage degeneration was almost twice as frequent in the group with rotator cuff tears (10/10 shoulders) as in those without tears (13/23 shoulders). This difference was statistically significant. This strong correlation between tears of the rotator cuff and articular degeneration has not been documented previously, other than in the extreme situation of massive cuff tears and cuff-tear arthropathy. This is deserving of further study because it may have implications for surgical management.

Aged↗
PubMed2006

Effectiveness of locked nailing for displaced three-part proximal humeral fractures.

BACKGROUND: Published reports about locked nailing for displaced comminuted proximal humeral fractures are few and the results contradictory. METHODS: Locked nailing was used to treat 27 selective patients with displaced three-part proximal humeral fractures. The average age of patients was 54.3 years. The operative indications were persistent severe displacement, intact or minimally displaced lesser tuberosity, tolerance of anesthesia, and adherence to rehabilitation programs. Three patients had associated shoulder dislocation and two had fractures with diaphyseal extension. By transdeltoid approach, the fractures were reduced and then fixed by antegrade nailing with either upward or downward locking screws. The patients were prospectively followed up for an average of 24 months. RESULTS: All fractures achieved eventual union. Three patients with proximal screw loosening required screw removal. On the basis of Neer criteria, excellent or satisfactory results were obtained in 21 patients whose scores averaged 87.5 points. Six patients had unsatisfactory outcomes, with an average of 75.8 points. Two patients with the complication of avascular necrosis still had a satisfactory outcome. Varus deformity of shoulder joints, deformity of the greater tuberosity, collapse of the humeral head, and old age could adversely affect shoulder elevation. However, the anatomic abnormalities might have limited effects on the pain scale, muscle power, and shoulder stability. CONCLUSIONS: Locked nailing can be an effective treatment for selected severely displaced three-part proximal humeral fractures. It is particularly useful for fractures with diaphyseal involvement. Familiarity with the fracture deformity and experience with the surgical techniques are critical for successful treatment results.

Adult↗
PubMed1996

[The importance of sonography in orthopedics for dogs].

For the ultrasonographic examination of the musculoskeletal system in dogs a 7,5 MHz linear scanner is used best, in some cases with a standoff pad. Radiography is the technique of choice to detect bone abnormalities. For certain circumstances the sonography can be used to give additional information (e.g. surrounding tissue with osteomyelitis or bone tumors). For the diagnostic of joint diseases ultrasonography is an excellent completion for the radiographic examination. Joint effusion and thickened capsule can be detected. Defects of articular cartilage like osteochondrosis dissecans in the knee or shoulder joint can be well seen. Instabilities of the joint can be identified with a dynamic examination. For evaluating the soft tissue areas ultrasonography is the optimal imaging procedure. Tears of muscles or tendons (e.g. achilles or biceps tendon), partial or complete ones, are seen in the sonographic examination. The process of healing with consolidation of the tendon can be controlled and documented. The tendon of the biceps brachii muscle is often affected in the soft tissue area of the shoulder. Luxation of the tendon, old injuries with scar formation, free dissections in the biceps tendon sheath and a tendovaginitis can be seen. Abscesses, foreign bodies, hematomas and soft tissue tumors in the musculoskeletal system can be well presented in the echotomogram. A tumor in the region of the brachial plexus can be detected directly with ultrasound.

Animals↗
PubMed2004

Mechanical loading of the low back and shoulders during pushing and pulling activities.

The objective of this study was to quantify the mechanical load on the low back and shoulders during pushing and pulling in combination with three task constraints: the use of one or two hands, three cart weights, and two handle heights. The second objective was to explore the relation between the initial and sustained exerted forces and the mechanical load on the low back and shoulders. Detailed biomechanical models of the low back and shoulder joint were used to estimate mechanical loading. Using generalized estimating equations (GEE) the effects were quantified for exerted push/pull forces, net moments at the low back and shoulders, compressive and shear forces at the low back, and compressive forces at the glenohumeral joint. The results of this study appeared to be useful to estimate ergonomics consequences of interventions in the working constraints during pushing and pulling. Cart weight as well as handle height had a considerable effect on the mechanical load and it is recommended to maintain low cart weights and to push or pull at shoulder height. Initial and sustained exerted forces were not highly correlated with the mechanical load at the low back and shoulders within the studied range of the exerted forces.

Adult↗
PubMed2000

Neurologic injuries in baseball players.

In baseball pitchers, injuries to the throwing arm are common due to the extreme stresses placed on the elbow and shoulder joints. These result in peripheral nerve syndromes including ulnar neuropathy at the elbow and suprascapular neuropathy at the shoulder. Recurrent trauma to the axillary artery causing aneurysm and thrombus formation may lead to distal ischemia and stroke. Careful evaluation is required to identify musculoskeletal, neurologic, and vascular causes of upper extremity symptoms in the throwing athlete.

Adult↗
PubMed2003

Kinesthetic sense of the shoulder in patients with impingement syndrome.

A proprioceptive deficit is an important determinant of disability in various shoulder disorders, such as instability and osteoarthrosis. In 15 patients with impingement syndrome stage II (Neer 1983), who were treated by arthroscopic subacromial decompression, we measured movement sense by determining threshold levels for the perception of motion of the shoulder. The patients were placed in a specially designed chair allowing continuous passive motion of the shoulder joint, while avoiding cutaneous, auditory and visual stimuli. To assess movement detection thresholds, passive abduction movements of the shoulder were performed at a starting angle of 60 degrees, an amplitude of 10 degrees and an angular velocity of 1.3 degrees/s. Before surgery, all patients had higher threshold levels for the perception of motion in their affected shoulders then in the other side. After decompression, proprioception had improved on the decompressed side, but was unchanged on the other side.

Adult↗