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PubMedDate not supplied

Reduction of acute anterior shoulder dislocations: comparing intraarticular lignocaine with intravenous anesthesia.

Anterior shoulder dislocation is the most common dislocation in the body. Various methods of anesthesia are available for reduction. The objective of this study was to compare the application of intra-articular anesthesia with intravenous anesthesia for reduction of acute anterior shoulder dislocation. This study was conducted at Kathmandu Medical College Teaching Hospital (KMCTH) and Kathmandu Hospital and comprised of patients coming with anterior dislocation of shoulder from July 2001 to June 2005. Forty-five patients aged 17-55 years with no associated fractures of adjoining bones were included in the study. In twenty-three patients, reduction was done using intra-articular anesthesia and in 22 patients intravenous anesthesia was given. In five patients (three in intra-articular group and two in intravenous group) the reduction technique had to be changed to the Hippocratic method. In these three patients intravenous anesthesia had to be given after intra-articular anesthesia failed to relieve pain and spasm. In the intravenous group two patients had to be admitted overnight while in the intra-articular group none had to be admitted to the hospital. However, in the intra-articular group the average time taken from injection to reduction was significantly longer (<.001). The use of intra-articular lignocaine for reduction of shoulder dislocation is safe and effective especially when patients present early. In patients presenting late (more than 5 hours) intravenous anesthesia should be primarily considered as the method for shoulder reduction.

Acute Disease↗
PubMed1991

Osteoarthritis: with emphasis on primary osteoarthritis of the shoulder.

Fifty-three shoulders in 35 patients were found to have osteoarthritis (OA) of the shoulder using radiographic criteria to establish the diagnosis. Thirty of these shoulders did not exhibit any predetermined signs of secondary OA and were labeled primary OA. The average age of the patients was 79 years. This article discusses OA, with special emphasis on primary OA of the shoulder. Primary OA of the shoulder appears to occur in older individuals and may not be as rare as many observers have stated.

Aged↗
PubMed1991

[Experimental study on a new non constrained total shoulder prosthesis].

We designed a new non constrained total shoulder prosthesis and examined it biomechanically. In order to adapt the shoulder prosthesis for the Japanese, fifty skeletal and one hundred radiographs shoulder joints of Japanese were measured. In radiographs we also measured curvature radius of the humeral head and glenoid fossa. We studied force analysis to elucidate the stability of gleno humeral joint using Rigid Body Spring Model. The result on this study indicate that to lengthen the glenoid surface and to make it near the same radius head and glenoid the joint stability will become stable. Our total shoulder prosthesis consist of a cobalt alloy humeral component, a cobalt alloy glenoid component and a high density polyethylene++ outer head put over a small head of humeral component. The glenoid component have two variations. One is for anatomical replacement and its central angle is 78 degrees. The other is for poor function of rotator cuff and its central angle is 110 degrees. The results of biomechanical experiments showed possibility and advantages of our non constrained total shoulder prosthesis being put into clinical practice.

Alloys↗
PubMed1990

[Value of diagnostic measures in soft tissue diseases and soft tissue lesions of the shoulder joint].

Calcifying tendinitis, acute tendinitis, frozen shoulder, rotator cuff rupture, subluxation of the gleno-humeral joint and injury of the biceps tendon are commonly classed under the blanket term "peri-arthropathy of the shoulder". It is now possible to make a precise diagnosis of these shoulder disorders by means of a clinical examination supported by X-ray examination, ultrasonography, arthrography, computed tomography (CT), magnetic resonance imaging (MRI) and arthroscopy. Calcifying tendinitis is diagnosed by consideration of the patient's history, followed by clinical examination and X-ray examination. Acute tendinitis is a clinical diagnosis, as is frozen shoulder. Ruptures of the rotator cuff can be detected by ultrasonography, which is a screening method; such ruptures can also be detected by arthrography. The localization and extent of the defect are best estimated by arthroscopy. Shoulder instability is another clinical diagnosis. Bony defects of the humeral head (Hill-Sachs lesion) or the glenoid rim are revealed by computed tomography (CT). CT arthrography reveals the presence of any Broca-Hartman lesion in the anterior inferior part of the anterior capsular mechanism. Rupture, subluxation or luxation of the biceps tendon are diagnosed either by clinical examination or by arthroscopy. Knowledge of the sensitivity, specificity and accuracy of the diagnostic procedures makes it possible to carry them out in a standardized, logical sequence. Arthroscopy allows a decidedly more accurate diagnosis than any of the other methods, but as it is an invasive procedure it should be kept until last when diagnosis of disorders of the gleno-humeral joint is required.

Arthroscopy↗
PubMed1990

Shoulder dystocia-a review at the Department of Obstetrics and Gynaecology, Alexandra Hospital, Singapore.

Shoulder dystocia is associated with a high incidence of perinatal morbidity, mortality and maternal morbidity. The present study was undertaken to review all the cases of shoulder dystocia at the Department of Obstetrics and Gynaecology, Alexandra Hospital during a 11-year period from January 1978 until December 1988. The incidence of shoulder dystocia in this series was 1:1739 deliveries or 0.05%. The constant awareness of the possibility of rapid development of shoulder dystocia with its potentially dangerous consequences should always be kept in mind. Shoulder dystocia drills should be held regularly in the resident training programme.

Dystocia↗
PubMed1990

[Possibilities of computerized arthrotomography in the diagnosis of shoulder instabilities].

Shoulder instability can usually be diagnosed by examination of the history and a careful physical examination. Additional diagnostic studies include radiographic investigations and arthroscopy as a functional and very comprehensive diagnostic procedure for shoulder lesions. Conventional radiographic investigations with special projections have proven to be reliable in revealing bony changes of the glenoid and of the humeral head, whereas CT arthrography is very helpful in evaluating capsulolabral lesions associated with shoulder instability. This kind of investigation is a highly sensitive and less invasive technique. Combined with intraarticular application of contrast medium the extent of pathologic changes associated with instability can be imaged and differentiated from other intraarticular causes of dysfunction. During a 1-year period, 42 patients were studied by double contrast arthrography followed by CT examination, and 33 were found to have a shoulder instability. The intention of this report is to describe a few CT arthrographic findings in the presence of pathologic anatomy of unstable shoulders.

Adolescent↗
PubMed1990

Approaches to senior care #10. Recurrent dislocation of the shoulder in an elderly patient.

A case in which 23 recurrent episodes of anterior dislocation of the shoulder occurred in a 76-year-old woman is presented. Du Toit and Roux staple capsulorrhaphy was used to achieve a stable, functioning shoulder. Recurrent dislocation of the shoulder is a problem of youth. Peak incidence occurs at age 20, after age 70, the incidence of recurrent dislocation of the shoulder is extremely low. The surgical treatment of a 76-year-old woman, who suffered 23 documented anterior dislocations of the right shoulder, is discussed and reviewed.

Aged↗
PubMed1989

Intramuscular pressure and electromyography in the supraspinatus muscle at shoulder abduction.

In ergonomic and biomechanic research, estimations of shoulder muscle load and evaluation of different measuring techniques are important. Intramuscular pressure (IMP), using the microcapillary infusion technique and bipolar intramuscular electromyography (EMG), was recorded from the same part of the supraspinatus muscle. In 12 subjects, IMP and EMG were recorded at shoulder abduction angles of 0 degrees, 30 degrees, 60 degrees, 90 degrees, and 135 degrees with no or a 1- or 2-kg hand load in each position. The shoulder torque was calculated for each test position. A correlation was found for both mean IMP and mean EMG versus shoulder torque if the position with extreme muscle shortening (135 degrees abduction) was excluded. IMP was high (greater than 50 mmHg) in almost all test situations. In seven other subjects, isometric force in abduction was correlated with IMP and EMG. Both methods showed an equally good correlation with external shoulder force, IMP gives as good an estimation of relative muscle force as EMG, but any comparison between EMG and IMP must be done at the same muscle length.

Adult↗
PubMedDate not supplied

[Assessment of the functional origin of shoulder pain in chronic polyarthritis by diagnostic local anesthesia of inflamed distal joints. A pilot study].

We examined 40 patients with rheumatoid arthritis suffering from painful shoulder. While the shoulder itself was not treated, Mepivacain was injected into an arthritic joint of wrist or elbow. In 36 out of 40 patients we achieved full or partial improvement of pain and movement of the shoulder. We conclude that pain in the shoulder of these patients was caused by a regulatory mechanism, triggered by nociceptors in an arthritic distal joint in order to protect this damaged structure. The therapeutic consequence implies treatment of the distal joint rather than treatment of the painful shoulder itself.

Aged↗
PubMed1989

Two-and three-dimensional imaging of the painful shoulder.

Fifty-six patients with musculoskeletal disorders involving the shoulder were examined using two-dimensional computed tomography multiplanar reconstruction and volumetric three-dimensional (3D) image processing. Two- and three-dimensional imaging of the shoulder demonstrated advantages over conventional radiography in clarifying areas of complex anatomy. The techniques were found most beneficial for (1) delineating complex fractures; (2) evaluating joint instability; (3) localizing foreign bodies; (4) detecting lytic lesions; (5) assessing soft tissue pathology; and (6) identifying causes for decreased range of motion. Two-dimensional multiplanar reconstruction provided superior views of the scapula and permitted a better understanding of the orientation of the glenoid. Multiplanar reconstruction displayed deep soft tissue anatomy more clearly, including the course of important neurovascular structures. Volumetric 3D imaging added several unique perspectives, providing a more comprehensive representation of the shoulder and its articulating surfaces. The ability to rotate the shoulder about he vertical and horizontal axes in an animated video loop and to edit away confusing, overlying structures provided a "real-time" 3D model of the shoulder for planning treatment.

Humans↗
PubMed1989

The efficacy of intraoperative autologous transfusion in major shoulder surgery.

Perioperative blood loss associated with 36 cases of major shoulder surgery in which an intraoperative autologous transfusion device was used was compared with a control group of 36 shoulder surgery patients to determine the effectiveness of intraoperative autologous transfusion (IAT). Total blood loss in this retrospective review was evaluated by assessing the volume of transfused banked blood and the change in hematocrit. All surgical cases were performed by the same surgeon. The procedures considered in the study were humeral head and total shoulder replacement. Use of an intraoperative autotransfusion device was associated with fewer units of transfused banked blood and similar or smaller drops in hematocrit. While shoulder surgery can involve substantial blood loss, the authors recommend intraoperative autologous transfusion for revision of failed shoulder surgery, arthrodesis, joint replacement, or repairs of massive cuff tears when mobilization and tendon transfers are anticipated. The risk of disease transmission through banked blood, especially of acquired immune deficiency syndrome (AIDS) and hepatitis viruses, has increased the need for a heightened awareness and use of alternative blood sources such as IAT.

Acquired Immunodeficiency Syndrome↗
PubMed1988

The painful shoulder.

Pain in the shoulder arises from a wide variety of abnormalities. The most common cause of acute pain in the nontraumatized shoulder is calcific tendonitis or bursitis readily identified by plain film radiography. On the other hand, the evaluation of chronic pain usually requires some combination of arthrography, CT, ultrasonography, and MRI to identify the source of the patients' complaints with certainty. The shoulder is rarely the site of a monoarticular process and is infrequently the dominant site of abnormality in a generalized articular disease. Clues to generalized disease processes are sometimes evidenced by changes within the shoulder present on the chest film. The source of pain in the shoulder was often elusive and puzzling to both the clinician and radiologist prior to the development of techniques such as arthrography, CT, and MRI that allow the precise delineation of soft tissue abnormalities. The judicious use of these techniques has, in large measure, helped to solve the puzzle.

Humans↗
PubMed1988

Shoulder arthrodesis using a pelvic-reconstruction plate. A report of eleven cases.

Eleven adults who had a flail shoulder due to brachial plexus palsy had arthrodesis of the shoulder using a single ten-hole pelvic-reconstruction plate. Both the glenohumeral and the acromiohumeral joints were fused with the shoulder in the position of 30 degrees of abduction, 30 degrees of flexion, and 30 degrees of internal rotation. No bone graft was used. The patients were immobilized in a spica cast for six weeks postoperatively. At an average follow-up of twenty-five months after the operation, the position of the arthrodesis had been maintained and solid fusion had occurred in each shoulder. No patient required removal of the plate. The pelvic-reconstruction plate is malleable and is more easily contoured in the operating room than a dynamic-compression plate. We recommend the use of a malleable pelvic-reconstruction plate when performing arthrodesis of the shoulder.

Adult↗
PubMed1988

Surgical treatment of bone and soft tissue tumors of the shoulder girdle.

Data on ninety-seven patients with tumors of the shoulder girdle underwent surgical treatment at Fukuoka University Hospital from August 1972 to September 1987 were analyzed. Fifty-six of these 97 consecutive patients with bone tumors (60) or soft tissue tumors (37) were treated surgically. Six patients were given an intra-arterial high-dose of adriamycin preoperatively. The 36 treated with simple resection or curettage and bone graft for benign tumor showed no evidence of local recurrence, except for 3 patients with bone cyst, Among the 20 treated with wide resection (limb salvage operation) for locally aggressive benign or malignant tumors, 11 patients (55%) were disease-free after a median follow-up of 18 months (among the 7 with primary malignant tumor 3 patients were continuously disease-free, 2 were disease-free after treatment of a local recurrence and 2 died.) Functions of the shoulder were studied in 12 patients who had undergone limb salvage operation. We wish to stress the importance of reconstruction of shoulder stability to preserve functions of the elbow and hand, particularly when diseased bone has been removed. If intra-articular resection can be accomplished for tumors of the proximal humerus, constrained total shoulder arthroplasty is an effective method of reconstruction of the surgical defect, yet will lead to preservation of a stable shoulder in patients whose deltoid muscle and axillary nerve have been spared. Preoperative and postoperative chemotherapy will increase the disease-free survival time and the percentage of functional limb saving procedures.

Adolescent↗
PubMed1987

A modified Bristow-Helfet-May procedure for recurrent dislocation and subluxation of the shoulder. Report of two hundred and twelve cases.

A modified Bristow-Helfet-May procedure was performed for recurrent dislocation or subluxation of the glenohumeral joint in 207 patients (212 shoulders), whose average age at the time of surgery was 20.3 years (range, fourteen to forty-seven years). The procedure was modified by directing the coracoid segment and conjoined tendon over the superior border rather than through the substance of the subscapularis tendon and muscle. The indications were either documented recurrent anterior dislocation of the glenohumeral joint or subluxation with instability as demonstrated on examination with the patient under anesthesia. The procedure was evaluated on the basis of the rate of recurrence of dislocation and subluxation, postoperative complications, the patients' subjective evaluation, and the effect of the procedure on the motion of the glenohumeral joint and the strength of the muscles of the shoulder as related to overhead throwing. Eight (3.8 per cent) of the shoulders redislocated and ten (4.7 per cent) had one or more subjective episodes of subluxation after the procedure. Complications included postoperative infection in two patients and problems with the screw that required its removal in ten. One hundred and thirty-one (62 per cent) of the patients responded to a questionnaire regarding their subjective evaluation of the results of surgery. Eleven (8 per cent) were unable to perform daily activities that involved overhead work, and forty-five (34 per cent) stated that they still had some degree of discomfort or pain in the shoulder. One hundred and twenty-six patients (96.2 per cent) stated that they were happy with the results of the surgery and would have the procedure again. Thirty patients had Cybex testing of the muscles of the shoulder. Only three (16 per cent) of the nineteen athletes whose dominant arm had been operated on returned to their pre-injury level of throwing. Data obtained with regard to changes in the range of motion and strength of the glenohumeral joint indicate that this loss of throwing ability was not due solely to a loss of glenohumeral motion. It appeared to be also related to a concomitant loss of strength at the extreme of external rotation of the humerus and the initiation of internal rotation of the humerus.

Adolescent↗
PubMed1986

Shoulder joint load and muscular activity during lifting.

The aim of this study was to investigate load on shoulder joint and muscles in healthy adults during four different ways of lifting a moderate burden (12.8 kg) from floor to table level. The methods used were surface electrode EMG with linear envelope, and calculation of loading moments of force using a static biomechanical model. The shoulder load at the beginning of the lift was lowest for the straight knee lift. The peak load occurred in the late phase of all lifts. On completion of the lift, load and activation were considerably lower when the subject was allowed to step forward before putting the box down. The most activated shoulder muscles were the anterior and lateral parts of the deltoid, and the serratus anterior. Around 80% of the shoulder load moment was caused by the weight of the burden. Some 75% of maximum shoulder strength was required for lifting the burden.

Adult↗
PubMed1983

Comparative study of the properties of the shoulder joint capsule with those of other joint capsules.

To compare the collagen structure of the shoulder joint with that of other joints, the collagen of shoulder, elbow, and hip joints was examined electron microscopically, electrophoretically, and by its response to mechanical stress. Collagen Types I, III, and V were common to joint capsules. Electron microscopy of shoulder and elbow joint capsules did not identify any structural difference. When subjected to a mechanical force, the shoulder joint showed a greater capacity to stretch than the elbow joint, and greater force was required to break the shoulder joint than the elbow joint.

Adult↗
PubMed1978

[Contribution to the study of scapulo-humeral periarthritis: anatomical lesions of simple chronic painful shoulder].

The authors restate that simple pain of the shoulder, which is a form of scapulo-humeral periarthritis characterized by the existence of pain without limitation of movement, is almost always associated with lesions of the tendons of the short muscle teres of the shoulder. They term chronic simple pain of the shoulder the rare cases where, despite therapy that is reputed to be efficient, there is a gradual development lasting more than one year, either continuously or with relaps periods of less than three weeks. They show that these chronic shoulders are practically always associated with a rupture of the coat of the muscle teres or a calcification of the tendons of the teres coat. Ruptures are as much frequent in men as in women and calcifications definitely more frequent in women (60%). Before 30 years of age, the most frequent lesion is almost always a calcification, and after 65 rupture is more common. Between 30 to 65, the probability of a calcification in a chronic simple painful shoulder, goes from 100% to 0, while the probability of a rupture increases from 0 to 100%.

Adult↗