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PubMed1991

[Treatment of axillary burn scars by a scapular island flap with a vascular pedicle].

Type 3 axillary burn retractions, involving the neck, the axilla, the upper arm and the lateral aspect of the chest, can cause difficult static and dynamic deficits altering the aesthetic appearance and the function of the shoulder. The posterior scapular area can provide an autonomized skin flap, based on the circumflex scapular vessels. This scapular flap, used as an island vascular flap, easily covers the anterior and posterior aspects of the axilla, obtaining a smooth skin surface, with a good underlying subcutaneous fatty tissue. Its elastic properties are well adapted to the dynamic requirements of the separate movements of the shoulder joint. Performed on 25 axillary burn retractions in 20 patients, this flap provided a convincing improvement in the shoulder range of movement and a return to a normal activity.

Axilla↗
PubMed2006

[Observation on clinical therapeutic effect of transcutaneous point electric stimulation on periarthritis of shoulder at different stages].

OBJECTIVE: To observe the therapeutic effect of transcutaneous point electric stimulation on periarthritis of shoulder at different stages and compare with electroacupuncture. METHODS: Three hundred and sixty cases of periarthritis of shoulder at different stages were divided into a treatment group (n=186) treated with transcutaneous point electric stimulation, and a control group (n=174) treated with electroacupuncture. Same acupoints were selected in the two groups. RESULTS: The total effective rate of transcutaneous point electric stimulation was 96.6% at the adhesion prophase and 96.9% at the adhesive stage, but electroacupuncture stimulation was 93.5% and 97.9%, respectively, with no significant differences between the two groups; transcutaneous point electric stimulation not only could relieve pain, but also significantly improve dysfunction of shoulder joints at the adhesive stage. CONCLUSION: Transcutaneous point electric stimulation is an effective and convenient therapy for periarthritis of shoulder.

Acupuncture Points↗
PubMed2002

Adhesive capsulitis: role of MR imaging in differential diagnosis.

The purpose of this study was to describe and characterize the MR imaging findings in a group of patients who underwent surgery for adhesive capsulitis. Twenty-four MR imaging studies in 24 consecutive patients with clinical evidence of adhesive capsulitis were performed prior to arthroscopic capsulotomy. There were 17 women and 7 men with a mean age of 53.5 years. Images were scrutinised for changes in the synovium particularly in the rotator interval, around the biceps anchor and axillary pouch. Intravenous gadolinium was given routinely. We also examined a control group of 22 patients who underwent the same MR imaging protocol after referral for rotator cuff pathology. Soft tissue density showing variable enhancement after gadolinium administration was visible in the rotator interval in 22 of 24 studies on MR imaging. Seventeen patients showed soft tissue density partially encasing the biceps anchor. Ten patients showed thickening and gadolinium enhancement of the axillary pouch. Three patients from the study cohort had partial tears of the supraspinatus tendon. All the patients subsequently had surgery which confirmed fibrovascular scar tissue in the rotator interval, around the biceps anchor and a variable degree of synovial inflammation of the glenohumeral capsule. Two patients from a control group with suspected rotator cuff pathology showed abnormal intensity in the rotator interval on MR imaging. Magnetic resonance imaging can identify changes in the shoulder joint that correspond to abnormalities seen at surgery. This may be useful for discriminating adhesive capsulitis from other causes of shoulder pain.

Adult↗
PubMed1994

The use of scapular skin island flaps in the treatment of axillary postburn scar contractures.

The scapular island flap easily covers the anterior and posterior aspects of the axilla, providing a smooth skin surface with good underlying subcutaneous fatty tissue. Its elastic properties are well adapted to the dynamic requirements of the shoulder joint. Performed in 20 patients for treatment of axillary postburn contractures, this flap led to a convincing improvement of the shoulder range of motion and satisfying aesthetic results.

Adolescent↗
PubMed1999

Total shoulder and relative muscle strength in the scapular plane.

Strength profiles of the shoulder joint are measured experimentally for two arm positions in "the scapular plane" in order to present quantitative data on the shoulder strength. Apart from yielding the actual force a subject can exert in various directions, these measurements also exhibit e.g. the strongest and weakest directions, in fact the relative strength in all directions. The inter-individual variation of the direction of maximal force was at most 14 degrees (sd). The experimental profiles are compared with the corresponding theoretical profiles, obtained by using a shoulder model. The calculations were made both with default muscle parameters and individually adapted parameters. The results show that the employed shoulder model, which is based on data from an elderly population, may be adapted to other populations and that the necessary changes in relative muscle strength are those expected on biomechanical grounds. Without model changes the difference between measured (in the mean) and predicted maximal force directions was at most 50 degrees. Muscle parameter adjustment reduced this difference to 23 degrees. The strength profiles clearly indicate in what direction a person can produce larger forces and which muscles that contribute.

Adult↗
PubMed1997

Candida infection of a silicone metacarpophalangeal arthroplasty.

Fungal infections following joint arthroplasty are extremely rare. Only 16 cases of Candida prosthetic infections have been reported, involving the hip, knee or shoulder joints. We report a case of a silicone metacarpophalangeal joint replacement complicated by a Candida albicans infection.

Aged↗
PubMedDate not supplied

A review of self-report scales for the assessment of functional limitation and disability of the shoulder.

A shoulder disorder affects a patient's overall quality of life. Self-report outcome measures can be used to assess the effects of shoulder dysfunction in terms of patients' functional limitations and disabilities. Selection of a shoulder-specific scale from the numerous scales available can be overwhelming. The purpose of this study was to review the self-report scales in current use for assessing the shoulder joint. A MEDLINE literature search was performed to locate scales appropriate to the assessment of function and disability of the shoulder. Only scales with established measurement properties were selected for review. Eleven scales were reviewed. Methodological and practical criteria were established to evaluate each scale. All scales met the minimal criteria, but not all scales were equal with regard to the criteria established for analysis.

Health Status Indicators↗
PubMed1983

[Diabetes-specific hand changes in type I diabetes mellitus].

Diabetes-specific hand alterations (cheirarthropathy) were observed in 44 out of a total of 215 children and adolescents with insulin-dependent diabetes. In 28 of them limitations of movement in the proximal or (and) distal interphalangeal joints of one finger, and in the remaining 16 patients changes of at least two fingers were seen. Hand and shoulder joints or the vertebral column were not affected. In a control group of 110 probands without metabolic disorder only five showed cheirarthropathy. The frequency of diabetes-specific alterations of the hand increased with the age of the patients, the duration of diabetes and insulin requirements. In particular, the quality of metabolic control is of paramount importance for the as yet unclear pathogenesis of cheirarthropathy.

Adolescent↗
PubMedDate not supplied

Shape of the acromion: congenital or acquired--a macroscopic, radiographic, and microscopic study of acromion.

Debate continues as to whether the differing shapes of the acromion are congenital or acquired. This has been investigated by neonatal cadaver study, adult cadaver study, radiographic study, magnetic resonance imaging study, or various other means. No one, to our knowledge, has investigated this by histologic study. A macroscopic and histologic study of 22 cadaveric shoulder joints was carried out to establish what, if any, developmental changes occur in the differing patterns of acromion. The cadaveric shoulders were dissected and examined macroscopically. All of the acromion processes were transected and photographed, and the histology of the anterior and inferior surfaces was studied. In all of the curved and hooked types of acromion, a common pattern of degeneration of collagen, fibrocartilage, and bone was observed, consistent with a traction phenomenon. None of the flat acromions exhibited these changes. Extensive histologic changes were noted on the anterior surface of acromion as compared to the inferior surface in curved or hooked acromion. We conclude that the different shapes of acromion are, therefore, acquired as a response to traction forces applied via the coracoacromial ligament and are not congenital in origin.

Acromion↗
PubMed2001

Joint accumulations of FDG in whole body PET scans.

PURPOSE: To retrospectively evaluate FDG accumulations in major joints in a large series of non-absorption corrected partial body and whole body FDG-PET scans, and to determine the frequency and intensity of accumulation. MATERIALS AND METHODS: 354 consecutive PET partial- and whole body non-transmission corrected scans of patients obtained for tumor staging were examined with respect to FDG accumulations in the acromio-clavicular (AC)-, gleno-humeral-, hip-, knee- and talo-tibial joints. FDG-uptake was graded using a semi-quantitative scale from 0 (no accumulation) to 4 (very strong accumulation comparable to brain uptake). RESULTS: Joint activity of grade 1-2 was noted frequently, while grade 3 was rare, occurring only in the knee and shoulder joints, and grade 4 was inexistent. The 43 patients with grade 3 accumulations or with at least 4 joints showing grade 2 uptake were interviewed, but all denied pain specifically referred to a joint. Joint accumulations were seen in 50% of the acromio-clavicular-, 80% in the glenohumeral-, 50% in the hip-, 90% in the knee and 80% in the talo-tibial joints. The intensities of joint accumulations correlated positively and significantly with patient age, ranging from r = 0.7 and p < 0.05 in the knee to r = 0.96 and p < 0.0001 in the AC joint. CONCLUSIONS: FDG accumulations in the joints in whole body FDG-PET scans are frequent and are very likely not related to symptoms. As there is a strong age correlation, and FDG is known to accumulate in inflammatory lesions, the findings are most likely a result of sub-clinical inflammatory synovial proliferation or other chronic inflammatory processes occurring in aging joints.

Adolescent↗
PubMed1996

[Diagnosis and therapy of shoulder instability].

Shoulder instability is based on various acquired or constitutional aspects which determine the therapy and clinical outcome. In order to differentiate between traumatic and atraumatic forms of shoulder instability a careful history has to be taken. A systematic clinical examination is necessary to evaluate the shoulder joint for general laxity or true instability and especially to assess direction and degree of glenohumeral translation. The basic diagnostic imaging includes X-rays in 3 planes. CT-arthrogram and MRI may provide additional information to evaluate the intraarticular pathology. An elective therapy depends on the patients age and demands. Recurrent anterior dislocations are treated by an anatomical reconstruction of the glenohumeral ligament complex. Open or arthroscopic Bankart-repair have been established as the treatment of choice. Conservative treatment is primarily indicated in cases of atraumatic posterior or multidirectional instability. If physiotherapy fails, surgical treatment should be discussed for these patients.

Diagnosis, Differential↗
PubMed2001

[Conservative treatment of shoulder disorders].

The extreme complexity of the shoulder joint results from the coordinated activity of five different articulations and the supporting soft-tissue girdle. Any perturbation of this system has deleterious biomechanical consequences to the shoulder muscular girdle integrity and will eventually lead to pain and functional limitations. A functional diagnosis of the lesion will always be a prerequisite for a targeted conservative therapy. Treating pain is often the basis of the treatment, but it should rapidly be implemented with a broad range of physiotherapeutic techniques and manual therapy as well when appropriate. The guidelines for therapy include an active stabilisation program in case of joint instability and passive mobilisation whenever functional limitations are present. This paper deals with the different problem-oriented interdisciplinary therapeutic modalities used in frequent shoulder problems.

Acute Disease↗
PubMed2004

Congruency effects on load bearing in diarthrodial joints.

Modelling load bearing in diarthrodial joints is challenging, due to the complexity of the materials, the boundary and interface conditions and the geometry. The articulating surfaces are covered with cartilage layers that are filled with a fluid that plays a major role in load bearing [Mow, V.C., Holmes, M.H., Lai, W.M. (1984) "Survey article: fluid transport and mechanical properties of articular cartilage: a review", Journal of Biomechanics 17(5), 377-394]. Researchers have tended to approximate joint geometry using axisymmetry [Donzelli, P.S., Spilker, R.L., Ateshian, G.A., Mow, V.C. (1999) "Contact analysis of biphasic transversely isotropic cartilage layers and correlations with tissue failure", Journal of Biomechanics 32, 1037-1047], often with a rounded upper articulating surface, creating a form of Hertz problem [Donzelli, P.S., Spilker, R.L., Ateshian, G.A., Mow, V.C. (1999) "Contact analysis of biphasic transversely isotropic cartilage layers and correlations with tissue failure", Journal of Biomechanics 32, 1037-1047]. However, diarthrodial joints (shoulder, hip and knee) are equipped with peripheral structures (glenoid labrum, acetabular labrum and meniscus, respectively) that tend to deepen the joint contact and thus cause initial contact to be established at the periphery of the joint rather than "centrally". The surface geometries are purposefully incongruent, and the incongruency has a significant effect on the stresses, pressures and pressure gradients inside the tissue. The models show the importance of the peripheral structures and the incongruency from a load-bearing perspective. Joint shapes must provide a compromise between demands for load-bearing, lubrication and the supply of nutrients to the chondrocytes of the cartilage and cells of the peripheral structures. Retention and repair of the functionality of these peripheral structures should be a prime consideration in any surgical treatment of an injured joint.

Animals↗
PubMed1989

[Open reduction and single screw fixation of acromioclavicular dislocation].

Open reduction of acromioclavicular dislocations and fixation with a single screw provides satisfactory alignment, and results in a pain-free pseudarthrosis. No correlation between subjective complaints and objective findings during prolonged follow-up were found. Arthrotic changes or calcification of the ligaments do not influence movement of the joint. It is pointed out that calcification is part of the normal healing process and does not impair function of the shoulder joint.

Acromioclavicular Joint↗
PubMed1986

[Neoplasias of the scapula--rare causes of chronic shoulder-arm syndrome].

The diseases most frequently resulting in a chronic shoulder-hand syndrome are definitely of a post-traumatic nature and are later - after a varying period - often combined with degenerative changes. The tendency to injury is enhanced by the particularly great mobility of the shoulder joint. Inflammatory changes - e.g. of bacterial, rheumatic origin - are much rarer. The authors present two patients with rare neoplastic lesions in the region of the shoulder-blade and show how the disease was identified via various differential diagnostic methods.

Acromioclavicular Joint↗
PubMed1984

Survey of orthopaedic surgical research in a university center (Linköping).

Since 1969, seven orthopedic dissertations on the following subjects were submitted from the author's hospital. Postoperative use of special elastic bandages and oxyphenbutazone significantly decreased the frequency of thrombosis. Use of a randomized single-blind technique significantly improved chronic cases of lumbago by a new traction treatment called auto-traction. Two control groups were treated by bed rest and analgesics or routine physiotherapy measures. With a new mechanical device for tibial osteotomy, the precision of the angular change was significantly increased. In intracapsular hip fractures treated by Deyerle's technique, only 18% had necrosis of the femoral head after two years. By use of a new radiologic method for determining the stability of tibial fractures it was possible to determine a stability quotient; the quotient established the point at which the fracture could be mobilized without risk of delayed union or pseudarthrosis. In shoulder joint dislocations, three to four weeks of immobilization resulted in a recurrence rate equal to that of ordinary treatment in a sling. In a randomly selected group of people in Sweden, the incidence of shoulder dislocations was 2%. Forty percent of these patients had never seen a doctor. In Colles' fracture, the uptake of radioactive Tc-MDP was significantly increased by treating the fracture with electromagnetic fields. Arthroscopic percutaneous meniscectomies reduced the operation time normally required for an arthrotomy by an average of 30 minutes.

Arthroscopy↗
PubMed1999

Chronology of upper limb anticipatory postural adjustments associated with voluntary wrist flexions and extensions in humans.

Six sitting healthy subjects were instructed to keep a constant upper limb posture while performing wrist flexions and extensions. Acceleration of the wrist, elbow and shoulder joints, and surface electromyograms (EMGs) of the upper limb's main flexors and extensors were studied. Results indicated the existence of anticipatory (APA) and corrective postural adjustments. The APAs were based on a reproducible directional chronology of postural muscle activations. As shown by a simple mechanical model, this chronology was in accordance with the muscular torque which should be applied to the joints to keep the upper limb posture constant. All these data indicate that APA are involved in segmental posture, where their general organization is similar to those of APA associated with whole-body movements. The use of constant directional postural synergies well agrees with a simplification of the motor control according to Bernstein's theory.

Arm↗
PubMed2001

Leukemic synovitis as a presentation of myelomonocytic blast crisis of chronic myeloid leukemia.

We describe a patient with a 2-month history of right shoulder monoarthritis and fever as the presenting symptoms of a subsequent diagnosis of chronic myeloid leukemia in blast crisis. Imaging studies showed changes consistent with leukemic infiltration of the soft tissues around the right shoulder joint and the proximal humerus. Immunophenotypic and morphologic analysis of the large number of cells obtained from the synovial fluid confirmed the shoulder synovitis to be an extramedullary manifestation of myelomonocytic blast crisis of chronic myeloid leukemia. The patient was not a candidate for aggressive chemotherapy treatment because of her poor overall condition, and she had no compatible donor for allogenic bone marrow transplantation. Her painful arthropathy was refractory to standard pain management but she achieved excellent pain relief with palliative radiation therapy. We conclude that the involvement of extramedullary sites by chronic myeloid leukemia blast cells can predate hematological blast crisis in some of chronic myeloid leukemia cases. Also, painful leukemic synovitis can be managed by low dose radiotherapy in a candidate who is refractory to chemotherapy and other medical therapy.

Adult↗