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At least 163 records · Page 9Linked to original sources
PubMed2004

Persistent abnormal shoulder elevation after accessory nerve injury and differential diagnosis with post-traumatic focal shoulder-elevation dystonia: report of a case and literature review.

We report on a patient with persistent abnormal shoulder posture associated with isolated neurogenic hypertrophy of the trapezius muscle due to accessory nerve injury. The patient complained of marked difficulty in shoulder elevation and abduction. Over 6-month treatment with botulinum toxin, there was a complete resolution.

Accessory Nerve Injuries↗
PubMed2006

The effect of total shoulder arthroplasty on self-assessed deficits in shoulder function in patients with capsulorrhaphy arthropathy.

The objective of this study was to characterize self-assessed functional deficits before and after total shoulder arthroplasty (TSA) in a consecutive series of 24 patients treated for capsulorrhaphy arthropathy. Deficits were determined by use of the Simple Shoulder Test. The effects of age, type of original stabilization surgery, duration of time since the initial repair, and pattern of glenoid erosion were analyzed. Deficits were significantly reduced from 8.5 to 4 of 12 SST items after TSA (P = .003). Items related to motion and function had the largest effect on improvement. Age did not affect results. There was a trend toward greater improvement in patients whose original stabilization was less than 20 years previously (P = .06) and in those with concentric glenoid erosion (P = .06). A prior Bristow procedure was associated with the least improvement. Overall, TSA was an effective treatment for capsulorrhaphy arthropathy at midterm follow-up. Restoring range of motion appears to have the largest impact on improvement in function.

Adult↗
PubMed1997

Shoulder and forelimb orientations and loading in sitting cats: implications for head and shoulder movement.

A three-dimensional static analysis was carried out to characterize the effects of ground reaction forces propagated through different joints in the forelimb and shoulder of quietly sitting cats. Stereofluoroscopy, used to identify the orientations of bones, showed that the scapula is held in a parasagittal plane, with its vertebral border located dorsally to the spines of thoracic vertebrae. The forelimb is held with the elbow flexed. Loading on the elbow tended to flex and adduct the ulna, whereas loading on the glenohumeral joint tended to extend, adduct and internally rotate the humerus. Loading on the scapula was confined primarily to the sagittal plane and tended to rotate the vertebral border of the scapula caudally around the head of the humerus. This caudally-directed moment suggests that the static equilibrium of the feline scapula depends upon muscular forces directed cranially, presumably by way of attachments on the skull and cervical column. The differing arrangement of the shoulder-to-neck transition in cats and humans suggests caution in the use of feline models to represent some aspects of human head movement.

Animals↗
PubMed2001

[Total inverted shoulder prosthesis and rotator cuff insufficiency: evaluation and determination of anatomical parameters predictive of good functional outcome in 21 shoulders].

OBJECTIVE: Evaluation of the functional results of the Delta 3 inverted shoulder prosthesis and determination of a radio-anatomical index predictive of best functional outcome. PATIENTS AND METHODS: Retrospective analysis of 19 patients (21 shoulders). Clinical (pain, satisfaction, amplitudes, Constant index) and radiological (acromio-epiphyseal distance) evaluation at a mean follow up of 13.6 months. RESULTS: Outcomes concerning pain, quality of life and Constant index were good and similar to other series. Few complications were observed. An increase of the acromio-epiphyseal distance of 33 to 50% compared to the non operated side is associated with a good functional result. CONCLUSION: Our results confirm those of other series and show that Delta 3 inverted prosthesis is an efficient therapeutic alternative in arthropathy with rotator cuff tears. Rehabilitation is fairly short and easy. The increase of the acromio-epiphyseal distance determines the tension of the deltoid muscle and could predict a favorable outcome.

Acromion↗
PubMed1998

Adhesive capsulitis of the shoulder (frozen shoulder) produces bone loss in the affected humerus, but long-term bony recovery is good.

The objective of the study was to assess the short- and long-term effects of adhesive capsulitis (frozen shoulder) on the bone mineral density (BMD) of the affected extremity. BMD and clinical status of 22 patients (group A) with active-phase unilateral adhesive capsulitis and 31 patients (group B) with a previous adhesive capsulitis (average 9 years before the examination) were determined. BMD was measured from the proximal humerus, humeral shaft, radial shaft, ulnar shaft, and distal forearm of both upper extremities using dual-energy X-ray absorptiometry (DXA). In group A, the mean BMD of the affected extremity, as compared with that of the unaffected side, was significantly lower in the proximal humerus (-5.6%; p = 0.001) and humeral shaft (-3.0%; p = 0.008). The radial shaft, ulnar shaft, and distal forearm showed no significant side-to-side differences. In contrast, in group B, the affected-to-unaffected side BMD differences were small and statistically insignificant. Compared with the 31 patients in group B, the relative side-to-side BMD difference of the 22 patients with active-phase disease (group A) was significantly lower in the proximal humerus (-5.6% vs. -1.5%, p = 0.009). In the other sites, groups A and B showed no significant differences. In conclusion, this study indicates that adhesive capsulitis of the shoulder results in significant bone loss in the humerus of the affected extremity, but in the long term, capsulitis-induced bone loss shows good recovery.

Aged↗
PubMed1998

One-year reproducibility and stability of the signal amplitude ratio and other variables of the electromyogram: test-retest of a shoulder forward flexion test in female workers with neck and shoulder problems.

We have studied 23 women with neck and shoulder problems in a car factory with a 1-year interval. Our main aim was to investigate the reproducibility and stability of the tension pattern. In addition, the mean frequency (MNF) of the power spectrum and the signal amplitude (RMS) of the surface electromyograph (EMG) of the trapezius, deltoid and infraspinatus muscles and mechanical output were determined throughout 100 maximal isokinetic shoulder forward flexions. The signal amplitude ratio (SAR) was calculated as the ratio between the signal amplitude of the EMG of the passive relaxation and the active flexion part of each contraction cycle. The SAR variable can be reproduced (r = 0.47-0.76) with a 1-year interval. There was a significantly lower SAR of the trapezius at the second test, which might have been due to lower work pace at the factory. The longitudinal patterns of SAR throughout the two tests were similar at both tests. There were significant correlations between tests for 18 out of 22 EMG variables, even though the correlations were generally lower than for SAR (initial MNF: r = 0.39-0.48; MNF endurance level: r = 0.55-0.83; RMS (%): r = 0.08-0.46). Peak torque had better reproducibility than work. In conclusion, SAR has a long-term reproducibility equal to or better than other EMG and biomechanical variables. The present results indicate that SAR has potential to measure unnecessary muscle tension in intervention studies and to identify individual movement patterns.

Electromyography↗
PubMed1994

Observer variability in measuring elevation and external rotation of the shoulder. Primary Care Rheumatology Society Shoulder Study Group.

The aim of the study was to assess the observer variation between trained primary care physicians in their assessment of two key shoulder movements: elevation and external rotation. Six observers each examined and recorded their visual estimate of the range of movements in six patients assessed in random order. There was good agreement on the range of passive elevation assessed to the start of pain (if present): intraclass correlation coefficient (ICC) = 0.84, and to the point of maximum elevation: ICC = 0.95. There was no evidence of an important systematic bias between observers. By contrast, external rotation was poorly reproducible: ICC = 0.43, with important systematic differences between observers. In the second experiment, six observers simultaneously witnessed a range of movements in a single volunteer subject, and the agreement on their visual estimation of the angles achieved was assessed. There was a marked reduction in the systematic bias in external rotation, but agreement was still poor. Agreement for elevation remained high with a reduction in the small amount of bias observed in the first experiment when variability in both examination and visual assessment had been investigated. We conclude that shoulder elevation is a reliable measurement for use in multicentre studies by trained primary care physicians. By contrast, external rotation is poorly reproducible because of systematic variation in examination technique and random variation in visual assessment.

Female↗
PubMed1986

Statistical data base for the biomechanical properties of the human shoulder complex--II: Passive resistive properties beyond the shoulder complex sinus.

In mathematical modeling of multi-segmented articulating total-human-body, there is no doubt that the shoulder complex plays one of the most important roles. However, proper biomechanical passive resistive force data have been lacking in the literature. This paper presents determination of the three-dimensional passive resistive joint properties beyond the maximal voluntary shoulder complex sinus. A functional expansion with two spherical angular variables in the local joint axis system is proposed to fit the overall restoring force (moment) data. A constant restoring force (moment) contour map as well as a three-dimensional perspective view of the results are presented in a new coordinate system defined in this study. Finally, a statistical data base is established by utilizing the statistical analysis procedures discussed in Part I of this paper.

Adolescent↗
PubMed2001

[Role of standard radiography and computed tomography in the assessment of shoulder instability: decision-making value in surgical planning. (Radio-anatomic study of 51 unstable shoulders)].

The therapeutic algorythm for shoulder instability, either arthroscopically, either surgically, should focus on clinical data as well as imaging ones. The latter involve standard X-rays and arthrotomodensitometry (AOTDM). Both of these are crucial for the surgical approach. This paper emphasizes their limits and places. We analysed anatomical and imaging data of 51 unstable shoulders operated on between January 1998 and February 2000. Our purpose was to determine the sensitivity and specificity of imaging techniques for each anatomical structure playing a role in the management. Standard X-rays include comparative AP and Bernageau's views. Based on our results, their efficiency is confirmed for the therapeutic approach of bony lesions. Their sensitivity was respectively 96% and 93% for the reconnaissance of Hill-Sachs lesions and lesions of the anterior glenoïd rim. The sensitivity of AOTDM in identifying labral desinsertions was 91% but their extent was not precisely documented likewise for the labral degeneration and absence. The sensitivity was respectively 69% and 71%. Results were poor for the evaluation of the anterior ligament complex. TDM could not accurately document 90% soft tissues lesions which carry a poor prognosis for arthroscopic reconstructive procedures. There is a good correlation between the aspect of anterior capsular attachment and the sprain lesions (P = 0.003). We could conclude that the AOTDM is not determinant factor for choice of the reconstructive procedure, either arthroscopically, either surgically.

Adolescent↗
PubMed1992

Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. A study using Moiré topographic analysis.

Qualitative visual inspection and manual muscle testing are traditional methods of evaluation that may overlook subtle weakness of the axioscapular musculature. A modification of the standard technique of Moiré topographic analysis of spinal deformity was applied to assess axioscapular muscle function in 51 subjects: 22 asymptomatic individuals, 22 with shoulder instability, and seven with impingement syndrome. Static Moiré evaluation demonstrated scapulothoracic asymmetry or increased topography in 14% of asymptomatic subjects, compared with 32% and 57% in the instability and impingement groups, respectively. The dynamic Moiré test demonstrated an abnormal Moiré pattern in 18% of asymptomatic individuals, compared with 64% and 100% in the instability and impingement groups, respectively. Axioscapular muscle dysfunction is common with both instability and impingement syndrome of the shoulder, although it remains to be determined whether this represents a primary or secondary phenomenon.

Adult↗
PubMed1991

[Early functional treatment of the injured shoulder supported by an active shoulder bandage].

The following study shows the results of treatment of 29 patients suffering from rotatory cuff lesion and of 20 patients with tendinosis. The results of functional physiotherapy of the patients with rotatory cuff lesion correspond to the results of post-operative treatment described in other studies. As a result of early functional physiotherapy backed up by an active shoulder support, the treatment was both improved and shortened considerably. The accompanying pain relief achieved an earlier usability of the shoulder joint in both groups of patients. Four patients with rotatory cuff lesions were resistant to physiotherapy and finally had to undergo surgery.

Bandages↗
PubMed1989

Evaluation and management of disorders of the shoulder: Part I. Evaluation of the shoulder: examination in throwing athletes.

The shoulder has been the subject of many recent advances in orthopaedic surgery. Arthroscopic evaluation of the glenohumeral joint and subacromial bursa has enabled the physician to increase both diagnostic and management skills. In Part I of this series, the author presents an illustrated examination of the shoulder. A thorough history and comprehensive examination may lead to an accurate diagnosis and management plan, obviating the need for expensive ancillary procedures.

Arm Injuries↗
PubMedDate not supplied

[Shoulder girdle and shoulder joint tuberculosis].

From 1955 to 1980 inclusive, 50 patients with tuberculous omarthritis and 11 with specific shoulder girdle disorders (nine sternoclavicular joints, one isolated clavicular shaft focus, as well as one acromioclavicular joint focus) were treated at this clinic with a combined tuberculostatic and surgical therapy. The youngest patient was nine years old, and the oldest patient was 89 years old (36 females, 25 males). The patients (average age 49.4 years) comprised 11 foreign workers. From the beginning of the symptoms up to diagnosis, an average of 1.4 years elapsed. 34 patients (56%) had already been treated earlier for tuberculosis, and 12 (20%) were suffering at the same time from an active specific infection of other localisation. Independently of abscesses and fistulae (35 patients = 57%) as well as other simultaneous tuberculosis, the one-hour value of the erythrocyte sedimentation rate was in the normal range, or it was only marginally to slightly raised (under 20 mm according to W.). In 28 patients (46%), arthrodeses were performed in the shoulder joint, whereas the focus was cleared in the remaining patients. One patient (89 years old) died of senile debility. All complications (16 reactivations, two dislocations of the bone chip implantations, one fail joint) healed without complications after secondary operations. In the follow-up examination (on average, after 3.1 years), we diagnosed one recurrence (sternoclavicular joint process). Of the 45 patients (74%) followed up, 36 (80%) had started working again on average 12 months after the end of hospital treatment, or had resumed their former occupation (pensioners, housewives). Three (7%) of those followed up needed a different occupation or were given a new job within their firm.

Acromioclavicular Joint↗
PubMed1979

Wheelchair user's shoulder? Shoulder pain in patients with spinal cord lesions.

A questionnaire was circulated to the 708 members of the Spinal Cord Injuries Association in 1976. The response rate was 79.5%. Over one half (51.4%) of the respondents suffered from shoulder pain, an incidence in excess of any age group in a control population derived from a general practitioner's register. The pain, which was related particularly to wheelchair usage and other attendant factors such as transfers, was in some instances clearly in the shoulder, whereas in others it was more likely to be cervical root pain. The implication of these findings are discussed.

Adolescent↗
PubMed1977

Increased association of diabetes mellitus with capsulitis of the shoulder and shoulder-hand syndrome.

Sixty consecutive patients with capsulitis of the shoulder (including those with shoulder-hand syndrome) seen in our clinic since 1971 underwent an oral glucose tolerance test (5 with previously recognized diabetes were excluded from this test). Capsulitis was primary in 35, secondary to other factors in 25 subjects. Females (34) out-numbered males (26). Their ages ranged from 40 to 72 years (mean age: 54 years). Sixty control subjects matched for age and sex with the 60 "capsulitis" patients underwent the same OGTT (except one with previously recognized diabetes). We have found diabetes in 17 out of 60 patients with capsulitis according to Hayner's criteria (12 according to Jackson's criteria) versus 7 (2 according to Jackson's criteria) in the 60 control subjects. The difference is statistically significant by both methods, with a p value of less than 0.02).

Adult↗
PubMed1994

Concomitant rotator cuff tear and brachial plexus injury in association with anterior shoulder dislocation: unhappy triad of the shoulder.

High incidences of nerve lesions or rotator cuff tears in association with shoulder dislocations have been reported. However, the simultaneous occurrence of these three lesions has only been reported once previously. This case is an example of a not so uncommon injury, which emphasizes the importance of looking for associated brachial plexus and rotator cuff lesions when examining a patient with shoulder dislocation.

Brachial Plexus↗
PubMed1997

Milwaukee shoulder with massive bilateral cysts: effective therapy for hydrops of the shoulder.

"Milwaukee shoulder" is often associated with large effusions that cannot be managed with conventional therapy. We describe a 75-year-old man whose massive hydrops of both shoulders was resistant to treatment with nonsteroidal antiinflammatory drugs (NSAID), multiple aspirations, and injections of corticosteroid. The effusions resolved completely after treatment with oral colchicine and an NSAID containing magnesium.

Aged↗
PubMedDate not supplied

Extensive shoulder capsule tearing as a main cause of recurrent anterior shoulder dislocation.

Anterior capsular and ligamentous injuries occur frequently at initial traumatic shoulder dislocation. However, these injuries have not been considered to be one of the main causes of recurrent anterior dislocation, which is believed to heal spontaneously. We evaluated five joints of five patients in which tears in the middle portion of the anterior capsule including the inferior glenohumeral ligament were considered to be the main cause of recurrent dislocation. History of present illness and physical and plain x-ray results were not specific. The only specific finding was a diverticulum-like expansion at the anteroinferior portion of the joint on arthrographic computed tomography. Treatment consisted of anatomic repair of the capsule and concurrent injuries. The outcome of the three cases in which at least 2 years had passed after surgery was excellent. The point of emphasis is that tears of the anterior capsule are one of the primary lesions in recurrent anterior dislocation.

Adult↗