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PubMedDate not supplied

The role of the scapula in athletic shoulder function.

The exact role and the function of the scapula are misunderstood in many clinical situations. This lack of awareness often translates into incomplete evaluation and diagnosis of shoulder problems. In addition, scapular rehabilitation is often ignored. Recent research, however, has demonstrated a pivotal role for the scapula in shoulder function, shoulder injury, and shoulder rehabilitation. This knowledge will help the physician to provide more comprehensive care for the athlete. This "Current Concepts" review will address the anatomy of the scapula, the roles that the scapula plays in overhead throwing and serving activities, the normal biomechanics of the scapula, abnormal biomechanics and physiology of the scapula, how the scapula may function in injuries that occur around the shoulder, and treatment and rehabilitation of scapular problems.

Biomechanical Phenomena↗
PubMed2005

Post-stroke shoulder subluxation: a concern for neuroscience nurses.

Approximately 84% of all stroke patients with hemiplegia will experience shoulder injury and pain. The importance of maintaining proper posture while positioning and transferring a stroke patient is key to decreasing risk for shoulder injury. Shoulder subluxation injury post-stroke is a consequence of sustained hemiplegia and spasticity. Current research evidence suggests that using therapies such as gentle range of motion and functional electrical stimulation may reduce and prevent shoulder subluxation and hemiplegic shoulder pain. However, physiotherapists are currently the only professionals who can implement such therapies. Considering that stroke care provided by neuroscience nurses includes transferring, positioning and assisting in activities of daily living, it is clear that nurses are an important part of the therapy process. Therefore, the question is: "What is the role of the neuroscience nurse in the reduction and prevention of shoulder pain post-stroke?" The purposes of this paper are to i) discuss the causes of shoulder subluxation and related pain post-stroke, ii) review current best practice in prevention and treatment of shoulder subluxation, and iii) explore ways in which the acute neuroscience nurse can prevent or reduce shoulder subluxation in the hemiplegic stroke patient.

Activities of Daily Living↗
PubMedDate not supplied

Electromyographic study during isometric exercise of the shoulder in head-out water immersion.

Water exercises are used for early rehabilitation programs after shoulder injury such as rotator cuff tear, yet no literature discusses the muscle activity of such rehabilitation programs in water. The purpose of this study was to analyze the electromyographic activity from 8 volunteers during isometric exercises in water and on land. Nine isometric exercises were studied: with 30 degrees, 60 degrees, and 90 degrees shoulder flexion and abduction, and 3 positions of shoulder rotation at 0 degrees abduction (both maximal internal and external rotation and mid-position). Nine parts of 6 muscles were studied: the supraspinatus, infraspinatus, subscapularis, 2 parts of the pectoralis major (clavicular and costal), 3 parts of the deltoid (anterior, middle, and posterior), and the latissimus dorsi. The electromyographic signals were low-pass filtered, full-wave rectified, and integrated for 5 seconds. The electromyographic activity was quantified as a percentage of the maximal manual muscle test. The results showed that supraspinatus activity at 90 degrees abduction significantly decreased from 22.3+/-15.8 on land to 3.9+/-3.3% manual muscle test in water (P < .01). Other muscle activities in water also decreased remarkably compared with those on land. These results provide valuable information for the safety of water exercise for early rehabilitation programs after shoulder injury such as rotator cuff tear.

Adult↗
PubMed2002

Fractures and tendon injuries of the athletic shoulder.

Athletic injuries in the shoulder range from a routine strain or sprain to a potentially disabling fracture or tendon rupture. The level of sports participation plays an important role in diagnosis and treatment. The nonprofessional athlete may be more likely to sustain injuries secondary to under-training or improper technique. The professional athlete may be capable of play under much higher velocities and applied loads and, therefore, may be subject to higher energy trauma than the amateur athlete. In addition to standard treatment considerations, return to play time must also be decided. Decisions regarding definitive treatment may be modulated depending on an athlete's desire to return to his or her previous level of competition.

Acute Disease↗
PubMed2006

Baseball and softball injuries.

Baseball and softball injuries can be a result of both acute and overuse injuries. Soft tissue injuries include contusions, abrasions, and lacerations. Return to play is allowed when risk of further injury is minimized. Common shoulder injuries include those to the rotator cuff, biceps tendon, and glenoid labrum. Elbow injuries are common in baseball and softball and include medial epicondylitis, ulnar collateral ligament injury, and osteochondritis dissecans. Typically conservative treatment with relative rest, medication, and a rehabilitation program will allow return to play. Surgical intervention may be needed for certain injuries or conservative treatment failure.

Athletic Injuries↗
PubMed1993

[Equestrian accidents in children].

In a retrospective study we reviewed 262 horse riding related injuries in children younger than 16 which were treated between 1975 and 1989 at the Section of Traumatology in the Department of Surgery, University Hospital Homburg/Saar. In 155 of these accidents, detailed information was gained via a questionnaire. The typical patient profile was that of young female equestrians with little experience and little weekly riding practice, without practicing falling-exercises and warming up often using different horses. At the time of the accident only 59% were wearing a head protection. Most accidents happened in the summer months in the afternoon during leisure riding on a large familiar horse in the riding hall. Apart from the typical accidents like falling of the horse (64.9%) and falling with the horse (5.7%) accidents in handling the horse were of special significance: Kick by horse's hoof (11.8%), being stepped by horse (3.8%), horsebite (7.3%) and injuries of horse's bridle had their own pattern of injuries. Injuries of the distal parts of the upper extremity are preeminent in falling of the horse, whilst in falling with the horse head injuries and shoulder injuries are preeminent. Remarkably often injuries of kick by horse's hoof were causing sometimes even dangerous head injuries (41.6%). Overall in horse riding related injuries in childhood superficial soft tissue injuries (48.6%) and fractures (30.6%) were predominant. Fractures of the clavicle which are well known as a riding injury proved to be typical for a fall with the horse, whilst a fractured vertebra was only seen once amongst the 262 children treated. The severity of the injuries was lower than expected: In 85.1% of all the injuries only one body region was injured, 90.1% could be assigned to an injury severity score (ISS) of 1-3. Ponyriders had less severe injuries than riders of large horses. One fatal accident happened in handling a horse, in these situations preventive measures are often disregard. Active (better education, warming up, falling practice) an passive (head protection!) safety measurements are recommended for prevention of injuries in young riders in particular.

Adolescent↗
PubMed2005

Brachial plexus injuries and shoulder dystocia: medico-legal commentary and implications.

Brachial plexus injuries may occur in association with or without recognised shoulder dystocia. Until recently many medico-legal experts argued that these injuries resulted from the negligent use of excessive or misdirected traction. These experts did not accept that the natural forces of labour could cause the injury. In cases of recognised shoulder dystocia, modern obstetric practice has recognised the importance of correct maternal positioning and the need to avoid excessive or misdirected traction, also the importance of not applying a rotational force to the fetal head. Informed practice and the increased use of caesarean section has not reduced the number of brachial plexus injuries. Judges in two recent trials found that the natural forces of labour were the cause of the injury and that the birth assistants had not caused the damage. This has important implications for medical note writing, teachers and risk managers, medico-legal experts and lawyers.

Brachial Plexus↗
PubMed1994

Isolated nerve injuries about the shoulder.

Infraclavicular nerve injuries are rare and potentially disabling problems. A retrospective study of 24 patients with 28 nerve injuries is presented, including 18 axillary, 7 suprascapular, and 3 musculocutaneous nerve injuries. Vague shoulder pain and weakness of the involved muscle groups were the main symptoms of nerve injury in these patients. All patients had atrophy of the specific muscles involved. Diagnosis of these nerve lesions can often be difficult because of this vague presentation. Followup from date of injury averaged 60 months and included evaluation by questionnaire, repeat physical examinations, and serial electromyograms. There were 21 complete or satisfactory nerve recoveries, while 7 patients had unsatisfactory results. The etiology of the injury appeared to be an important factor with respect to outcome. Eight of 10 nerve injuries secondary to blunt trauma went on to complete recovery, and 4 of 6 nerve injuries secondary to shoulder dislocation recovered completely. None of the 7 nerves injured during surgery recovered completely. No patient with spontaneous onset of nerve dysfunction had an unsatisfactory result. Poor results were noted in patients with initial total denervation as shown by electromyogram and in patients with intraoperative nerve damage.

Adolescent↗
PubMed1991

Safety and efficacy of transcatheter embolization of axillary and shoulder arterial injuries.

The authors performed 13 transcatheter embolizations (TCEs) within the axilla and shoulder in nine patients with major trauma to one or more vessels in these regions. Indications for TCE included active hemorrhage, pseudoaneurysms, arteriovenous fistulas (AVFs) caused by penetrating trauma, and a postsurgical AVF. Embolizations were performed within branches of the subclavian, axillary, and brachial arteries in nine male patients aged 20-38 years. All procedures were performed with use of either Gianturco coils or Hilal wires, with or without gelatin sponge pledgets or autologous clot. Nine of 11 procedures in eight patients resulted in successful treatment of active bleeding, pseudoaneurysms, and AVFs, thus enabling avoidance of surgery. After two embolizations in the ninth patient, TCE failed to occlude an AVF, necessitating surgical treatment. Only one complication (asymptomatic pulmonary embolization with Gianturco coils) was encountered in this series. No neurologic sequelae occurred. The authors' experience demonstrates the safety and efficacy of TCE in the nonsurgical management of axillary and shoulder hemorrhage and vascular injuries secondary to penetrating trauma and surgical complications.

Adult↗
PubMed2000

Nonoperative treatment of ipsilateral fractures of the scapula and clavicle.

BACKGROUND: Internal fixation of one or both bones is the recommended treatment for floating shoulder injuries (ipsilateral fractures of the scapula and clavicle). Perceived risks of nonoperative treatment include abduction weakness, decreased range of motion, chronic pain, malunion, and nonunion. None of these problems, however, have been confirmed by clinical studies. The purpose of this retrospective study was to analyze the clinical and radiographic results of nonoperative treatment of floating shoulder injuries. METHODS: Twenty patients with a floating shoulder injury were treated with either a sling or a shoulder immobilizer. Eleven clavicular fractures were displaced ten millimeters or more, and five scapular fractures were displaced more than five millimeters. Physical therapy was begun three days to two weeks after the injury. Patients were evaluated with three separate scoring systems: those of Herscovici et al., Rowe, and Constant and Murley. Shoulder abduction and flexion were measured, and abduction strength was evaluated by clinical examination and comparison with the uninjured extremity. The duration of follow-up averaged twenty-eight months (range, nine to seventy-nine months). RESULTS: Nineteen of the twenty pairs of fractures united uneventfully. One clavicular nonunion occurred secondary to segmental bone loss from a gunshot wound. On the basis of the Herscovici rating system, seventeen patients had an excellent result and three had a good result. According to the Rowe system, eighteen patients had an excellent result, one had a good result, and one had a fair result. The average Rowe score was 95. The average Constant score was 96. In all twenty patients, the strength of the injured extremity was equal to that of the uninjured extremity. Eighteen patients had a full, symmetrical range of shoulder motion, one lost 15 degrees of flexion, and one lost 20 degrees of abduction. CONCLUSIONS: Nonoperative treatment of floating shoulder injuries, especially those with less than five millimeters of fracture displacement, can achieve satisfactory results that are probably equal or superior to those reported after operative treatment, without the risk of operative complications.

Adolescent↗
PubMed2006

What factors are associated with neonatal injury following shoulder dystocia?

OBJECTIVE: To identify factors associated with the development of neonatal injury in the setting of shoulder dystocia. STUDY DESIGN: Medical record ICD-9 codes and a computerized perinatal database were reviewed to identify cases of shoulder dystocia from January 1996 to January 2001 in a tertiary care center. For confirmation of the diagnosis and collection of data, both maternal and neonatal charts were then reviewed and neonatal injuries categorized as either neurological (brachial plexus injury) or skeletal (clavicular fracture, humeral fracture). Shoulder dystocia cases were divided into groups based on the presence of neonatal injury at delivery or at discharge (with or without Erb's palsy). The group with neonatal injury was compared for demographic and obstetrical factors to the group without injury (control). chi (2) test, Mann-Whitney test and logistic regression were used as appropriate. RESULTS: During this 5-year period, there were 25,995 deliveries and 206 (0.8%) confirmed cases of shoulder dystocia. Of these cases, 36 (17.5%) had neonatal injury diagnosed at delivery and 25 (12%) remained with significant residual injury at discharge. Of these there were 19 cases of Erb's palsy and six cases of clavicular fracture. No association was found between neonatal injury and maternal age, ethnicity, diabetes, operative vaginal delivery or number of obstetrical maneuvers. However, maternal body mass index >30 kg/m2, a second stage of labor >20 min and a birth weight >4500 g were all associated with an increased risk of neonatal injury at delivery and at discharge, including Erb's palsy. After logistic regression analysis, only a second stage of delivery >20 min remained significantly associated with neonatal injury at discharge. CONCLUSION: In our population, maternal obesity was associated with an increased risk of neonatal injury after shoulder dystocia. In addition, a short second stage of labor (<20 min) was associated with a lower rate of neonatal injury.

Adult↗
PubMed2005

The effect of wrist guard use on upper-extremity injuries in snowboarders.

The objective of this investigation was to determine the effect of wrist guard use on all upper-extremity injuries in snowboarders. This matched case-control study was conducted at 19 ski areas in Quebec, Canada. Cases were 1,066 injured snowboarders who reported upper-extremity injuries to the ski patrol during the 2001-2002 season. Controls were 970 snowboarders with non-upper-extremity injuries who were matched to cases on ski area and the nearest date, age, and sex, in that order. The response rate was 71.8% (73.5% for cases and 70.1% for controls). Cases were compared with controls with regard to wrist guard use. The prevalence of wrist guard use among snowboarders with hand, wrist, or forearm injuries was 1.6%; for those with elbow, upper arm, or shoulder injuries, it was 6.3%; and for controls, it was 3.9%. Thus, wrist guard use reduced the risk of hand, wrist, or forearm injury by 85% (adjusted odds ratio = 0.15, 95% confidence interval: 0.05, 0.45). However, the adjusted odds ratio for elbow, upper arm, or shoulder injury was 2.35 (95% confidence interval: 0.70, 7.81). These results provide evidence that use of wrist guards reduces the risk of hand, wrist, and forearm injuries but may increase the risk of elbow, upper arm, and shoulder injuries.

Adolescent↗
PubMed1995

Injuries of the shoulder girdle.

Shoulder girdle injuries occur infrequently, but can lead to high rates of morbidity and mortality if these high energy injuries are underdiagnosed or mistreated. Most injuries can be treated conservatively, but a high index of suspicion and aggressive physical and radiographic evaluations should be used to evaluate patients with polytrauma. This article discusses these injuries, their associated pathoanatomy, and current management.

Acromioclavicular Joint↗
PubMedDate not supplied

Glenohumeral joint kinematics and kinetics for three coordinate system representations during wheelchair propulsion.

The shoulder plays a very important role during manual wheelchair propulsion. Unfortunately, substantial numbers of manual wheelchair users eventually develop shoulder injury or pain. Recently, studies have begun to investigate the etiology of wheelchair user shoulder injuries. This study compared three coordinate systems used to represent the shoulder during wheelchair propulsion. Our results show statistically significant differences between the three shoulder representations analyzed. Differences are seen for individuals and for the subjects as a group. Based upon our results, the fixed-z model appears preferable over the other representations due to its simplicity, low hardware requirements, and the similarity of the results to the free representation. This article also provides some insight into maximal shoulder joint forces and moments recorded during manual wheelchair propulsion. Future work should include more sophisticated models of the shoulder complex.

Acceleration↗
PubMed1984

Football shoulder and neck injury: a study of the "stinger".

Twenty football players with preliminary diagnosis of "stinger" were examined and treated. Of the 12 on whom EMGs were performed, all but one were proven to have C6 radiculopathy rather than lateral stretch of brachial plexus. Most frequent mode of injury was neck flexion during tackling by a linebacker. Athletes should not return to competition until abnormal neurologic signs disappear.

Adolescent↗