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PubMed1983

[Tilting angle of the scapula].

The shoulder joint has the most freedom of range of motion in the human body. This joint is composed of the gleno-humeral joint, the acromio-clavicular joint, the sterno-clavicular joint and the scapulo-thoracic articulation. The scapula has a very important role in the scapulo-humeral rhythm in the shoulder motions, but the scapular position could be identified from the two roentgenograms from different distances in the same direction. Three points of the scapula were chosen to decide the plane of the scapula as below: A: The intersection of the vertebral border and the scapular spine, B: The inferior angle, C: The tuberos, infraarticularis. The two roentgenograms were taken using the distances of one and two meters from the X-ray tube to the X-ray film. The X-ray was concentrated on the point A of the scapula. Points B and C on each roentgenogram were measured by X-Y coordinates. The lengths of AB, BC and CA and the scapular angles (the medially tilting angle, the downward tilting angle and the upward rotation angle) were calculated by using specific equations. The lengths of AB, BC and CA and the medially tilting angle of 16 scapulae (dry bones) were measured by using a caliper, and those were calculated by roentgenograms. Each measurement was almost accurate the length of AB, BC and CA; r equal 0.965, the medially tilting angle; r equal 0.928). Then the scapular angles of a human body determined from the roentgenographic examination in the standing position. Also the shoulder was loaded with five kg at the forearm and the length were reconfirmed. The results were as below: The medially tiling angles were 42.7 degrees +/- 1.3 degrees (n equal 50) in the resting position (R.P.) and 47.5 degrees +/- 2.0 degrees (n equal 23) in the five kg loaded position (5 L.P.) among the males. Those angles were 45.5 degrees +/- 2.6 degrees (n equal 19, R.P.) and 49.5 degrees +/- 2.1 degrees (n equal 13, 5 L.P.) among the females. The downward tilting angles were 8.5 degrees +/- 1.6 degrees (R.P.) and 7.8 degrees +/- 2.0 degrees (5 L.P.) among the males and were 7.7 degrees +/- 2.6 degrees (R.P.) and 5.1 degrees +/- 4.8 degrees (5 L.P.) among the females. The upward rotation angle was 8.7 degrees +/- 0.9 degrees (R.P.) and was 5.6 degrees +/- 1.5 degrees (5 L.P.) among the males, and was 6.6 degrees +/- 1.8 degrees (R.P.) and was 4.4 degrees +/- 2.6 degrees (5 L.P.) among the females.

Adult↗
PubMed1995

Repair of complete acromioclavicular separations using the acromioclavicular-hook plate.

Complete Tossy III acromioclavicular separations in 21 male patients (according to the Rockwood classification: 7 Type III and 14 Type V lesions) with a mean age of 31 years were treated by surgical repair with the acromicroclavicular-hook plate within a period of 6 years. The population consisted of 18 patients with acute injuries and 3 with old injuries. Six patients experienced infections and delayed wound healing; osteitis did not occur. In 1 case, delayed wound healing was combined with dislocation of the hook. Bending of the implant occurred in another patient. Sixteen patients underwent clinical and radiographic followup at a mean of 38 months. Four patients who had no complications and free mobility of the shoulder joint at the end of treatment after removal of the implant did not appear for followup. One patient died of a malignant brain tumor. According to a modified evaluation system by Poigenfürst et al, clinical and radiographic findings showed 8 excellent, 7 good, and 1 poor result. A secondary widening of the hook hole in the acromion was seen in 13 patients; this was related to the large range of motion of the acromioclavicular joint. Calcifications and ossifications in the coracoclavicular ligaments, diastases in the acromioclavicular joint, and redislocations were not significantly different when this method was compared with other surgical techniques as reported in the literature. Use of the acromioclavicular-hook plate permits retention in the transverse plane without impairing the joint itself, but the technique is challenging.

Acromioclavicular Joint↗
PubMed1996

Assessment of shoulder function in rheumatoid arthritis.

OBJECTIVE: (1) To develop a simple outcome measure of shoulder function in rheumatoid arthritis (RA), the Shoulder Function Assessment (SFA) Scale; (2) to compare the properties of this scale with those of 2 existing measures of shoulder function, the Constant Scale and the Hospital for Special Surgery (HSS) Scale. METHODS: Fifty consecutive patients with RA participated in an inpatient multidisciplinary treatment program. The SFA Scale was constructed by selecting items considered simple to assess and relevant to shoulder function by a team consisting of a rheumatologist, an orthopedic surgeon, a physical therapist, and an occupational therapist. To examine the intra and interobserver reliability in 25 patients the SFA Scale, the Constant, and the HSS Scale were assessed twice by examiner CHME, in the other 25 patients once by examiner CHME, and once by examiner EMV. The validity of all 3 scales was determined by calculating the correlation with (1) the observed shoulder function, (2) the patient's opinion of shoulder function, and (3) shoulder joint deformity. A receiver operating characteristic curve was constructed to determine the accuracy of all scales to discriminate between differences in the shoulder function of the "best" and "worst" shoulder as reported by the patient. RESULTS: The validity and the reliability of the SFA Scale were equivalent to or better than the validity and reliability of the Constant and the HSS scale. The discriminative ability of the SFA Scale was superior to both other scales. CONCLUSION: The SFA Scale is a reliable, valid, and accurate measure of shoulder function in patients with RA that can be completed within 3 minutes.

Adult↗
PubMed1988

The latissimus dorsi flap for reconstruction of the brachium and shoulder.

The latissimus dorsi was transferred on its neurovascular pedicle to reconstruct the shoulder or brachium in nineteen patients. Group I consisted of seven patients in whom transfer of the latissimus dorsi was used only to obtain active flexion of the elbow. Although there was complete necrosis of the transferred muscle in one patient, six patients achieved an average of 111 degrees of active flexion and full extension of the elbow. There was only a modest gain in active supination because of pre-existing pronation contractures. The three patients in Group II had sustained loss of the flexor muscles of the elbow and the overlying soft tissue as a result of trauma. After the latissimus dorsi musculocutaneous flexorplasty, an average of 135 degrees of active flexion of the elbow was restored, but there was an average loss of 12 degrees of extension. The three patients in Group III had a large, noninfected defect of the soft tissue over the shoulder or brachium; the bone, shoulder joint, or neurovascular structures were exposed in each patient. Transfer of the latissimus dorsi with the overlying skin provided satisfactory coverage of the defect. The six patients in Group IV had chronic osteomyelitis or septic arthritis of the glenohumeral joint. Treatment consisted of radical débridement of the infected soft tissue and bone followed by transfer of the latissimus dorsi. This provided satisfactory coverage for subsequent osteosynthesis of the humerus or arthrodesis of the shoulder when one of these procedures was indicated. At the time of writing, an average of 2.3 years after the latissimus dorsi transfer, none of the patients in this group (including one who died nine months post-operatively of unrelated causes) had drainage.

Adult↗
PubMed2006

Stabilisation of a posteriorly unstable glenohumeral joint during total shoulder arthroplasty: A novel capsulorrhaphy technique.

Restoration of the soft tissue balance is of great importance during shoulder arthroplasty. We report a novel technique of posterior capsulorrhaphy through an anterior approach for the management of intraoperative posterior instability during implantation of the prosthesis. After the operation, the patients were able to follow a rehabilitation program with some minor restrictions, avoiding the necessity of a shoulder spica or other constrictive measures. This technique is simple, safe and sufficient to address instability due to abundance of the posterior shoulder capsule.

Adult↗
PubMed1983

[Diabetes specific hand changes (cheiropathy) in children and adolescents with insulin-dependent diabetes (type I)].

215 children and adolescents with insulin dependent diabetes (age: 12(6)/12 +/- 3(9)/12 yrs; duration of diabetes 4(5)/12 +/- 3(9)/12 yrs, daily insulin requirement: 0.74 +/- 0.26 I.U./kg b.w.) were investigated for the presence of hand changes (cheiropathy) due to diabetes. Controls were 110 healthy persons of similar age (age: 11(5)/12 +/- 4(8)/12 yrs). Signs of cheiropathy were found in 44 (20.5%) of the diabetics. In 28 of these diabetics reduced mobility of the proximal and/or distal interphalangeal joints of one finger and in 16 others of at least two fingers was observed. No pathological alterations were found in the wrists, shoulder joints or spine. Mild signs of cheiropathy were seen in 5 (4.5%) of the controls. A significant positive relationship was found between age and duration of diabetes and the severity of cheiropathy. Diabetics with cheiropathy also had significantly higher daily insulin requirements than others. Of 49 patients with good diabetic control only one (2.0%) had signs of cheiropathy. In the group of 82 diabetics with fair control 12 (14.6%) showed hand changes, in the group of 84 patients with poor control 31 (36.9%). Cheiropathy must be considered to be a prognostic indicator of impending microangiopathy (retinopathy, nephropathy and neuropathy) in diabetic children and adolescents.

Adolescent↗
PubMed2004

Measures of accuracy for active shoulder movements at 3 different speeds with kinesthetic and visual feedback.

STUDY DESIGN: Repeated-measures experiment. OBJECTIVE: To compare measures of end point accuracy (EPA) for 2 feedback conditions: (1) visual and kinesthetic feedback and (2) kinesthetic feedback alone, during shoulder movements, at 3 different speeds. BACKGROUND: Shoulder joint kinesthesia is typically reported with EPA measures, such as constant error. Reporting multiple measures of EPA, such as variable error and absolute error, could provide a more detailed description of performance. METHODS AND MEASURES: Subjects were seated with the shoulder abducted 90 degrees in the scapular plane and externally rotated 75 degrees, with the forearm placed in a custom shoulder wheel. Subjects internally rotated the shoulder 27 degrees to a target position at 48 degrees of shoulder external rotation for both conditions. Motion analysis was used to determine peak angular velocity and 3 EPA measures for shoulder movements. Each EPA measure was compared between the 2 feedback conditions and among the 3 speeds with a separate 2-way analysis of variance. RESULTS: Movements performed with kinesthetic feedback alone, measured by constant error (P<.01), variable error (P<.01), and absolute error (P<.01), were less accurate than movements performed with visual and kinesthetic feedback. Faster movements were less accurate when measured by constant error (P = .01) and absolute error (P<.01) than slower movements. Subjects tended to overshoot the target in the absence of visual feedback; however, movement speed played minimal role in the overshooting. CONCLUSIONS: Multiple measures of EPA, such as constant, variable, and absolute error during simple restricted shoulder movements may provide additional information regarding the evaluation of a motor performance or identify different central nervous system control mechanisms for joint kinesthesia.

Adult↗
PubMed2000

From Hippocrates to the Eskimo--a history of techniques used to reduce anterior dislocation of the shoulder.

It has been recognised for thousands of years that the shoulder joint is particularly prone to dislocation following trauma. From the time of Hippocrates, physicians have described a variety of different techniques aimed at reducing shoulder dislocations. In this article we review the historical development of these techniques and suggest that, despite being described as new, many of these are simply variations on an already established method.

History, 16th Century↗
PubMed2000

[In Process Citation]

Since their first description several years ago, superior||| glenoid labral lesions have increasingly been blamed for shoulder problems||| associated with sports. Originally merely describing arthroscopically visible||| upper labral/biceps abnormalities, the current understanding is that often||| clinical problems such as impingement pain or even rotator cuff disease can be||| secondary to these lesions, especially in overhead athletes. Impingement in||| these cases is caused by superior shoulder instability originating from an||| unstable biceps insertion that is present for example in SLAP (superior labrum||| from anterior to posterior) lesions. Additional problems such as internal or||| posterosuperior impingement that are often found simultaneously in these||| patients are pathomorphologically located in the same anatomical region and||| therefore make exact diagnosis and thus treatment more complex. Magnetic||| resonance imaging with intra-articular contrast enhancement and particularly||| arthroscopy are the primary tools for exact diagnosis and classification of||| superior labral/biceps pathology. Therapeutically, lesions with unstable biceps||| origin (SLAP types 2 and 4) require operative refixation, as we have seen in||| our 50 cases in the last 4 years, in order to reestablish the stabilising||| effect of the biceps tendon for the shoulder joint. The arthroscopic technique||| for repair of these lesions using different devices of implantable suture||| anchors is presented. Long-term pain-free shoulder function in competitive||| athletes, throwers in particular, thus requires anatomical reconstruction of||| the originally unstable biceps, which is the causal therapy for these||| lesions.

Journal Article↗
PubMed2005

[Isokinetic testing of the shoulder of handball players].

Aim of the study was to evaluate an isokinetic profile testing handball players to describe muscular imbalance. 30 athletes (15 male and 15 female) were measured at the Cybex 6000 test-unit for concentric internal and external rotation. Both shoulders, throwing arm (dominant shoulder) and the opposite shoulder were tested by speeds at 60 degrees/s and 180 degrees/s. There were sex specific differences which are also found in other sports. But these contrary data are not useful to define effective training concepts for handball-players with shoulder problems. From our point of view isokinetic testing of the shoulder joint in handball players can not reach any sufficient result. From our point of view there is no reason for using isokinetic testing to evaluate shoulder problems.

Adult↗
PubMed2005

Biomechanical similarities of progressions for the longswing on high bar.

Based on specificity of training and biomechanical analysis, the aim of this study was to develop a method to rank selected progressions for learning the longswing on high bar. Four members of the Men's National Gymnastics Squad were recorded (50 Hz) performing three series of five longswings and eight progressions. Real world co-ordinates from the digitized data were determined using two-dimensional direct linear transformation. Biomechanical similarity between the functional phases of the longswing and the corresponding phases of the progressions were calculated. The functional phases were described as a hyperextension to flexion of the hip and hyperflexion to extension of the shoulder joints as the gymnast passed underneath the bar. Using a combined score of 'Difference' and movement 'Variability' a 'Specificity score' was calculated for hip and shoulder angular displacements and velocities. An overall score based on the average of the four scores provided a ranked list of progressions based on their similarity to the target skill. The progression that showed the greatest similarity to the biomechanics of the longswing, and was therefore ranked first, was the chalked bar pendulum swing. The least similar progression, and, therefore, eighth ranked, was the chalked bar bent knee longswing. The hip kinematics were found to contribute most to the overall differences because the performance requirements of these progressions emphasize an increase in hip flexion during the ascending phase. The method described provides a means to quantify and rank progressions based on their kinematic similarity to the longswing.

Adult↗
PubMed2001

Langerhans cell granulomatosis manifested as pigmented villonodular synovitis.

We report an unusual case of Langerhans cell granulomatosis (LCG) manifested as a villous synovial proliferation in a 38-year-old female jogger. One year after the onset of joint symptoms, she had a classical LCG presentation with skin and visceral lymph node involvement. Review of the literature revealed only one case of synovial shoulder joint tenosynovitis associated with LCG in a middle-aged woman. Ours is the first reported case presenting clinically in the synovium of the hip joint as pigmented villonodular synovitis. Histiocytic/dendritic proliferations involving the synovial tissues are not uncommon. These lesions as well as the rare multicentric reticulohistiocytosis (MRH), a systemic monocytoid/histiocytic disorder with multinucleated giant cells, polyarthritis, and papulonodular skin lesions, should be considered in the differential diagnosis. Clinical and pathologic features will distinguish LCG from MRH.

Adult↗
PubMed2002

Contribution of primate magnocellular red nucleus to timing of hand preshaping during reaching to grasp.

Magnocellular red nucleus (RNm) is involved in controlling goal-directed limb movements such as reaching to grasp. We tested two hypotheses related to RNm's role in controlling reach-to-grasp movements. One hypothesis is that forelimb RNm neurons are grasp specific, and the other is that they specify the timing of metacarpi-phalangeal (MCP) extension to preshape the hand during the appropriate phase of the reach. We recorded single-unit discharge while monkeys performed two behavioral tasks that elicited similar reaches but differed in grasp. One task consisted of a reach with a precision grasp that elicited independent use of thumb and forefinger; the other included a whole-hand grasp that elicited concerted use of the four fingers. Most RNm neurons tested were engaged strongly during both the whole-hand and precision tasks, and the magnitude of discharge modulation did not differ between tasks. Thus most RNm neurons are not grasp specific but, instead, may contribute to behavioral features common to the two tasks. Two methods were used to investigate relations between single-unit discharge and kinematic data from the same individual trials of the whole-hand and precision tasks for a subset of forelimb RNm neurons. One method focused on correlations between parameters of RNm discharge and the duration, amplitude, and velocity of rotation of forelimb joints for each of the tasks. The second method compared between-task differences in times of peak neuronal discharge to between-task differences in times of rotations of forelimb joints. Parameters of reach-related RNm discharge were more frequently correlated with parameters of MCP extension than with parameters of rotation of wrist, elbow, and shoulder joints. Analyses of temporal relations between discharge and kinematic data during both the whole-hand and precision tasks indicate that discharge was time locked most frequently to MCP extension and, to a lesser extent, elbow extension during both tasks. We conclude that RNm may command muscle synergies that provide a basic preshape of the hand at the appropriate phase of limb transport. In addition, the timing of RNm's contribution to hand preshaping varies with the behavioral requirements of the task.

Animals↗
PubMed1983

[Systemic chronic juvenile arthritis (Still's disease) in adults. Review of the literature].

UNLABELLED: The entire literature up to the present of 119 patients described as having adult Still's disease is reviewed. Clinical, laboratory, radiological and histological findings, treatment, follow-up and outcome are presented. 1. CLINICAL FINDINGS: All patients had arthralgias and/or myalgias. Seven did not fulfill strict diagnostic criteria as they did not have overt arthritis. All had fever, and 93% had septic fever with temperature peaks of greater than or equal to 39 degrees C. The characteristic maculo-papular rash was present in 89%. Other findings were sore throat, lymphadenopathy, splenomegaly (in about 50% each), weight loss, pericarditis, hepatomegaly, pleuritis (in 1/4 to 1/3 of the cases each). Less frequent were alopecia, pneumonitis and abdominal pain (in less than 10% each). 2. LABORATORY FINDINGS: The ESR was uniformly elevated. Over 90% of the patients exhibited neutrophilic leukocytosis. Anemia, hypoalbuminemia and pathologic liver function tests were found in 60-80%. IgM-RF and ANA were both negative in 95% of the patients and hence were not more frequently present than in the normal population. 3. X-ray findings: There were no pathognomonic radiological abnormalities of the joints. Nevertheless, the tendency to ankylosis, especially of the carpus, seems to be typical. A few patients developed severe destructive lesions, especially of the hip and shoulder joints. 4. Biopsies: Many biopsies were performed and did not reveal specific histologic abnormalities. Nonetheless, they sometimes are necessary in order to exclude other disease entities. 5. Treatment, follow-up, prognosis: Therapeutically high-dosage ASA and (if necessary) systemic steroids are recommended for the acute phase. The efficacy of this treatment is controversial. Even after successful control of the acute disease, exacerbations are frequent for many years. Despite the initial optimism, there is significant long-term morbidity due to recurrent disease flare-ups on the one hand, and articular destructions in some patients on the other.

Adult↗
PubMed1982

[Post-traumatic ankylosis (pathomorphologic aspects)].

At first, the symptoms observed in case of a post-traumatic ankylosis are defined. Then the possible reactions of tissue to a trauma to the joint or the joint region which may lead to an ankylosis are discussed with regard to general pathologic points of view. Some special pathologic aspects of lesions and their consequences are shown for the shoulder joint, the elbow joint, and the knee joint. Finally, several examples are given in order to illustrate possible histomorphologic symptoms leading to a post-traumatic ankylosis.

Adult↗