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At least 1,639 records · Page 91Linked to original sources
PubMed1997

[Functional outcome of Eden-Hybinette-Lange operation in post-traumatic recurrent shoulder dislocation].

OBJECTIVE: Post-traumatic recurrent dislocation is a major problem in the operative treatment of shoulder dysfunction in young athletes. This prospectively designed study evaluates the long-term results of a modified Eden-Hybinette procedure in young male athletes. The criteria were: capacity in sports, functional limit, and persistent pain. Genuine disorders of the glenoid or muscular imbalance of the shoulder joint were criteria for exclusion. PATIENTS AND METHODS: From 1982 to 1990, 143 patients underwent surgery. Seventy percent were reevaluated within a minimum period of 18 months after the operation. The functional results were calculated using the ROWE score as well as a visual analog scale (VAS). X-rays were done after the patient had given informed consent. RESULTS: VAS and ROWE score showed excellent/good results in 61%, fair results in 18%, and poor results in 21% of the documented cases. The rate of arthrosis was 25%. Redislocation occurred in 7%, mainly without any relevant trauma. The X-rays showed complete resorption of the bone graft in 30% of the cases. Best functional results and no redislocation were found in the patients who underwent surgery with fewer than 3 dislocations compared to those with more than 4 dislocation episodes. CONCLUSIONS: In cases of post-traumatic recurrent dislocation of the shoulder in young athletes, the modified Eden-Hybinette procedure is a good method of reestablishing sufficient stability of the shoulder. The operation should be performed prior to the 3rd dislocation episode. Four or more dislocation episodes show an increased tendency to redislocate and poor functional results.

Adult↗
PubMed2004

[Shoulder instability].

Shoulder instability is a common clinical feature leading to recurrent pain and limited range of motion within the glenohumeral joint. Instability can be due a single traumatic event, general joint laxity or repeated episodes of microtrauma. Differentiation between traumatic and atraumatic forms of shoulder instability requires careful history and a systemic clinical examination. Shoulder laxity has to be differentiated from true instability followed by the clinical assessment of direction and degree of glenohumeral translation. Conventional radiography and CT are used for the diagnosis of bony lesions. MR imaging and MR arthrography help in the detection of soft tissue affection, especially of the glenoid labrum and the capsuloligamentous complex. The most common lesion involving the labrum is the anterior labral tear, associated with capsuloperiostal stripping (Bankart lesion). A number of variants of the Bankart lesion have been described, such as ALPSA, SLAP or HAGL lesions. The purpose of this review is to highlight different forms of shoulder instability and its associated radiological findings with a focus on MR imaging.

Arthrography↗
PubMedDate not supplied

Radiographic examination of the acute shoulder.

Since 1988 the routine shoulder examination at our department has consisted of the anteroposterior projection (AP), the transthoracic projection (TT) and the apical oblique projection (AO). To save discomfort to the patients - including unnecessary X-rays - as well as time and money, we wanted to see, whether one of the projections could be omitted from the primary examination without losing diagnostic information. Retrospectively, 125 acute shoulder examinations were reevaluated - each projection separately - and the findings from the three radiographs of each shoulder compared. In 47 patients the examinations were normal. The remaining 78 patients had a total of 112 lesions. The AO alone showed 17 of 112 lesions (15%) of which eight were isolated lesions. The AO together with the AP presented 111 of 112 lesions, and with a supplementary TT obtained in case of fracture, no lesions were overlooked. Based on this present material and the literature, we recommend that the routine radiographic examination of the acute shoulder includes the AO and the AP, to be supplemented with the TT - or another lateral projection - in case of humeral fracture.

Adolescent↗
PubMed2005

Diagnosis and treatment of chronic painful shoulder: review of nonsurgical interventions.

Chronic painful shoulder is a common complaint, yet its initial pathogenesis may have multiple etiologies as well as multiple and perhaps distinct primary or secondary etiologies responsible for its final clinical presentation. While the clinical presentation of pain and limitation of motion is easily defined, there are no standardized criteria for the differential diagnosis of various chronic shoulder pain syndromes, much less a consensus on their treatment. At present, there are limited nonsurgical options and medications approved for the treatment of chronic painful shoulder, and, with limited exceptions, there are no definitive conclusions about the efficacy of these therapies based on controlled clinical studies reported in the literature. There is a clear clinical need for local nonsurgical treatments that are safe and effective for chronic painful conditions. In this article, an attempt is made to review the diagnoses associated with chronic shoulder pain and some of the limited data that exist so as to suggest a therapeutic algorithm.

Algorithms↗
PubMed2026

The impact of an intact rotator cuff on the outcomes of reverse shoulder arthroplasty: a meta-analysis of 20,924 patients.

BACKGROUND: While reverse shoulder arthroplasty (rTSA) is commonly utilized for rotator cuff tear arthropathy, indications have expanded to include, primary glenohumeral osteoarthritis (GHOA) with intact cuff. The presence of an intact cuff may influence outcomes after rTSA because preserved cuff musculature can contribute to shoulder stability and force which could potentially improve postoperative function and reduce complication rates. However, studies have reported contradictory results on whether or not an intact cuff would provide better outcomes in patients receiving an rTSA. METHODS: This is a systematic review and Meta-analysis performed according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane, Embase, and Google Scholar (pages 1-20) were queried through December 2025. Inclusion criteria consisted of studies comparing the outcomes of rTSA based on whether patients had a diagnosis of GHOA with intact cuff, or had a deficient rotator cuff (ie had a diagnosis of rotator cuff tears without OA, or cuff tear arthropathy). Extracted data included adverse events, improvement in patient reported outcome measures, and improvement in range of motion. RESULTS: Eleven retrospective articles and 1 prospective article met the inclusion criteria with 4,542 in the GHOA with intact cuff group and 16,382 in the cuff-deficient group (cuff tear arthropathy: 15,423 patients; rotator cuff tear: 959 patients). Patients undergoing rTSA for GHOA and intact cuff had a lower rate of revisions (odds ratio [OR] = 0.53; 95% CI: 0.41- 0.68, P < .001; I2 = 0%), overall complications (OR = 0.57; 95% CI: 0.46-0.71, P < .001; I2 = 0%), acromial stress fracture (OR = 0.22; 95% CI: 0.08- 0.59, P = .003; I2 = 0%), infection (OR = 0.43; 95% CI: 0.26- 0.73, P = .002; I2 = 37%), and instability (OR = 0.60; 95% CI: 0.40- 0.90, P = .01; I2 = 0%). In addition, GHOA patients had a better improvement in both American Shoulder and Elbow Surgeons scores (mean difference = 7.17; 95% CI: 2.13- 12.21, P = .005; I2 = 81%) without exceeding the minimal clinically important difference, and external rotation (mean difference = 12.00&#xb0;; 95% CI: 9.63- 14.37, P < .001; I2 = 38%). CONCLUSION: Rotator cuff-deficient patients undergoing rTSA have a higher risk of postoperative complications compared to patients undergoing rTSA for GHOA with an intact cuff. They also showed less improvement in American Shoulder and Elbow Surgeons scores and external rotation. However, the clinical significance of these differences should be interpreted with caution, as not all improvements exceeded established thresholds for clinical importance.

Humans↗
PubMed2004

The stiff shoulder.

Shoulder stiffness is a common but poorly understood disorder of the glenohumeral joint. Many terms are used to describe a stiff shoulder, including frozen shoulder and adhesive capsulitis. This article reviews the terminology, classification, diagnostic options, and management options of shoulder stiffness. Conservative measures,emphasizing a four-quadrant stretching program, typically produce effective treatment outcomes. Operative interventions, which may be required for the small percentage of patients who fail conservative therapy, are also presented.

Arthroscopy↗
PubMed2004

Shoulder arthroscopy: principles and practice.

Shoulder arthroscopy has an expanding role in the diagnostic and therapeutic management of shoulder disorders. This article describes the principles of shoulder arthroscopy, including basic technique,indications, and complications. The clinical applications to several shoulder pathologies, such as rotator cuff disorders, glenohumeral instability, and biceps anchor superior lesions, ar reviewed.

Acromioclavicular Joint↗
PubMed1999

Active responses decrease impact forces at the hip and shoulder in falls to the side.

Active responses, such as using the arm to break the fall, may be an effective means of decreasing likelihood of injury in a fall and may help explain why only a small percentage of falls result in a fracture. We quantified the impact force at the hip and shoulder in falls to the side from a kneeling position under three conditions: (1) attempting to break the fall by using an arm; (2) falling with the body relaxed; and (3) falling with the body tensed. Subjects fell from a kneeling position onto a force platform array covered with foam padding and impact force data were recorded. The ground reaction force-time curve was generally bimodal due to sequential impacts of the hip and shoulder. Impact forces at the hip and shoulder were 12 and 16% less for the slap condition (p < 0.05) than for the tensed condition. The impact forces for the relaxed and tensed conditions were not significantly different, although impact forces tended to be less in the relaxed condition. We concluded that active responses reduce the impact forces experienced at the hip and shoulder in falls to the side. Decreased effectiveness of protective responses, due to increases in reaction time and decreases in strength with age, may help explain why so many hip fractures occur in the elderly but so few occur in younger people.

Accidental Falls↗
PubMed1984

The shoulder in sports.

Many sports activities that involve the upper extremity entail similar patterns of movement. Analysis of these activities, a better understanding of the throwing motion, and an awareness of shoulder diseases or injuries have led to a rational plan for investigation and management of shoulder problems. Evaluation often extends beyond the usual medical boundaries and must be based on information obtained from an analysis of sports mechanics, a review of training methods, and a physical examination directed at determination of flexibility, strength, endurance, and the presence of inflammation. Three common sports injuries are damage to the acromioclavicular joint (shoulder separation), instability of the glenohumeral joint, and a spectrum of pathologic changes in the rotator cuff. Sports that are commonly associated with shoulder problems include swimming, baseball, tennis, football, and gymnastics. Treatment may comprise rest, changes in training methods, an alteration of technique, and a physical rehabilitation program. Surgical treatment has a well-defined role, but it is usually optional.

Acromioclavicular Joint↗
PubMed1998

Revision of failed total shoulder arthroplasty.

The complexity of revision shoulder surgery remains a supreme challenge for the experienced shoulder surgeon. The difficulty of surgery is often accompanied by unpredictable patient cooperation during the postoperative rehabilitation program. Recognition of the problems associated with the failed shoulder arthroplasty is necessary for successful revision surgery. Numerous reconstructive techniques are necessary for restoration of soft tissue and bony deficiencies. Component revision is often necessary in treating component loosening or glenohumeral instability. Glenoid component removal may be necessary in the presence of severe rotator cuff insufficiency or marked glenoid bone deficiency. Humeral revision is most predictably treated with methylmethacrylate fixation. Humeral fractures associated with humeral arthroplasty are most successfully treated surgically, except in those instances where a long oblique or spiral fracture is not associated with prosthetic loosening. Deep infection is most predictably treated by extensive debridement, parenteral antibiotics, and delayed exchange of the components. The success of revision shoulder arthroplasty is often unpredictable, with 60% of revisions offering satisfactory pain relief and restoration of function. Critical to the success of revision arthroplasty is the status of the soft tissues, particularly the anterior deltoid and rotator cuff.

Anti-Bacterial Agents↗
PubMed1988

Clinical use of the olecranon-manubrium percussion sign in shoulder trauma.

We conducted a study to assess the efficacy of the use of osteophony in the evaluation of shoulder trauma. Evaluation of the shoulder includes the physical examination and often a radiographic series. We studied the usefulness of the olecranon-manubrium percussion (OMP) test, a physical diagnostic procedure performed in shoulder trauma. The bell of the stethoscope is placed over the manubrium, both elbows are flexed at 90 degrees, and the olecranon is percussed. In the normal examination with no disruption of bony conduction, both sides should produce a crisp equal sound. In the event of a dislocation or fracture with disruption of bony conduction, the affected side should be duller in pitch and intensity. We evaluated the utilization of the OMP test to assess its accuracy when used as a screening test for radiographs in conjunction with the physical examination and radiographic examination. Ninety-six patients were prospectively evaluated by the OMP test and also received radiographs. In those patients who had radiographic abnormalities, 40 of 47 (85.1%) had an abnormal OMP sign. In those patients without radiographic abnormalities, none had an abnormal OMP sign. In assessing anterior shoulder dislocations, 11 of 13 (84.6%) had an abnormal OMP sign (P less than .02). After relocation, 100% had a normal OMP sign. Of those with clavicular fractures, nine of nine (100%) had abnormal OMP signs (P less than .005). Of those with a fracture of the humerus, 16 of 20 (80%) revealed an abnormal OMP test (P less than .01). The test was not significant in assessing acromio-clavicular joint abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed2000

Classification, clinical findings and operative treatment of degenerative and posttraumatic shoulder disease: what do we really need to know from an imaging report to establish a treatment strategy?

Successful patient care involves interdisciplinary Cupertino. Images allow an interpretation of a static dimension, but may not be sufficient to develop a surgical treatment strategy, since many shoulder problems have its origin in a dynamic pathology. This article outlines dynamic clinical tests of shoulder pathology, classifies various degenerative and posttraumatic shoulder problems and stresses key facts an imaging report should include in order to plan surgery. This article conveys basic knowledge of those tests and the dynamic background of shoulder pathology. Basic surgical treatment principles are summarised briefly.

Biomechanical Phenomena↗
PubMed1999

Magnetic resonance arthrography (MRA) in the postoperative shoulder.

To evaluate changes in capsular mechanisms and the labroligamentous complex with magnetic resonance arthrography (MRA) after shoulder surgery and to establish possible criteria for the expected post-operative appearance of the shoulder. MRA of the shoulder was performed in 16 patients, before and 6 months after undergoing arthroscopic surgery for recurrent unidirectional dislocation. MR studies were performed after application of a constant amount of contrast solution (2 mmol Gd-DTPA). Axial and coronal oblique T1-weighted images were obtained with and without fat suppression techniques. Anterior (a) and posterior (p) capsular distances were measured, and the p/a ratio was established. Capsule thickness, capsular leaking, estimation of the volume of the axillary recess, appearance of the glenohumeral ligaments, and evidence of labral lesions were compared on pre- and postoperative images. Mean anterior capsular distance (a) decreased from 9.73 +/- 1.03 mm preoperatively to 5.27 +/- 2.49 mm postoperatively, whereas dorsal capsular distance (p) increased from 6.13 +/- 2.36 to 8.93 +/- 2.37. The p/a ratio increased from 0.64 +/- 0.25 to 2.36 +/- 2.54 (p = 0.007). Capsular leaking was suspected preoperatively in seven patients, but was not evident postoperatively. Capsular thickness and the estimated volume in the axillary recess did not change significantly. Contrast extension into pre-existent labral tears (nine patients) decreased or were not evident postoperatively. Changes in the appearance of the glenohumeral ligaments were found in six patients. Changes in capsular distances might be indicative of a decreased capsular laxity and could be a valuable criterion in the evaluation of the postoperative shoulder. Postoperative follow-up of labral tears is demonstrated by a decrease in contrast extension into or under a tear. Reactive capsular thickening or scar tissue formation can be reactive or preexistent. Changes in ligaments might be secondary to surgery. MRA may be helpful in the reevaluation of patients with suspected recurrent instability.

Adolescent↗
PubMed1993

The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder.

Recurrent anterior unidirectional instability of the shoulder is not always associated with a classic Bankart lesion, which is an avulsion of the anterior labroligamentous structures from the anterior glenoid rim. Because the anterior scapular periosteum ruptures, the labrum and the attached ligaments are found to float out anterior to the glenoid rim when viewed arthroscopically. The anterior labroligamentous periosteal sleeve avulsion (ALPSA) of the supporting anterior inferior ligamentous and labral structures of the shoulder joint was found in four of eight acute primary anterior shoulder dislocations. This lesion differs from the Bankart lesion because the anterior scapular periosteum does not rupture, thereby allowing the labroligamentous structures to displace medially and rotate inferiorly on the scapular neck. These lesions eventually heal, and lead to recurrent anterior dislocations because of the subsequent incompetence of the anterior inferior glenohumeral ligament. An arthroscopic technique that converts the ALPSA lesion to a Bankart lesion and subsequently reconstructs the supporting anterior inferior structures of the shoulder has been successful in 26 cases (4 acute and 22 chronic) which were followed for > or = 2 years. Only one dislocation occurred, and it was the result of severe trauma.

Acute Disease↗
PubMedDate not supplied

Terrible triad of the shoulder.

The purpose of this study was to assess the functional outcome of the terrible triad of the shoulder, a rare combination of anterior shoulder dislocation, massive rotator cuff tear, and neurologic injury. Six patients with this condition have been treated at our institution since 1990. The mean age was 57 years. All patients underwent rotator cuff repair (RCR). The mean time from injury to surgery was 5 months. Follow-up averaged 5.6 years. Functional outcome was recorded by use of the Shoulder Pain and Disability Index. Preoperative mean active forward elevation was 24 degrees, as compared with 98 degrees postoperatively. Strength improved from 3 lb to a mean of 12 lb in forward elevation and from 2 lb to 16 lb in external rotation. Clinically, 5 of 6 patients achieved recovery of their nerve injury. Total Shoulder Pain and Disability Index postoperative scores revealed good or excellent results in 4 of 6 patients. For this injury pattern, performing an RCR offers the patient the best chance for a favorable outcome. Waiting for neurologic recovery before performing RCR is not recommended.

Adult↗
PubMedDate not supplied

Arthroscopic lavage compared with nonoperative treatment for traumatic primary anterior shoulder dislocation: a 2-year follow-up of a prospective randomized study.

A prospective randomized study was performed on 30 consecutive patients with traumatic primary anterior shoulder dislocation to compare treatment results of arthroscopic lavage with results of conventional nonoperative treatment. The patients were between 18 and 30 years of age and had no history of shoulder problems. At the 2-year follow-up, 3 (20%) of 15 patients in the lavage group had a redislocated shoulder compared with 9 (60%) of 15 patients in the nonoperative group (P = .03). Two of the patients in the lavage group compared with 6 of the patients in the control group had been operated on or were scheduled for stabilizing surgery. Functional outcome according to the Constant and Rowe shoulder scores did not reveal any significant difference (P = .07) between the groups. However, by the Rowe classification 2 of 15 patients in the lavage group had poor results versus 8 of 15 in the control group, indicating an advantage for the lavage treatment. The study showed that arthroscopic lavage reduced the risk for recurrent dislocation when compared with nonoperative treatment.

Adolescent↗
PubMedDate not supplied

[MR-based 3D-analysis of the pathomechanics of traumatic and atraumatic shoulder instability].

AIM: Until now it is unknown to what extent malpositioning of the scapula is a relevant factor in shoulder instability that should be considered in therapy. The objective was to analyse 3D-scapular kinematics and humeral head (de-)centering in patients with atraumatic and/or traumatic shoulder instability and to investigate the correlation between the two factors. METHOD: The shoulders of 28 healthy volunteers and of 14 patients each with atraumatic or traumatic instability were examined in various arm positions - with and without muscle activity - using open MR imaging. After 3D reconstruction, analyses of scapular kinematics and glenohumeral translation were performed. RESULTS: In atraumatic unstable shoulders, the scapular position [30 degrees of abduction: scapulo-humeral rhythm: 3.5 +/- 2.6 : 1 vs. healthy 2.4 +/- 1.3 : 1; internal rotation: 59 +/- 9 degrees vs. healthy 49 +/- 3 degrees (p < 0.05)] and humeral head position was significantly decentered in both planes (p < 0.05). While the correlation between the two factors was high during passive elevation (r = 0.60-0.87), it was low during muscular activity (r = 0.25-0.62). In patients with traumatic instability no alterations of the scapula kinematics were observed. Significant humeral head decentering (p < 0.05) occurred only during abduction and external rotation. CONCLUSIONS: Patients with atraumatic instability demonstrated significant alterations of scapular kinematics and decentering of the humeral head. In traumatic instability a decentering occurred only in specific arm positions with no changes in scapula position. Because of the high correlation between the two factors, physiotherapeutic strategies for the scapula-stabilising muscles should be adapted to the direction of instability.

Adolescent↗
PubMed1989

[Possibilities for using sonography in sports injuries of the shoulder joint].

Sonography is a useful tool for the examination of the shoulder joint. Concomitant cartilaginous and soft tissue lesions (Hill-Sachs, effusion, cuff-tears) can be visualized. Subacromial pathology can be differentiated. The type of instability in the unstable shoulder can be documented. The ultrasound investigation is of diagnostic value for the unstable shoulder as well as for the impingement shoulder in athletes. Therefore it may be helpful for planning the adequate treatment and also for the follow up of the patients.

Athletic Injuries↗