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At least 1,639 records · Page 91Linked to original sources
PubMed1990

Bilateral anterior glenohumeral dislocation in a weight lifter.

A case of bilateral anterior dislocation of the shoulder joint is described. The patient was a recreational weight lifter who sustained the injury while performing the 'pull-over' bench movement using free weights. Probably, the shoulders dislocated when the force developed by the periarticular muscles was less than the actual weight that the patient was trying to lift. The need for stricter safety rules and better supervision in health clubs is stressed.

Adult↗
PubMed2003

Propagation of surface fissures in articular cartilage in response to cyclic loading in vitro.

BACKGROUND: Mechanical overloading of synovial joints can damage the articular cartilage surface and may lead to osteoarthritis. However, causal links between mechanical and biological events in cartilage are poorly understood. OBJECTIVES: To test the hypothesis that surface fissures in cartilage can propagate mechanically if the joint surface is subjected to vigorous cyclic loading. METHODS: Thirty-five cartilage-on-bone specimens, 15-mm square, were removed from mature bovine knee and shoulder joints. Specimens were loaded by means of a 9-mm-diameter flat indenter with a beveled edge, and their compressive strength determined. Failure occurred in the cartilage surface at an average stress of 36 MPa. Cartilage fissures were marked with Indian ink, photographed, and their length and width measured using image analysis software. Each damaged specimen was subjected to cyclic loading at 40% of its compressive strength, at 0.5 Hz, for up to 5 h. Fissure length and width were measured at regular intervals. After testing, fissure depth was measured from histological sections, and compared with measurements from damaged cartilage which was not cyclically loaded. RESULTS: Cyclic loading caused cartilage fissures to increase in length (mean 353%, P<0.01) and width (360%, P<0.01) but not depth. Propagation was rapid at first, but approached equilibrium after several hundred cycles. Rehydration in saline had no effect on fissure length, but width returned to pre-cyclic loading values. CONCLUSION: Cartilage fissures can propagate mechanically when a joint surface is subjected to cyclic compressive loading in vitro. The transient opening-up of fissures to form wide surface "wounds" during cyclic loading could be of biological significance if it occurred in living people. RELEVANCE: In living joints, wide open fissures in the cartilage surface could promote degenerative changes in the tissue.

Animals↗
PubMed1990

Non traumatic dislocation of shoulder with rupture of axillary vessel branch in a paraplegic patient: a case report.

Spinal cord injured (SCI) patients utilize the shoulder joints for wheelchair propulsion, for transfers in and out of wheelchairs and for wheelchair "push-ups" for pressure relief, to prevent pressure sores. Accurate incidence of shoulder dislocation in SCI patients is not known. A majority of the dislocations seen are secondary to trauma. A 66-year-old, T10 paraplegic since 1942, developed severe osteoarthritic changes in both shoulders and experienced nontraumatic, recurrent dislocation of his right shoulder with a rupture of the axillary vessel branch. This case is reported here because of its rarity.

Aged↗
PubMed1982

[CT diagnosis of recurrent subluxation of the shoulder (author's transl)].

CT provides a clear, unobstructed and reproducible view of the shoulder joint. This permits, unlike conventional methods, for the first time a complete view of the anatomy and of the factors which predispose to a recurrent subluxation of the shoulder. In addition it is possible to see bone lesions resulting from the subluxation.

Chronic Disease↗
PubMed1983

Posttraumatic osteolysis of the clavicle.

Posttraumatic osteolysis of the distal clavicle should be considered when continued pain follows trauma. The osteolysis and accompanying symptoms can be partially alleviated by immobilization of the shoulder joint. The pathology is poorly understood, but synovial hyperplasia appears to play an integral part in the resorptive process.

Accidents, Traffic↗
PubMed1992

[Anatomicosurgical comments on the importance of the spinal accessory nerve].

The preserved integrity of the spinal accessory nerve plays an extremely important role in cervico-facial surgery since the majority of surgical approaches involve this nervous structure. Following a short historical outline of the surgical method, the Authors illustrate the anatomo-topographical aspects and anatomo-surgical problems. A number of points emerge from a review of the literature which are vital to isolate the spinal accessory nerve: 1) the transversal apophysis of the atlas is particularly prominent in the retrostyloid space and lies half-way across an imaginary horizontal segment connecting the mastoid process with the angle of the mandible; 2) the posterior edge of the sternocleidomastoid muscle at approximately six centimetres from the mastoid process; 3) the nervous point of Erb located at the point where the superficial branches of the cervical plexus emerge from the posterior edge of the sternocleidomastoid muscle (the nerve generally emerges from the posterior edge of the sternocleidomastoid muscle two centimetres above this point and two centimetres below it the nerve meets the anterior edge of the trapezius). This is followed by an analysis of the possible complications deriving from lesions to this vital nervous structure. The resection of the spinal accessory nerve leads to the so-called "shoulder syndrome" mainly due to the denervation of the trapezius. This syndrome is characterised by the onset of regional pain, the typical deformation of the shoulder joint and functional deficit. The deformation is provoked by the decreased muscular strength of the superior and middle portion of the trapezius manifested as the rocking of the shoulder and a higher superointernal angle.(ABSTRACT TRUNCATED AT 250 WORDS)

Accessory Nerve↗
PubMed2004

Posterior shoulder dislocation in infants with neonatal brachial plexus palsy.

BACKGROUND: Glenoid dysplasia and posterior shoulder subluxation with resultant shoulder stiffness is a well-recognized complication in infants with neonatal brachial plexus palsy. It is generally considered to be the result of a slowly progressive glenohumeral deformation secondary to muscle imbalance, physeal trauma, or both. Recent publications about infantile posterior shoulder dislocation have suggested that the onset of dysplasia occurs at an earlier age than has been previously recognized. The prevalence of early dislocation in infants with this disorder has not been previously reported, to our knowledge. METHODS: We studied 134 consecutive infants with neonatal brachial plexus palsy who were seen at our institution over a period of two years. All infants were examined at monthly intervals to assess neurological recovery and the status of the upper extremity until recovery occurred or a treatment plan was established. The type of brachial plexus involvement was classified. Specific clinical signs associated with subluxation and dislocation were recorded. These included asymmetry of skin folds of the axilla or the proximal aspect of the arm, apparent shortening of the humeral segment, a palpable asymmetric fullness in the posterior region of the shoulder, or a palpable click during shoulder manipulation. The infants who were identified as having these clinical signs were evaluated with ultrasonographic imaging studies. RESULTS: Eleven (8%) of the 134 infants had a posterior shoulder dislocation. The mean age at the time of diagnosis was six months (range, three to ten months). There was no correlation between the occurrence of dislocation and the type of initial neurological deficit. A rapid loss of passive external rotation between monthly examinations indicated a posterior shoulder dislocation. CONCLUSIONS: Posterior shoulder dislocation can occur earlier (before the age of one year) and more rapidly in infants with neonatal brachial plexus palsy than has been appreciated previously. As with developmental dysplasia of the hip, a high index of suspicion, recognition of clinical signs, and the use of ultrasonography will allow the diagnosis to be established. Following early diagnosis, attention should be focused on improving the stability and congruency of the shoulder joint.

Brachial Plexus Neuropathies↗
PubMed1992

Accessory head of the biceps brachii. Case report demonstrating clinical relevance.

Although anatomic variations in the origin of both the coracobrachialis or biceps brachii have been observed, there have been no previous reports of clinical relevance. In a 22-year-old man, recognition and mobilization of an accessory long head of the biceps brachii was necessary for adequate exposure of the shoulder joint dislocation through a deltopectoral incision.

Adult↗
PubMed1993

Interaction between the joints in the shoulder mechanism: the function of the costoclavicular, conoid and trapezoid ligaments.

By developing a measurement method based on the palpation of bony landmarks, the three-dimensional positions of the scapula and clavicle can be measured at several angles of humerus elevation. An analysis of these measurements shows the interaction between all joints of the shoulder mechanism. With the help of a biomechanical shoulder model the role of some of the extracapsular ligaments in the motion pattern of scapula and clavicle can be derived. In addition, the interaction between the rotations in the acromioclavicular and sternoclavicular joints is shown, and the possible implications for the treatment of joint problems in the shoulder are discussed.

Biomechanical Phenomena↗
PubMed2003

[Experiences with the OrTra-prosthesis in primary prosthetic replacement of fractures of the humeral head--indication, technique and results].

Displaced three - and four - part fractures of the humeral head are at high risk for a poor functional outcome after internal fixation. Primary prosthetic replacement can restore the pretraumatic anatomy and early mobilisation is possible. Functional outcome after hemiarthroplasty of the shoulder joint after trauma however is poor, regardless the type of implant used. However, a stable, painless joint is obtained at a "one time surgery". In our institute from April 1996 until January 2001 fifty-eight primary OrTra-prostheses were implanted. In 43 patients we could perform the follow up. The patients revealed a mean range of active movement from about flex./ext. 54 degrees/0/40 with abd./add. 67 degrees/0/20 degrees. Most important for the patients was the achieved painfree shoulder in 86% (ASES index) of all cases.

Follow-Up Studies↗
PubMed1997

Trajectory formation of the center-of-mass of the arm during reaching movements.

We attempted to identify the invariant kinematic properties of multijoint arm reaching movements in the horizontal plane to explore the planning variable(s) involved in their coordination. Different targets were placed near the perimeter of the workspace boundary, thereby causing variation of size and orientation of the hand stroke. We have a special interest in the trajectory characteristics of the most massive point within the arm system, the center-of-mass of the entire arm system, in addition to those of the hand or joints. The motion of the individual segments (the forearm plus hand and the upper arm) or joints (shoulder and elbow) was modulated in a different way depending on the tasks; thus, there was no invariance in the relationships between paired variables (displacement or velocity) for segment or joint motions. For relatively short hand strokes, the trajectory of the hand and the center-of-mass of the entire arm system were characterized by a nearly straight path, and a smooth, bell-shaped velocity curve along the path, symmetrical about the mid-portion of the movement, starting from nearly zero, growing to a single peak and declining again to nearly zero. However, in large hand strokes the hand path was highly curved and the velocity curve was asymmetric. Although the path of the center-of-mass of the entire arm system also tended to be curved with the increase of the hand stroke, a bell-shaped velocity curve along the path and its typical symmetry were preserved over a wide range of stroke sizes and orientations, and its peak was scaled in proportion to movement distance and movement time. Our findings indicate that it is not valid to postulate solely the joint- or hand-based planning strategies which have been proposed previously. Rather, the planning of the spatial aspects of the motion is largely dependent on the interaction of multiple variables, including those not analysed in this study. The bell-shaped pattern of the center-of-mass velocity profile represents a certain efficiency of movement, since it corresponds to a single accelerative and a decelerative phase of a mass over the movement, with no intermediate force reversals. The simple structure of the center-of-mass velocity profiles may reflect a fundamental organization principle underlying the temporal aspects of movement planning.

Adult↗
PubMed2004

Therapeutic results of acromioclavicular joint dislocation complicated by rotator cuff tear.

PURPOSE: To evaluate the operative findings and postoperative results of one-stage repair on patients with acromioclavicular joint dislocation complicated by rotator cuff tear. METHODS: Between 1992 and 1999, one-stage repair was performed on 5 patients with acromioclavicular joint dislocation complicated by rotator cuff tears. Modified Cadenat procedure for acromioclavicular joint dislocation, and McLaughlin procedure for rotator cuff tear, were performed on these patients. Postoperative results at the final examination were assessed according to the criteria for therapeutic effects on shoulder joint disorders of the Japanese Orthopaedic Association. RESULTS: There was partial-thickness cuff tear in one patient, and full-thickness cuff tear in the remaining 4 patients. In all patients, tears were located only in the supraspinatus tendon, and were medium or small ones with maximal diameter of 3 cm or less. After a mean follow-up period of 56 months (range, 36-79 months), all patients were assessed to have excellent results. No patient showed a good reduction of the acromio-clavicular joint. CONCLUSION: For patients successfully treated by one-stage repair, satisfactory results were obtained without pain or disturbance in activities of daily living.

Acromioclavicular Joint↗
PubMedDate not supplied

[Shoulder-hand syndrome after stroke: a case report].

A case of shoulder-hand syndrome (algodystrophy, reflex sympathetic dystrophy) in a stroke patient is presented. Six weeks after stroke the condition started with pain, swelling and considerable reduction of movements of the hand and wrist followed by involvement of shoulder joint a few days later. Initially, the complaints were attributed to excessive rehabilitation, however, when cessation of exercises and anti-inflammatory treatment failed to improve, the diagnosis of shoulder-hand syndrome was suspected. Three phase bone scintigraphy performed 2 weeks after the onset of symptoms revealed features of possible algodystrophy. X-ray revealed no significant changes. The patient satisfactory responded to nasal salmon calcitonin treatment 300 units daily during 4 weeks. The reassessment performed 3 months after the onset of disease showed regression of most signs and symptoms as well as satisfactory range of motion of the hand and shoulder. Bone scintigraphy revealed typical algodystrophy pattern (diffusely increased periarticular uptake). The cause of such evolution of scintigraphic changes as well as some implications of nasal calcitonin administration were discussed.

Administration, Intranasal↗
PubMed1997

Anatomic considerations for a modified posterior approach to the scapula.

A modified posterior approach to the scapula was tested on 20 cadavers. The approach also was used in 2 cases with fractures involving the scapular neck and glenoid fossa. The incision is C shaped, with the convexity directed toward the lateral angle of the scapula. The posterior muscle fibers of the deltoid are reflected laterally after detaching them from their origin. The infraspinatus is mobilized without division to expose the posterior surface of the scapular neck and glenoid. Access to the rest of the posterior and the superior surfaces of the glenoid can be achieved by osteotomizing the acromion. The suprascapular neurovascular bundle is identified and protected at an average of 1.4 +/- 0.1 cm from the glenoid rim, where it is adherent to the spinoglenoid angle of the scapula. The circumflex scapular artery is protected at the lateral border of the scapula at an average of 2.8 +/- 0.5 cm from the inferior glenoid margin. The axillary nerve is protected inferior to the teres minor. However, care should be taken not to excessively retract the teres minor because the nerve lies in close proximity to the shoulder joint capsule.

Acromion↗
PubMed1979

[Neurologic syndromes affecting the shoulder (author's transl)].

A number of locally defined as well as generalised diseases of the peripheral nervous system is manifested in the shoulderarm region besides lesions of individual nerves through traumas or as a result of pressure. Radicular syndromes are particularly frequent. These are based on prolapsed disks or degenerative changes of the cervical vertebral column. We must differentiate between these syndromes and the often rather unknown neuralgic amytrophy of the shoulder. Our experience has shown that in too many cases, paralysis of the plexus cervico-brachialis is assumed, although this occurs almost exclusively on the basis of traumatic violence, much rarer due to pressure. In such cases, the physician should look for the scalenus syndrome, the costoclavicular syndrome, and the hyperabduction syndrome. As a rule, pain is the most prominent symptom in plexus pareses through new growths, eg Pancoast's tumour. In such cases, a clear distinction must be made against bursitis of the shoulder (periarthritis humeroscapularis), in which there are no neurogenic changes, but only myogenic changes manifested in the electromyogram. If the sudden pain is accompanied by swelling and weakness of the arm, there is every likelihood of the existence of Paget-von Schrötter's syndrome. A remarkably painless deformation of the shoulder joint should also suggest neurogenic arthropathy in syringomyelia. The physician should also consider disturbances of distant origin, for example in the region of the carpal tunnel, with pain radiating to the shoulder in the manner of brachialgia paraesthetica. Finally, any noticeable weakness or muscular atrophy in the shoulder region should suggest a disease of the neuromuscular system, mainly progressive muscular dystrophy or the rare shoulder girdle type of amyotrophic lateral sclerosis.

Arthropathy, Neurogenic↗
PubMed1997

Pneumococcal pyomyositis secondary to pneumonia.

A case of pneumococcal pyomyositis of the brachial and shoulder region is presented. A bacteremic right lower lobe pneumonia was the source of infection. The spread of pneumococci was presumed to be blood-borne, presenting with cellulitis over the right shoulder region, progressing over 5 days to abscess formation in the right biceps muscle and right shoulder joint despite adequate antibiotic treatment.

Abscess↗
PubMed2004

Plating of humeral shaft fractures--has the pendulum swung back?

We reviewed 49 patients following plate osteosynthesis of humeral shaft fractures. There were no complications as a result of surgery. Union occurred in 47 patients (96%) at a mean of 9 weeks. Two patients required secondary procedures to achieve union. All patients had full range of motion in the elbow and shoulder joints following union. In the light of the popularisation of intramedullary nailing techniques in the last decade, with recognised complications of iatrogenic radial nerve injury, inadequate rotational stabilisation, non-union and shoulder impingement, we advocate plating of humeral shaft fractures as the surgical treatment of choice.

Adolescent↗