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PubMed1987

[Arthroplastic resection of the shoulder. Results and indications apropos of 35 cases].

The only aim of this retrospective study of 35 patients who had undergone resection of shoulder is to report overall results of this well established operation. Although no result could be rated as excellent, those in one half of the patients were evaluated as good and in one quarter as acceptable. The shoulder can be used in two-thirds of cases and of major importance is that pain is absent in two-thirds and tolerable in 80% of cases. In addition to cases of septic arthritis and poorly tolerated recurrent luxations, this operation is indicated for elderly patients with a fracture-luxation or compound fracture of upper end of humerus. However, the operation requires very strict conditions and re-attachment of the cap of rotator muscles. Resection of shoulder should therefore conserve a place in the therapeutic arsenal of shoulder disorders.

Adult↗
PubMed1987

Skiing-related injuries to the shoulder.

An analysis of 135 consecutive shoulder injuries seen in one clinic during a single ski season revealed anterior dislocation to be the most common ailment, constituting 52% of the total. Rotator cuff tears accounted for 20% of the total, followed by acromioclavicular (AC) separations (18%) and a miscellaneous group of contusions and isolated fractures comprising the other 10%. All of the shoulder dislocations were anterior, most were primary (81%) and men (83%) were involved more frequently. Twenty-four percent of the dislocations were thought to be equipment related. At follow-up examination three to four years after injury, a significant number (41%) were still symptomatic either from a recurrence (18%) or pain and weakness (23%). Patients with rotator cuff tears tended to be about ten years older than the average skier. Their injuries were usually a result of a fall on ipsilateral arm and were not equipment related. Of the 13 patients responding after a three-year follow-up period, most (10/13) were asymptomatic. There were 24 AC separations. All resulted from a direct fall on the shoulder. Sixty percent were first degree, 22% were second degree, and 18% were third degree. About one-third of the respondents with first and second degree injuries were still having significant pain at three-year follow-up examination. The most frequent isolated fracture was a minimally displaced fracture of the greater tuberosity (only three cases in 135 injuries), but this same fracture occurred in 10% of the shoulder dislocations.

Acromioclavicular Joint↗
PubMed1984

Arthroscopy of the shoulder joint--a cadaver and clinical study. Part 2: Clinical study.

Shoulder arthroscopy was carried out 56 times on 50 patients. Different types of arthroscopes were employed. Anterior and posterior approaches were used. Diagnoses were 21 cases of glenohumeral instability including 17 of recurrent anterior dislocation and subluxation; 2 of voluntary anterior subluxation and 2 of habitual posterior dislocation, 13 of rotator cuff tear, 6 of chronic subacromial bursitis, 2 of fracture-dislocation, 2 of frozen shoulder, 2 of baseball shoulder, one of rheumatoid arthritis, and 3 miscellaneous. The arthroscopic findings in the instability group and rotator cuff tear group were verified. Bankart lesion and Hill-Sachs lesion were identified arthroscopically. The indications for shoulder arthroscopy are outlined. There was no significant morbidity with this procedure.

Adolescent↗
PubMed1995

The clinical presentation of shoulder instability including on field management.

In the athlete, shoulder instability may result from external high-energy trauma or repetitive overuse. Our understanding of how shoulder instability may contribute to and result from shoulder injury has improved considerably during the past decade. In addition, the delicate balance between mobility and stability and the interrelationship between instability and rotator cuff disease make the clinical management of the unstable shoulder and its field treatment a challenge for physicians, therapists, trainers, and others responsible for the care of injured athletes.

Arm Injuries↗
PubMed1996

[Ultrasound examination of the shoulder joint].

The ultrasound examination of the shoulder is an effective, quick and painless diagnostic method. The skilled examiner has no problem to detect rotator cuff tears, bursitis, tendinitis and instabilities as well as arthrosis or hematoma of the acromioclavicular joint and biceps tendon rupture. In the literature the sensitivity of ultrasound examination of the shoulder depended from 91 to 100% and specificity from 83 to 100%. The dynamic examination gives a special view of gliding tendons, muscles and bony landmarks of the shoulder. With standardized pictures the orthopedic surgeon should be able to diagnose and document almost every shoulder soft tissue pathology.

Arthritis↗
PubMed1996

Rehabilitation of the shoulder.

Rehabilitation of the shoulder has undergone significant changes during the past few years due to many clinical and basic science projects that have taught us about biomechanics of the shoulder. The athlete's shoulder is a particularly good model to allow us an understanding related to rehabilitation for treatment of injuries, injury prevention and performance enhancement. A comprehensive rehabilitation program for athletes can be based on these clinical and basic science principles to aid in our understanding of rehabilitation for shoulders in general.

Athletic Injuries↗
PubMed1996

[Diagnostic reliability of radiography in shoulder trauma. Considerations on the use and choice of more radiographic projections].

The radiographic examination of the shoulder, one of the most common studies performed in the emergency department of examine trauma patients, very often yields poor and incorrect results. A radiographic study of the shoulder requires at least two radiographs, and different projections-namely, a frontal anteroposterior view and some additional projections, at right angles to one another. The shoulder radiographs of 126 patients examined for acute trauma were retrospectively reviewed to investigate the adequacy of lateral and oblique apical views in detecting shoulder injuries missed on anteroposterior view. The antero-posterior view was the most effective one, showing 88% of the injuries. Even though the oblique apical and the lateral views were less sensitive than the antero-posterior view, detecting 82% and 60% of the injuries, respectively, they were more sensitive for some specific injuries missed by the other views. Thus, glenohumeral dislocations with or without fracture and some clavicular fractures were best depicted by the oblique apical view, while the fractures of the body and coracoid process of the scapula were best detected by the lateral view. However, the two views had a complementary role and, in our series of patients, both of them showed four injuries missed by the anteroposterior view. Therefore, we conclude that the radiologist should collaborate with the orthopedist to choose which projections to use in each patient on the basis of physical and clinical examinations.

Female↗
PubMed1997

Posterosuperior glenoid rim impingement as a cause of shoulder pain in top level waterpolo players.

OBJECTIVE: To further define the impingement occurring between the undersurface of the rotator cuff and the posterosuperior glenoid rim as a cause of shoulder pain in waterpolo athletes. EXPERIMENTAL DESIGN: A prospective design was used in the last three years. SETTING: Data were collected in Science Sports Institute of Rome. PARTICIPANTS: Eleven top level waterpolo players of both sexes all members of Italian National Waterpolo teams complaining of shoulder pain. INTERVENTION: All the eleven cases were previously examined with clinical test and X-ray and MR imaging in conventional and functional views, and then underwent arthroscopy. RESULTS: In four cases, X-ray showed erosions of the posterosuperior glenoid and in 5 cases, osteochondral defects on the posterior aspect of humeral head. In eleven cases, MR detected posterosuperior labral damages, partial tears of the undersurface of the rotator cuff and posterosuperior glenoid impingement. Furthermore arthroscopy detected in all cases the pathological findings associated with the posterosuperior glenoid impingement. CONCLUSIONS: Even if the shoulder pain in the overhead athlete may be multifactorial, this study provides further evidence that the posterosuperior glenoid impingement may be the major cause of shoulder pain in waterpolo athletes.

Adolescent↗
PubMed1991

Neck and shoulder complaints among sewing-machine operators: a study concerning frequency, symptomatology and dysfunction.

The occupation of sewing-machine operators (SMO) involves monotonous and repetitive tasks, performed in a work position equivalent to a static component of muscular load on the neck and shoulder. The present study concerns the occurrence of neck-shoulder problems in a population of SMO. A total of 224 SMO from four textile factories in the western part of Sweden were subjected to a comprehensive questionnaire about demographic, vocational, medical and psychosocial data. The Nordic Ministry Questionnaire specifically directed towards neck-shoulder complaints showed a prevalence rate during the last 12 months of 75% and during the last seven days a rate of 51%. Daily problems were experienced by 26%. Some 27% had had problems leading to restraints in work time and 37% in leisure time. Those SMO screening positive were clinically examined in an attempt to describe the clinical picture behind the complaints. Diagnoses were made according to specific criteria. The tension neck syndrome (TNS) was most frequent, followed by the cervical syndrome. In half of those examined, symptoms and findings were too unspecific for diagnosis. A positive correlation between the TNS and working hours per week suggests a daily prolonged static load on the neck and shoulder to be of importance for neck-shoulder problems among the SMO.

Journal Article↗
PubMed1988

Shoulder dystocia: its incidence and associated risk factors.

A case-control study (73 cases, 146 controls) was conducted to evaluate maternal, obstetrical and fetal factors associated with shoulder dystocia. Several factors were identified that were associated with a higher incidence of shoulder dystocia. However, none of them accurately predict those deliveries that will be complicated by shoulder dystocia. Among the 73 shoulder dystocia cases there were no perinatal deaths and all birth-related injuries associated with shoulder dystocia were temporary except for two cases of mild muscular weakness among 12 brachial palsy cases.

Birth Injuries↗
PubMed2004

Design and construction of shoulder recesses into the beam aperture shields for improved patient positioning at the FiR 1 BNCT facility.

Improvements have been made at the FiR 1 BNCT facility to ease the positioning of the patient with a tumor in the head and neck region into a lateral neutron beam. Shoulder recesses were constructed horizontally on both sides of the beam aperture. When shoulder recesses are not needed, they are filled with neutron attenuating filling blocks. MCNP simulations using an anthropomorphic human model BOMAB phantom showed that the main contribution to the increase in the effective dose to the patient's body due to the shoulder recesses was from the neutron dose of the arm. In a position when one arm is inside the shoulder recess, the maximal effective dose of the patient was estimated to be 0.7Sv/h. Dose measurements using the twin ionization chamber technique showed that the neutron dose increased on the sides as predicted by the MCNP model but there was no noticeable change in the gamma doses. When making the recesses into the lithium containing neutron shield material tritium contamination was confined using an underpressurized glove box and machine tools with local exhaust. The shoulder recesses give space for more flexible patient positioning and can be considered as a significant improvement of the Finnish BNCT facility.

Boron Neutron Capture Therapy↗
PubMed2005

Changes in the long head of the biceps tendon in rotator cuff tear shoulders.

BACKGROUND: Morphologic changes in the long head of the biceps tendon have been described in association with rotator cuff disease, yet mechanical significance of these changes remains unclear. METHODS: An experiment was designed to test the hypotheses that the cross-sectional area and material properties of the long head of the biceps tendon are different in shoulders with full thickness rotator cuff tears and shoulders with intact rotator cuff tendons. Seven pairs of cadaver shoulders were tested. In each pair one shoulder had a full thickness rotator cuff tear and the other did not. Thus, a matched design was used. Cross sectional areas were measured. Tendon material properties were measured using an optical strain system. FINDINGS: We were unable to detect a statistically significant difference in the long head of the biceps area or material properties between tendons in shoulders with and without rotator cuff tears. An a priori power analysis was conducted indicating the sample size was sufficient to detect a difference of 70 MPa in the elastic modulus measurement. INTERPRETATION: Our data indicate there is no difference in the long head of the biceps cross sectional area or material properties. Therefore, the long head of the biceps tendon appears to retain its material properties in the presence of a rotator cuff tear. The clinical significance of this finding is that the long head of the biceps can be retained in the presence of a rotator cuff tear without concern that mechanical properties have substantially deteriorated.

Anatomy, Cross-Sectional↗
PubMed2003

Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study.

OBJECTIVES: To evaluate the therapeutic effect of extracorporeal shock wave therapy (ESWT) in shoulders with chronic calcific tendinitis, to compare the functional outcomes of ESWT and transcutaneous electric nerve stimulation (TENS) therapy, and to investigate which types of calcium deposit effectively respond to ESWT. DESIGN: Randomized controlled trial. SETTING: Outpatient clinics of the departments of physical medicine and rehabilitation and of orthopedics and traumatology of a veterans hospital in Taiwan. PARTICIPANTS: Sixty patients with continuous shoulder pain for 6 months or more and with radiographically and sonographically verified calcific tendinitis. Patients were randomly allocated to receive ESWT (33 shoulders) or TENS treatment (30 shoulders). INTERVENTIONS: ESWT was performed with 2000 shock waves at 2Hz and energy level between.26 and.32mJ/mm(2) per session. Treatment was given in 2 sessions, 14 days apart. TENS therapy was given 3 times a week for 4 weeks. MAIN OUTCOME MEASURES: Mean Constant score, visual analog scale (VAS), manual muscle test, and changes of sonographic size and shape of calcium deposits were calculated for 4 time points: at baseline, 2 weeks, 4 weeks, 12 weeks posttherapy. RESULTS: In both groups, Constant score and VAS improved significantly at 2-, 4-, and 12-week follow-ups (P<.05), and the size of calcium deposits decreased significantly at the 4- and 12-week follow-ups. Moreover, the arc-shaped calcific plaques of the rotator cuff were markedly meliorated with ESWT. CONCLUSIONS: ESWT is more effective in the treatment of chronic calcific tendinitis of the shoulder than is TENS therapy, especially for arc-type calcific plaque.

Activities of Daily Living↗
PubMed1999

Validity of pain and motion indicators recorded on a movement diagram of shoulder lateral rotation.

This study examined criterion and construct validity of passive range of motion (PROM) and pain variables recorded on a Maitland-style movement diagram. Passive lateral rotation of the shoulder was assessed in 34 patients with a variety of shoulder pathologies. Two experienced manipulative physiotherapists performed the testing in a randomised block design. The physiotherapists were blinded to all clinical information and ROM measures. The criterion comparators were a blinded goniometric measure of PROM and pain scores from the Shoulder Pain and Disability Index (SPADI). Correlation coefficients between PROM recorded on the movement diagram and goniometry were high (r = 0.79 to 0.94). Moderate correlations were observed between the patient's pain scores recorded on the SPADI and the physiotherapist's recording of pain onset (r = -0.43 to 0.69) and intensity (r = 0.58 to 0.72). Impairment measures from the movement diagram were moderately related to patient-rated shoulder disability (r = 0.50 for ROM and -0.56 for pain). Movement diagrams of passive shoulder rotation can provide valid information on motion and pain.

Journal Article↗
PubMed1997

A method to determine joint moments and force distributions in the shoulders during ceiling work -- a study on house painters.

OBJECTIVE: The purpose of this study was to propose and apply a method to study the net load and the force distribution in the shoulder during sanding of a ceiling. DESIGN: Sanding of a ceiling was studied in an experimental set-up. BACKGROUND: Among painters there is a high frequency of neck and shoulder complaints and some particularly strenuous tasks are sanding and painting of ceilings with tools attached to extension handles. METHODS: A biomechanical model predicted the load pattern in the shoulder from measured external forces and body postures. Measurements were made on 40 subjects by means of a force plate, an extension handle supplied with two pairs of strain gauges and a load cell, and a 3D optoelectronic measurement system. RESULTS: Work techniques may seem to be similar at visual inspection, but nevertheless produce quite different loading patterns in the shoulder. The observed work techniques varied largely among the subjects but the intra-individual variability was rather small. CONCLUSIONS: The study showed that the proposed method can be used to evaluate loads and force distribution in the shoulder. Since the method involves the use of a biomechanical model that can scarcely be validated, results must be interpreted cautiously.

Journal Article↗
PubMed1998

3D shoulder position measurements using a six-degree-of-freedom electromagnetic tracking device.

OBJECTIVE: To describe a recording and processing methodology for obtaining kinematic data of the shoulder which meets three more criteria besides usual requirements regarding precision and accuracy: sufficient speed, obtaining complete 3D kinematics including joint rotations, and usage of coordinate systems based on reference points. DESIGN: Static recordings of shoulder bone orientations during standardized humerus elevations based on the palpation technique using a six-degree-of-freedom electromagnetic tracking device. BACKGROUND: An easy, fast, well standardized measurement methodology for obtaining complete 3D shoulder kinematic data is urgently needed for fundamental musculoskeletal and clinical research. METHODS: A measurement methodology was designed and developed. Shoulder kinematics were obtained from repeated measurements on 15 healthy subjects performed by two observers. Inter-trial, inter-day, inter-observer and inter-subject variability were established. Results were compared to literature. RESULTS: Complete kinematic descriptions were obtained. A measurement speed of about one position per second could be reached. The measured kinematics and accuracy of the measurements were found to be in concordance with the literature. CONCLUSION: All previously formulated criteria for a clinical useful method for obtaining shoulder kinematics have been met.

Journal Article↗
PubMed1998

Sensory manifestations in experimental and work-related chronic neck-shoulder pain.

Little is known about the mechanisms leading to chronic neck-shoulder musculo-skeletal disorders. The aim of the present study was to investigate and compare the sensory manifestations of experimental or chronic neck-shoulder pain under controlled, low load, repetitive work. Experimental and clinical experiments were carried out. In Experiment 1, experimental muscle pain was induced in healthy subjects by intramuscular injection of hypertonic saline in the trapezius (n = 10) and infraspinatus (n = 10) muscles. Experiment 2 was performed on 18 workers with (n = 12) and without (n = 6) chronic neck-shoulder pain. Sensory assessments were performed before and/or after a session of controlled, low load, repetitive work. The pain intensity was assessed by a visual analogue scale. The pain quality and location(s) were monitored together with pressure-pain thresholds. Moderate-to-strong deep pain intensity was experienced in the experimental and clinical part of the working session (six patients out of 12). The verbal descriptors used to describe the experimental or chronic pain qualities were partially similar, i.e. first of all verbal descriptors from the sensory class. The patterns of local and referred pain characteristics were similar (around the shoulder girdle), but it is difficult to evoke pain in extensive areas with hypertonic saline. Patients exhibited hypersensitivity or tenderness to pressure stimuli in both sides of the upper body, i.e. in the trapezius, supraspinatus, infraspinatus and pectoralis major muscles (p < 0.05). This hypersensitivity was only seen at the referred pain site in the healthy volunteers exposed to infraspinatus experimental muscle pain. In conclusion, the present study demonstrated similar sensory manifestations in the experimental and clinical neck-shoulder pain experiments. The presented experimental model can most likely be used to investigate the underlying pain mechanisms involved in work-related chronic musculoskeletal pain.

Journal Article↗
PubMed1991

[Routine ultrasound diagnosis of the shoulder. A simplified examination procedure].

With increasing use of ultrasonography at the shoulder, a confusing number of transducer positions have been recommended. At the shoulder, however, dynamic examination yields more information than fixed transducer orientations. In our examination routine, the transducer is guided across the shoulder following the shape of a triangle. Orientation is secured by palpable, bony structures. The clinically relevant parts of the rotator cuff and the long biceps tendon are investigated, first medially and laterally in a transverse projection and then longitudinally. Dynamic examination is provided by moving the transducer as well as the shoulder joint. In a time-saving examination routine, all important soft tissue structures of the shoulder are visualized.

Humans↗