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PubMed1987

Fatal injuries caused by underarm use of shoulder belts.

Safety belt use has dramatically increased in the past decade in North America because of safety belt use laws. Underarm use of shoulder belts is a means of relieving neck irritation and other complaints from shoulder belts but may result in serious or fatal injuries. Loads far in excess of the injury tolerance of the lower chest and upper abdomen are imposed by the shoulder belt in the underarm position. Six recent cases are presented in which fatal injury was caused by underarm use of shoulder belts. Lacerations of the liver, spleen, intestines, mesentery, diaphragm, and aorta, and spine injury have occurred in accidents, most of which should have been survivable. The motoring public must be warned that underarm use of shoulder belts is hazardous and may cause fatal injuries in otherwise survivable accidents.

Accidents, Traffic↗
PubMed2004

Evaluation of residents' delivery notes after a simulated shoulder dystocia.

OBJECTIVE: To describe and analyze delivery notes after a shoulder dystocia drill with a birthing simulator METHODS: A total of 33 residents from 2 university training programs underwent testing on a standardized shoulder dystocia scenario with an obstetric birthing simulator. After the completion of the delivery, each resident was informed of the infant's Apgar scores and birth weight and told that the infant was moving all extremities. The resident was then given a blank progress note and asked to write a delivery note. The notes were evaluated for 15 key components. RESULTS: Seventy-six percent (n = 25) of residents recorded less than 10 of 15 key components of a delivery note after a shoulder dystocia. The majority of residents (91%, 30/33) included the correct order of the maneuvers used during the delivery, but most did not note which shoulder was anterior (18%, 6/33) or how long the head-to-body interval was during delivery (45%, 15/33). CONCLUSION: Residents' delivery notes after a shoulder dystocia simulation often lacked critical elements. Training in documentation is needed in residency training. The addition of the delivery note and feedback regarding the note represents a simple innovation in this teaching scenario that may help identify deficiencies in documentation. LEVEL OF EVIDENCE: III

Adult↗
PubMed2005

Temporary Erb-Duchenne palsy without shoulder dystocia or traction to the fetal head.

BACKGROUND: Although many retrospective studies report that brachial plexus palsies occur after vaginal delivery in the absence of recorded shoulder dystocia, there are no known prospective reports by a treating clinician (PubMed, English language only, 1952-June 2004, search terms: shoulder dystocia, nonshoulder dystocia, obstetric brachial plexus injury, Erb's palsy, Erb-Duchenne palsy, spontaneous vaginal delivery). CASE: A multiparous patient presented with a birth plan requesting that the baby be allowed to deliver on its own, without traction on the head and without suctioning. Although induced at term for elevated blood pressure, the otherwise healthy patient experienced a normal labor with a 30-minute second stage. At delivery, which was videotaped by the father, the fetal head presented over an intact perineum in a right-occiput-anterior position. Without traction, the anterior shoulder delivered spontaneously with the next contraction and Valsalva, followed by the posterior shoulder. The trunk followed routinely. The average-weight for gestational age neonate exhibited an Erb-Duchenne palsy of the right (posterior) arm that resolved on the fourth day of life. CONCLUSION: Temporary Erb-Duchenne palsy can occur in the posterior arm after normal labor and spontaneous delivery without shoulder dystocia or traction on the fetal head.

Adult↗
PubMed1995

Shoulder dystocia. Report of 2 cases and review of the literature.

Shoulder dystocia, or impacted shoulders is an infrequently encountered obstetric emergency. Despite various risk factors identified by investigators, the occurrence of shoulder dystocia is difficult to predict. Two cases of severe shoulder dystocia managed personally by the author are presented. These cases illustrate some of the important issues regarding prediction of shoulder dystocia and the need to begin a series of well-tested manoeuvres immediately, to successfully deliver the baby.

Adult↗
PubMed1986

Shoulder lameness in horses: an analysis of 58 suspected cases.

The results of a detailed investigation of 58 horses with suspected shoulder lameness are described. Lameness was found to originate distal to the shoulder region in 22 horses. No diagnosis was reached in five horses. Genuine shoulder problems occurred in 29 horses. The clinical signs of shoulder lameness are described and contrasted with lower limb lameness. The limitations of currently available diagnostic techniques are discussed. Problems identified in the shoulder region included osteochondritis dissecans, subchondral bone cysts, arthrosis, fracture, luxation, septic arthritis and soft tissue damage. Some of the differences between osteochondritis dissecans and subchondral bone cysts are described and it is suggested that these are two separate conditions.

Animals↗
PubMedDate not supplied

Shoulder strength following acromioclavicular injury.

The acromioclavicular (AC) joint enjoys the dubious distinction of being one of the few joints in the body whose total dislocation is routinely treated by simply leaving the joint dislocated. Adherents of both conservative and operative treatment have presented reasons for their viewpoints. Residual shoulder weakness has been offered as a sequela of untreated acromioclavicular injury and a reason for repairing the joint. An objective evaluation of shoulder strength would be valuable in determining the optimum treatment for this injury. The purpose of our study was to quantitate, using the Cybex II, the residual shoulder weakness following various modes of treatment. Seventeen patients with Grade III AC separations and eight patients with Grade II AC sprains were reviewed. Nine of the Grade III injuries were treated and eight nonoperatively. All Grade II injuries were treated nonsurgically. All patients were tested on the Cybex II isokinetic dynamometer at both slow and fast speeds through various ranges of motion. Grade III injuries treated nonoperatively showed no significant strength deficits. Surgically treated Grade III injuries had a significant strength deficit in vertical abduction at fast speeds (19.8%) when compared to the uninjured shoulder. Interestingly, the Grade II injuries led to a significant weakness in horizontal abduction (24.3%) at fast velocity. Evaluation of subjective results showed that Grade III injuries treated conservatively had the most pain and stiffness, despite their strong shoulders. Patients with Grade III injuries treated operatively rated their overall outcome below that of those treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromioclavicular Joint↗
PubMedDate not supplied

Magnetic resonance imaging evaluation of the rotator cuff tendons in the asymptomatic shoulder.

Thirty shoulders in 20 volunteers (average age, 29 years; range, 17 to 49) with no shoulder symptoms or known abnormalities were scanned using magnetic resonance imaging. All scans were interpreted by one radiologist who was blinded to clinical data. Appearance of rotator cuff tendons on the images was graded. Grade 0 was normal, homogeneous low signal intensity structure. Grade 1 lesion was focal, linear, or diffuse intermediate signal through the tendon. Grade 2 lesion was high signal intensity within the tendon and less than full thickness. Grade 3 was high signal intensity through full thickness of the tendon. No supraspinatus or infraspinatus tendons were grade 0 (normal); all supraspinatus and infraspinatus tendons had grade 1 changes through the tendons; and 7 of 30 (23%) of the tendons had grade 2 changes. None of the 30 shoulders had grade 3 changes in the rotator cuff tendons. There is a wide array of abnormal magnetic resonance imaging signals in shoulders of young asymptomatic individuals, but they do not have full-thickness rotator cuff tears (grade 3 lesion). Nonenhanced magnetic resonance imaging may be of limited value in defining rotator cuff injury in a patient with shoulder pain unless a full-thickness rotator cuff tear is suspected clinically.

Adolescent↗
PubMed2000

Management of shoulder dystocia.

OBJECTIVE: We sought to determine the management of shoulder dystocia currently practiced by physicians in the Middle Tennessee region and the frequency of use of the all-fours (Gaskin) maneuver in clinical practice. METHODS: A questionnaire was developed and sent to physicians in the Middle Tennessee area, asking how they would manage shoulder dystocia in specific practice scenarios. RESULTS: The methods most commonly used to manage shoulder dystocia are episiotomy, the McRoberts maneuver, and suprapubic pressure. Twenty-four percent of practitioners listed more than four options for the management of shoulder dystocia. Only 8% of those surveyed claimed knowledge of and use of the all-fours maneuver. CONCLUSION: Educational programs should be developed to inform practitioners of additional options for the management of shoulder dystocia.

Algorithms↗
PubMed2001

Relationship between isokinetic strength of the internal and external shoulder rotators and ball velocity in team handball.

BACKGROUND: The purpose of this study was to examine the relationship between the rotational strength of shoulder and ball velocity in team handball players from various levels. METHODS: Three groups of young healthy, male subjects took part in the experiments: one group of 15 handball players, the best of League A1 scorers, another group of 12 handball players, the best of League A2 scorers and a random sample of 15 physical education students. Each subject was tested on a Cybex II isokinetic dynamometer. The concentric action of the internal and external rotation of the dominant shoulder was examined at 60, 180 and 300 deg/sec. Ball velocity was examined in three types of throw: (a) on the spot, (b) with a cross-over step, and (c) with a vertical jump. Statistical analysis was performed using the Pearson product-moment correlation and one-way analysis of variance. RESULTS: The differences of peak torque values of the internal and external shoulder rotation between the three groups were not statistically significant. The differences between groups regarding ball velocity in all types of throw were statistically significant (p<0.001). The relationship between IR and ER rotation of the shoulder and ball velocity was not statistically significant, except the jump shot. CONCLUSIONS: The main finding of this study was that peak torque of IR and ER of the shoulder was not a good indicator of throwing velocity at any type of throw, except the jump shot, in all subjects, regardless of their throwing ability.

Adult↗
PubMedDate not supplied

Atlantoaxial disorders in rheumatoid arthritis associate with the destruction of peripheral and shoulder joints, and decreased bone mineral density.

OBJECTIVE: To evaluate whether cervical spine changes are associated with the destruction of shoulder or peripheral joints and with bone mineral density (BMD) in patients with long-term RA. METHODS: An inception cohort of 67 patients with seropositive and erosive RA were followed up for 20 years. Cervical spine, shoulder, hand and foot radiographs, and the BMD of the lumbar spine and femoral neck were evaluated. RESULTS: A positive relationship was detected between the occurrence of atlantoaxial disorders and the destruction of both shoulder (p < 0.001) and peripheral (p = 0.001) joints. In addition, the severity of anterior atlantoaxial subluxation and atlantoaxial impaction positively correlated with the grade of destruction in the evaluated joints. Furthermore, patients with atlantoaxial disorders presented decreased BMD of the femoral neck (p = 0.019). The occurrences of subaxial subluxations (SAS) and subaxial disc space narrowings only associated with higher onset age of RA. CONCLUSIONS: Patients with severe RA and osteoporosis have an increased risk for atlantoaxial disorders. The co-existence of shoulder destruction and cervical spine disorders makes the differential diagnosis of shoulder and neck pain challenging.

Adult↗
PubMed1992

Patterns of shoulder flexibility among college baseball players.

In this study, I investigated and analyzed the various joint motions in the shoulders of college baseball players. Twenty-six players (age=20.38+/-1.36 yr) from two colleges were examined for upper extremity range of motion (ROM), including shoulder flexion, extension, internal rotation at 90 degrees abduction, and external rotation at 90 degrees abduction. Joint motions were measured using a JAMAR(R), six-inch, double-arm goniometer. Pitchers demonstrated 22 degrees more shoulder flexion and 21 degrees more external rotation at 90 degrees abduction than infield position players, and 17 degrees more shoulder flexion than outfield position players. There was no significant difference between the dominant arm flexibility of infield and outfield position players. When comparing the dominant to nondominant arm relative to the position, infield position players demonstrated 5 degrees less shoulder flexion and 6 degrees more external rotation on the dominant side at 90 degrees abduction. Pitchers did not demonstrate any significant difference between the dominant and nondominant arm. There was, however, an indication that pitchers had a tendency to exhibit greater flexibility during flexion and external rotation at 90 degrees abduction in the dominant side than in the nondominant side.

Journal Article↗
PubMed2000

Rehabilitation after ligamentous and labral surgery of the shoulder: guiding concepts.

OBJECTIVE: To provide treatment guidelines for rehabilitation after ligamentous and labral surgery of the shoulder. DATA SOURCES: We searched Index Medicus for the last 10 years using the key words "shoulder instability," "shoulder exercises," and "shoulder surgery." DATA SYNTHESIS: Detailed rehabilitation programs for patients with anterior shoulder instability reconstructions can be found in the literature, but many are based on anecdotal evidence and clinical observation. Randomized, prospective outcome studies on these rehabilitation protocols have not been performed. Therefore, we offer a performance- and criteria-based guideline for rehabilitation that is rooted in basic science, surgeons' recommendations, clinical experience, and common sense. CONCLUSIONS/RECOMMENDATIONS: To return an athlete to the preinjury level of function, range of motion, strengthening, proprioception, and functional activities must be used judiciously, keeping healing constraints and arthrokinematics in mind.

Journal Article↗
PubMedDate not supplied

A functional fatiguing protocol and deceleration time of the shoulder from an internal rotation perturbation.

CONTEXT: Muscular fatigue impedes sensorimotor function and may increase the risk of shoulder injury during activity. The effects of fatigue on the sensorimotor system of the shoulder have been studied with various results. Deceleration times have been used to study neuromuscular control of the shoulder; however, no studies involving the effects of fatigue on deceleration times have been reported. OBJECTIVE: To compare shoulder deceleration times after a shoulder internal rotation perturbation before and after a repetitive throwing exercise protocol. DESIGN: A 2 x 2 repeated-measures design. SETTING: Exercise and sport injury laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty healthy, recreationally active men (age = 24.76 +/- 4.03 years, height = 178.41 +/- 8.36 cm, mass = 80.16 +/- 15.20 kg) volunteered to participate in the study. To ensure familiarity with the overhead motion, all subjects chosen had previously participated in an overhead throwing sport. INTERVENTION(S): The independent variables were time (preintervention and postintervention) and session (experimental and control). The intervention consisted of continuous overhead throwing. The subjects were considered fatigued when a 10% decrease in velocity was noted on 3 consecutive pitches. MAIN OUTCOME MEASURE(S): Time necessary to decelerate from an internal rotation perturbation. RESULTS: Deceleration time was significantly increased by the fatiguing intervention ( P = .001). CONCLUSIONS: The decreased ability to decelerate may be an adaptive response by the subjects to dissipate a lower percentage of force per second.

Journal Article↗
PubMed1984

The role of glutathione and DNA strand break repair in determining the shoulder of the radiation survival curve.

The nonprotein thiol glutathione (GSH) and the rate and extent of repair of DNA strand breaks were investigated as two possible determinants of the size of the shoulder of the X-ray survival curve in Chinese Hamster Ovary (CHO) cells. Both cell survival and DNA single strand break repair were measured at comparable radiation doses (using clonogenic and alkaline elution assays respectively) following treatment of CHO cells with agents which deplete GSH levels and/or reduce the shoulder of the radiation survival curve. CHO cells were treated with diethylmaleate (DEM) at doses which reduce GSH levels from 10% to less than 1% of control values. GSH depletion produced dose-modifying radiosensitization of hypoxic but not aerobic cells, reducing the oxygen enhancement ratio (OER) from 2.6 to 1.7, with no change in the survival curve shoulder, nor in the rate of repair of DNA strand breaks. Since mitotic CHO cells exhibited a reduced shoulder compared to asynchronous cells with no difference in the Do of the survival curve, they provided an opportunity to test the possible association of the shoulder size with the repair rate of DNA breaks. Both mitotic and asynchronous cells had the same initial number of strand breaks for a given radiation dose, but mitotic cells had a half-life for repair of those breaks which was significantly longer.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Induction and repair of DNA double-strand breaks in the same dose range as the shoulder of the survival curve.

We have used pulsed-field gel electrophoresis (PFGE) to test two hypotheses that have been proposed to explain the survival curves with shoulders which are characteristic of low-LET ionizing radiation: (1) Neutral elution studies of the induction of double-strand breaks (DSBs) have suggested that ionizing radiation might induce DSBs in a nonlinear fashion at low doses. (2) Based on analogies to enzyme kinetics, DSB repair might be saturating in the shoulder region. We quantified DSB induction and survival resulting from doses between 0 and 5 Gy spanning the shoulder region of the survival curve. We found that DSB induction was linear at all doses tested down to 0.5 Gy, the limits of sensitivity. Therefore, nonlinear DSB induction cannot account for the shape of the survival curve. To determine whether the DSB repair system was saturated in the shoulder region, we quantified the rate of DSB repair as a function of dose of X rays between 1.25 and 20 Gy. The repair of DSBs was exponential with half-times of repair constant for doses below 10 Gy, and averaged 28 min. We determined the initial rate of repair from the exponential repair kinetics for each dose. The initial rate of repair after radiation treatment increased linearly with dose up to at least 10 Gy. Therefore, saturating DSB repair cannot explain the shoulder of the survival curve.

Cell Survival↗
PubMed1999

Tikhoff-Linberg procedure for bone and soft tissue tumors of the shoulder girdle.

OBJECTIVE: To evaluate complications and the oncological and intermediate-term functional results in patients with bone and soft tissue tumors of the shoulder girdle who were managed with interscapulothoracic resection (Tikhoff-Linberg procedure). DESIGN: Case series of 19 consecutive patients during a 10-year period at a mean follow-up of 6.3 years (range, 1-11 years). SETTING: University hospital; referral center for musculoskeletal tumor surgery. PATIENTS: The initial diagnosis in this consecutive series of patients with shoulder girdle tumors requiring the Tikhoff-Linberg procedure was chondrosarcoma in 7 patients, Ewing sarcoma in 3 patients, malignant fibrous histiocytoma in 3 patients, solitary metastasis of thyroid carcinoma in 2 patients, osteosarcoma, synovial sarcoma, angiosarcoma, ancd neurofibrosarcoma in 1 patient each. According to the Musculoskeletal Tumor Society staging system, there were 6 in surgical stage IB, 10 in stage IIB, and 3 in stage III. Nine tumors involved the proximal humerus, 8 were located in the scapula or surrounding soft tissues, 1 in the lateral clavicle, and 1 in the acromioclavicular joint. INTERVENTIONS: For reconstruction of the proximal humerus after en bloc tumor resection an isoelastic cemented shoulder tumor prosthesis was inserted in every patient to restore arm length. MAIN OUTCOME MEASURES: Complications, and oncological and intermediate-term functional results. RESULTS: Twelve patients were alive with no evidence of disease. One of these patients died of nontumorous disease 2 years after surgery. One patient is alive with pulmonary metastases after 12 months. Six patients died of metastases at a mean (SD) interval of 18 months (range, 3-35 months) postoperatively. Two of these patients had additional local recurrence. A deep infection necessitated the explantation of the prosthesis in 1 patient. The mean functional score and SD according to the rating system of the Musculoskeletal Tumor Society was 72%+/-14% (range, 33%-87%) for the 12 surviving patients evaluated. Major complications (1 infection and 2 local recurrences) that may be attributed to the procedure occurred in 3 of the 19 patients. CONCLUSION: Despite an overall complication rate of 74% the Tikhoff-Linberg procedure proved to be a valuable surgical procedure for extended tumors of the shoulder girdle for functional and oncological outcome and is superior to forequarter amputation.

Adolescent↗
PubMed2003

Doppler sonographic findings in the long bicipital tendon sheath in patients with rheumatoid arthritis as compared with patients with degenerative diseases of the shoulder.

OBJECTIVE: To compare power Doppler sonography (PDS) findings inside the bicipital tendon sheath in patients with rheumatoid arthritis (RA) and degenerative disorders of the shoulder, in order to evaluate the diagnostic value of PDS in distinguishing between inflammatory and noninflammatory shoulder pain. METHODS: The glenohumeral joints of 41 consecutive patients with shoulder pain were examined by ultrasound. Using ventral transverse and longitudinal scanning, the vascularity near and/or inside the bicipital tendon sheath was visualized by PDS. One fully trained and experienced examiner performed the sonography. Representative images were digitally stored and were read, under blinded conditions, by 2 independent investigators, who categorized the Doppler signals as being either inside or outside the tendon sheath. RESULTS: Biceps tendon sheath effusion, represented by the typical hypoechoic rim, was found in 95.8% of the RA patients (23 of 24) and in 58.8% of the patients with degenerative disorders (10 of 17). PDS signals were localized to inside the tendon sheath in 22 of the RA patients (91.7%) and in none of the patients with degenerative disorders. Although no PDS signal was found inside the tendon sheath in patients with degenerative disorders, in 9 of these patients (52.9%), signals could be localized to the environment of the tendon sheath. CONCLUSION: PDS demonstrates vascularity in the long bicipital tendon sheath of patients with RA, but not in those with degenerative shoulder disorders.

Adult↗
PubMed2004

Shoulder and neck morbidity in quality of life after surgery for head and neck cancer.

BACKGROUND: Quality of life has become a major issue in determining the outcome of treatment in head and neck surgery with curative intent. The aim of our study was to determine which factors in the postoperative care, especially shoulder and neck morbidity, are related to quality of life and how these outcomes compared between patients who had undergone surgery and a control group. METHODS: We analyzed physical symptoms, psychological symptoms, and social and functional well-being at least 1 year after surgery and evaluated the differences in quality of life between patients who had undergone head and neck surgery and a control group. RESULTS: Depression scores contributed significantly to all domains of quality of life. Reduced shoulder abduction, shoulder pain, and neck pain are related to several domains of quality of life. The patient group scored significantly worse for social functioning and limitations from physical problems but scored significantly better for bodily pain and health changes. CONCLUSION: Depression and shoulder and neck morbidity are important factors in quality of life for patients who have undergone surgery for head and neck cancer.

Case-Control Studies↗