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At least 1,729 records · Page 96Linked to original sources
PubMed2004

Intramuscular neuromuscular electric stimulation for poststroke shoulder pain: a multicenter randomized clinical trial.

OBJECTIVE: To assess the effectiveness of intramuscular neuromuscular electric stimulation (NMES) in reducing poststroke shoulder pain. DESIGN: Multicenter, single-blinded, randomized clinical trial. SETTING: Ambulatory centers of 7 academic rehabilitation centers in the United States. PARTICIPANTS: Volunteer sample of 61 chronic stroke survivors with shoulder pain and subluxation. INTERVENTION: Treatment subjects received intramuscular NMES to the supraspinatus, posterior deltoid, middle deltoid, and trapezius for 6 hours a day for 6 weeks. Control subjects were treated with a cuff-type sling for 6 weeks. Main outcome measure Brief Pain Inventory question 12 (BPI 12), an 11-point numeric rating scale administered in a blinded manner at the end of treatment, and at 3 and 6 months posttreatment. RESULTS: The NMES group exhibited significantly higher proportions of success based on the 3-point or more reduction in BPI 12 success criterion at the end of treatment (65.6% vs 24.1%, P<.01), at 3 months (59.4% vs 20.7%, P<.01), and at 6 months (59.4% vs 27.6%, P<.05). By using the most stringent "no pain" criterion, the NMES group also exhibited significantly higher proportions of success at the end of treatment (34.4% vs 3.4%, P<.01), at 3 months (34.4% vs 0.0%, P<.001), and at 6 months (34.4% vs 10.3%, P<.05). CONCLUSIONS: Intramuscular NMES reduces poststroke shoulder pain among those with shoulder subluxation and the effect is maintained for at least 6 months posttreatment.

Electric Stimulation Therapy↗
PubMed2004

Complaint-severity and cervical spine problems successfully classified patients with shoulder complaints.

OBJECTIVE: To construct a classification of patients with shoulder complaints based on their physical examination. To investigate (1) the interobserver reliability, (2) to what extent the setting in which the patients were recruited, and demographic and clinical characteristics are related to the classification. STUDY DESIGN AND SETTING: Data from 132 patients with shoulder complaints recruited in various health care settings in The Netherlands were examined. Two observers independently performed a physical examination of the cervical spine and shoulder joint. A nonmetric multidimensional scaling procedure was performed for each observer separately. The interobserver reliability of both observers was computed. Differences between setting, demographic and clinical characteristics, and the resulting dimensions were investigated. RESULTS: For both observers two dimensions (severity of complaints of the shoulder joint, and severity of problems of the cervical spine) were sufficient to classify all patients. Agreement between the two observers was good (r=0.84) to moderate (r=0.69). Patients with neck pain in history taking showed higher scores on both dimensions. CONCLUSION: Despite moderate interobserver agreement for each variable from physical examination found in previous studies, observers agree on the scores of the patients on the relevant dimensions. Given the limited number of effective treatments available to the general practitioner, a more sophisticated classification system seems unnecessary.

Adolescent↗
PubMed2004

Locked anterior-inferior shoulder subluxation presenting as luxatio erecta.

Shoulder subluxation may present as a complication of either traumatic injury to a joint, repetitive mictrotrauma, or atraumatic joint laxity. The case of a middle-aged man who presented with a confusing clinical picture similar to inferior shoulder dislocation, luxatio erecta, with a radiographic diagnosis of anterior-inferior shoulder subluxation is discussed. An understanding of the differential diagnosis of shoulder dislocation and subluxation and the management of atypical presentations is critical to the emergency physician.

Diagnosis, Differential↗
PubMedDate not supplied

A prospective, double-blind comparison of magnetic resonance imaging and arthroscopy in the evaluation of patients presenting with shoulder pain.

The purpose of this study was to determine the diagnostic ability of magnetic resonance imaging (MRI) compared with a reference standard, arthroscopy, in patients presenting with shoulder pain consistent with the signs and symptoms of shoulder impingement. Fifty-eight patients in whom conservative management failed underwent standardized MRI with intravenous gadolinium enhancement and arthroscopic evaluation. The prevalence of supraspinatus tendon, long head of the biceps tendon, and acromioclavicular joint pathology in this population was high: 79.3%, 66%, and 56%, respectively. MRI was highly accurate in detecting full-thickness supraspinatus tears and acromioclavicular joint pathology. However, it had poor concordance with arthroscopy in diagnosing pathology in the biceps tendon and in classifying the curvature of the acromion. A smaller number of other abnormal structures were identified in this population of patients, including labral abnormalities (superior labral anterior-posterior and Bankart tears), Hill-Sachs lesions, and articular surface damage. Concordance between MRI and arthroscopy would increase with improved radiologist-surgeon communication, a more reliable classification of pathology, and possibly the use of intraarticular contrast. This study demonstrates that patients presenting with the clinical findings of shoulder impingement syndrome represent a heterogeneous population. Overall, MRI is a useful tool in the identification of shoulder pathology; however, the clinical correlation of this information and the assessment of outcomes remains unknown.

Adult↗
PubMedDate not supplied

Intraobserver and interobserver reliability for the strength test in the Constant-Murley shoulder assessment.

This study evaluates the standardized strength test in the Constant-Murley shoulder assessment of adults with healthy shoulders in a randomized, single-blind design. The following questions were to be answered: (1) Can the spring balance and a digital dynamometer both yield the same result? (2) What is the intraobserver and interobserver reliability of the strength test? (3) Is the strength test sensitive to change in technique or affected by calculation with mean or maximum values? Ten subjects were included in a comparison of the Handyscale (digital dynamometer) and the mechanical spring balance for concurrent validity, resulting in intraclass correlation coefficient values ranging from 0.96 to 0.99. For intraobserver and interobserver reliability, 2 observers tested 20 subjects with the Handyscale and retested them after 2 weeks. Regardless of technique during testing, this resulted in almost perfect agreement (intraclass correlation coefficient range, 0.89-0.98). The digital dynamometer can replace the conventional spring balance. The standardized strength test in the Constant-Murley shoulder assessment is reliable in young subjects with healthy shoulders, independent of technique or whether calculated with mean or maximum values.

Adult↗
PubMedDate not supplied

Changes of the mineralization pattern in the subchondral bone plate of the glenoid cavity in the shoulder joints of the throwing athletes.

The distribution of mineralization in the subchondral bone plate (DMSB) is used as a parameter for individual stress distribution of shoulder joints. We have analyzed 28 shoulder joints of throwing athletes by DMSB of the glenoid with computed tomography osteoabsorptiometry and described their mineralization patterns. The throwing motion imposes a heavy rotational load on the shoulder joint, and this, in turn, may lead to excessive translation of the humeral head on the glenoid. This could explain why the two most frequent density maxima were localized to the anterior and posterior portions of the glenoid. Our finding of a frequent bicentric density distribution of the shoulder joints of throwing athletes should be useful in any future analysis of the relationship between the DMSB and the bone morphology of the glenoid.

Adolescent↗
PubMed2006

Subacromial plica as a cause of impingement in the shoulder.

The subacromial bursa is the largest bursa in the body. In 1934, Codman described the presence of subacromial plicae, similar to the suprapatellar plicae found in the knee. It is recognized that plicae in the knee can cause anterior knee pain with impingement against the patella in young persons. We investigated the possibility that a similar situation exists with plicae of the subacromial bursa. The aims of this study were to document the prevalence of bursal plicae seen at bursoscopy during arthroscopic subacromial decompression of the shoulder and to assess whether there is any pattern in the occurrence of these plicae, as well as the relationship to impingement lesions seen at bursoscopy. Between January 1996 and July 2001, all cases undergoing arthroscopic decompression were evaluated for anatomic-pathologic changes of the subacromial bursa, including the presence of plicae and impingement lesions. A total of 1732 cases complying with inclusion criteria were recorded, with plicae observed in 104 (6.0%). The occurrence of plicae showed a highly significant younger age predilection (P = .0008, chi(2) test) but no differences between sexes or sides. The occurrence of subacromial plicae was highly associated with the combined severity of the impingement lesion on the acromial and bursal side. Plicae were most common in shoulders showing an impingement lesion on the cuff bursal side, with no impingement lesion on the acromial side. The odds of the impingement lesion being milder on the acromial side was 3.41 times higher in shoulders with a plica compared with shoulders without a plica. This suggests that impingement of the cuff may be due to the plica itself. This study is the first to describe the presence of subacromial plicae in living subjects and correlates with previous anatomic studies. The younger age predominance correlates with the findings of plicae in the knee. Our findings suggest that subacromial plicae may be a cause of impingement in young patients.

Adolescent↗
PubMed2005

Shoulder dystocia: prevention and management.

Knowledge of the maneuvers used for the alleviation of shoulder dystocia is relevant not only for obstetric residents and attending house staff but also for family practitioners, nurses, and nurse midwives. The performance of shoulder dystocia "drills" can be helpful not only to coordinate a teamwork approach to this obstetric emergency but also to provide an opportunity to practice the maneuvers. Shoulder dystocia continues to represent an immense area of clinical interest because it typically occurs without prediction. All patients in labor should be considered at risk for the development of shoulder dystocia.

Delivery, Obstetric↗
PubMed2004

Sport-specific shoulder injuries.

This article reviews basic shoulder anatomy and biomechanics and discusses the impact these have on the etiology of shoulder injuries in sports. Four types of sport activities lead to shoulder injuries:muscle and tendon overuse, acute tears of the dynamic stabilizers,impingement and overuse injury. Most shoulder injuries initially are treated nonoperatively with rehabilitation. Rehabilitation protocols are successful in most patients. This article also discusses why postoperative rehabilitation is vital to the ultimate success of patients who require operative treatment.

Athletic Injuries↗
PubMed1999

Shoulder pain and dysfunction in hemiplegia: effects of functional electrical stimulation.

OBJECTIVE: To determine the influence of functional electrical stimulation (FES) on subluxation and shoulder pain in hemiplegic patients. DESIGN: Controlled study of 24 months' duration beginning in the first month after onset of stroke. SUBJECTS AND SETTING: One hundred twenty hemiplegic patients with both subluxed and painful shoulder were followed for rehabilitation before and after discharge between 1989 and 1993. All subjects received conventional rehabilitation based on the Bobath concept. In addition, patients were alternately assigned to a control group or to receive additional FES for 5 weeks on muscles surrounding their subluxed and painful shoulder. MAIN MEASURES: Clinical examinations, including range of motion, pain assessment, and x-rays, were performed at the start of the study, between the second and fourth weeks after onset of stroke, and subsequently at 6, 12, and 24 months. RESULTS: The FES group showed significantly more improvement than the control group in both pain relief (80.7% vs. 55.1%, p<.01) and reduction of subluxation (78.9% vs. 58.6%, p<.05). Furthermore, recovery of arm motion appeared to be significantly improved in the FES group (77.1% vs. 60.3% in the control group, p<.01). CONCLUSION: The FES program was significantly effective in reducing the severity of subluxation and pain and possibly may have facilitated recovery of the shoulder function in hemiplegic patients.

Adult↗
PubMed1999

Calibration of the "Flock of Birds" electromagnetic tracking device and its application in shoulder motion studies.

In this paper the applicability in terms of measurement accuracy of the "Flock of Birds" six D.O.F. electromagnetic tracking device in shoulder research is investigated. Position measurements in a workspace of approximately 1 m3 were performed using a stylus. The andom error at the stylus tip appeared to be 1.86, 1.98 and 2.54 mm for x-, y- and z-coordinate, respectively. The error caused by distortion of the magnetic field by metal in the concrete of especially the floor was 20.8, 22.2 and 20.4 mm for the x-, y- and z-coordinate, respectively. Calibration and leaving out the measurements closest to the floor lowered this error to 2.07, 2.38 and 2.35 mm. Orientation errors of the shoulder bones evolving from the measurement inaccuracy were estimated from repeated measurements of shoulder bony landmarks of ten subjects by means of the stylus. These errors were generally below 2 degrees. This is lower than found for the same measurements using a spatial linkage digitizer. It is concluded that the "Flock of Birds" is a useful tool for shoulder kinematic studies.

Algorithms↗
PubMed1977

The painful shoulder.

The shoulder, a very common site of pain syndromes in medical practice, lends itself well to precise clinical analysis and identification of the pain-sensitive structure or structures. Once identified, rational and effective management can be applied, associated with predictably good prognosis. Early identification of the emerging specific syndrome is important in decreasing the duration of the clinical disorder and in achieving optimum return of shoulder function. Laboratory and X-ray studies are not commonly required in diagnosis and management. There are a confusing variety of names attached to the many shoulder pain syndromes; however, there are two most common categories. One is associated with severe pain but little or no limitation of shoulder movement (at least passive movement), in which the pain-sensitive structure is tendon or tendon sheath; the other is associated with both pain and limitation of active and passive motion, in which the pain-sensitive structures are capsule, bursa, and synovium as well as muscle and multiple tendons.

Arm↗
PubMed2001

Dynamic contributions to superior shoulder stability.

It has been suggested that superior decentralization of the humeral head is a mechanical factor in the etiology of degenerative rotator cuff tears. This superior decentralization may be caused by muscular imbalance. The objective of this study was to investigate the contribution of individual shoulder muscles to superior stability of the glenohumeral joint. In 10 fresh frozen cadaver shoulders the tendons of the rotator cuff, teres major, latissimus, pectoralis major, deltoid and biceps were prepared. The shoulders were tested in a shoulder-loading device in 0 degrees, 30degrees, 60 degrees and 90 degrees of glenohumeral abduction. A constant superior force of 20 N was applied to the humerus. Tensile loads were applied sequentially to the tendons in proportion to their cross-sectional areas and translations of the humeral head relative to the glenoid were recorded with a 3Space Fastrak system. Depression of the humeral head was most effectively achieved by the latissimus (5.6 +/- 2.2 mm) and the teres major (5.1 +/- 2.0 mm). Further studies should elucidate their possible in vivo role in the frontal plane force couple to counter balance the deltoid. The infraspinatus (4.6 +/- 2.0 mm) and subscapularis (4.7 +/- 1.9 mm) showed similar effects while the supraspinatus (2.0 +/- 1.4 mm) was less effective in depression. Therefore, the infraspinatus and subscapularis should be surgically repaired whenever possible. The supraspinatus may be of less importance for superior stability than previously assumed.

Biomechanical Phenomena↗
PubMed2003

Vascular endothelial growth factor 121 and 165 in the subacromial bursa are involved in shoulder joint contracture in type II diabetics with rotator cuff disease.

Vascular endothelial growth factor (VEGF) is a glycoprotein that plays an important role in neovascularization and increases vascular permeability. We reported that VEGF is involved in motion pain of patients with rotator cuff disease by causing synovial proliferation in the subacromial bursa (SAB). The present study investigates whether VEGF is also involved in the development of shoulder contracture in diabetics with rotator cuff disease. We examined 67 patients with rotator cuff disease, including 36 with complete cuff tears, 20 with incomplete tears, and 11 without apparent tears (subacromial bursitis). The patients were into groups according to the presence or absence of diabetes (14 type II diabetics and 53 non-diabetics). Specimens of the synovium of the SAB were obtained from all patients during surgery. Expression of the VEGF gene in the synovium of the subacromial bursa was evaluated by using the reverse transcriptase polymerase chain reaction. The VEGF protein was localized by immunohistochemistry, and the number of vessels was evaluated based on CD34 immunoreactivity. The results showed that VEGF mRNA was expressed in significantly more diabetics (100%, 14/14) than in non-diabetics (70%, 37/53) (P=0.0159, Fisher's test). Investigation of VEGF isoform expression revealed VEGF121 in all 14 diabetics and in 37 of the 53 non-diabetics, VEGF165 in 12 of the 14 diabetics and in 21 of the 53 non-diabetics, and VEGF189 in 1 of the 14 diabetics and in 2 of the 53 non-diabetics. No VEGF206 was expressed in either group. VEGF protein was localized in both vascular endothelial cells and synovial lining cells. The mean number of VEGF-positive vessels and the vessel area were also significantly greater in the diabetics (p<0.015, Mann-Whitney U test). Synovial proliferation and shoulder joint contracture were more common in the diabetics (P=0.0329 and P=0.073, respectively; Fisher's test). The mean preoperative range of shoulder motion significantly differed in terms of elevation between two groups: 103.8 degrees in diabetics and 124.9 degrees in no diabetics (p=0.0039 Mann-Whitney U test). In contrast, external rotation did not significantly differ: 44 degrees in diabetics and 49 degrees in non-diabetics (p=0.4957, Mann-Whitney U test). These results suggest that VEGF121 and VEGF165 expression in the SAB is responsible for the development of shoulder joint contracture, especially in elevation, among type II diabetic patients with rotator cuff disease.

Acromioclavicular Joint↗
PubMed2002

Comparative study of intra-articular lidocaine and intravenous meperidine/diazepam for shoulder dislocations.

The purpose of this study was to compare the analgesic effectiveness of intra-articular lidocaine versus intravenous meperidine and diazepam during the reduction of anterior shoulder dislocations. Patients were randomized to one of the two methods before the reduction of shoulder dislocations. Patients marked a visual analog pain scale at baseline, after anesthesia just before reduction, and at the time of discharge. Interference with the procedure caused by pain or lack of muscle relaxation, perception of adequacy of analgesia by the patient, adverse effects, and time to discharge from the Emergency Department (ED) were measured. Differences of outcomes, relative risks (RR), and 95% confidence intervals (CIs) were derived. Fifty-four patients with anterior shoulder dislocations presenting from May 21, 1998 through January 21, 1999 were included in this study; 29 were randomly assigned to receive intra-articular lidocaine (IAL) and 25 to receive intravenous meperidine/diazepam (IVMD). IAL was less effective than IVMD in relieving pre-reduction pain (p = 0.045) but equally effective in overall pain relief (p = 0.98). IAL was more effective than IVMD in shortening recovery time (p = 0.025). There was an indication favoring IVMD in terms of physician-perceived muscle relaxation and patient's perception of analgesia adequacy. In conclusion, although the IVMD method appears to have some clinically and statistically significant advantages, IAL possesses some favorable features that render it to be an analgesia alternative in shoulder dislocation reduction.

Adult↗
PubMed1996

The BHAGL lesion: a new variant of anterior shoulder instability.

This article describes a new lesion associated with anterior instability of the shoulder. The bony humeral avulsion of the glenohumeral ligaments (BHAGL) is a rare lesion that may occur after anterior dislocation of the shoulder. There is a bone fragment noted on radiographs of the shoulder that may appear similar to a bony glenoid avulsion. Computed tomography typically will show that the bone is attached to the glenohumeral ligaments and does not originate from the glenoid. Arthroscopy may or may not show the lesion. This variant of anterior shoulder instability may present with impingement or instability symptoms. If symptoms fail to respond to conservative management, treatment through open excision of the bony fragment and reattachment of the glenohumeral ligaments to their origin on the anterior aspect of the humerus is indicated.

Adult↗
PubMed1997

Penetration of cryotherapy in treatment after shoulder arthroscopy.

Fifteen patients undergoing shoulder arthroscopy had indwelling temperature probes placed in the glenohumeral and subacromial spaces. All shoulders underwent diagnostic arthroscopy and debridement of the subacromial space. Cryotherapy was delivered to the shoulder via a Cryo/Cuff (AirCast, Summit, NJ) and temperatures were monitored for 90 minutes. Ten shoulders received cryotherapy and 5 were used as controls. Before cryotherapy, temperature averaged 34 degrees C in the glenohumeral joint and 31 degrees C in the subacromial space. No significant difference was seen between the temperatures recorded in the cold therapy and control groups for either the glenohumeral or subacromial space. In all cases, the subacromial space averaged 1 degree cooler than the glenohumeral joint at the conclusions of arthroscopy. These slowly equalized to an average of 35 degrees postoperatively. The present study shows that surface-applied cryotherapy does not penetrate either the glenohumeral joint or the subacromial space. Attention must be turned elsewhere to delineate how cryotherapy works.

Adult↗
PubMed1997

[Interscalenic block and surgery of the shoulder. A prospective study of a continuous series of 167 patients].

OBJECTIVES: To determine the relationship between minimal stimulating current and success rate of interscalene brachial plexus block (IBPB), to assess the quality of anaesthesia and postoperative analgesia, and to evaluate the benefits and drawbacks of this technique in shoulder surgery. STUDY DESIGN: Prospective study of a continuous series of clinical cases. PATIENTS: Series of 167 patients undergoing shoulder surgery under IBPB, obtained with Winnie's technique, in 1995. METHODS: The plexus was located with a nerve stimulator and an insulated needle, 25 mm long and with a short 30 degrees bevel (Stimuplex, Braun). Data were collected with questionnaires, filled in by the anaesthetists, the surgeon and patients. RESULTS: Shoulder surgery was performed either under IBPB alone in 51.5% of cases (group A), or under IBPB associated with sedation (midazolam: 1-3 mg) in 31.7% (group B), or under IBPB associated with general anaesthesia either on the patient's request (11.4% = group C) or due to IBPB failure (5.4% = group D). The success rate was 94.6% and the efficiency of postoperative analgesia obtained in 100% of cases (no pain at admission in the recovery room). For the nerve location a minimal stimulating current of 0.08 to 1 mA (mean minimal stimulating current 0.42 +/- 0.17 mA) had been required, with a significant difference (P = 0.0001) between group A (0.38 +/- 0.14 mA) and the others (0.43 +/- 0.15 mA in group B, 0.50 +/- 0.21 mA in group C, 0.59 +/- 0.23 mA in group D). CONCLUSIONS: The correlation between minimal stimulating current and success rate has clearly shown the benefit of the nerve stimulation. IBPB, which provides a successful and efficient anaesthesia with minimal risk and satisfactory postoperative analgesia, has become the standard technique for shoulder surgery.

Adolescent↗