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PubMed1988

Investigations into shoulder function after radical neck dissection.

In order to determine shoulder function after radical neck dissection, and to evaluate the outcome of postoperative physical treatment, 43 patients were investigated 10 days up to 1 month after this procedure. Shoulder function was judged by means of (a) clinical investigation of the shoulder girdle and by (b) electromyographic testing of the trapezius muscle. Our results demonstrated a correlation between the extent of atrophy and clinical parameters such as abduction and lateral displacement of the scapula. Electromyography revealed damage present mainly in the descending part of the trapezius, while in the majority of patients the ascending part was only slightly damaged or normal. Electromyography proved a valuable tool for the determination of the clinical state after neck dissection. There was also evidence supporting the efficacy of physical therapy in case of irreversible shoulder disability.

Adult↗
PubMedDate not supplied

Anatomy of provocative tests for impingement syndrome of the shoulder.

The purpose of this study was to describe the extra- and intra-articular anatomic relationships present during the Neer and Hawkins tests. Nine fresh-frozen cadaveric shoulders were positioned in the impingement position described by Neer (n = 5) or that described by Hawkins (n = 4), embedded in polyurethane, and studied with the use of a cross-sectional technique. All shoulders placed in the Neer position demonstrated soft tissue contact with the medial acromion and contact between the articular surface of the rotator cuff tendons and the anterosuperior glenoid rim. Shoulders placed in the Hawkins position demonstrated consistent contact between soft tissues and the coracoacromial ligament. In all Hawkins positioned shoulders, contact between the articular surface of the rotator cuff tendons and the anterosuperior glenoid was observed. The subscapularis tendon was deformed by the coracoid in 1 of the Hawkins positioned specimens. Although factors inherent to human subjects such as edema and muscle tone may influence the anatomy, these provocative tests for subacromial impingement appear to elicit contact consistent with impingement.

Cadaver↗
PubMedDate not supplied

Chronic shoulder dislocations.

Thirty-two patients with chronic dislocation of the shoulder were diagnosed over a 5-year period at King Edward VIII Hospital, Durban, South Africa. Thirty-one patients had an anterior subcoracoid dislocation. One patient had a chronic posterior dislocation. The duration of dislocation ranged from 6 days to 2 years. Six patients were epileptic, and it was an affliction of all ages. None of the patients had a vascular deficit, but 4 had neurologic damage on presentation. Closed manipulation was only successful in 1 patient. Ten patients' shoulders were left unreduced in the dislocated position. Twenty-one patients, including the patient with a single posterior dislocation, underwent open reduction. The author treated 10 patients with chronic anterior dislocations surgically. The coracoid was transferred to the glenoid, and acromiohumeral K-wire fixation was used for 4 weeks in this group. These 10 cases, as well as 5 cases left unreduced, were followed up for more than 2 years. The results were evaluated by the system proposed by Rowe and Zarins and showed that surgically treated patients fared better than those whose shoulders were left unreduced regardless of the duration of the dislocation or the age of the patient. This series differs from previous reports in several respects. All but one of the dislocations were anterior, the incidence of epilepsy was lower, and successful reduction by manipulation was rarely achieved. In all 10 cases in which the author performed the operation, the shoulder was successfully relocated without neurovascular complications. Dissection of the axillary vessels and nerves was never necessary.

Adolescent↗
PubMedDate not supplied

Late prosthetic shoulder arthroplasty for displaced proximal humerus fractures.

Twenty-three shoulders in 23 patients with failed treatment of three- and four-part proximal humerus fractures subsequently treated with prosthetic arthroplasty were reviewed. The initial treatment was closed in 10 cases and open in 13. The complications of treatment included malunions in 17, nonunions in four, traumatic arthritis in 14, avascular necrosis in nine, humeral shortening in six, and deltoid paresis in four. In 20 cases prosthetic arthroplasty was performed an average of 15.8 months after injury. Three other cases had arthroplasty 19, 20, and 22 years after the original fracture. Seventeen were treated with a total shoulder arthroplasty, and six had a humeral head replacement. Thirteen had a tuberosity osteotomy, and eight had lengthening of the subscapularis tendon. Prosthetic arthroplasty reduced the shoulder pain in 22 (95%). Average active forward elevation increased from 68 degrees to 92 degrees, and active external rotation increased from 6 degrees to 27 degrees. After arthroplasty 53% of the patients were able to do activities at or above shoulder level compared with 15% before arthroplasty. Late surgery for failed early treatment is technically difficult, and the results are inferior to those reported for acute humeral head replacement. These findings should be considered when treatment is selected for acute three- and four-part proximal humerus fractures. Nonetheless late arthroplasty is a satisfactory reconstructive option when primary treatment of proximal humerus fractures fails.

Adolescent↗
PubMedDate not supplied

Magnetic resonance imaging evaluation of capsulolabral tears after traumatic primary anterior shoulder dislocation. A prospective comparison with arthroscopy of 25 cases.

The purpose of our study was to evaluate the use of static magnetic resonance imaging (MRI) as a preoperative diagnostic tool in young patients with a traumatic primary anterior shoulder dislocation. Twenty-five patients who had acute primary traumatic anterior shoulder dislocation were examined with MRI and arthroscopy. The patients (18 male and 7 female) were between 16 and 39 years old (mean age, 27 years). They had no previous shoulder dislocations. The dislocations were confirmed radiographically. Examination with MRI and arthroscopy was performed within 10 days after the trauma. The MRI evaluation was performed before the arthroscopic examination, and the images were interpreted by an experienced magnetic resonance radiologist. No information from the MRI examination was available to the orthopedic surgeons before arthroscopy. The standard of reference for comparison was arthroscopy. Subacute MRI evaluation identified 15 labral tears, 12 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff lesion, and 1 partial rupture of the biceps tendon. Arthroscopic examination revealed 22 labral tears, 15 Hill-Sachs lesions, 1 total rotator cuff lesion, 1 partial joint side rotator cuff tear, 1 partial rupture of the biceps tendon, and 1 osseous Bankart lesion. Anterior capsulolabral tears and Hill-Sachs lesions appeared with a high incidence after acute anterior primary shoulder dislocation. Conventional MRI was only moderately reliable in the preoperative evaluation of labral tears and Hill-Sachs lesions, and it failed to give an accurate, differentiated preoperative diagnosis of the capsulolabral lesions.

Adolescent↗
PubMedDate not supplied

Abnormal synovium in the frozen shoulder: a preliminary report with dynamic magnetic resonance imaging.

We studied 16 patients (18 shoulders) with frozen shoulders, 8 patients with subacromial impingement syndrome, and 3 healthy volunteers with dynamic magnetic resonance imaging enhanced with gadolinium diethylenetriaminepentaacetic acid. After intravenous contrast was administered, gradient-recalled echo images were obtained in the oblique coronal plane every 11 to 13 seconds for a total period of 4 to 5 minutes. The signal intensity was measured at the periphery of the glenohumeral joint and in the subacromial bursa. The coefficient of enhancement (percent signal increase per second) in the frozen shoulders was 1.33 +/- 0.43 (mean +/- SD) for the glenohumeral joint and 0.89 +/- 0.47 for the subacromial bursa. These values were far greater than those in subacromial impingement syndrome or in the control group, indicating increased blood flow to the synovium in the frozen shoulders. No previous reports have shown a clinical measure related to the pathophysiology of this disease.

Adult↗
PubMedDate not supplied

Self-assessment of general health status in patients with five common shoulder conditions.

The SF-36 Health Survey is a patient self-administered general health status evaluation designed to measure the impact of disease on an individual's perception of his or her health. Five hundred forty-four patients with five common shoulder conditions (anterior glenohumeral instability (149 patients), complete reparable rotator cuff tear (111 patients), adhesive capsulitis (100 patients), glenohumeral osteoarthritis (67 patients), and impingement (117 patients)) completed the SF-36 Health Survey before undergoing treatment. When compared with U.S. general population norms, the patients with each of these shoulder conditions had statistically significant decreases in their health for Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, Role-Emotional, and the Physical Component Summary as measured by the SF-36 Health Survey. Comparison with published data demonstrated that these shoulder conditions rank in severity (in terms of affecting a patient's perception of his or her general health) with five major medical conditions (hypertension, congestive heart failure, acute myocardial infarction, diabetes mellitus, and clinical depression). The data presented in this study should serve as a baseline to document the impact of shoulder musculoskeletal conditions and possibly to allow comparison among various methods of operative and nonoperative treatment.

Adolescent↗
PubMedDate not supplied

Electromyographic study during isometric exercise of the shoulder in head-out water immersion.

Water exercises are used for early rehabilitation programs after shoulder injury such as rotator cuff tear, yet no literature discusses the muscle activity of such rehabilitation programs in water. The purpose of this study was to analyze the electromyographic activity from 8 volunteers during isometric exercises in water and on land. Nine isometric exercises were studied: with 30 degrees, 60 degrees, and 90 degrees shoulder flexion and abduction, and 3 positions of shoulder rotation at 0 degrees abduction (both maximal internal and external rotation and mid-position). Nine parts of 6 muscles were studied: the supraspinatus, infraspinatus, subscapularis, 2 parts of the pectoralis major (clavicular and costal), 3 parts of the deltoid (anterior, middle, and posterior), and the latissimus dorsi. The electromyographic signals were low-pass filtered, full-wave rectified, and integrated for 5 seconds. The electromyographic activity was quantified as a percentage of the maximal manual muscle test. The results showed that supraspinatus activity at 90 degrees abduction significantly decreased from 22.3+/-15.8 on land to 3.9+/-3.3% manual muscle test in water (P < .01). Other muscle activities in water also decreased remarkably compared with those on land. These results provide valuable information for the safety of water exercise for early rehabilitation programs after shoulder injury such as rotator cuff tear.

Adult↗
PubMedDate not supplied

Surgical anatomy of the posterior shoulder: effects of arm position and anterior-inferior capsular shift.

The purposes of this study were to evaluate anatomically various surgical intervals to the posterior shoulder and to determine the effects of varying arm positions and anterior-inferior capsular shift (AICS) on the relation of the posterior neurovascular structures to fixed bony landmarks. Fourteen cadaveric shoulders were dissected. The posterior surgical anatomy was defined, and the distances from fixed bony landmarks to neurovascular and musculotendinous structures were determined with digital calipers. Measurements were made with the arm in various positions and repeated after AICS. The most direct anatomic approach to the posterior shoulder was through a deltoid split in the raphe from the posterolateral corner of the acromion (PLCA), followed by an infraspinatus (IS) splitting incision. The IS/teres minor interval was at the inferior aspect of the glenoid rim and was difficult to locate in all specimens. The distance to the axillary nerve from the PLCA averaged 65 mm and decreased by an average of 14 mm (22%) with abduction and by 19 mm (29%) with extension. The posterior humeral circumflex artery was located along the humeral neck and was vulnerable to injury during lateral capsular dissection. The suprascapular nerve had multiple branches to the IS with most penetrating the muscle at its inferior portion. The closest branch to the glenoid rim was an average of 20 mm medial from it. No branch entered at the level of the IS raphe. The anatomic relations of the suprascapular nerve were unchanged after AICS. On the basis of this study, surgical exposure of the posterior shoulder with a deltoid split from the PLCA, followed by an IS split, appears to be anatomically safe. The arm position should be in neutral rotation, especially if previous anterior capsular procedures have been performed, which can alter the posterior neurovascular anatomic relations.

Adult↗
PubMed2004

Shoulder function after thoracic surgery.

Thoracic procedures are considered to be among the most painful surgical incisions and are associated with considerable postoperative pain and shoulder dysfunction, severely affecting mobility and activities of daily living. Improper patient positioning, muscle division, perioperative nerve injury, rib spreading, and consequent postoperative pain influence the patient's postoperative shoulder function and quality of life. To reduce access trauma and postoperative morbidity, various alternative modalities have been proposed to replace the standard PLT, including muscle-sparing techniques and VATS. Initial evaluations suggest that these alternatives are associated with significantly better postoperative shoulder function. Proper comparative studies using standardized questionnaires, objective evaluations, or quality-of-life assessments are scarce, however. Proper postoperative care, including early mobilization and effective physiotherapy, is a cornerstone in successful patient rehabilitation and rapid return to normal daily activities. Whether upper extremity exercises can contribute to improvement in postoperative shoulder function and the ability to perform activities of daily living needs to be studied further.

Humans↗
PubMed2002

Is shoulder impingement syndrome a problem in otolaryngologists?

Shoulder problems are well-documented as an occupational illness. The incidence of occupational shoulder problems is increasing. A postal questionnaire survey was conducted to see if otolaryngologists are more susceptible to shoulder impingement syndrome because of their occupation. Endocrinologists were used as the control group. Among 556 questionnaires sent to otolaryngologists, 367 (64.6%) responses were returned compared with 210 questionnaires sent to endocrinologists, of which 138 (65.7%) responses were returned. A total of 88 (24.0%) of the otolaryngologists had suffered from impingement syndrome compared with 15 (10.9%) of the endocrinologists, which was significantly different. Of those with impingement syndrome, more endocrinologists gave a history of injury or overuse compared with otolaryngologists. There must be another factor, leading to increased incidence of impingement syndrome, which may be because of the continuous flexion, and abduction of their shoulders during examination and operating on patients.

Cumulative Trauma Disorders↗
PubMed1999

The use of combined suprascapular and circumflex (articular branches) nerve blocks in the management of chronic arthritis of the shoulder joint.

Sixteen patients suffering from rheumatoid or osteoarthritis of the shoulder joint were studied. All patients complained of pain and limitation of active movement of the shoulder joint. Combined neural blockade of the suprascapular nerve (SSNB) and articular branches of the circumflex nerve (ACNB) was carried out using 4 mL of 1% prilocaine and 4 mL of 6% aqueous phenol. Following this procedure, the mean value for pain intensity decreased by 69% (VASP 2.7) and for abduction, adduction and flexion increased by 36-67% over a mean time of 13 weeks. Functional external and internal rotation of the shoulder joint also increased after neural blockade. These findings were significant (P < 0.05). Further clinical evaluation of combined SSNB and ACNB in relation to previously reported methods of neural blockade of the shoulder joint is warranted using a randomized, controlled, comparative study. Conventional power calculations (80% power, 5% test) indicate that 17 patients per group would be necessary to detect one standard deviation (about 2 VASP) or 64 per group to detect a change of 0.5 standard deviations.

Aged↗
PubMed2002

Industrial medicine and acute musculoskeletal rehabilitation. 2. Acute cervical spine and shoulder injuries in the industrial setting.

UNLABELLED: This self-directed learning module highlights the underlying anatomy and biomechanics of the cervical spine and shoulder as a basis for developing a differential diagnosis of contributing pathology in an industrial injury. This includes components of the history, examination, and appropriate diagnostic testing that are necessary to develop an optimal rehabilitation plan. Treatment options are reviewed and include medications, therapy, selective injections, and return-to-work programs in the industrial setting. OVERALL ARTICLE OBJECTIVES: (a) To be able to identify neck and shoulder pathology, (b) to effectively evaluate cervical spine and shoulder injuries, and (c) to rehabilitate acute cervical spine and shoulder injuries in the industrial setting.

Acute Disease↗
PubMedDate not supplied

Subacromial and intra-articular morphine versus bupivacaine after shoulder arthroscopy.

PURPOSE: Multiple studies have compared the effects of intra-articular bupivacaine and morphine for postoperative pain control after arthroscopy of the knee. To date, these agents have not been compared in the shoulder. The purpose of this study was to compare intra-articular (IA)/subacromial (SA) morphine, bupivacaine, and placebo after shoulder arthroscopy. TYPE OF STUDY: Prospective, double-blind, randomized clinical trial. METHODS: The effectiveness of each drug was measured by comparing the amount of supplemental analgesics required as well as the evaluation of each patient's level of pain after surgery. A visual analog scale was used to record each patient's level of pain before surgery and at various time intervals after surgery. The amount of supplemental analgesic was likewise recorded for 24 hours after surgery. Sixty-four patients were randomized into 3 groups and injected with morphine (n = 22), bupivacaine (n = 22), or saline (n = 20) at the conclusion of shoulder arthroscopy. The injection was directed intra-articular as well as subacromial if surgical dissection had been performed in this area. Statistical significance was determined at P <.05. RESULTS: There were no differences between groups before surgery. A statistically significant difference in pain level at 30 and 60 minutes was found. At 30 and 60 minutes, patients who were administered IA/SA bupivacaine reported average pain levels less than those administered morphine or saline. Morphine was not statistically different from saline at reducing postarthroscopy pain at any time interval. Despite differences in pain level, there were no significant differences in the amount of supplemental analgesics requested at any time interval among these 3 groups. CONCLUSIONS: IA/SA morphine does not contribute to postoperative pain control after shoulder arthroscopy, whereas IA/SA bupivacaine improves pain control during the first 60 minutes after surgery.

Adult↗
PubMedDate not supplied

The microscopic pathoanatomy of acute anterior shoulder dislocations in a simian model.

PURPOSE: The purpose of this study was to determine the extent of capsular injury that occurs at a microscopic level in association with acute anterior shoulder dislocations. TYPE OF STUDY: The study was an anatomic, cadaveric study using a simian model. The microscopic slide review was blinded regarding the presence or absence of dislocation. METHODS: Three cadaveric monkey shoulder specimens were dissected free of muscle tissue but left undislocated as controls. Eleven cadaveric monkey shoulder specimens were dislocated with an abduction and external rotation force and subsequently evaluated grossly and histologically for the presence and direction of gross and microscopic injury. RESULTS: All dislocated specimens had an associated Bankart lesion. In addition, all dislocated specimens had histologic evidence of capsular microtearing. The tears were in no specific location or direction and were at times located perpendicular to, obliquely to, or between the longitudinal orientation of the fibers. CONCLUSIONS: Based on this model, a Bankart lesion is a common and usual occurrence with acute anterior shoulder dislocations. In these specimens, the Bankart lesion was never an isolated pathology. Microscopic capsular injury was always associated. Additionally, the direction of the capsular injury is highly variable.

Animals↗
PubMed2000

Posterior dislocation fractures of the shoulder in seizure disorders--two case reports and a review of literature.

We present two patients with complaints of shoulder pain after an epileptic seizure. Both patients had a posterior dislocation fracture of the shoulder. After reviewing the literature the following conclusions can be drawn: (1) A posterior shoulder dislocation fracture is rare. (2) One should not underestimate the muscular forces in seizure disorders and be alert for dislocation fractures of the shoulder and/or other joints. (3) The diagnosis is frequently missed, but an axillary radiograph or a CT scan always reveals the fracture.

Adult↗
PubMed1999

Metabolic and cardiocirculatory reactions after concentric and eccentric exercise of the shoulder.

Lower metabolic and cardiocirculatory reactions to eccentric compared to concentric exercise are known for large muscle groups. The extent of exercise reaction depends on the muscle mass involved and moreover differs between the various muscle groups, while it is unclear to which extent cardiovascular and metabolic reactions and differences between the types of work exist in the shoulder, also it is not known whether these reactions differ according to training status. Lactate production (LA), heart rate (HR), and blood pressure (BP) were examined following eccentric and concentric shoulder movements in 16 male gymnasts (GN) and 15 male untrained subjects (US). Differentiation was made according to the types of work for peak torque (PT) and local muscle endurance (LME). Following eccentric exercise, the increase of LA and HR was clearly lower than following concentric exercise (p<0.05). No difference was observed between the groups. Diastolic BP showed no changes, whereas systolic BP was higher following concentric exercise. Eccentric PT was higher than concentric PT in GN within a test-retest variability of 15%. LME showed a lower degree of fatigue under eccentric conditions, independent of the group. It is concluded that eccentric exercise of the shoulder leads to lower metabolic and cardiocirculatory reactions than concentric exercise, in spite of higher peak torque and less fatigue. Exercises consisting of a high proportion of eccentric movement may thus be beneficial in the therapy of shoulder complaints, especially in patients with cardiovascular disease.

Adult↗
PubMedDate not supplied

[Shoulder arthroplasty - Clinical results in 171 patients].

AIM: Review and critical evaluation of 181 shoulder arthroplasties performed on 171 patients between December 1992 and January 1997. METHOD: We performed 118 hemiarthroplasties and 63 total shoulder replacements in 171 patients with an average age of 56.5 years. The patients were examined clinically and radiologically before surgery and followed-up for an average of two years. The Constant score was used for postoperative functional assessment. RESULTS: 46 % of the patients were very satisfied and 31 % were satisfied with the outcome. We found a significant pain reduction and an improvement of active joint function. The average Constant score was 34.9 preoperatively and 65.2 postoperatively. Overall, we found the best results after joint replacement in patients treated for avascular necrosis or fracture sequelae of the humeral head. A revision surgery had to be performed in 16 patients (8.8 %). CONCLUSION: The results of this study are encouraging and underline the growing importance of shoulder arthroplasty. The preoperative limited range of motion, previous surgeries, and the status of the rotator cuff are preoperative indicators for a favourable postoperative outcome. Preoperative planning, anatomical reconstruction, and an optimal rehabilitation programme are the keys for successful shoulder arthroplasty.

Adult↗