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PubMed1994

[Chronic shoulder pain in the volleyball attack player].

30 competitive volleyball attackers of the German third league, 15 with shoulder pain (group I) and 15 without shoulder pain (group II) were examined clinically and sonographically. Anamnesis was also carried out. The results were compared with those of a control of 15 non-volleyball players not subject to stress caused by overhead use of their arms. On the visual analog scale the average pain was 5.1 (SD 1.4). The average history of pain was 2.7 (SD 2.7) years. Cause for the pain was "spiking without warming up" (n = 7) or "unknown" (n = 8). Spiking respectively serving caused new pain sensation in 14 (11) attackers. Players of group I stretched shorter than those of group II. Pain was located laterally to the greater tuberculum (n = 8), at the origin of the deltoid muscle (n = 3), at the bicipital groove (n = 2) or in the area of the ventral glenoid (n = 2). Pain was caused by active anteversion above 160 degrees (n = 3), active abduction above 140 degrees (n = 2) or both (n = 10). The playing shoulder was depressed in all 30 volleyball attackers. By measuring the distance from the epicondylus radii to the acromion of the other side by maximal forced horizontal adduction, the distance from the margo medialis scapula to the spine, the distance from the tip of middle finger to the lumbar spine by maximal internal rotation of the shoulder up the back showed significant differences between both sides and between the groups. The spiking arm scapula is significantly lateralised compared to the opposite side and compared to sportsmen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

[Instability and impingement of the shoulder of the high performance athlete in overhead stress].

The present prospective study was performed on 89 competitive sportsmen (league players of handball, basketball, volleyball and water polo). The evaluation was based on information obtained from a review of training methods, a standardised anamnestic, physical and sonographic examination directed at pain, function, flexibility and all signs of impingement and instability of the shoulder counted in a score. The incidence of shoulder pain, which handicapped during training and play within the last 6 months was for water polo 60%, handball 40%, volleyball 25% and basketball 3.5%. Analysing these problems we found severe problems predominantly in handball, fewer in water polo or volleyball. According to data obtained from sports with throwing activity we found a high incidence of shoulder disorders. Using basketball players as a control group with less throwing activity our results would suggest that this mechanism seems to be the most important. The high incidence of severe disorders in handball players is additionally caused by traumatic injuries. Ultrasonography shows predominantly incomplete tears of the deep surface of the supraspinatus tendon near to the insertion with exception of the basketball players. Only in 5 shoulders (2.8%) we found the coincidence of clear signs of instability and subacromial pathology. The term "instability impingement" has not proved to be very helpful and has turned out to be far too diffuse to establish a diagnosis.

Acromioclavicular Joint↗

PubMed1991

[CT diagnosis in instability of the shoulder joint].

CT is able to demonstrate the predisposing factors for recurrent and posttraumatic subluxation of the shoulder. In addition to demonstrating bony changes in the glenoid (Bankart lesion) and in the humeral head (Hill-Sachs lesion), CT can measure the degree of retroversion of the glenoid and torsion of the humerus. Measurements on 17 shoulders with habitual and 24 shoulders with recurrent posttraumatic subluxation showed low values for glenoid retroversion as compared with a control group. Particularly patients with habitual anterior subluxation frequently showed anteversion of the glenoid. Measurements of humeral torsion showed wide scatter amongst all groups, indicating wide biological variability. The results were compared with those published in the literature and the indications and limitations of CT for the investigation of shoulder instability are discussed.

Humans↗

PubMedDate not supplied

[Shoulder stiffness and metal allergy--a possible link? A single case report].

The authors report on the link between shoulder stiffness following surgery for a traumatically recurrent dislocation of the shoulder and an allergy to the metal bone clamp used. In addition to a review of the literature on the problems of metal allergies and their verification, the relationship between metal allergy and the stiffening of a shoulder due to an allergy and the stiffening of a shoulder due to an allergy to nickel, hitherto unknown to the present authors, is discussed.

Adult↗

PubMedDate not supplied

Comparison of an arthroscopic and an open procedure for posttraumatic instability of the shoulder: a prospective, randomized multicenter study.

From 1993 through 1996, a multicenter study was conducted on the surgical treatment of patients with posttraumatic recurrent anterior shoulder dislocations. Fifty-six patients (40 men, 16 women; mean age 26 years [range 18-51 years]), were evaluated with shoulder arthroscopy. If a Bankart lesion was present, the patients were randomly allocated to either an arthroscopic reconstruction with the use of biodegradable tacks or an open reconstruction with suture anchors. The postoperative rehabilitation protocol for the two groups was identical. In all patients, the range of shoulder motion, stability, and the Constant and Rowe scores were evaluated at 3, 12, and 24 months postoperatively. Thirty patients were surgically treated with the arthroscopic technique and 26 patients with the open technique. In the arthroscopic group, there were recurrences in 7 (23%) of 30 patients at a mean of 13 months (range 5 to 21 months) after surgery. All patients with stable shoulders had a negative apprehension test result. In the open group, there were recurrences in 3 (12%) of 26 patients at a mean of 10 months (range 2 to 23 months) after surgery (P = not significant). In the arthroscopic group, 2 patients had new traumatic redislocations, whereas 1 patient redislocated during an epileptic seizure. In the open group, 1 traumatic redislocation occurred. The 2-year results in this study demonstrate a large number of redislocations after reconstruction, even in the open surgery group. Patient noncompliance with the rehabilitation protocol and predisposing disease may partially explain these results. A tendency was seen toward more redislocations in the arthroscopic group, which emphasizes the importance of correct patient selection and careful surgical technique in the difficult surgical procedure.

Adolescent↗

PubMed2026

Effect of different liposomal bupivacaine concentrations in ultrasound-guided superior trunk block on postoperative analgesia and mobility: a randomized double-blind controlled trial protocol for shoulder arthroscopy.

BACKGROUND: Shoulder arthroscopy frequently causes severe postoperative pain that may impede recovery. Liposomal bupivacaine provides prolonged analgesia, and ultrasound-guided superior trunk block (STB) offers comparable analgesia to interscalene block with a lower risk of hemidiaphragmatic paralysis. However, the optimal concentration of liposomal bupivacaine for STB remains unknown. METHODS: This randomized, double-blind, controlled trial will enrol 282 adult patients scheduled for elective arthroscopic rotator cuff repair. Patients will be randomly allocated (1:1:1) to receive ultrasound-guided STB with liposomal bupivacaine 66 mg (Group A), 44 mg (Group B) or 33 mg (Group C), each diluted to 10 mL. The co-primary outcomes are (1) rest pain Numeric Rating Scale (NRS) score at 48 h post-surgery and (2) cumulative oral morphine milligram equivalents (MME) consumption within 0-48 h after surgery. Secondary outcomes include rest pain NRS scores at 6, 24 and 72 h; motor function assessed by Muscle Balance Scale, Bromage score and American Shoulder and Elbow Surgeons (ASES) score at 6, 24, 48 and 72 h; and Quality of Recovery-15 (QoR-15) score at 24 and 48 h. DISCUSSION: This study will provide evidence on the optimal concentration of liposomal bupivacaine for STB in arthroscopic shoulder surgery, aiming to achieve effective and prolonged analgesia without compromising shoulder mobility.

Humans↗

PubMed1999

The long-term course of shoulder complaints: a prospective study in general practice.

OBJECTIVE: Assessment of the long-term course of shoulder complaints in patients in general practice with special focus on changes in diagnostic category and fluctuations in the severity of the complaints. DESIGN: Prospective descriptive study. SETTING: Four general practices in The Netherlands. METHOD: All patients (101) with shoulder complaints seen in a 5 month period were included. Assessment took place 26 weeks and 12-18 months after inclusion in the study with a pain questionnaire and a physical examination. RESULTS: A total of 51% of the patients experienced (mostly recurrent) complaints after 26 weeks and 41% after 12-18 months. Diagnostic changes were found over the course of time, mostly from synovial disorders towards functional disorders of the structures of the shoulder girdle, but also the other way round. Although 52 of the 101 patients experienced complaints in week 26, 62% of those patients considered themselves 'cured'. After 12-18 months, 51% of the 39 patients experiencing complaints felt 'cured'. CONCLUSION: Many patients seen with shoulder complaints in general practice have recurrent complaints. The nature of these complaints varies considerably over the course of time, leading to changes in diagnostic category. Because of the fluctuating severity of the complaints over time, feeling 'cured' or not 'cured' is also subject to change over time.

Adult↗

PubMed2002

Glenoid shape in atraumatic posterior instability of the shoulder.

Glenoid shape is related closely to shoulder stability and its abnormality is thought to affect the humeral head position in shoulders with atraumatic instability. However, it is unclear how the glenoid shape in shoulders with atraumatic instability is different from the glenoid shape in normal shoulders. The current authors investigated glenoid shape of 45 healthy individuals (20 males and 25 females; average age, 22 years) and 20 patients with atraumatic posterior instability with multidirectional laxity (six males and 14 females; average age, 19 years) using three-dimensional magnetic resonance imaging. The tilting angles of the glenoid bone were measured in five consecutive planes perpendicular to the long axis of the glenoid and cross sections were divided into three types (concave, flat, convex). In healthy individuals, the average tilting angles from the bottom to the top of the glenoid bone were 3.0 degrees +/- 3.6 degrees, 1.0 degrees +/- 3.2 degrees, -1.0 degrees +/- 2.0 degrees, -2.3 degrees +/- 3.9 degrees, and -6.9 degrees +/- 3.7 degrees anteriorly, and tilting angles of patients were -6.1 degrees +/- 4.0 degrees, -4.0 degrees +/- 3.6 degrees, -4.8 degrees +/- 3.2 degrees, -5.5 degrees +/- 2.7 degrees, and -7.5 degrees +/- 3.1 degrees. The type of cross section also was different on the bottom plane where the concave shape accounted for 78% of healthy individuals whereas it accounted for 0% of patients. The loss of tilting angles and concavity of the inferior glenoid would correlate with the direction of the head translation in posterior instability.

Adolescent↗

PubMedDate not supplied

Range of motion of the shoulder performed while patient is anesthetized.

Significant loss of shoulder range of motion (ROM) in the early stages of burn recovery is a common and frustrating complication of burn injury. Pain is a primary reason for decreased motion: it prevents the patient from cooperating in an aggressive therapy program that could minimize contracture formation. To combat loss of movement without inflicting severe pain, the performance of ROM exercises and gentle passive stretching while patients were anesthetized was used as a treatment. A total of 59 treatments were performed on 14 patients who had limited unilateral or bilateral shoulder motion. A significant gain in shoulder ROM was attained when this treatment was performed and resulted in an increase in shoulder ROM when the patient was alert after anesthesia compared with preanesthesia measurements.

Adult↗

PubMed1998

A new strategy of muscle transposition for treatment of shoulder deformity caused by obstetric brachial plexus palsy.

Cross-innervation (caused by misdirection of regenerated axons), muscular imbalance (caused by muscle paresis or earlier recovery), and growth are the three main causes of shoulder deformity due to obstetric brachial plexus palsy. If perioperative studies demonstrate the existence of muscle recovery by cross-innervation, a new strategy of muscle transposition to minimize the influence of cross-innervation is used. Release of antagonistic muscles (pectoralis major and teres major muscles) and augmentation of paretic muscles (transferring teres major to the infraspinatus muscle, reinserting both ends of the clavicular part of the pectoralis major muscle laterally) are performed for reconstruction. Since 1993, 29 patients having shoulder deformity caused by obstetric brachial plexus palsy underwent reconstruction utilizing this strategy of muscle transposition. The timing for the reconstruction was at an average of 8.5 years (range, 4 to 21 years). The average shoulder abduction following the muscle transposition was 151 degrees (i.e., average gain 104 percent, or 77 degrees) and that of external rotation was 72 degrees (average gain 200 percent, or 48 degrees). Compared with the patients who had no surgery for shoulder deformity caused by obstetric brachial plexus palsy and early nerve surgery for the infant obstetric brachial plexus palsy, the results of the strategy seem to be significantly impressive.

Adolescent↗

PubMed2005

A review of the biomechanical and functional changes in the shoulder following transfer of the latissimus dorsi muscles.

The latissimus dorsi muscle is among the most commonly used muscle flaps because it has broad versatility and is generally believed to result in minimal donor-site morbidity. However, the normal physiology of the shoulder girdle depends on the function of this muscle. Therefore, we have undertaken this review of the literature to examine the issue of biomechanical and functional changes of the shoulder that occur with transfer of the latissimus dorsi muscle and to determine whether these changes result in deficits in normal function. A review of the literature pertaining to all aspects of the latissimus muscle and shoulder function following muscle transfer was conducted. The latissimus muscle functions in extension, adduction, and internal and external rotation. After the transfer of the muscle there are deficits in extension and adduction. These deficits result in a faster rate of fatigue during activities in which the arms are extended over the head, such as ladder climbing and swimming. In addition, there is no decrease in range of shoulder motion.

Biomechanical Phenomena↗

PubMed2026

Effects of single-injection vs. continuous brachial plexus blocks for shoulder surgeries on patient-reported outcomes: a systematic review and meta-analysis with trial sequential analysis of randomised controlled trials.

INTRODUCTION: Single-injection and continuous brachial plexus block techniques are used widely for postoperative analgesia in patients undergoing shoulder surgery. Although patient-reported outcomes are described in individual studies, their effects have not been synthesised comprehensively using a patient-centred framework. We sought to compare the effects of single-injection vs. continuous brachial plexus block techniques on patient-reported outcomes in adult patients following elective shoulder surgery. METHODS: Databases were searched from inception to October 2025 and randomised controlled trials reporting patient-reported outcomes were included. Co-primary outcomes were postoperative patient-reported pain intensity at rest and during movement at 12 h, 24 h and 48 h post-surgery. Secondary outcomes included nausea and vomiting; sleep quality; patient satisfaction; opioid requests; and functional scores. Random-effects meta-analysis and trial sequential analysis were performed, with risk of bias and quality of patient-reported outcome reporting assessed. RESULTS: Twenty randomised controlled trials that included 1198 patients were analysed. Continuous brachial plexus blocks were associated with lower pain at rest at 12 h, 24 h and 48 h, with mean differences (MD) of -1.96 (95%CI -2.81 to -1.11, p < 0.001), -1.66 (95%CI -2.27 to -1.05, p < 0.001) and - 1.18 (95%CI -1.84 to -0.53, p < 0.001), respectively. Pain on movement could only be pooled at 24 h and 48 h and showed MD -2.04 (95%CI -4.26-0.19, p = 0.07) and - 1.30 (95%CI -3.67-1.07, p = 0.28) respectively. The co-primary outcomes approached or exceeded the predefined minimal clinically important difference for pain scores after shoulder surgery, in favour of continuous techniques. DISCUSSION: Continuous brachial plexus blocks are associated with better pain at rest and other patient-centred outcomes following shoulder surgery, while effects on dynamic pain and long-term functional recovery remain uncertain.

Humans↗

PubMed1995

Arthroscopy of the shoulder.

Arthroscopy of the shoulder has developed during the last decade to play a major role in diagnoses and treatment of a variety of shoulder disorders. In most incidences, arthroscopy is required at the time of shoulder surgery to refine the final diagnosis. In over 75% of the cases are arthroscopic methods used for surgical repair of the shoulder pathology. This article describes the indications for surgery as well as the techniques to treat rotator cuff disease label injuries, etc. with the arthroscope. The arthroscopic techniques dealing with subacromial decompression and instability is described.

Arthroscopy↗

PubMedDate not supplied

Techniques for reduction of anteroinferior shoulder dislocation.

Dislocation of the shoulder joint is common. The shoulder is affected in up to 60% of all major joint dislocations, one study citing an incidence of 1.7% in the general population. The most common form is anteroinferior dislocation. A variety of techniques to reduce shoulder dislocation has been described. The key to successful relocation is a thorough understanding of the anatomy of both the enlocated and the dislocated shoulder joint.

Adult↗

PubMed2006

Shoulder injuries in tennis players.

The mechanism of the overhead action in throwing sports has been studied extensively. This motion is unnatural and highly dynamic, often exceeding the physiological limits of the joint. Owing to overload of various anatomical structures, the shoulder is susceptible to injury. Optimal shoulder function requires good kinetic chain function, optimal stability, and coordination of the scapula in the overhead action. A well balanced action of the rotator cuff muscles and capsular structures is necessary to obtain a stable centre of rotation during the overhead action. This review concerns shoulder injuries, related to the overhead motion in tennis players, which can be explained by the same mechanism as thrower's shoulder.

Biomechanical Phenomena↗

PubMed2000

Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder.

PURPOSE: To determine the accuracy of magnetic resonance (MR) arthrography in the diagnosis of superior labrum anterior-posterior (SLAP) lesions of the shoulder. MATERIALS AND METHODS: From January 1995 to June 1998, MR arthrography of the shoulder was performed in 159 patients with a history of chronic shoulder pain or instability. Fifty-two patients underwent arthroscopy or open surgery 12 days to 5 months after MR arthrography. Diagnostic criteria for SLAP lesion included marked fraying of the articular aspect of the labrum, biceps anchor avulsion, inferiorly displaced bucket handle fragment, and extension of the tear into the biceps tendon fibers. Surgical findings were correlated with those from MR arthrography. RESULTS: SLAP injuries were diagnosed at surgery in 19 of the 52 patients (37%). Six of the 19 lesions (32%) were classified as type I, nine (47%) as type II, one (5%) as type III, and three (16%) as type IV. MR arthrography had a sensitivity of 89% (17 of 19 patients), a specificity of 91% (30 of 33 patients), and an accuracy of 90% (47 of 52 patients). The MR arthrographic classification showed correlation with the arthroscopic or surgical classification in 13 of 17 patients (76%) in whom SLAP lesions were diagnosed at MR arthrography. CONCLUSION: MR arthrography is a useful and accurate technique in the diagnosis of SLAP lesions of the shoulder. MR arthrography provides pertinent preoperative information with regard to the exact location of tears and grade of involvement of the biceps tendon.

Adult↗

PubMed2001

Role of us in the preoperative evaluation of patients with anterior shoulder instability.

PURPOSE: To assess the value of ultrasonography (US) in the preoperative evaluation of patients with anterior shoulder instability. MATERIALS AND METHODS: Twenty-two patients with one-sided anterior shoulder instability were examined with US by using three dynamic scanning approaches: two frontal and one axillary. The anterior labrum, the anterior ligamental-capsular complex, and the presence of humeral head and glenoid rim fractures were evaluated. Arthroscopy or arthrotomy was subsequently performed in all patients and was considered the standard. RESULTS: US correctly depicted the presence (n = 20) or absence (n = 1) of humeral head fractures and the presence (n = 10) or absence (n = 9) of glenoid rim fractures. All 22 patients had anterior labral tears; 21 tears were correctly depicted with US. The labral tear was seen as a hypoechoic zone larger than 2 mm (n = 15), labral movement (n = 10), a degenerated labrum (n = 6), or a vacuum phenomenon (n = 3). The anterior ligamental-capsular complex was correctly evaluated in 14 patients. The use of multiple approaches helped to prevent misinterpretation, but there were no substantial differences among the approaches in the depiction of the anterior shoulder structures. CONCLUSION: The high accuracy in the depiction of labral tears and associated fractures indicates that US can provide useful preoperative information in patients with anterior shoulder instability.

Adult↗

PubMed1999

Prevention of shoulder subluxation after stroke with electrical stimulation.

BACKGROUND AND PURPOSE: Subluxation is a significant problem in poststroke hemiplegia, resulting in pain and loss of function. Current treatments are not proved and not considered effective. It has been demonstrated that cyclical electrical stimulation of the shoulder muscles can reduce existing subluxation. The purpose of this study was to determine whether electrical stimulation could prevent subluxation in both the short and long terms. METHODS: A prospective, randomized controlled study was used to determine the efficacy of electrical stimulation in preventing shoulder subluxation in patients after cerebrovascular accidents. Forty patients were selected and randomly assigned to a control or treatment group. They had their first assessment within 48 hours of their stroke, and those in the treatment group were immediately put on a regimen of electrical stimulation for 4 weeks. All patients were assessed at 4 weeks after stroke and then again at 12 weeks after stroke. Assessments were made of shoulder subluxation, pain, and motor control. RESULTS: The treatment group had significantly less subluxation and pain after the treatment period, but at the end of the follow-up period there were no significant differences between the 2 groups. CONCLUSIONS: Electrical stimulation can prevent shoulder subluxation, but this effect was not maintained after the withdrawal of treatment.

Aged↗