[The mini-open Latarjet procedure for treatment of recurrent anterior instability of the shoulder].

Science.gov (United States)

Pogorzelski, J; Beitzel, K; Imhoff, A B; Braun, S

2016-12-01

Shoulder stabilization. Symptomatic recurrent anterior shoulder instability combined with glenoid bone loss of approximately 20-35 % of the glenoid surface, engaging Hill-Sachs lesion and/or previously failed arthroscopic Bankart repair. In patients with a high risk of redislocation (contact sports) or irreparable soft tissue injury the Latarjet procedure can be considered as a first-line treatment. Contraindicated if arthroscopic Bankart repair is possible. Irreparable damage of subscapularis tendon. Bony defect >35 % of the glenoid that cannot be filled with coracoid bone block. Arbitrary shoulder dislocation. Young patients with open growth plates (relative contraindication). Mini-open deltopectoral approach of approximately 6 cm. Preparation of the coracoid process and the conjoined tendons. Osteotomy of the coracoid process at its base using a 90° sawblade. Split of the subscapularis tendon. Preparation of the glenoid defect and implantation of 2-3 suture anchors where appropriate. Drilling of two parallel holes through the coracoid process. Fixation of the bone block with cannulated screws at the anterior glenoid rim and refixation of the joint capsula, if necessary with the help of the suture anchors. Wound drainage and closure in layers. Intermittent immobilization in a sling for 6 weeks with limited abduction, flexion and external rotation. Sport-specific training after 3 months, over-head sports after 6 months. Since 2009 64 mini-open Latarjet procedures (61 patients) performed. In all, 9.4 % of patients suffered from persistent instability (dislocations and subluxations); only 1 patient needed revision surgery due to instability.

Recovery of shoulder strength and proprioception after open surgery for recurrent anterior instability: a comparison of two surgical techniques.

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Rokito, Andrew S; Birdzell, Maureen Gallagher; Cuomo, Frances; Di Paola, Matthew J; Zuckerman, Joseph D

2010-06-01

Previous studies have documented a decrease in proprioceptive capacity in the unstable shoulder. The degree to which surgical approach affects recovery of strength and proprioception is unknown. The recovery of strength and proprioception after open surgery for recurrent anterior glenohumeral instability was compared for 2 surgical procedures. A prospective analysis of 55 consecutive patients with posttraumatic unilateral recurrent anterior glenohumeral instability was performed. Thirty patients (group 1) underwent an open inferior capsular shift with detachment of the subscapularis, and 25 (group 2) underwent an anterior capsulolabral reconstruction. Mean preoperative proprioception and strength values were significantly lower for the affected shoulders in both groups. At 6 months after surgery, there were no significant differences for mean strength and proprioception values between the unaffected and operative sides for group 2 patients. In group 1 patients, however, there were still significant deficits in mean position sense and strength values. Complete restoration of proprioception and strength, however, was evident by 12 months in group 1. This study demonstrates that there are significant deficits in both strength and proprioception in patients with posttraumatic, recurrent anterior glenohumeral instability. Although both are completely restored by 1 year after surgery, a subscapularis-splitting approach allows for complete recovery of strength and position sense as early as 6 months postoperatively. Detachment of the subscapularis delays recovery of strength and position sense for up to 12 months after surgery. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

[Capsular retensioning in anterior unidirectional glenohumeral instability].

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Benítez Pozos, Leonel; Martínez Molina, Oscar; Castañeda Landa, Ezequiel

2007-01-01

To present the experience of the Orthopedics Service PEMEX South Central Hospital in the management of anterior unidirectional shoulder instability with an arthroscopic technique consisting of capsular retensioning either combined with other anatomical repair procedures or alone. Thirty-one patients with anterior unidirectional shoulder instability operated-on between January 1999 and December 2005 were included. Fourteen patients underwent capsular retensioning and radiofrequency, and in 17 patients, capsular retensioning was combined with suture anchors. Patients with a history of relapsing glenohumeral dislocations and subluxations, with anterior instability with or without associated Bankart lesions were selected; all of them were young. The results were assessed considering basically the occurrence of instability during the postoperative follow-up. No cases of recurring instability occurred. Two cases had neuroma and one experienced irritation of the suture site. Six patients had residual limitation of combined lateral rotation and abduction movements, of a mean of 10 degrees compared with the healthy contralateral side. The most frequent incident was the leak of solutions to the soft tissues. Capsular retensioning, whether combined or not with other anatomical repair techniques, has proven to result in a highly satisfactory rate of glenohumeral stabilization in cases of anterior unidirectional instabilities. The arthroscopic approach offers the well-known advantages of causing less damage to the soft tissues, and a shorter time to starting rehabilitation therapy and exercises.

The effectiveness of arthroscopic stabilisation for failed open shoulder instability surgery.

Science.gov (United States)

Millar, N L; Murrell, G A C

2008-06-01

We identified ten patients who underwent arthroscopic revision of anterior shoulder stabilisation between 1999 and 2005. Their results were compared with 15 patients, matched for age and gender, who had a primary arthroscopic stabilisation during the same period. At a mean follow-up of 37 and 36 months, respectively, the scores for pain and shoulder function improved significantly between the pre-operative and follow-up visits in both groups (p = 0.002), with no significant difference between them (p = 0.4). The UCLA and Rowe shoulder scores improved significantly (p = 0.004 and p = 0.002, respectively), with no statistically significant differences between groups (p = 0.6). Kaplan-Meier analysis for time to recurrent instability showed no differences between the groups (p = 0.2). These results suggest that arthroscopic revision anterior shoulder stabilisation is as reliable as primary arthroscopic stabilisation for patients who have had previous open surgery for recurrent anterior instability.

Return to Sports and Recurrences After Arthroscopic Anterior Shoulder Stabilization in Martial Arts Athletes.

Science.gov (United States)

Ranalletta, Maximiliano; Rossi, Luciano A; Sirio, Adrian; Dilernia, Fernando Diaz; Bertona, Agustin; Maignon, Gastón D; Bongiovanni, Santiago L

2017-09-01

The high demands to the glenohumeral joint and the violent shoulder blows experienced during martial arts (MA) could compromise return to sports and increase the recurrence rate after arthroscopic stabilization for anterior shoulder instability in these athletes. To report the functional outcomes, return to sports, and recurrences in a series of MA athletes with anterior shoulder instability treated with arthroscopic stabilization with suture anchors. Case series; Level of evidence, 4. A total of 20 consecutive MA athletes were treated for anterior shoulder instability at a single institution between January 2008 and December 2013. Range of motion (ROM), the Rowe score, a visual analog scale (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Return-to-sport and recurrence rates were also evaluated. The mean age at the time of surgery was 25.4 years (range, 18-35 years), and the mean follow-up was 71 months (range, 36-96 months). No significant difference in preoperative and postoperative shoulder ROM was found. The Rowe, VAS, and ASOSS scores showed statistical improvement after surgery ( P < .001). In all, 19 athletes (95%) returned to sports. However, only 60% achieved ≥90% recovery after surgery. The recurrence rate was 20%. In this retrospective study of a consecutive cohort of MA athletes, arthroscopic anterior shoulder stabilization significantly improved functional scores. However, only 60% of the athletes achieved the same level of competition, and there was a 20% recurrence rate.

Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence.

Science.gov (United States)

Ahmed, Issaq; Ashton, Fiona; Robinson, Christopher Michael

2012-07-18

Arthroscopic Bankart repair and capsular shift is a well-established technique for the treatment of anterior shoulder instability. The purpose of this study was to evaluate the outcomes following arthroscopic Bankart repair and capsular shift and to identify risk factors that are predictive of recurrence of glenohumeral instability. We performed a retrospective review of a prospectively collected database consisting of 302 patients who had undergone arthroscopic Bankart repair and capsular shift for the treatment of recurrent anterior glenohumeral instability. The prevalence of patient and injury-related risk factors for recurrence was assessed. Cox proportional hazards models were used to estimate the predicted probability of recurrence within two years. The chief outcome measures were the risk of recurrence and the two-year functional outcomes assessed with the Western Ontario shoulder instability index (WOSI) and disabilities of the arm, shoulder and hand (DASH) scores. The rate of recurrent glenohumeral instability after arthroscopic Bankart repair and capsular shift was 13.2%. The median time to recurrence was twelve months, and this complication developed within one year in 55% of these patients. The risk of recurrence was independently predicted by the patient's age at surgery, the severity of glenoid bone loss, and the presence of an engaging Hill-Sachs lesion (all p surgery. Varying the cutoff level for the predicted probability of recurrence in the model from 50% to lower values increased the sensitivity of the model to detect recurrences but decreased the positive predictive value of the model to correctly predict failed repairs. There was a significant improvement in the mean WOSI and DASH scores at two years postoperatively (both p instability and individualizing treatment options for particular groups of patients. Prognostic level I. See Instructions for authors for a complete description of levels of evidence.

Shoulder MRI after surgical treatment of instability

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Vahlensieck, Martin [University of Bonn, Department of Radiology, Sigmund-Freud-Strasse 25, 53105 Bonn (Germany); Lang, Philipp [University of California San Francisco, Department of Radiology, 505 Pamassus Avenue, San Francisco, CA 94143 (United States); Wagner, Ulli [University of Bonn, Department of Orthopedic Surgery, Sigmund-Freud-Strasse 25, 53105 Bonn (Germany); Moeller, Frank [University of Bonn, Department of Orthopedic Surgery, Sigmund-Freud-Strasse 25, 53105 Bonn (Germany); Deimling, Urs van [University of Bonn, Department of Orthopedic Surgery, Sigmund-Freud-Strasse 25, 53105 Bonn (Germany); Genant, H K [University of California San Francisco, Department of Radiology, 505 Pamassus Avenue, San Francisco, CA 94143 (United States); Schild, Hans H [University of Bonn, Department of Radiology, Sigmund-Freud-Strasse 25, 53105 Bonn (Germany)

1999-04-01

Objective: To analyze magnetic resonance imaging (MRI) findings of the shoulder after an instability operation. Materials and methods: Physical examinations, radiographs and MRI of 10 patients after anterior glenoid bone block insertion for ventral instability were compared. MRI included T{sub 1}-weighted spin-echo (TR=600, TE=20 ms) and T{sub 2}*-weighted gradient-echo sequences (TE=600, TE=18, Flip=30 deg.) in the axial, oblique-coronal and oblique-sagittal planes. Results: No patient suffered from recurrent subluxation. We found fusion of the bone block with the anterior glenoid in seven cases, dislocation of the bone block without contact to the glenoid in one case, and no visible bone block in two cases. On MRI, the bone block showed either signal intensity equivalent to fatty bone marrow (n=4) or was devoid of signal consistent with cortical bone or bone sclerosis (n=4). In all patients, a low signal intensity mass, 2-4 cm in diameter, was visible next to the glenoid insertion site. Conclusion: Insertion of a bone block onto the anterior glenoid induces formation of scar tissue, increasing the stability of the shoulder joint. This scar is well visible on MRI and forms independently of the behavior of the bone block itself. MRI is ideally suited for evaluating postoperative shoulder joints after bone-grafting procedures.

Shoulder MRI after surgical treatment of instability

International Nuclear Information System (INIS)

Vahlensieck, Martin; Lang, Philipp; Wagner, Ulli; Moeller, Frank; Deimling, Urs van; Genant, H.K.; Schild, Hans H.

1999-01-01

Objective: To analyze magnetic resonance imaging (MRI) findings of the shoulder after an instability operation. Materials and methods: Physical examinations, radiographs and MRI of 10 patients after anterior glenoid bone block insertion for ventral instability were compared. MRI included T 1 -weighted spin-echo (TR=600, TE=20 ms) and T 2 *-weighted gradient-echo sequences (TE=600, TE=18, Flip=30 deg.) in the axial, oblique-coronal and oblique-sagittal planes. Results: No patient suffered from recurrent subluxation. We found fusion of the bone block with the anterior glenoid in seven cases, dislocation of the bone block without contact to the glenoid in one case, and no visible bone block in two cases. On MRI, the bone block showed either signal intensity equivalent to fatty bone marrow (n=4) or was devoid of signal consistent with cortical bone or bone sclerosis (n=4). In all patients, a low signal intensity mass, 2-4 cm in diameter, was visible next to the glenoid insertion site. Conclusion: Insertion of a bone block onto the anterior glenoid induces formation of scar tissue, increasing the stability of the shoulder joint. This scar is well visible on MRI and forms independently of the behavior of the bone block itself. MRI is ideally suited for evaluating postoperative shoulder joints after bone-grafting procedures

Subjective and objective outcome after revision arthroscopic stabilization for recurrent anterior instability versus initial shoulder stabilization.

Science.gov (United States)

Krueger, David; Kraus, Natascha; Pauly, Stephan; Chen, Jianhai; Scheibel, Markus

2011-01-01

The value of arthroscopic revision shoulder stabilization after failed instability repair is still a matter of debate. Arthroscopic revision shoulder stabilization using suture anchors provides equivalent subjective and objective results compared with initial arthroscopic instability repair. Cohort study; Level of evidence, 3. Twenty consecutive patients who underwent arthroscopic revision shoulder stabilization using suture anchors (group 2) were matched for age, gender, and handedness (dominant or nondominant) with 20 patients who had initial arthroscopic instability repair using the same technique (group 1). At the time of follow-up, a complete physical examination of both shoulders and evaluation with the Rowe score, Walch-Duplay score, Melbourne Instability Shoulder Score, Western Ontario Shoulder Instability Index, and the Subjective Shoulder Value were performed. In addition, standard radiographs (true AP and axillary views) were taken to evaluate signs of osteoarthritis. After a minimum follow-up of 24 months, no recurrent dislocations were observed in either group. The apprehension sign was positive in 2 cases of revision surgery (0 vs 2; P > .05). No significant differences in the Rowe score (89 vs 81.8 points) were found between groups 1 and 2 (P > .05). However, group 2 revealed significantly lower scores in the Walch-Duplay score (85.3 vs 75.5 points), Melbourne Instability Shoulder Score (90.2 vs 73.7 points), Western Ontario Shoulder Instability Index (89.8% vs 68.9%), and Subjective Shoulder Value (91.8% vs 69.2%) (P instability arthropathy were found more often in patients with arthroscopic revision surgery (2 vs 5; P > .05). Arthroscopic revision shoulder stabilization is associated with a lower subjective outcome compared with initial arthroscopic stabilization. The objective results found in this study may overestimate the clinical outcome in this patient population.

INTEGRITY OF THE SUBSCAPULARIS TENDON AFTER OPEN SURGERY FOR THE TREATMENT OF ANTERIOR SHOULDER INSTABILITY: A CLINICAL AND RADIOLOGICAL EVALUATION.

Science.gov (United States)

Lech, Osvandré; Piluski, Paulo; Tambani, Renato; Castro, Nero; Pimentel, Gilnei

2009-01-01

To evaluate the integrity of the subscapularis tendon by strength, function and magnetic resonance imaging after deltopectoralis access for anterior shoulder instability. 20 patients with anterior shoulder instability have been evaluated. Minimum follow-up was 12 months, with a mean of 40 months. Only male patients were included, with a mean of age of 29 years (20 - 42 years). The patients have been submitted to physical examinations of mobility, muscular strength, Belly Test and Gerber Test. The isokinetic strength in internal and external rotation, in angular speeds of 60(0)/s and 180(0)/s, for both shoulders was measured using a dynamometer. In 15 patients magnetic resonance imaging (MRI) was carried out on both shoulders for evaluating the thickness, cross-sectional area and atrophy of the subscapularis muscle. A significant difference was found between torque peaks at the speed of 60(0)/s for internal (p=0.036) and external (p=0.008) rotation. However, at 180(0)/s the opposite happens (internal rotation: p=0.133; external rotation: p=0.393). Subscapularis muscle thickness and area are significantly smaller than the normal side, with a deficit of 19% and 23%, respectively. According to Rowe and UCLA scores, we find excellent and good results for the majority of patients, with a mean of 88 and 31.6 points, respectively. Despite of the good functional results, open surgery can limit strength and reduce the thickness and the cross-sectional area of subscapularis muscle. However, the best results were found in the patients who had the dominant side operated.

INTEGRITY OF THE SUBSCAPULARIS TENDON AFTER OPEN SURGERY FOR THE TREATMENT OF ANTERIOR SHOULDER INSTABILITY: A CLINICAL AND RADIOLOGICAL EVALUATION

Science.gov (United States)

Lech, Osvandré; Piluski, Paulo; Tambani, Renato; Castro, Nero; Pimentel, Gilnei

2015-01-01

Objective: To evaluate the integrity of the subscapularis tendon by strength, function and magnetic resonance imaging after deltopectoralis access for anterior shoulder instability. Methods: 20 patients with anterior shoulder instability have been evaluated. Minimum follow-up was 12 months, with a mean of 40 months. Only male patients were included, with a mean of age of 29 years (20 − 42 years). The patients have been submitted to physical examinations of mobility, muscular strength, Belly Test and Gerber Test. The isokinetic strength in internal and external rotation, in angular speeds of 600/s and 1800/s, for both shoulders was measured using a dynamometer. In 15 patients magnetic resonance imaging (MRI) was carried out on both shoulders for evaluating the thickness, cross-sectional area and atrophy of the subscapularis muscle. Results: A significant difference was found between torque peaks at the speed of 600/s for internal (p=0.036) and external (p=0.008) rotation. However, at 1800/s the opposite happens (internal rotation: p=0.133; external rotation: p=0.393). Subscapularis muscle thickness and area are significantly smaller than the normal side, with a deficit of 19% and 23%, respectively. According to Rowe and UCLA scores, we find excellent and good results for the majority of patients, with a mean of 88 and 31.6 points, respectively. Conclusion: Despite of the good functional results, open surgery can limit strength and reduce the thickness and the cross-sectional area of subscapularis muscle. However, the best results were found in the patients who had the dominant side operated. PMID:27004190

A neuromuscular exercise programme versus standard care for patients with traumatic anterior shoulder instability

DEFF Research Database (Denmark)

Eshoj, Henrik; Rasmussen, Sten; Frich, Lars Henrik

2017-01-01

BACKGROUND: Anterior shoulder dislocation is a common injury and may have considerable impact on shoulder-related quality of life (QoL). If not warranted for initial stabilising surgery, patients are mostly left with little to no post-traumatic rehabilitation. This may be due to lack of evidence......-based exercise programmes. In similar, high-impact injuries (e.g. anterior cruciate ligament tears in the knee) neuromuscular exercise has shown large success in improving physical function and QoL. Thus, the objective of this trial is to compare a nonoperative neuromuscular exercise shoulder programme...... dislocations due to at least one traumatic event will be randomised to 12 weeks of either a standardised, individualised or physiotherapist-supervised neuromuscular shoulder exercise programme or standard care (self-managed shoulder exercise programme). Patients will be stratified according to injury status...

ARTHROSCOPIC REPAIR OF BANKART’S LESION USING SUTURE ANCHORS IN RECURRENT ANTERIOR SHOULDER INSTABILITY

OpenAIRE

Santosh Kumar; Anant Kumar; Sanjay

2015-01-01

BACKGROUND : Shoulder instability and its treatment were described even in ancient times by the Greek and Egyptian physicians. Evidence of shoulder dislocation has been found in archaeological and paleopathological examinations of human shoulders several thousand years old. 1 Many techniques have been described in literature for treatment of recurrent shoulder dislocation. Arthroscopic repair of Bankart’s lesion using suture anchors is a noble technique. A sut...

Eden-Hybinette and Pectoralis Major Transfer for Recurrent Shoulder Instability Due to Failed Latarjet and Chronic Subscapularis Rupture.

Science.gov (United States)

Li, Xinning; Cusano, Antonio; Eichinger, Josef

2017-01-01

Shoulder dislocations are a common injury, with anterior shoulder dislocation among male patients being the most common presentation. A patient with recurrent shoulder instability, anterior-superior escape, and chronic subscapularis tendon rupture following multiple shoulder stabilization surgeries presents the surgeon with a complex and challenging case. This report describes a 40-year-old man with an extensive left shoulder history that included a failed Latarjet procedure, an irreparable, chronic subscapularis tear with grade 4 Goutallier fatty infiltration, and associated anterior-superior escape. Given his marked dysfunction, weakness, pain, and recurrent instability in the absence of glenohumeral arthritis, he underwent an open Eden-Hybinette procedure (iliac crest autograft), a pectoralis major transfer, and an anterior capsule repair. The patient returned to his previous work activities without limitations. To the authors' knowledge, this is the first report describing a combination of anterior glenoid bone grafting with a full pectoralis major muscle transfer for a patient with chronic subscapularis rupture and anterior-superior escape after a failed Latarjet procedure with minimum glenoid bone loss. Furthermore, the authors provide a biomechanical rationale for the reconstruction used for this problem. [Orthopedics. 2017; 40(1):e182-e187.]. Copyright 2016, SLACK Incorporated.

Thermal Shrinkage for Shoulder Instability

OpenAIRE

Toth, Alison P.; Warren, Russell F.; Petrigliano, Frank A.; Doward, David A.; Cordasco, Frank A.; Altchek, David W.; O’Brien, Stephen J.

2010-01-01

Thermal capsular shrinkage was popular for the treatment of shoulder instability, despite a paucity of outcomes data in the literature defining the indications for this procedure or supporting its long-term efficacy. The purpose of this study was to perform a clinical evaluation of radiofrequency thermal capsular shrinkage for the treatment of shoulder instability, with a minimum 2-year follow-up. From 1999 to 2001, 101 consecutive patients with mild to moderate shoulder instability underwent...

Rugby Union on-field position and its relationship to shoulder injury leading to anterior reconstruction for instability.

Science.gov (United States)

Sundaram, Abayasankar; Bokor, Desmond J; Davidson, Andrew S

2011-03-01

Due to the unique demands of each position on the Rugby Union field, the likelihood of an athlete sustaining a dislocation of their shoulder joint that requires surgical reconstruction may be affected by their position on the field. 166 patients with 184 involved shoulders requiring anterior reconstruction following an on-field Rugby Union injury between January 1996 and September 2008 were analysed. The mean age at time of injury was 18 years with the mean age at time of surgery being 20 years. The most prevalent mechanism of injury was a tackle in 66.3% of players. Players were more likely to suffer injury to their non-dominant shoulder than their dominant side (McNemar's Test, prisk of injury for all player positions. Positions with significantly different risk of injury were five-eighth (increased risk) and wing (reduced risk). Although we observed an increased risk in flankers and fullbacks, and a lower risk in second row, these results did not reach statistical significance after application of the Bonferroni correction. This information can be utilized by team staff to assist in pre-season conditioning as well as the development of improved muscle co-ordination programmes for the non-dominant shoulder, and planning a graduated return to sport by the player recovering from surgical reconstruction of the shoulder for instability. Copyright © 2010 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Arthroscopic Bankart repair and subscapularis augmentation: an alternative technique treating anterior shoulder instability with bone loss.

Science.gov (United States)

Maiotti, Marco; Russo, Raffaele; Zanini, Antonio; Schröter, Steffen; Massoni, Carlo; Bianchedi, Diana

2016-06-01

This study presents the preliminary results of a new arthroscopic technique consisting of the association of 2 procedures, capsulolabral repair and subscapularis augmentation tenodesis, in the treatment of traumatic anterior shoulder instability with both glenoid bone loss and a Hill-Sachs lesion. Eighty-nine patients engaged in sports were enrolled in this retrospective case-series study with 2 to 5 years' follow-up. All patients underwent a computed tomography scan to assess the percentage of glenoid bone loss by the Pico method. A prior stabilization procedure had failed in 20 patients, who were then segregated into a different group. Visual analog scale (VAS), Rowe, and American Shoulder and Elbow Surgeons (ASES) scores were used to assess the results. Only 3 of 89 patients had a post-traumatic redislocation. The mean length of follow-up was 31.5 months (range, 25-60 months). The VAS, Rowe, and ASES scores showed significant improvements: The VAS score decreased from a mean of 3.1 to 0.5 (P = .0157), the Rowe score increased from 58.9 to 94.1 (P = .0215), and the ASES score increased from 68.5 to 95.5 (P = .0197). The mean deficit of external rotation was 6° with the arm at the side of the trunk, and the mean deficit was 3° with the arm in 90° of abduction. The described procedure is a reproducible and effective technique used to restore joint stability in patients engaged in sports who have incurred anterior recurrent shoulder dislocation associated with glenoid bone loss (Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Primary versus revision arthroscopic reconstruction with remplissage for shoulder instability with moderate bone loss.

Science.gov (United States)

McCabe, Michael P; Weinberg, Douglas; Field, Larry D; O'Brien, Michael J; Hobgood, E Rhett; Savoie, Felix H

2014-04-01

This study aims to evaluate our outcomes of arthroscopic remplissage in this setting. A retrospective review was performed to identify patients who underwent arthroscopic remplissage of an engaging Hill-Sachs lesion along with anterior capsulolabral reconstruction for anterior glenohumeral instability with moderate glenohumeral bone loss at our institution. Thirty-five patients, with a minimum of 2 years' follow-up, were identified. We assessed the American Shoulder and Elbow Surgeons score, incidence of recurrent instability, and postoperative Rowe instability score. Follow-up was available for 30 patients (31 shoulders). The mean age was 24.6 years, with a mean follow-up period of 41 months. Prior instability surgery had failed in 11 patients, and they underwent capsulolabral reconstruction and remplissage ("revision surgery"). The failure rate in revision cases (36%) was significantly higher than the failure rate in primary surgery cases (0%) (P = .01). Failure resulted from trauma in all 4 patients, and none required further surgery. The mean American Shoulder and Elbow Surgeons score for all patients improved from 50 preoperatively to 91 postoperatively (P instability patients with moderate bone loss and engaging humeral Hill-Sachs lesions yields acceptable outcomes for primary instability surgery. However, a significantly higher failure rate occurred when arthroscopic reconstruction with remplissage was performed in the revision setting. Level IV, therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. All rights reserved.

Redefining "Critical" Bone Loss in Shoulder Instability: Functional Outcomes Worsen With "Subcritical" Bone Loss.

Science.gov (United States)

Shaha, James S; Cook, Jay B; Song, Daniel J; Rowles, Douglas J; Bottoni, Craig R; Shaha, Steven H; Tokish, John M

2015-07-01

Glenoid bone loss is a common finding in association with anterior shoulder instability. This loss has been identified as a predictor of failure after operative stabilization procedures. Historically, 20% to 25% has been accepted as the "critical" cutoff where glenoid bone loss should be addressed in a primary procedure. Few data are available, however, on lesser, "subcritical" amounts of bone loss (below the 20%-25% range) on functional outcomes and failure rates after primary arthroscopic stabilization for shoulder instability. To evaluate the effect of glenoid bone loss, especially in subcritical bone loss (below the 20%-25% range), on outcomes assessments and redislocation rates after an isolated arthroscopic Bankart repair for anterior shoulder instability. Cohort study; Level of evidence, 3. Subjects were 72 consecutive anterior instability patients (73 shoulders) who underwent isolated anterior arthroscopic labral repair at a single military institution by 1 of 3 sports medicine fellowship-trained orthopaedic surgeons. Data were collected on demographics, the Western Ontario Shoulder Instability (WOSI) score, Single Assessment Numeric Evaluation (SANE) score, and failure rates. Failure was defined as recurrent dislocation. Glenoid bone loss was calculated via a standardized technique on preoperative imaging. The average bone loss across the group was calculated, and patients were divided into quartiles based on the percentage of glenoid bone loss. Outcomes were analyzed for the entire cohort, between the quartiles, and within each quartile. Outcomes were then further stratified between those sustaining a recurrence versus those who remained stable. The mean age at surgery was 26.3 years (range, 20-42 years), and the mean follow-up was 48.3 months (range, 23-58 months). The cohort was divided into quartiles based on bone loss. Quartile 1 (n = 18) had a mean bone loss of 2.8% (range, 0%-7.1%), quartile 2 (n = 19) had 10.4% (range, 7.3%-13.5%), quartile 3 (n

Outcomes and complications following graft reconstruction for anterior sternoclavicular joint instability.

Science.gov (United States)

Willinger, Lukas; Schanda, Jakob; Herbst, Elmar; Imhoff, Andreas B; Martetschläger, Frank

2016-12-01

Publications describing tendon graft reconstruction for anterior sternoclavicular joint (SCJ) instability are rare and usually refer to small patient numbers. The aim of this study was to systematically review the literature regarding outcomes and complications following tendon graft reconstruction techniques for anterior SCJ instability. An online database was systematically searched to identify studies on graft reconstruction for anterior SCJ instability. Reported outcome scores were graded as excellent, good, fair and poor to summarize the study results. All reported complications were recorded. Five articles with a total of 80 patients met the inclusion criteria. Reported outcomes were excellent in 10 %, good in 89 % and fair in 1 %. Recurrent instability was found in 10 % of the patients, and 5 % underwent revision surgery due to persistent impairment of shoulder function related to SCJ instability or osteoarthritis. Surgical stabilization techniques for the SCJ using autologous tendon grafts have shown to be safe and reliable and make better patients' pain situation and shoulder function. However, a certain amount of impairment might persist, which needs to be discussed with patients. Severe complications were rare and revision rates were as low as 5 %. Therefore, graft reconstruction techniques should be considered for patients with chronic anterior SCJ instability after a course of failed conservative treatment. This study is valuable for clinicians in daily clinical practice when dealing with this difficult-to-treat pathology and can help surgeons to better predict the clinical outcomes and complications following SCJ graft reconstruction. It should, however, not lead to underestimation of the potential risks of the procedure. Systematic review, Level IV.

Return to Play Following Anterior Shoulder Dislocation and Stabilization Surgery.

Science.gov (United States)

Donohue, Michael A; Owens, Brett D; Dickens, Jonathan F

2016-10-01

Anterior shoulder instability in athletes may lead to time lost from participation and decreases in level of play. Contact, collision, and overhead athletes are at a higher risk than others. Athletes may successfully be returned to play but operative stabilization should be considered for long-term treatment of recurrent instability. Open and arthroscopic stabilization procedures for athletes with less than 20% to 25% bone loss improve return to play rates and decrease recurrent instability, with a slightly lower recurrence with open stabilization. For athletes with greater than 20% to 25% bone loss, an open osseous augmentation procedure should be considered. Published by Elsevier Inc.

Clinical forms of shoulder instability in pediatric patients

Directory of Open Access Journals (Sweden)

Yaroslav N. Proshchenko

2016-12-01

Full Text Available Background. The recurrence rate of adolescent chronic shoulder instability is approximately 56%–68%. However, this pathology is often missed in childhood and adolescence. Aim. To identify the clinical forms of shoulder joint instability in pediatric patients. Materials and methods. The authors present the data from 57 pediatric patients aged 3−17 years with a total of 61 unstable shoulder joints. All patients were divided into groups according to the form of instability. Traumatic chronic shoulder instability was identified in 40 patients (Bankart and Hill–Sachs injuries. Of these, non-traumatic shoulder instability was diagnose in 17, including five with recurrent dislocation, and spontaneous shoulder dislocation due to dysplasia of glenoid and labrum was diagnosed in 12. Of the 57 patients in the study cohort, 53 underwent surgery. Postoperatively, two patients developed recurrent shoulder dislocation (Andreev–Boichev technique due type III shoulder dysplasia in the first patient and multidirectional injury in the second. Conclusions. Shoulder joint instability should be considered as the traumatic or non-traumatic form. Treatment decisions should be based on anatomical characteristics that predispose to recurrent dislocation.

Return to sports after arthroscopic capsulolabral repair using knotless suture anchors for anterior shoulder instability in soccer players: minimum 5-year follow-up study.

Science.gov (United States)

Alentorn-Geli, Eduard; Álvarez-Díaz, Pedro; Doblas, Jesús; Steinbacher, Gilbert; Seijas, Roberto; Ares, Oscar; Boffa, Juan José; Cuscó, Xavier; Cugat, Ramón

2016-02-01

To report the return to sports and recurrence rates in competitive soccer players after arthroscopic capsulolabral repair using knotless suture anchors at a minimum of 5 years of follow-up. All competitive soccer players with anterior glenohumeral instability treated by arthroscopic capsulolabral repair using knotless suture anchors between 2002 and 2009 were retrospectively identified through the medical records. Inclusion criteria were: no previous surgical treatment of the involved shoulder, absence of glenoid or tuberosity fractures, absence of large Hill-Sachs or glenoid bone defect, minimum follow-up of 5 years, instability during soccer practice or games, and failure of non-surgical treatment. The charts of included players were reviewed, and a phone call was performed in a cross-sectional manner to obtain information on: current soccer, return to soccer, recurrence of instability, shoulder function (Rowe score), and disability [Quick-Disability of the Arm, Shoulder, and Hand (DASH) score and Quick-DASH Sports/Performing Arts Module]. Fifty-seven young male soccer players were finally included with a median (range) follow-up of 8 (5-10) years. Forty-nine (86 %) of the soccer players were able to return to soccer and 36 of them (73 %) at the same pre-injury level. There were 6 (10.5 %) re-dislocations in the 57 players, all of them of traumatic origin produced during soccer and other unrelated activities. The main reasons to not return to soccer were: knee injuries (two players), changes in personal life (two players), and job-related (three players). None of the players quit playing soccer because of their shoulder instability injury. The median (range) Rowe score, Quick-DASH score, and Quick-DASH sports score were 80 (25-100), 2.3 (0-12.5), and 0 (0-18.8), respectively. Competitive soccer players undergoing arthroscopic capsulolabral repair with knotless suture anchors for shoulder instability without significant bone loss demonstrate excellent return to

Results of revision anterior shoulder stabilization surgery in adolescent athletes.

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Blackman, Andrew J; Krych, Aaron J; Kuzma, Scott A; Chow, Roxanne M; Camp, Christopher; Dahm, Diane L

2014-11-01

The purpose of this study was to determine failure rates, functional outcomes, and risk factors for failure after revision anterior shoulder stabilization surgery in high-risk adolescent athletes. Adolescent athletes who underwent primary anterior shoulder stabilization were reviewed. Patients undergoing subsequent revision stabilization surgery were identified and analyzed. Failure rates after revision surgery were assessed by Kaplan-Meier analysis. Failure was defined as recurrent instability requiring reoperation. Functional outcomes included the Marx activity score; American Shoulder and Elbow Surgeons score; and University of California, Los Angeles score. The characteristics of patients who required reoperation for recurrent instability after revision surgery were compared with those of patients who required only a single revision to identify potential risk factors for failure. Of 90 patients who underwent primary anterior stabilization surgery, 15 (17%) had failure and underwent revision surgery (mean age, 16.6 years; age range, 14 to 18 years). The mean follow-up period was 5.5 years (range, 2 to 12 years). Of the 15 revision patients, 5 (33%) had recurrent dislocations and required repeat revision stabilization surgery at a mean of 50 months (range, 22 to 102 months) after initial revision. No risk factors for failure were identified. The Kaplan-Meier reoperation-free estimates were 86% (95% confidence interval, 67% to 100%) at 24 months and 78% (95% confidence interval, 56% to 100%) at 48 months after revision surgery. The mean final Marx activity score was 14.8 (range, 5 to 20); American Shoulder and Elbow Surgeons score, 82.1 (range, 33 to 100); and University of California, Los Angeles score, 30.8 (range, 16 to 35). At 5.5 years' follow-up, adolescent athletes had a high failure rate of revision stabilization surgery and modest functional outcomes. We were unable to convincingly identify specific risk factors for failure of revision surgery. Level IV

Kinesthetically guided reaching accuracy in individuals with a history of traumatic anterior shoulder dislocation

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Hung Y

2013-05-01

Full Text Available You-jou Hung,1 Warren G Darling2 1Doctor of Physical Therapy Program, Department of Nursing and Rehabilitation Sciences, Angelo State University, San Angelo, TX, USA; 2Department of Health and Human Physiology, The University of Iowa, Iowa City, IA, USA Background: The purpose of the study was to investigate whether individuals with a history of traumatic anterior shoulder dislocation show larger reaching errors than those with healthy shoulders and to determine if they implement different reaching strategies to protect the injured shoulder. Methods: Ten people with a history of traumatic anterior shoulder dislocation and 15 with healthy shoulders volunteered for this study. After viewing targets in space, participants pointed with the unconstrained arm to remembered target locations in space without visual guidance. Nine different targets were located in various planes and heights. Endpoint reaching errors were determined by comparing the finger endpoint position without visual guidance to the target location. Shoulder rotation angle at the endpoint was also compared between groups. Results: Participants with injured shoulders were able to point voluntarily to visually specified targets as accurately as participants with healthy shoulders (1 cm difference. However, participants with injured shoulders showed less shoulder external rotation (average 12° difference at the target location when compared with healthy shoulders. This difference was consistent over a large range of target locations. Conclusion: Individuals with a history of traumatic anterior shoulder dislocation have sufficient kinesthetic information about their upper limb orientation to point accurately to visually specified targets in space. However, individuals with injured shoulders acquired a new motor strategy to reach with less shoulder external rotation, presumably to protect the injured shoulder from recurrent injuries. Keywords: shoulder injuries, physiotherapy, shoulder

Anterior labral tear: diagnostic value of MR arthrography of the shoulder

International Nuclear Information System (INIS)

Ryu, Jung Kyu; Yoon, Yeong Cheol; Ryu, Kyung Nam; Rhee, Yong Girl

2001-01-01

To assess the accuracy of magnetic resonance(MR) arthrography in the diagnosis of anterior labral tear of the shoulder Between september 1996 and February 2000, MR arthrography of the shoulder was performed in 281 patients with a history of shoulder pain or instability. Among this total, only 157 shoulders in 154 patients who underwent arthroscopy or open surgery 0 to 230 (average, 20.9) days after MR arthrography were included in this study; the subjects comprised of 150 males and 4 females with an average age of 23.3 years. MR arthrographs of these 154 patients were analyzed for the presence of anterior labral tears, and the findings were correlated with the arthroscopic and surgical findings. Anterior labral tear was classified as A to D according to its location, as determined by arthroscopy and surgery. (A=4 to 6 o'clock direction, anteroinferior; B=2 to 4 o'clock direction, central; C=12 to 2 o'clock direction, anterosuperior; D= SLAP lesion). The retrospective analysis of MR arthrographs showing false-positive and negative findings was also underthken.. In the diagnosis of anterior labral tear, MR arthrography showed a sensitivity of 94%, a specificity of 90% and an accuracy of 91%. Anterior labral tears were confirmed by arthroscopy or surgery in 62 of the 157 shoulders (39%). Among 62 lesion, two (3%) were observed in area A, 32(52%) in area A+B, nine (15%) in area A+B+C, one(2%) in area A+B+D,13(21%) in area A+B+C+D, two (3%) in area B+C, one(2%) in area B+D, and two(3%) in area C. Among ten false-positive cases, seven were focal lessions (two, three and two lesions in area A, B and C, respectively), and in the remaining three cases, lacated in area A+B, MR arthrography revealed thickening and deformation. All four false negatives were focal lesions (two in area A and two in area C). Other than in focal lesions, in which accuracy was relatively low, MR arthrography showed high sensitivity, specificity and accuracy in the diagnosis of anterior labral tear

Utility of the Instability Severity Index Score in Predicting Failure After Arthroscopic Anterior Stabilization of the Shoulder.

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Phadnis, Joideep; Arnold, Christine; Elmorsy, Ahmed; Flannery, Mark

2015-08-01

The redislocation rate after arthroscopic stabilization for anterior glenohumeral instability is up to 30%. The Instability Severity Index Score (ISIS) was developed to preoperatively rationalize the risk of failure, but it has not yet been validated by an independent group. To assess the utility of the ISIS in predicting failure of arthroscopic anterior shoulder stabilization and to identify other preoperative factors for failure. Case-control study; Level of evidence, 3. A case-control study was performed on 141 consecutive patients, comparing those who suffered failure of arthroscopic stabilization with those who had successful arthroscopic stabilization. The mean follow-up time was 47 months (range, 24-132 months). The ISIS was applied retrospectively, and an analysis was performed to establish independent risk factors for failure. A receiver operator coefficient curve was constructed to set a threshold ISIS for considering alternative surgery. Of 141 patients, 19 (13.5%) suffered recurrent instability. The mean ISIS of the failed stabilization group was higher than that of the successful stabilization group (5.1 vs 1.7; P surgery (P < .001), age at first dislocation (P = .01), competitive-level participation in sports (P < .001), and participation in contact or overhead sports (P = .03). The presence of glenoid bone loss carried the highest risk of failure (70%). There was a 70% risk of failure if the ISIS was ≥4, as opposed to a 4% risk of failure if the ISIS was <4. This is the first completely independent study to confirm that the ISIS is a useful preoperative tool. It is recommended that surgeons consider alternative forms of stabilization if the ISIS is ≥4. © 2015 The Author(s).

Electromyographical Comparison of Four Common Shoulder Exercises in Unstable and Stable Shoulders

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Aaron Sciascia

2012-01-01

Full Text Available This study examines if electromyographic (EMG amplitude differences exist between patients with shoulder instability and healthy controls performing scaption, prone horizontal abduction, prone external rotation, and push-up plus shoulder rehabilitation exercises. Thirty nine subjects were categorized by a single orthopedic surgeon as having multidirectional instability (n=10, anterior instability (n=9, generalized laxity (n=10, or a healthy shoulder (n=10. Indwelling and surface electrodes were utilized to measure EMG activity (reported as a % of maximum voluntary isometric contraction (MVIC in various shoulder muscles during 4 common shoulder exercises. The exercises studied effectively activated the primary musculature targeted in each exercise equally among all groups. The serratus anterior generated high activity (50–80% MVIC during a push-up plus, while the infraspinatus and teres major generated moderate-to-high activity (30–80% MVIC during both the prone horizontal and prone external rotation exercises. Scaption exercise generated moderate activity (20–50% MVIC in both rotator cuff and scapular musculature. Clinicians should feel confident in prescribing these shoulder-strengthening exercises in patients with shoulder instability as the activation levels are comparable to previous findings regarding EMG amplitudes and should improve the dynamic stabilization capability of both rotator cuff and scapular muscles using exercises designed to address glenohumeral joint instability.

Shoulder instability in professional football players.

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Leclere, Lance E; Asnis, Peter D; Griffith, Matthew H; Granito, David; Berkson, Eric M; Gill, Thomas J

2013-09-01

Shoulder instability is a common problem in American football players entering the National Football League (NFL). Treatment options include nonoperative and surgical stabilization. This study evaluated how the method of treatment of pre-NFL shoulder instability affects the rate of recurrence and the time elapsed until recurrence in players on 1 NFL team. Retrospective cohort. Medical records from 1980 to 2008 for 1 NFL team were reviewed. There were 328 players included in the study who started their career on the team and remained on the team for at least 2 years (mean, 3.9 years; range, 2-14 years). The history of instability prior to entering the NFL and the method of treatment were collected. Data on the occurrence of instability while in the NFL were recorded to determine the rate and timing of recurrence. Thirty-one players (9.5%) had a history of instability prior to entering the NFL. Of the 297 players with no history of instability, 39 (13.1%) had a primary event at a mean of 18.4 ± 22.2 months (range, 0-102 months) after joining the team. In the group of players with prior instability treated with surgical stabilization, there was no statistical difference in the rate of recurrence (10.5%) or the timing to the instability episode (mean, 26 months) compared with players with no history of instability. Twelve players had shoulder instability treated nonoperatively prior to the NFL. Five of these players (41.7%) had recurrent instability at a mean of 4.4 ± 7.0 months (range, 0-16 months). The patients treated nonoperatively had a significantly higher rate of recurrence (P = 0.02) and an earlier time of recurrence (P = 0.04). The rate of contralateral instability was 25.8%, occurring at a mean of 8.6 months. Recurrent shoulder instability is more common in NFL players with a history of nonoperative treatment. Surgical stabilization appears to restore the rate and timing of instability to that of players with no prior history of instability.

Humeral avulsion of the anterior shoulder stabilizing structures after anterior shoulder dislocation: demonstration by MRI and MR arthrography

International Nuclear Information System (INIS)

Tirman, P.F.J.; Steinbach, L.S.; Feller, J.F.; Stauffer, A.E.

1996-01-01

Objective. To demonstrate the MRI findings of an anterior shoulder capsular avulsion from the humerus, with or without subscapularis rupture, after anterior dislocation or severe abduction external rotation injury. Design and patients. We retrospectively reviewed the MRI and MR arthrographic examinations of seven patients who were identified at surgery with avulsion of the anterior shoulder stabilizers from the humerus. MRI was correlated with clinical history and surgical results. Results. MRI findings included: inhomogeneity or frank disruption of the anterior capsule at the humeral insertion (all), fluid intensity anterior to the shoulder (six patients), tear of the subscapularis tendon (six patients), dislocation of the biceps tendon (four patients), and a Hill-Sachs deformity (four patients). MR arthrography additionally found extravasation of contrast through the capsular defect (two patients). Conclusions. Our findings suggest that MRI is helpful for diagnosing humeral avulsion of the anterior glenohumeral capsule, especially when a tear of the subscapularis tendon insertion is present. MR arthrography may be of benefit for diagnosing capsular avulsion without associated subscapularis tendon abnormality. (orig.). With 4 figs

ARTHROSCOPIC REPAIR OF BANKART’S LESION USING SUTURE ANCHORS IN RECURRENT ANTERIOR SHOULDER INSTABILITY

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Santosh Kumar

2015-06-01

Full Text Available BACKGROUND : Shoulder instability and its treatment were described even in ancient times by the Greek and Egyptian physicians. Evidence of shoulder dislocation has been found in archaeological and paleopathological examinations of human shoulders several thousand years old. 1 Many techniques have been described in literature for treatment of recurrent shoulder dislocation. Arthroscopic repair of Bankart’s lesion using suture anchors is a noble technique. A suture anchor is a tiny screw with a thread attached to it. The screw is inserted into the bone over the glenoid rim while the sutures hold onto the labral tissue. These anchors provide a stable base for reattachment of the capsulolabral complex. We conducted a study on evaluation of long term effe ct of arthroscopic repair of Bankart’s lesion using suture anchors and compared our results with other studies published in literature . MATERIALS & METHODS : Since June 2012, arthroscopic Bankart’s repair using suture anchors was performed on 35 patients, who presented with recurrent anterior dislocation of shoulder. 34 man and 1 woman patients were included in the study. METHOD OF COLLECTION OF DATA: Adult patients with recurrent dislocations of shoulder with . INCLUSION CRITERIA: All patients > 15 years but =2 . EXCLUSION CRITERIA: Age group 60 years. Clinical evidence of multidirectional instability. Surgery of injured shou lder before 1 st episode of traumatic shoulder dislocation. Number o f dislocations <2 . Generalised ligamentous laxity. Presence of neuromuscular disorders. Presence of other comorbid conditions . Majority of patients were in the age group between 17 years to 49years, with mean age of 27.43 years. Most patients were young active individuals in the age group of 25 to 35 years. 20 patients (57% were involved in significant occupation requiring overhead activity such as students with sporting activities, agricul turists. 21(60% patients had their Right shoulder involved

Bone fragment union and remodeling after arthroscopic bony bankart repair for traumatic anterior shoulder instability with a glenoid defect: influence on postoperative recurrence of instability.

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Nakagawa, Shigeto; Ozaki, Ritsuro; Take, Yasuhiro; Mae, Tatsuo; Hayashida, Kenji

2015-06-01

Although good clinical outcomes have been reported after arthroscopic bony Bankart repair, the extent of bone union is still unclear. To investigate bone union after arthroscopic bony Bankart repair and its influence on postoperative recurrence of instability. Cohort study; Level of evidence, 3. Among 113 consecutive shoulders that underwent arthroscopic bony Bankart repair, postoperative evaluation of bone union by computed tomography (CT) was performed at various times in 81 shoulders. Bone union was investigated during 3 periods: 3 to 6 months postoperatively (first period), 7 to 12 months postoperatively (second period), and 13 months or more postoperatively (third period). The influence of the size of the preoperative glenoid defect and the size of the bone fragment on bone union was investigated, as well as the influence of bone union on postoperative recurrence of instability. In shoulders with bone union, bone fragment remodeling and changes in the glenoid defect size were also investigated. The bone union rate was 30.5% in the first period, 55.3% in the second period, and 84.6% in the third period. Among 53 shoulders with CT evaluation in the second period or later and follow-up for a minimum of 1 year, there was complete union in 33 shoulders (62.3%), partial union in 3 (5.7%), nonunion in 8 (15.1%), and no fragment on CT in 9 (17.0%). The complete union rate was 50% for 22 shoulders with small bone fragments (fragments (5%-10%), and 86.7% for 15 shoulders with large fragments (>10%). The recurrence rate for postoperative instability was only 6.1% for shoulders with complete union, while it was 50% for shoulders with partial union, nonunion, no fragment, and no fragment on CT. The recurrence rate was significantly higher (36.4%) in shoulders with small fragments, but it was significantly lower in shoulders with bone union. In shoulders with bone union, the bone fragment frequently became larger over time, while the size of the glenoid defect decreased

Incidence of and risk factors for traumatic anterior shoulder dislocation: an epidemiologic study in high-school rugby players.

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Kawasaki, Takayuki; Ota, Chihiro; Urayama, Shingo; Maki, Nobukazu; Nagayama, Masataka; Kaketa, Takefumi; Takazawa, Yuji; Kaneko, Kazuo

2014-11-01

The incidence of reinjuries due to glenohumeral instability and the major risk factors for primary anterior shoulder dislocation in youth rugby players have been unclear. The purpose of this study was to investigate the incidence, mechanisms, and intrinsic risk factors of shoulder dislocation in elite high-school rugby union teams during the 2012 season. A total of 378 male rugby players from 7 high-school teams were investigated by use of self-administered preseason and postseason questionnaires. The prevalence of a history of shoulder dislocation was 14.8%, and there were 21 events of primary shoulder dislocation of the 74 overall shoulder injuries that were sustained during the season (3.2 events per 1000 player-hours of match exposure). During the season, 54.3% of the shoulders with at least one episode of shoulder dislocation had reinjury. This study also indicated that the persistence of glenohumeral instability might affect the player's self-assessed condition, regardless of the incidence during the current season. By a multivariate logistic regression method, a history of shoulder dislocation on the opposite side before the season was found to be a risk factor for contralateral primary shoulder dislocation (odds ratio, 3.56; 95% confidence interval, 1.27-9.97; P = .02). High-school rugby players with a history of shoulder dislocation are not playing at full capacity and also have a significant rate of reinjury as well as a high risk of dislocating the other shoulder. These findings may be helpful in deciding on the proper treatment of primary anterior shoulder dislocation in young rugby players. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Online resources for shoulder instability: what are patients reading?

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Garcia, Grant H; Taylor, Samuel A; Dy, Christopher J; Christ, Alexander; Patel, Ronak M; Dines, Joshua S

2014-10-15

Evaluations of the medical literature suggest that many online sites provide poor-quality information. The purpose of our study was to investigate the value of online resources for patient education about shoulder instability. Three search terms ("shoulder instability," "loose shoulder," and "shoulder dislocation") were entered into three Internet search engines. Three orthopaedic residents independently gauged the quality and accuracy of the information with use of a set of predetermined scoring criteria, in addition to noting whether or not four potential surgery options were mentioned. The readability of the web sites was evaluated with use of the Flesch-Kincaid score. Eighty-two unique web sites were evaluated. Quality and accuracy were significantly higher with use of the term "shoulder instability" compared with the term "loose shoulder" (quality, p reading level was significantly more advanced for the "shoulder instability" web sites (p reading levels above the eighth grade level (p = 0.001) (88% of web sites). Only twenty-three sites (28%) mentioned surgical options for shoulder instability, and of these, only eight mentioned thermal capsulorrhaphy as a primary treatment. Online information regarding shoulder instability is often inaccurate and/or at an inappropriately high reading level. The quality of information is highly dependent on the specific search term used. Clinicians need to be aware of the information that is available online and should help direct patients to proper sites and guide Internet search terms. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Surgical versus nonsurgical treatment in first traumatic anterior dislocation of the shoulder in athletes

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Gustavo Gonçalves Arliani

2011-03-01

Full Text Available Gustavo Gonçalves Arliani, Diego da Costa Astur, Carina Cohen, Benno Ejnisman, Carlos Vicente Andreoli, Alberto Castro Pochini, Moises CohenCentro de Traumatologia do Esporte (CETE, Departamento de Ortopedia e Traumatologia da Universidade Federal de São Paulo, São Paulo, BrazilAbstract: Anterior traumatic dislocation is a common problem faced by orthopedic surgeons. After the first episode of shoulder dislocation, a combination of lesions can lead to chronic instability. The management in treatment of young athletes after the first acute anterior shoulder dislocation is controversial. The available literature supports early surgical treatment for young male athletes engaged in highly demanding physical activities after the first episode of traumatic dislocation of the shoulder. This is because of the best functional results and lower recurrence rates obtained with this treatment in this population. However, further clinical trials of good quality comparing surgical versus nonsurgical treatment for well-defined lesions are needed, especially for categories of patients who have a lower risk of recurrence.Keywords: athlete, conservative treatment, surgical treatment, immobilization, stabilization, primary treatment, shoulder dislocation

Open capsular shift for multi directional shoulder instability.

NARCIS (Netherlands)

Tankeren, E. van; Waal Malefijt, M.C. de; Loon, C. van

2002-01-01

We evaluated the outcome of open antero-inferior capsular shift in 17 patients with multidirectional instability of the shoulder who failed to respond to conservative treatment. Six shoulders presented with secondary impingement syndrome and 11 with involuntary instability. The mean duration of

Systematics of shoulder instability; Systematik der Schulterinstabilitaet

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Kreitner, K.F.; Maehringer-Kunz, A. [Johannes-Gutenberg-Universitaet Mainz, Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Mainz (Germany)

2015-03-01

Shoulder instability is defined as a symptomatic abnormal motion of the humeral head relative to the glenoid during active shoulder motion. Glenohumeral instabilities are classified according to the causative factors as the pathogenesis of instability plays an important role with respect to treatment options. Instabilities are classified into traumatic and atraumatic instabilities as part of a multidirectional instability syndrome and into microtraumatic instabilities. For diagnostics plain radiographs (''trauma series'') are performed to document shoulder dislocation and its successful repositioning. Direct magnetic resonance (MR) arthrography is the most important imaging modality for delineation of the different injury patterns of the labral-ligamentous complex and bony structures. Monocontrast computed tomography (CT) arthrography with the use of multidetector CT scanners represents an alternative imaging modality; however, MR imaging should be preferred in the work-up of shoulder instabilities due to the mostly younger age of patients. (orig.) [German] Unter einer Schulterinstabilitaet versteht man jede zu Beschwerden fuehrende Translation des Humeruskopfs in Relation zur Gelenkpfanne waehrend einer aktiven Bewegung der Schulter. Glenohumerale Instabilitaeten werden heute nach ihrer Aetiologie eingeteilt, da bei der Wahl der Therapie der Entstehungsmechanismus der Instabilitaet eine wichtige Rolle spielt. Danach unterscheidet man primaer traumatisch von atraumatisch entstandenen Instabilitaeten sowie Mikroinstabilitaeten. Bei der Diagnostik dienen konventionelle Roentgenuebersichtsaufnahmen nur noch zur Dokumentation einer Luxation und zur Beurteilung der Reposition. Die durch eine Instabilitaet hervorgerufenen Verletzungsfolgen am labroligamentaeren Komplex und den knoechernen Strukturen werden heute bevorzugt mit der direkten MR-Arthrographie dargestellt. Hierbei koennen unterschiedliche Verletzungsmuster dargestellt werden. Nach

CT investigation of instability of the shoulder joint. CT-Diagnostik bei der Instabilitaet des Schultergelenkes

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Grasshoff, H.; Buhtz, C.; Gellerich, I.; Knorre, C. v. (Medizinische Akademie, Magdeburg (Germany). Klinik fuer Orthopaedie Medizinische Akademie, Magdeburg (Germany). Klinik fuer Neurologie und Psychiatrie)

1991-12-01

CT is able to demonstrate the predisposing factors for recurrent und 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 retriversion as compared with a control group. Particulary 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. (orig.).

Diagnosis of shoulder instability in dogs and cats: a retrospective study

International Nuclear Information System (INIS)

Bardet, J.F.

1998-01-01

The glenohumeral joint is a remarkable articulation providing the greatest range of motion of any joint in the body. Glenohumeral stabilityresults from several mechanisms, including those that do not require expenditure of energy by muscle ('''passive mechanisms'') and those that do (''active mechanisms''). Glenohumeral instability has been recognized in 47 shoulders of 45 dogs and one cat. Cases are presented because of chronic foreleg lameness. Shoulder joint pain is obviated by theorthopedic examination. Only 57% of the involved shoulders presented with degenerative joint disease. Signs of instability are recognized under anesthesia using a craniocaudal or mediolateral drawer sign or both. This report describes the radiographic and arthroscopic findings of shoulder instability. Arthroscopy of the shoulder joint allows identification of all intra-articular pathologies. Shoulder instability notfully recognized in the past, appears to be the most common cause of shoulder lameness in the dog

Can arthroscopic revision surgery for shoulder instability be a fair option?

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De Giorgi, Silvana; Garofalo, Raffaele; Tafuri, Silvio; Cesari, Eugenio; Rose, Giacomo Delle; Castagna, Alessandro

2014-04-01

the aim of this study was to evaluate the role of arthroscopic capsuloplasty in the treatment of failed primary arthroscopic treatment of glenohumeral instability. we retrospectively examined at a minimum of 3-years follow-up 22 patients who underwent arthroscopic treatment between 1999 and 2007 who had recurrent anterior shoulder instability with a post-surgical failure. A statistical analysis was performed to evaluate which variable could influence the definitive result and clinical outcomes at final follow-up. A p value of less than 0.05 was considered significant. we observed after revision surgery an overall failure rate of 8/22 (36.4%) including frank dislocations, subluxations and also apprehension that seriously inhibit the patient's quality of life. No significant differences were observed in the examined parameters. according to our outcomes we generally do not recommend an arthroscopic revision procedure for failed instability surgery.

Tratamento artroscópico da instabilidade anterior do ombro: estudo retrospectivo de 159 casos Anterior instability of the shoulder: retrospective study on 159 cases

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Arnaldo Amado Ferreira Neto

2011-01-01

Full Text Available OBJETIVO: Análise dos resultados de 159 pacientes com instabilidade anterior do ombro submetidos ao tratamento artroscópico de janeiro de 2001 a dezembro de 2005. MÉTODOS: Estudo retrospectivo de prontuários com dados completos. RESULTADOS: Em 108 pacientes notou-se a lesão de Bankart e em 62 pacientes a lesão do tipo SLAP estava presente. Utilizou-se em média 2,7 âncoras. Apresentaram complicações 42 casos; 14 tinham dor aos esforços, 12 tinham algum grau de diminuição da rotação externa, 16 apresentaram recidiva. Os pacientes que evoluíram com complicações utilizaram em média 2,5 âncoras, enquanto naqueles sem complicações a média foi de 2,8 (pOBJECTIVE: To analyze the results of 159 patients with anterior instability of the shoulder submitted to arthroscopic treatment from January 2001 to December 2005. METHODS: Retrospective study of complete patient records. RESULTS: In 108 patients the Bankart lesion was found, while in 62 patients, SLAP type lesions were found. An average of 2.7 anchors was used. 42 cases presented complications; 14 had pain on effort, 12 had some degree of reduction of external rotation, and 16 had recorrence. The patients who developed complications used an average of 2.5 anchors, while those without complications used an average of 2.8 anchors (p<0.05. Of the 35 patients with anterior glenoid bone lesion, 8 had recorrence, while of the 124 patients without fractures, 8 had recorrence (p<0.05. Of the 113 patients with first-time traumatic dislocations, 12 developed limitation of external rotation, while in 46 atraumatic cases none developed limitation (p<0.05. Of the patients with SLAP lesion, 11 developed pain, while in the cases without this lesion, only 3 presented pain (p<0.05. CONCLUSION: There were more recurrences (deveria ser plural e recurrences, nao recurrence in cases of anterior glenoid bone lesion. Post-operative pain was more frequent when the lesion type was SLAP. Limitation of

Imaging findings in posterior instability of the shoulder

International Nuclear Information System (INIS)

Harish, Srinivasan; Rebello, Ryan; O'Neill, John; Nagar, Arpit; Moro, Jaydeep; Pugh, David

2008-01-01

Posterior shoulder instability refers to the symptoms and signs resulting from excessive posterior translation of the humerus. Magnetic resonance (MR) imaging is the radiological modality of choice in the diagnostic assessment of posterior instability. Computed tomography (CT) is useful in the evaluation of osseous abnormalities associated with posterior instability. A detailed description of the posterior osseous and labroligamentous abnormalities has evolved recently, and many variant lesions of the posteroinferior labrum and/or capsular structures have been described. As the recommended surgical management of lesions associated with posterior instability is a lesion-specific approach, awareness of the specific lesions that have been described in association with posterior instability helps in pre-surgical planning. The purpose of this article is to review the classification of, and injury mechanisms leading to, posterior shoulder instability and to describe imaging findings associated with posterior instability, with emphasis on MR imaging. (orig.)

Imaging findings in posterior instability of the shoulder

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Harish, Srinivasan; Rebello, Ryan; O' Neill, John [St. Joseph' s Healthcare, Department of Diagnostic Imaging, Hamilton, ON (Canada); McMaster University, Faculty of Health Sciences, Hamilton (Canada); Nagar, Arpit [St. Joseph' s Healthcare, Department of Diagnostic Imaging, Hamilton, ON (Canada); Moro, Jaydeep [St. Joseph' s Healthcare, Department of Orthopedic Surgery, Hamilton, ON (Canada); McMaster University, Faculty of Health Sciences, Hamilton (Canada); Pugh, David [Brantford General Hospital, Department of Orthopedic Surgery, Brantford, ON (Canada)

2008-08-15

Posterior shoulder instability refers to the symptoms and signs resulting from excessive posterior translation of the humerus. Magnetic resonance (MR) imaging is the radiological modality of choice in the diagnostic assessment of posterior instability. Computed tomography (CT) is useful in the evaluation of osseous abnormalities associated with posterior instability. A detailed description of the posterior osseous and labroligamentous abnormalities has evolved recently, and many variant lesions of the posteroinferior labrum and/or capsular structures have been described. As the recommended surgical management of lesions associated with posterior instability is a lesion-specific approach, awareness of the specific lesions that have been described in association with posterior instability helps in pre-surgical planning. The purpose of this article is to review the classification of, and injury mechanisms leading to, posterior shoulder instability and to describe imaging findings associated with posterior instability, with emphasis on MR imaging. (orig.)

Intertester reliability of clinical shoulder instability and laxity tests in subjects with and without self-reported shoulder problems.

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Eshoj, Henrik; Ingwersen, Kim Gordon; Larsen, Camilla Marie; Kjaer, Birgitte Hougs; Juul-Kristensen, Birgit

2018-03-03

First, to investigate the intertester reliability of clinical shoulder instability and laxity tests, and second, to describe the mutual dependency of each test evaluated by each tester for identifying self-reported shoulder instability and laxity. A standardised protocol for conducting reliability studies was used to test the intertester reliability of the six clinical shoulder instability and laxity tests: apprehension, relocation, surprise, load-and-shift, sulcus sign and Gagey. Cohen's kappa (κ) with 95% CIs besides prevalence-adjusted and bias-adjusted kappa (PABAK), accounting for insufficient prevalence and bias, were computed to establish the intertester reliability and mutual dependency. Forty individuals (13 with self-reported shoulder instability and laxity-related shoulder problems and 27 normal shoulder individuals) aged 18-60 were included. Fair (relocation), moderate (load-and-shift, sulcus sign) and substantial (apprehension, surprise, Gagey) intertester reliability were observed across tests (κ 0.39-0.73; 95% CI 0.00 to 1.00). PABAK improved reliability across tests, resulting in substantial to almost perfect intertester reliability for the apprehension, surprise, load-and-shift and Gagey tests (κ 0.65-0.90). Mutual dependencies between each test and self-reported shoulder problem showed apprehension, relocation and surprise to be the most often used tests to characterise self-reported shoulder instability and laxity conditions. Four tests (apprehension, surprise, load-and-shift and Gagey) out of six were considered intertester reliable for clinical use, while relocation and sulcus sign tests need further standardisation before acceptable evidence. Furthermore, the validity of the tests for shoulder instability and laxity needs to be studied. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evaluation and Management of Failed Shoulder Instability Surgery.

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Cartucho, António; Moura, Nuno; Sarmento, Marco

2017-01-01

Failed shoulder instability surgery is mostly considered to be the recurrence of shoulder dislocation but subluxation, painful or non-reliable shoulder are also reasons for patient dissatisfaction and should be considered in the notion. The authors performed a revision of the literature and online contents on evaluation and management of failed shoulder instability surgery. When we look at the reasons for failure of shoulder instability surgery we point the finger at poor patient selection, technical error and an additional traumatic event. More than 80% of surgical failures, for shoulder instability, are associated with bone loss. Quantification of glenoid bone loss and investigation of an engaging Hill-Sachs lesion are determining facts. Adequate imaging studies are determinant to assess labrum and capsular lesions and to rule out associated pathology as rotator cuff tears. CT-scan is the method of choice to diagnose and quantify bone loss. Arthroscopic soft tissue procedures are indicated in patients with minimal bone loss and no contact sports. Open soft tissue procedures should be performed in patients with small bone defects, with hiperlaxity and practicing contact sports. Soft tissue techniques, as postero-inferior capsular plication and remplissage, may be used in patients with less than 25% of glenoid bone loss and Hill-Sachs lesions. Bone block procedures should be used for glenoid larger bone defects in the presence of an engaging Hill-Sachs lesion or in the presence of poor soft tissue quality. A tricortical iliac crest graft may be used as a primary procedure or as a salvage procedure after failure of a Bristow or a Latarjet procedure. Less frequently, the surgeon has to address the Hill-Sachs lesion. When a 30% loss of humeral head circumference is present a filling graft should be used. Reasons for failure are multifactorial. In order to address this entity, surgeons must correctly identify the causes and tailor the right solution.

Prevalence and variance of shoulder injuries in elite collegiate football players.

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Kaplan, Lee D; Flanigan, David C; Norwig, John; Jost, Patrick; Bradley, James

2005-08-01

Shoulder injuries are the fourth most common musculoskeletal injury encountered in American football players. There is little information in the literature on the role of playing position in the type of shoulder injuries seen. There is a high prevalence of shoulder injuries in elite collegiate American football players, with type of injury varying by playing position. Cohort study (prevalence); Level of evidence, 3. A total of 336 elite collegiate American football players were invited to the National Football League Combine for physical testing and medical evaluation. Current and historical data were evaluated for the purpose of this study, and all players underwent radiographic examinations, including plain radiographs and/or magnetic resonance imaging when necessary. All shoulder pathological conditions and shoulder surgical procedures were recorded. Players were categorized by position for the analysis of position-specific trends. Of the players, 50% had a history of shoulder injuries, with a total of 226 shoulder injuries (1.3 injuries per player injured); 56 players (34%) had a total of 73 surgeries. The most common injuries were acromioclavicular separation (41%), anterior instability (20%), rotator cuff injury (12%), clavicle fracture (4%), and posterior instability (4%). The most common surgeries performed were anterior instability reconstruction (48%), Mumford/Weaver-Dunn surgery (15%), posterior instability surgery (10%), and rotator cuff surgery (10%). Shoulder injuries were more common in quarterbacks and defensive backs. Surgery was more common in linebackers or linemen. A history of anterior instability was more common in defensive players, with surgery required 76% of the time. Linemen had more rotator cuff injuries and posterior instability than players in other positions. Shoulder injuries are common injuries in elite collegiate football players, with one-third undergoing surgical procedures. There are definitive trends in the types of injuries

Reverse arthroplasty for osteoarthritis and rotator cuff deficiency after previous surgery for recurrent anterior shoulder instability.

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Raiss, Patric; Zeifang, Felix; Pons-Villanueva, Juan; Smithers, Christopher J; Loew, Markus; Walch, Gilles

2014-07-01

Osteoarthritis in combination with rotator cuff deficiency following previous shoulder stabilisation surgery and after failed surgical treatment for chronic anterior shoulder dislocation is a challenging condition. The aim of this study was to analyse the results of reverse shoulder arthroplasty in such patients. Thirteen patients with a median follow-up of 3.5 (range two to eight) years and a median age of 70 (range 48-82) years were included. In all shoulders a tear of at least one rotator cuff tendon in combination with osteoarthritis was present at the time of arthroplasty. The Constant score, shoulder flexion and external and internal rotation with the elbow at the side were documented pre-operatively and at the final follow-up. Pre-operative, immediate post-operative and final follow-up radiographs were analysed. All complications and revisions were documented. Twelve patients were either satisfied or very satisfied with the procedure. The median Constant score increased from 26 points pre-operatively to 67 points at the final follow-up (p = 0.001). The median shoulder flexion increased significantly from 70° to 130° and internal rotation from two to four points (p = 0.002). External rotation did not change significantly (p = 0.55). Glenoid notching was present in five cases and was graded as mild in three cases and moderate in two. One complication occurred leading to revision surgery. Reverse arthroplasty leads to high satisfaction rates for patients with osteoarthritis and rotator cuff deficiency who had undergone previous shoulder stabilisation procedures. The improvements in clinical outcome as well as the radiographic results seem to be comparable with those of other studies reporting on the outcome of reverse shoulder arthroplasty for other conditions.

Return to Play After Shoulder Instability Surgery in National Collegiate Athletic Association Division I Intercollegiate Football Athletes.

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Robins, R Judd; Daruwalla, Jimmy H; Gamradt, Seth C; McCarty, Eric C; Dragoo, Jason L; Hancock, Robert E; Guy, Jeffrey A; Cotsonis, George A; Xerogeanes, John W; Tuman, Jeffrey M; Tibone, James E; Javernick, Matthew A; Yochem, Eric M; Boden, Stephanie A; Pilato, Alexis; Miley, Jennifer H; Greis, Patrick E

2017-08-01

Recent attention has focused on the optimal surgical treatment for recurrent shoulder instability in young athletes. Collision athletes are at a higher risk for recurrent instability after surgery. To evaluate variables affecting return-to-play (RTP) rates in Division I intercollegiate football athletes after shoulder instability surgery. Case series; Level of evidence, 4. Invitations to participate were made to select sports medicine programs that care for athletes in Division I football conferences (Pac-12 Conference, Southeastern Conference [SEC], Atlantic Coast Conference [ACC]). After gaining institutional review board approval, 7 programs qualified and participated. Data on direction of instability, type of surgery, time to resume participation, and quality and level of play before and after surgery were collected. There were 168 of 177 procedures that were arthroscopic surgery, with a mean 3.3-year follow-up. Overall, 85.4% of players who underwent arthroscopic surgery without concomitant procedures returned to play. Moreover, 15.6% of athletes who returned to play sustained subsequent shoulder injuries, and 10.3% sustained recurrent instability, resulting in reduction/revision surgery. No differences were noted in RTP rates in athletes who underwent anterior labral repair (82.4%), posterior labral repair (92.9%), combined anterior-posterior repair (84.8%; P = .2945), or open repair (88.9%; P = .9362). Also, 93.3% of starters, 95.4% of utilized players, and 75.7% of rarely used players returned to play. The percentage of games played before the injury was 49.9% and rose to 71.5% after surgery ( P surgery. Scholarship status significantly correlated with RTP after surgery ( P = .0003). The majority of surgical interventions were isolated arthroscopic stabilization procedures, with no statistically significant difference in RTP rates when concomitant arthroscopic procedures or open stabilization procedures were performed. Athletes who returned to play often

Avoiding Shoulder Injury from Resistance Training.

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Durall, Chris J.; Manske, Robert C.; Davies, George J.

2001-01-01

Identifies shoulder exercises commonly performed in fitness centers that may contribute to or exacerbate glenohumeral joint (shoulder) injury, describing alternative exercises that may be substituted and a offering rationale for the variations. The article focuses on anterior and posterior glenohumeral instability, subacromial impingement (primary…

An Evaluation of the Responsiveness and Discriminant Validity of Shoulder Questionnaires among Patients Receiving Surgical Correction of Shoulder Instability

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Kyle A. R. Kemp

2012-01-01

Full Text Available Health-related quality-of-life (HRQL measures must detect clinically important changes over time and between different patient subgroups. Forty-three patients (32 M, 13 F; mean age  =  26.00  ±  8.19 years undergoing arthroscopic Bankart repair completed three validated shoulder questionnaires (Western Ontario Shoulder Instability index (WOSI, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment form (ASES, Constant score preoperatively, and at 6, 12, and 24 months postoperatively. Responsiveness and discriminant validity was assessed between those with a satisfactory outcome and those with (1 a major recurrence of instability, (2 a single episode of subluxation, (3 any postoperative episode of instability. Eight (20% patients reported recurrent instability. Compared to baseline, the WOSI detected improvement at the 6- (P<0.001 and 12-month (P=0.011 evaluations. The ASES showed improvement at 6 months (P=0.003, while the Constant score did not report significant improvement until 12 months postoperatively (P=0.001. Only the WOSI detected differential shoulder function related to shoulder instability. Those experiencing even a single episode of subluxation reported a 10% drop in their WOSI score, attaining the previously established minimal clinically important difference (MCID. Those experiencing a frank dislocation or multiple episodes of subluxation reported a 20% decline. The WOSI allows better discrimination of the severity of postoperative instability symptoms following arthroscopic Bankart repair.

[Open-wedge osteotomy of the glenoid for treatment of posterior shoulder instability with increased glenoid retroversion].

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Pogorzelski, J; Braun, S; Imhoff, A B; Beitzel, K

2016-12-01

Treatment of posterior shoulder instability with increased retroversion of the glenoid using open-wedge osteotomy of the glenoid neck stabilized with an autologous bone block. Symptomatic, atraumatic posterior shoulder instability with increased retroversion (>20°) of the glenoid and previously failed conservative or surgical treatment. General contraindications against surgery. Relative contraindications: osteoporosis, nicotine abuse, or suspected patient noncompliance. Posterior approach with a 7 cm long incision starting medial of the posterolateral corner of the acromion heading to the posterior axillary fold and subsequent preparation of the deltoid muscle and the infraspinatus muscle. The posterior glenohumeral capsule is incised by performing a capsular T‑shift. The osteotomy is performed intracapsulary medial to the genoid rim. The wedge bone graft, harvested from spina scapulae or iliac spine, is placed "press fit" in position. Additional fixation of the graft is not necessary if the anterior cortex is intact. For reinforcing the posterior capsule, a posterior capsule shift should be performed. Insertion of extracapsular wound drainage. Successive wound closure. Postoperative immobilization in a 0° shoulder orthesis for 6 weeks; avoidance of horizontal abduction for 8 weeks. After removing the wound drainage, start of limited active-assisted range of motion. Over-head sports after 6 months. From 2009-2015, 6 posterior open wedge glenoid osteotomies were performed. Postoperative retroversion of the glenoid was 11.2 ± 9.4° compared to 26.0 ± 8.6° before surgery. Of 6 shoulders, 2 showed postoperative signs of persistent posterior instability; the other 4 shoulders were free of complaints. No revision surgery was needed.

The anterior tilt of the acromion: radiographic evaluation and correlation with shoulder diseases

International Nuclear Information System (INIS)

Prato, N.; Peloso, D.; Franconeri, A.; Tegaldo, G.; Ravera, G.B.; Silvestri, E.; Derchi, L.E.

1998-01-01

The aim of this study was to test whether the anterior tilt of the acromion can be objectively evaluated on lateral radiographs, and whether there is a relation between this anatomical feature and the most common shoulder diseases. Lateral radiographs of 15 dried scapulas were performed in neutral position and with 5 of caudal, cranial, anterior and posterior angulations. Two hundred and forty-three shoulders, both asymptomatic and affected by chronic and post-traumatic impingement, calcific tendinitis and instability, were examined by conventional radiography. The presence of rotator-cuff tears was investigated by sonography. A method was elaborated to obtain reproducible lateral radiographs and to determine the acromial tilt angle. Inter- and intraobserver and inter- and intraoperator variations in measurements were evaluated. Variations in tube angulation produced changes in tilt-angle values on dried scapulas. The average tilt angle for the chronic impingement and the instability groups were significantly different from the post-traumatic, calcific tendinitis and control groups. Rotator-cuff tears were significantly more frequent in the chronic impingement group and related to a more acute tilt angle. The inter- and intraobserver variability coefficients were 0.95 and 0.98, whereas the inter- and intraoperator variability coefficients were 0.94 and 0.96, respectively. Conventional radiography using fluoroscopy for positioning is a well-reproducible method for the evaluation of acromial tilt. There is a significant difference in tilt-angle values between some groups of subjects examined, but the lack of specificity limits the clinical importance of such measurement. (orig.)

The anterior tilt of the acromion: radiographic evaluation and correlation with shoulder diseases

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Prato, N.; Peloso, D.; Franconeri, A. [Department of Radiology, San Carlo Hospital, Genoa (Italy); Tegaldo, G. [Dept. of Orthopaedic Surgery, San Carlo Hospital, Genoa (Italy); Ravera, G.B. [Inst. of Medical Statistics and Biometry, University of Genoa (Italy); Silvestri, E.; Derchi, L.E. [Inst. of Radiology, University of Genoa (Italy)

1998-12-01

The aim of this study was to test whether the anterior tilt of the acromion can be objectively evaluated on lateral radiographs, and whether there is a relation between this anatomical feature and the most common shoulder diseases. Lateral radiographs of 15 dried scapulas were performed in neutral position and with 5 of caudal, cranial, anterior and posterior angulations. Two hundred and forty-three shoulders, both asymptomatic and affected by chronic and post-traumatic impingement, calcific tendinitis and instability, were examined by conventional radiography. The presence of rotator-cuff tears was investigated by sonography. A method was elaborated to obtain reproducible lateral radiographs and to determine the acromial tilt angle. Inter- and intraobserver and inter- and intraoperator variations in measurements were evaluated. Variations in tube angulation produced changes in tilt-angle values on dried scapulas. The average tilt angle for the chronic impingement and the instability groups were significantly different from the post-traumatic, calcific tendinitis and control groups. Rotator-cuff tears were significantly more frequent in the chronic impingement group and related to a more acute tilt angle. The inter- and intraobserver variability coefficients were 0.95 and 0.98, whereas the inter- and intraoperator variability coefficients were 0.94 and 0.96, respectively. Conventional radiography using fluoroscopy for positioning is a well-reproducible method for the evaluation of acromial tilt. There is a significant difference in tilt-angle values between some groups of subjects examined, but the lack of specificity limits the clinical importance of such measurement. (orig.) With 6 figs., 3 tabs., 34 refs.

Arthroscopic Bankart Repair Versus Open Bristow-Latarjet for Shoulder Instability: A Matched-Pair Multicenter Study Focused on Return to Sport.

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Blonna, Davide; Bellato, Enrico; Caranzano, Francesco; Assom, Marco; Rossi, Roberto; Castoldi, Filippo

2016-12-01

The arthroscopic Bankart repair and open Bristow-Latarjet procedure are the 2 most commonly used techniques to treat recurrent shoulder instability. To compare in a case control-matched manner the 2 techniques, with particular emphasis on return to sport after surgery. Cohort study; Level of evidence, 3. A study was conducted in 2 hospitals matching 60 patients with posttraumatic recurrent anterior shoulder instability with a minimum follow-up of 2 years (30 patients treated with arthroscopic Bankart procedure and 30 treated with open Bristow-Latarjet procedure). Patients with severe glenoid bone loss and revision surgeries were excluded. In one hospital, patients were treated with arthroscopic Bankart repair using anchors; in the other, patients underwent the Bristow-Latarjet procedure. Patients were matched according to age at surgery, type and level of sport practiced before shoulder instability (Degree of Shoulder Involvement in Sports [DOSIS] scale), and number of dislocations. The primary outcomes were return to sport (Subjective Patient Outcome for Return to Sports [SPORTS] score), rate of recurrent instability, Oxford Shoulder Instability Score (OSIS), Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability Index (WOSI), and range of motion (ROM). After a mean follow-up of 5.3 years (range, 2-9 years), patients who underwent arthroscopic Bankart repair obtained better results in terms of return to sport (SPORTS score: 8 vs 6; P = .02) and ROM in the throwing position (86° vs 79°; P = .01), and they reported better subjective perception of the shoulder (SSV: 86% vs 75%; P = .02). No differences were detectable using the OSIS or WOSI. The rate of recurrent instability was not statistically different between the 2 groups (Bankart repair 10% vs Bristow-Latarjet 0%; P = .25), although the study may have been underpowered to detect a clinically important difference in this parameter. The multiple regression analysis showed that the independent

Shoulder instability: the role of MR arthrography in diagnosing anteroinferior labroligamentous lesions our experience at king hussein medical center

International Nuclear Information System (INIS)

Hiari, A. A.

2008-01-01

To determine the reliability and accuracy of magnetic resonance arthrography of the shoulder for the diagnosis of anteroinferior labroligamentous lesions in patients with gleno-humeral joint instability. This retrospective study was performed at King Hussein Medical Center in Jordan. Twenty eight patients who underwent shoulder MR arthrogram and arthroscopy during a 22-month period were reviewed. All the twenty eight patients had history of previous shoulder dislocation and clinical suspicion of anteroinferior labroligamentous lesions and glenohumeral joint instability. The series included 24 males and 4 females. The mean average age of the patients was 29 years. All patients underwent shoulder MR arthrogram and the results of MR arthrogram were compared with the arthroscopic findings which were used as the reference standard. MR arthrograms were analyzed for the presence and type of labroligamentous injuries which include (Bankart, anterior labral periosteal sleeve avulsion (ALPSA), Perthes, glenolabral articular disruption (GLAD), or nonclassifiable lesion). Sensitivity, specificity and accuracy for the detection and classification of anteroinferior labroligamentous lesions with MR arthrography were calculated. At arthroscopy, 21 anteroinferior labroligamentous lesions were diagnosed, including 15 Bankart lesions, three ALPSA lesions, two Perthes lesions and one GLAD lesion. Seven labral lesions were nonclassifiable at arthroscopy, all of which occurred after a history of chronic instability. When compared with arthroscopic findings, Shoulder MR Arthrography had two false-negative results (sensitivity, 92.8%) and no false-positive results. The sensitivity of shoulder MR Arthrography in detecting anteroinferior labroligamentous lesions was 92.8% (26/28) and specificity was (100%). The overall accuracy of Shoulder MR Arthrography in detecting labroligamentous lesions in this study was 90.5% (19/21). MR arthrography of the shoulder is reliable and accurate in

External rotation immobilization for primary shoulder dislocation: a randomized controlled trial.

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Whelan, Daniel B; Litchfield, Robert; Wambolt, Elizabeth; Dainty, Katie N

2014-08-01

The traditional treatment for primary anterior shoulder dislocations has been immobilization in a sling with the arm in a position of adduction and internal rotation. However, recent basic science and clinical data have suggested recurrent instability may be reduced with immobilization in external rotation after primary shoulder dislocation. We performed a randomized controlled trial to compare the (1) frequency of recurrent instability and (2) disease-specific quality-of-life scores after treatment of first-time shoulder dislocation using either immobilization in external rotation or immobilization in internal rotation in a group of young patients. Sixty patients younger than 35 years of age with primary, traumatic, anterior shoulder dislocations were randomized (concealed, computer-generated) to immobilization with either an internal rotation sling (n = 29) or an external rotation brace (n = 31) at a mean of 4 days after closed reduction (range, 1-7 days). Patients with large bony lesions or polytrauma were excluded. The two groups were similar at baseline. Both groups were immobilized for 4 weeks with identical therapy protocols thereafter. Blinded assessments were completed by independent observers for a minimum of 12 months (mean, 25 months; range, 12-43 months). Recurrent instability was defined as a second documented anterior dislocation or multiple episodes of shoulder subluxation severe enough for the patient to request surgical stabilization. Validated disease-specific quality-of-life data (Western Ontario Shoulder Instability index [WOSI], American Shoulder and Elbow Surgeons evaluation [ASES]) were also collected. Ten patients (17%, five from each group) were lost to followup. Reported compliance with immobilization in both groups was excellent (80%). With the numbers available, there was no difference in the rate of recurrent instability between groups: 10 of 27 patients (37%) with the external rotation brace versus 10 of 25 patients (40%) with the

Immobilization in External Rotation Versus Internal Rotation After Primary Anterior Shoulder Dislocation: A Meta-analysis of Randomized Controlled Trials.

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Whelan, Daniel B; Kletke, Stephanie N; Schemitsch, Geoffrey; Chahal, Jaskarndip

2016-02-01

The recurrence rate after primary anterior shoulder dislocation is high, especially in young, active individuals. Recent studies have suggested external rotation immobilization as a method to reduce the rate of recurrent shoulder dislocation in comparison to traditional sling immobilization. To assess and summarize evidence from randomized controlled trials on the effect of internal rotation versus external rotation immobilization on the rate of recurrence after primary anterior shoulder dislocation. Meta-analysis. PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and abstracts from recent proceedings were searched for eligible studies. Two reviewers selected studies for inclusion, assessed methodological quality, and extracted data. Six randomized controlled trials (632 patients) were included in this review. Demographic and prognostic variables measured at baseline were similar in the pooled groups. The average age was 30.1 years in the pooled external rotation group and 30.3 years in the pooled internal rotation group. Two studies found that external rotation immobilization reduced the rate of recurrence after initial anterior shoulder dislocation compared with conventional internal rotation immobilization, whereas 4 studies failed to find a significant difference between the 2 groups. This meta-analysis suggested no overall significant difference in the rate of recurrence among patients treated with internal rotation versus external rotation immobilization (risk ratio, 0.69; 95% CI, 0.42-1.14; P = .15). There was no significant difference in the rate of compliance between internal and external rotation immobilization (P = .43). The Western Ontario Shoulder Instability Index scores were pooled across 3 studies, and there was no significant difference between the 2 groups (P = .54). Immobilization in external rotation is not significantly more effective in reducing the recurrence rate after primary anterior shoulder dislocation than

Simultaneous Anterior Glenohumeral Dislocation and Ipsilateral Acromioclavicular Separation: A Dual Injury of the Shoulder.

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Kılıçaslan, Ömer Faruk; Acar, Baver; Atik, Aziz; Kose, Ozkan

2017-08-19

Isolated acromioclavicular separations or shoulder dislocations are common injuries. However, a combination of complete acromioclavicular separation and anterior shoulder dislocation is extremely rare. Herein we present a combination of anterior shoulder dislocation and type III acromioclavicular separation that was succesfully treated conservatively. Orthopaedic surgeons should have a high clinical suspicion in daily practice. We believe that both pathologies can be treated conservatively.

Operative shoulder instability injury management in Australian Football League players: A case series.

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Bonacci, Jason; Manson, Brent; Bowe, Steven J; Gill, Stephen; Seward, Hugh; Hoy, Greg; Page, Richard

2017-11-27

The purpose of this study was to review the surgical management procedures of shoulder instability injuries in Australian Football League (AFL) players, and determine outcomes regarding return to sport and injury recurrence. Retrospective cohort study. Elite AFL players with shoulder instability resulting in surgery were assessed in a retrospective cohort design (72 players/77 shoulders). Type of initial injury, surgical management, return to sport and injury recurrence were obtained. The mean follow-up period post-surgery was 2.9 years. Return to sport outcomes were compared between arthroscopic and open surgery using a Kaplan-Meier survival analysis. Logistic regression modelling was used to determine associations between injury recurrence, type of injury, participant age and method of surgery. Shoulder instability injuries occurred most frequently during tackling (40%). Arthroscopic surgery was preferred for primary shoulder instability. Nine (16%) recurrences occurred in those who underwent arthroscopic surgery compared to two (9%) following open surgery. Return to the elite level was slightly but significantly (2 weeks, p=0.049) longer for open compared to arthroscopic surgery. Recurrence was 5 times more likely if the primary injury was a dislocation and more likely in players who were younger at the time of surgery. Tackling was the predominant mechanism for shoulder instability injuries in AFL players and arthroscopic surgery was more commonly performed for primary injuries. Sustaining a dislocation as the primary injury and younger age increased the likelihood of recurrent instability. Careful consideration should be given to the operative management of these individuals. Copyright © 2017. Published by Elsevier Ltd.

The MR arthrographic anatomy of the biceps labral insertion and its morphological significance with labral tears in patients with shoulder instability

International Nuclear Information System (INIS)

Jakanani, G.C.; Botchu, R.; Rennie, W.J.

2012-01-01

Introduction: Most of the fibres of the long head of biceps tendon attach on the superior labrum just posterior to the supraglenoid tubercle. Aim: Our hypothesis was that posteriorly attached biceps tendons predispose to posterior superior labral tears and SLAP lesions. Methods and materials: A prospective analysis of all MR shoulder arthrograms for shoulder instability referred from the shoulder specialist clinics, performed during a one year period were reviewed by two independent observers who were blinded to clinical history. The biceps attachment was classified into four groups according to the method described in an earlier cadaveric study into four groups; posterior-type 1, predominantly posterior-type 2, equal contributions to both anterior and posterior labrum-type 3 and predominantly anterior labral attachment-type 4. Data was analysed using Kappa statistics and Fischer's exact test. Results: 48 patients (33 males and 15 females) were included in this study with a mean age of 32 years. Majority, 22 patients (46%) had a type 1 attachment of the biceps on the superior labrum. There was moderate intra-observer and good interobserver agreement with a Kappa of 0.58 and 0.63 respectively. There was a significant association between a type 2 attachment and posterior tears (p ≤ 0.04) and also between a type 2 attachment and SLAP tears (p ≤ 0.04). Conclusion: Our results suggest that variation in anatomy of biceps origin influences the type of labral tears that occur in patients with shoulder instability. The importance of these findings could influence selection of individuals in throwing sports like cricket and baseball.

The MR arthrographic anatomy of the biceps labral insertion and its morphological significance with labral tears in patients with shoulder instability

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Jakanani, G.C., E-mail: gcjakanani@gmail.com [Leicester Royal Infirmary, Leicester (United Kingdom); Botchu, R., E-mail: drrajeshb@gmail.com [Leicester Royal Infirmary, Leicester (United Kingdom); Rennie, W.J., E-mail: winston.rennie@gmail.com [Leicester Royal Infirmary, Leicester (United Kingdom)

2012-11-15

Introduction: Most of the fibres of the long head of biceps tendon attach on the superior labrum just posterior to the supraglenoid tubercle. Aim: Our hypothesis was that posteriorly attached biceps tendons predispose to posterior superior labral tears and SLAP lesions. Methods and materials: A prospective analysis of all MR shoulder arthrograms for shoulder instability referred from the shoulder specialist clinics, performed during a one year period were reviewed by two independent observers who were blinded to clinical history. The biceps attachment was classified into four groups according to the method described in an earlier cadaveric study into four groups; posterior-type 1, predominantly posterior-type 2, equal contributions to both anterior and posterior labrum-type 3 and predominantly anterior labral attachment-type 4. Data was analysed using Kappa statistics and Fischer's exact test. Results: 48 patients (33 males and 15 females) were included in this study with a mean age of 32 years. Majority, 22 patients (46%) had a type 1 attachment of the biceps on the superior labrum. There was moderate intra-observer and good interobserver agreement with a Kappa of 0.58 and 0.63 respectively. There was a significant association between a type 2 attachment and posterior tears (p {<=} 0.04) and also between a type 2 attachment and SLAP tears (p {<=} 0.04). Conclusion: Our results suggest that variation in anatomy of biceps origin influences the type of labral tears that occur in patients with shoulder instability. The importance of these findings could influence selection of individuals in throwing sports like cricket and baseball.

Posterior shoulder instability in the athletic population: Variations in assessment, clinical outcomes, and return to sport.

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DeLong, Jeffrey M; Bradley, James P

2015-12-18

Posterior instability of the shoulder is becoming an increasingly recognized shoulder injury in the athletic population. Diagnostic elements, such as etiology, directionality, and degree of instability are essential factors to assess in the unstable athletic shoulder. Concomitant injuries and associated pathologic lesions continue to be a significant challenge in the surgical management of posterior shoulder instability. Return to sport and previous level of play is ultimately the goal for every committed athlete and surgeon, thus subpopulations of athletes should be recognized as distinct entities requiring unique diagnostic, functional outcome measures, and surgical approaches.

Measurement of angles of abduction for diagnosis of shoulder instability in dogs using goniometry and digital image analysis.

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Cook, James L; Renfro, Daniel C; Tomlinson, James L; Sorensen, Jill E

2005-01-01

To compare abduction angles of shoulders with medial instability and unaffected shoulders in the same dogs and in age- and breed-matched dogs. Case-control study. Dogs with medial instability of the shoulder (n=33) and 26 control dogs. Dogs were sedated and positioned in lateral recumbency with both scapulas parallel to the table. With the elbow and shoulder in extension, the non-recumbent limb was maximally abducted and the angle between the scapular spine and lateral aspect of the brachium measured with a goniometer; a digital image was taken from the cranial aspect. Both techniques were performed in triplicate by 2 examiners. Mean abduction angles for each shoulder were determined from goniometric measurements and image analysis. Data were analyzed for significant differences between affected and unaffected shoulders, measurement techniques, and examiners. Strength of correlation between measurement techniques was determined. Mean abduction angles for shoulders with instability (53.7+/-4.7 degrees goniometric, 51.2+/-4.9 degrees image) were significantly (P<.001) larger than for all unaffected shoulders (32.6+/-2.0 degrees goniometric, 30.9+/-2.3 degrees image). In dogs diagnosed with instability, affected shoulders had significantly (P<.001) larger abduction angles than the contralateral (unaffected) shoulders. No significant differences were identified between right and left shoulders for control dogs, measurement techniques, or examiners. A strong (r=0.90) significant (P<.001) positive correlation between measurement techniques was noted. Shoulder abduction angles measured under sedation provide objective data for diagnosis of shoulder instability in dogs. Shoulders with clinical and arthroscopic evidence of medial instability have significantly higher abduction angles than shoulders that are considered normal. Determination of shoulder abduction angles should be included in the diagnostic protocol for forelimb lameness assessment in dogs.

History and Physical Examination for Shoulder Instability.

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Haley, Col Chad A

2017-09-01

Glenohumeral instability frequently occurs in young active individuals especially those engaged in athletic and military activities. With advanced imaging and arthroscopic evaluation, our understanding of the injury patterns associated with instability has significantly improved. The majority of instability results from a traumatic anterior event which presents with common findings in the history, examination, and imaging studies. As such, a comprehensive evaluation of the patient is important to correctly diagnose the instability patterns and thus provide appropriate treatment intervention. With the correct diagnosis and improved surgical techniques, the majority of patients with instability can return to preinjury levels.

Conservative management following closed reduction of traumatic anterior dislocation of the shoulder.

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Hanchard, Nigel C A; Goodchild, Lorna M; Kottam, Lucksy

2014-04-30

returning to pre-injury levels of activity, this equates to 161 more (95% CI 76 fewer to 395 more) participants per 1000 resuming activity after immobilisation in external rotation.One trial reported that the difference between the two groups in Western Ontario Shoulder Instability Index scores, analysed using non-parametric statistics, was "not significant (P = 0.32)". Of our secondary outcomes, pooling was possible for "any instability" (two trials) and for important adverse events (three events, two trials). However, adverse event data were collected only in an ad hoc way, and it is unclear whether identification and reporting of such events was comprehensive. No report addressed participant satisfaction or health-related quality of life outcome measures.There was no evidence confirming a difference between the two positions of immobilisation in any of the primary or secondary outcomes; for each outcome, the confidence intervals were wide, covering the possibility of substantial benefit for each intervention. Numerous conservative strategies may be adopted after closed reduction of a traumatic anterior dislocation of the shoulder, and many warrant investigation. However, our review reveals that evidence from randomised controlled trials is only available for a single approach: immobilisation in external rotation versus immobilisation in the traditional position of internal rotation. Moreover, this evidence is insufficient to demonstrate whether immobilisation in external rotation confers any benefit over immobilisation in internal rotation.We identified six unpublished trials and two ongoing trials that compare immobilisation in external versus internal rotation. Given this, the main priority for research on this question consists of the publication of completed trials, and the completion and publication of ongoing trials. Meanwhile, increased attention to other interventions is required. Sufficiently powered, good quality, well reported randomised controlled trials with

Arthroscopic management of traumatic anterior shoulder instability in collision athletes: analysis of 204 cases with a 4- to 9-year follow-up and results with the suture anchor technique.

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Larrain, Mario Victor; Montenegro, Hugo Jorge; Mauas, David Marcelo; Collazo, Cristian Carlos; Pavón, Facundo

2006-12-01

The purpose of this study was to determine the effectiveness of arthroscopy in the selection of surgical procedure and treatment of both acute and recurrent traumatic anterior shoulder instability in rugby players by use of pre-established selection criteria. We describe the injury mechanisms, analyze the pathologic lesions and treatment indications based on surgical findings, and assess the results in patients treated with the arthroscopic suture anchor technique. From November 1996 to November 2001, 204 rugby players with acute or recurrent traumatic anterior instability underwent an initial arthroscopic examination. Criteria such as type of Bankart lesion, tissue quality, and presence of bony defects were evaluated and used to determine the method of stabilization: arthroscopy or open stabilization. Open surgery was indicated in patients with bone humeral deficiencies greater than one fourth of the articular humeral head, bone glenoid deficiencies greater than 25% of the glenoid extension, capsular laxity with poor tissue quality, and humeral avulsion of the glenohumeral ligament; all other patients underwent arthroscopic reconstruction via the bone suture anchor technique. The mean follow-up was 5.9 years (range, 3.9 to 8.9 years). We performed arthroscopic stabilization in 39 cases of acute instability; only 1 case (2.5%) required the mini-open technique for reinsertion of humeral avulsion of the glenohumeral ligament. Of 158 cases of recurrent instability, 121 underwent arthroscopic stabilization, and 37 (23.4%) required reconstruction with open surgery. The main cause was bony deficiency (treated with the Latarjet procedure). The results of the arthroscopic reconstructions were evaluated by use of the Rowe scale and analyzed according to stability and range of motion. Good or excellent results were found in 94.9% of cases in the acute instability group and in 91.8% in the recurrent instability group, the poor results were due to instability recurrence. In

BILATERAL ANTERIOR DISLOCATION OF SHOULDER WITH GREATER TUBEROSITY FRACTURE DUE TO HYPONATREMIA : A RARE PRESENTATION

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Sivananda

2015-01-01

Full Text Available We here report a rare presentation of bilateral anterior dislocation of shoulder with associated fracture of greater tuberosity in a 38 year old male due to minor trauma which he sustained secondary to hyponatremia induced irritability. There was no associ ated rotator cuff tear which is often associated with BADS which makes this presentation unique. Unilateral dislocation of shoulder is a common condition which is frequently encountered in emergency trauma department. Anterior dislocation is more common th an posterior dislocation. However, simultaneous bilateral shoulder dislocations are usually posterior. Bilateral anterior dislocations with fractures of the greater tuberosity are even rarer and are usually associated with trauma or seizures

Management of primary anterior shoulder dislocations using immobilization.

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Smith, Brent I; Bliven, Kellie C Huxel; Morway, Genoveffa R; Hurbanek, Jason G

2015-05-01

Reference/Citation : Paterson WH, Throckmorton TW, Koester M, Azar FM, Kuhn JE. Position and duration of immobilization after primary anterior shoulder dislocation: a systemic review and meta-analysis of the literature. J Bone Joint Surg Am. 2010;92(18):2924-2933. Does an optimum duration and position of immobilization after primary anterior shoulder dislocation exist for reducing recurrence rates? MEDLINE/PubMed, EMBASE, and Cochrane databases were searched up to December 2009 without limitations. The search terms for all databases used were shoulder AND dislocation and shoulder AND immobilization. Criteria used to include articles were (1) English language, (2) prospective level I or level II studies (according to Journal of Bone & Joint Surgery guidelines), (3) nonoperative management of initial anterior shoulder dislocation, (4) minimum follow-up of 1 year, and (5) rate of recurrent dislocation as a reported outcome. A standardized evaluation method was used to extract data to allow assessment of methods issues and statistical analysis to determine sources of bias. The primary outcome was the recurrence rate after nonoperative management of anterior shoulder dislocation. Additional data extracted and used in subanalyses included duration and position of immobilization and age at the time of initial dislocation. Data were analyzed to determine associations among groups using 2-tailed Fisher exact tests. For pooled categorical data, relative risk of recurrent dislocation, 95% confidence intervals, and heterogeneity using the I(2) statistic and χ(2) tests were calculated for individual studies. The Mantel-Haenszel method was used to combine studies and estimate overall relative risk of recurrent dislocation and 95% confidence intervals. The statistical difference between duration of immobilization and position was determined using z tests for overall effect. Pooled results were presented as forest plots. In the initial search of the databases, the authors

Irreducible Anterior Shoulder Dislocation Associated With Displaced Fracture of the Greater Tuberosity: An Analysis of Seven Cases

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Morteza Nakhaei Amroodi

2015-11-01

Full Text Available Background: Although anterior shoulder dislocation is the most prevalent type of body dislocation, irreducible anterior shoulder dislocation is seldom reported in the literature, which is usually due to physical obstacles. Objectives: This study presents our findings regarding the causes of irreducibility of anterior shoulder dislocation associated with displaced fracture of the greater tuberosity. Patients and Methods: CT scans, open reduction of the joint, and internal fixation of the tuberosity was performed in seven patients with irreducible anterior shoulder dislocation associated with displaced fracture of the greater tuberosity. Results: As confirmed by intraoperative findings, the CT scans showed the cause of irreducible shoulder dislocation in six cases was the interposition of the long head of biceps (LHB in the anterior of the head that was displaced from the fracture line between the greater and lesser tuberosities. In another case, the greater and lesser tuberosities were attached to each other and were separated from the head. This fractured part was trapped. Conclusions: We suggest that performing CT scans in all cases of anterior shoulder dislocations with displaced fracture of the greater tuberosity can help surgeons to diagnose the accompanying fractures and possible complications, such as irreducibility. If the fracture line passes through the bicipital groove or in the case of a shield fracture, possible irreducibility should be borne in mind.

Treatment of chronic anterior shoulder dislocation by open reduction and simultaneous Bankart lesion repair

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Rouhani Alireza

2010-06-01

Full Text Available Abstract Background Untreated chronic shoulder dislocation eventually leads to functional disability and pain. Open reduction with different fixation methods have been introduced for most chronic shoulder dislocation. We hypothesized that open reduction and simultaneous Bankart lesion repair in chronic anterior shoulder dislocation obviates the need for joint fixation and leads to better results than previously reported methods. Methods Eight patients with chronic anterior dislocation of shoulder underwent open reduction and capsulolabral complex repair after an average delay of 10 weeks from injury. Early motion was allowed the day after surgery in the safe position and the clinical and radiographic results were analyzed at an average follow-up of one year. Results The average Rowe and Zarin's score was 86 points. Four out of eight shoulders were graded as excellent, three as good and one as fair (Rowe and Zarins system. All patients were able to perform their daily activities and they had either mild or no pain. Anterior active forward flexion loss averaged 18 degrees, external active rotation loss averaged 17.5 degrees and internal active rotation loss averaged 3 vertebral body levels. Mild degenerative joint changes were noted in one patient. Conclusion The results show that the overall prognosis for this method of operation is more favorable than the previously reported methods and we recommend concomitant open reduction and capsulolabral complex repair for the treatment of old anterior shoulder dislocation. Level of Evidence Therapeutic study, Level IV (case series [no, or historical, control group

Shoulder arthroplasty for sequelae of poliomyelitis.

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Werthel, Jean-David; Schoch, Bradley; Sperling, John W; Cofield, Robert; Elhassan, Bassem T

2016-05-01

Polio infection can often lead to orthopedic complications such as arthritis, osteoporosis, muscle weakness, skeletal deformation, and chronic instability of the joints. The purpose of this study was to assess the outcomes and associated complications of arthroplasty in shoulders with sequelae of poliomyelitis. Seven patients (average age, 70 years) were treated between 1976 and 2013 with shoulder arthroplasty for the sequelae of polio. One patient underwent reverse shoulder arthroplasty, 2 had a hemiarthroplasty, and 4 had total shoulder arthroplasty. Average follow-up was 87 months. Outcome measures included pain, range of motion, and postoperative modified Neer ratings. Overall pain scores improved from 5 to 1.6 points (on a 5-point scale) after shoulder arthroplasty. Six shoulders had no or mild pain at latest follow-up, and 6 shoulders rated the result as much better or better. Mean shoulder elevation improved from 72° to 129°, and external rotation improved from 11° to 56°. Average strength in elevation decreased from 3.9 to 3.4 postoperatively, and external rotation strength decreased from 3.9 to 3.3. This, however, did not reach significance. Evidence of muscle imbalance with radiographic instability was found in 4 shoulders that demonstrated superior subluxation, anterior subluxation, or both. This remained asymptomatic. No shoulder required revision or reoperation. Shoulder arthroplasty provides significant pain relief and improved motion in patients with sequelae of poliomyelitis. Muscle weakness may be responsible for postoperative instability, and careful selection of the patient with good upper extremity muscles must be made. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The quantification of glenoid bone loss in anterior shoulder instability; MR-arthro compared to 3D-CT

International Nuclear Information System (INIS)

Markenstein, Jeroen E.; Jaspars, Kjell C.C.J.; Hulst, Victor P.M. van der; Willems, W.J.

2014-01-01

The purpose of this study is to investigate if magnetic resonance imaging with intra-articular contrast (MR-arthro) is as reliable as three-dimensionally reconstructed computed tomography imaging (3D-CT) in quantifying the glenoid bone loss in patients with anterior shoulder instability. Thirty-five patients were included. Sagittal MR-arthro and 3D-CT images of the glenoid surface were obtained pre-operatively. Two observers measured these images twice with OsiriX software in a randomized and blinded way. The intraclass correlations (ICC) of the intra- and inter-observer reliability within one method and an additional Bland-Altman plot for calculating agreement between the two methods were obtained. The joint estimates of the intra-observer reliability, taking into account the data from both observer A and B, for 3D-CT and MR-arthro were good to excellent. The intra-observer reliability was 0.938 (95 % CI: 0.879, 0.968) for 3D-CT and 0.799 (95 % CI: 0.639, 0.837) for MR-arthro. The inter-observer reliability between the two observers within one method (3D-CT or MR-arthro) was moderate to good. 3D-CT: 0.724 (95 % CI: 0.236, 0.886) and MR-arthro: 0.534 (95 % CI: 0.128, 0.762). Comparing both the 3D-CT and MR-arthro method, a Bland-Altman plot showed satisfying differences with the majority of outcomes (89 %) within 1 SD. Good to excellent intra- and moderate to good inter-observer correlations and a satisfying Bland-Altman plot when compared to 3D-CT show tendencies that MR-arthro is reliable and valid for measuring bony defects of the glenoid. (orig.)

The quantification of glenoid bone loss in anterior shoulder instability; MR-arthro compared to 3D-CT

Energy Technology Data Exchange (ETDEWEB)

Markenstein, Jeroen E. [Onze Lieve Vrouwe Gasthuis, Department of Orthopedic Surgery, Postbox 95500, Amsterdam (Netherlands); Jaspars, Kjell C.C.J. [Van Weel-Bethesda Ziekenhuis, Department of Orthopedic Surgery, Dirksland (Netherlands); Hulst, Victor P.M. van der [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Postbox 95500, Amsterdam (Netherlands); Willems, W.J. [Delairesse Kliniek, Department of Orthopedic Surgery, Amsterdam (Netherlands)

2014-04-15

The purpose of this study is to investigate if magnetic resonance imaging with intra-articular contrast (MR-arthro) is as reliable as three-dimensionally reconstructed computed tomography imaging (3D-CT) in quantifying the glenoid bone loss in patients with anterior shoulder instability. Thirty-five patients were included. Sagittal MR-arthro and 3D-CT images of the glenoid surface were obtained pre-operatively. Two observers measured these images twice with OsiriX software in a randomized and blinded way. The intraclass correlations (ICC) of the intra- and inter-observer reliability within one method and an additional Bland-Altman plot for calculating agreement between the two methods were obtained. The joint estimates of the intra-observer reliability, taking into account the data from both observer A and B, for 3D-CT and MR-arthro were good to excellent. The intra-observer reliability was 0.938 (95 % CI: 0.879, 0.968) for 3D-CT and 0.799 (95 % CI: 0.639, 0.837) for MR-arthro. The inter-observer reliability between the two observers within one method (3D-CT or MR-arthro) was moderate to good. 3D-CT: 0.724 (95 % CI: 0.236, 0.886) and MR-arthro: 0.534 (95 % CI: 0.128, 0.762). Comparing both the 3D-CT and MR-arthro method, a Bland-Altman plot showed satisfying differences with the majority of outcomes (89 %) within 1 SD. Good to excellent intra- and moderate to good inter-observer correlations and a satisfying Bland-Altman plot when compared to 3D-CT show tendencies that MR-arthro is reliable and valid for measuring bony defects of the glenoid. (orig.)

Surgical treatment of anterior instability in rugby union players: clinical and radiographic results of the Latarjet-Patte procedure with minimum 5-year follow-up.

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Neyton, Lionel; Young, Allan; Dawidziak, Bérangère; Visona, Enrico; Hager, Jean-Philippe; Fournier, Yann; Walch, Gilles

2012-12-01

Anterior instability in rugby players is characterized by the common finding of a bony lesion, which has been identified as a potential cause of recurrence after soft-tissue reconstruction. The Latarjet-Patte procedure is effective in the treatment of recurrent anterior instability in collision sports such as rugby union. We retrospectively assessed 34 rugby players (37 shoulders) stabilized with the Latarjet-Patte procedure. The mean follow-up was 12 years. All patients underwent clinical and radiographic assessment preoperatively and at final follow-up. Functional evaluation was performed with the Walch-Duplay and Rowe scores. A visual analog scale score for the evaluation of pain and the subjective shoulder value were recorded. In addition, all patients completed a questionnaire regarding the return to playing rugby. No recurrence of either dislocation or subluxation occurred. Persistent apprehension on clinical examination was present in 5 patients (14%). A bony lesion of the glenoid was present in 73% and a Hill-Sachs lesion in 68%. Sixty-five percent of the patients returned to playing rugby; only 1 patient did not return to playing rugby because of his shoulder. The mean Walch-Duplay and Rowe scores were 86 and 93 points, respectively. The mean subjective shoulder value was 90%. Radiographic healing of the bone block was observed in 89% of cases. At final follow-up, 11 patients (30%) had minor arthritic changes, with no cases of moderate or severe arthritis. The Latarjet-Patte procedure provides a reliable method for stabilizing the shoulder, resulting in a return to playing rugby in a high number of cases without increasing the risk of long-term arthritic degradation. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Bilateral recurrent anterior fracture dislocation of shoulder joint due to grand mal epileptic convulsions

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Chandrashekara Chowdipalya Maliyappa

2013-01-01

Full Text Available Bilateral shoulder dislocation is very much common with convulsions of different etiology. Often, these dislocations are associated with fractures due to violent muscle contractions. The typical lesion is bilateral posterior dislocation or fracture dislocations. The recurrent shoulder dislocations are common with traumatic etiology. The lack of asymmetry of the shoulders is stressed as a potential pitfall in the clinical evaluation of patients with this condition. We present a rare case of bilateral recurrent anterior fracture dislocation of the shoulder sustained due to repetitive episodes of convulsive seizures. Patient was treated by close reductions and immobilization on each episode. In epilepsy although posterior dislocations are common, the rare possibility of bilateral anterior fracture dislocation should be kept in mind. Often these patients are vulnerable for recurrence, similar to traumatic cases.

Fluoroscopically-Guided Posterior Approach for Shoulder Magnetic Resonance Arthrography: Comparison with Conventional Anterior Approach

International Nuclear Information System (INIS)

Yoo, Koun J.; Ha, Doo Hoe; Lee, Sang Min

2011-01-01

To prospectively evaluate the usefulness of the fluoroscopically-guided posterior approach compared with the anterior approach for shoulder magnetic resonance(MR) arthrography. Institutional review board approval and informed consent were obtained. Among 60 shoulder MR arthrographies performed on 59 patients with symptomatic shoulders, an intra-articular injection was performed (30 cases using the anterior approach and 30 using the posterior approach). Procedure-related pain was assessed by using a 5 score visual analogue scale (VAS). Depth of the puncture and standardized depth of puncture by body mass index (BMI) were recorded. The contrast leakage along the course of the puncture was evaluated by reviewing the MR. The statistical analyses included the Mann-Whitney U and Kruskal-Wallis test. There was no significant difference in VAS scores between the anterior and posterior groups (1.77 ± 1.10 vs. 1.80 ± 0.96). Depth of puncture and standardized depth of puncture by BMI were significantly shorter in the posterior group than those in the anterior group (4.4 ± 0.8 cm and 1.8 ± 0.3 cm vs. 6.6 ± 0.9 cm and 2.8 ± 0.4 cm, p < 0.001), respectively. The incidence of contrast leakage was more frequent in the posterior group (p = 0.003). The posterior approach will be useful in shoulder MR arthrography with a suspected anterior pathology, a postoperative follow-up study or obese patient.

Shoulder Instability

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... hit hard with your shoulder in a football game or serve a volleyball really hard. Diagnosis How ... editorial staff Categories: Family Health, Kids and Teens, Men, WomenTags: laxity, out of place, shakiness, shoulder, subluxation ...

Management of failed instability surgery: how to get it right the next time.

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Boone, Julienne L; Arciero, Robert A

2010-07-01

Traumatic anterior shoulder dislocations are the most frequent type of joint dislocation and affect approximately 1.7% of the general population. The literature supports the consideration of primary stabilization in high-risk patients because of reported recurrences as high as 80% to 90% with nonoperative treatment regimens. Successful stabilization of anterior glenohumeral instability relies on not only good surgical techniques but also careful patient selection. Failure rates after open and arthroscopic stabilization have been reported to range from 2% to 8% and 4% to 13%, respectively. Recurrent shoulder instability leads to increased morbidity to the patient, increased pain, decreased activity level, prolonged time away from work and sports, and a general decrease in quality of life. This article reviews the potential pitfalls in anterior shoulder stabilization and discusses appropriate methods of addressing them in revision surgery. Copyright 2010 Elsevier Inc. All rights reserved.

Arthroscopic repair of acute traumatic anterior shoulder dislocation in young athletes.

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Larrain, M V; Botto, G J; Montenegro, H J; Mauas, D M

2001-04-01

To compare the results of arthroscopic repair in acute anterior shoulder traumatic dislocation with those of nonoperative treatment. A prospective nonrandomized study was performed. Between August 1989 and April 1997, 46 patients were seen after a first episode of traumatic anterior shoulder dislocation. The average age was 21 years (range, 17 to 27 years). Most dislocations were in rugby players (36 patients). There were 18 patients treated by nonoperative methods and 28 patients treated by acute arthroscopic repair; 22 patients using transglenoid suture and 6 patients with bone anchor suture fixation. Of the patients treated nonoperatively, 94.5% suffered a redislocation between 4 and 18 months (average, 6 months). In the operative group, 96% of the patients (27) obtained excellent results according to the Rowe scale. Only 1 patient suffered a redislocation 1 year after surgery. Three different types of lesions were found during surgery: group I, capsular tear with no labrum lesion (4%); group II, capsular tear with partial labrum detachment (32%); and group III, capsular tear and full anterior labrum detachment (64%). The average follow-up was 67.4 months (range, 28 to 120). There were no surgical complications. The operative group obtained 96% excellent results, but the nonoperative group only obtained 5.5% excellent results, according to the Rowe scale. The nonoperative group showed a high incidence of redislocation (94.5%) compared with the operative group (4%). Based on the findings of this study, we recommend using an arthroscopic evaluation and repair after an initial anterior traumatic shoulder dislocation in young athletes.

Classification of instability after reverse shoulder arthroplasty guides surgical management and outcomes.

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Abdelfattah, Adham; Otto, Randall J; Simon, Peter; Christmas, Kaitlyn N; Tanner, Gregory; LaMartina, Joey; Levy, Jonathan C; Cuff, Derek J; Mighell, Mark A; Frankle, Mark A

2018-04-01

Revision of unstable reverse shoulder arthroplasty (RSA) remains a significant challenge. The purpose of this study was to determine the reliability of a new treatment-guiding classification for instability after RSA, to describe the clinical outcomes of patients stabilized operatively, and to identify those with higher risk of recurrence. All patients undergoing revision for instability after RSA were identified at our institution. Demographic, clinical, radiographic, and intraoperative data were collected. A classification was developed using all identified causes of instability after RSA and allocating them to 1 of 3 defined treatment-guiding categories. Eight surgeons reviewed all data and applied the classification scheme to each case. Interobserver and intraobserver reliability was used to evaluate the classification scheme. Preoperative clinical outcomes were compared with final follow-up in stabilized shoulders. Forty-three revision cases in 34 patients met the inclusion for study. Five patients remained unstable after revision. Persistent instability most commonly occurred in persistent deltoid dysfunction and postoperative acromial fractures but also in 1 case of soft tissue impingement. Twenty-one patients remained stable at minimum 2 years of follow-up and had significant improvement of clinical outcome scores and range of motion. Reliability of the classification scheme showed substantial and almost perfect interobserver and intraobserver agreement among all the participants (κ = 0.699 and κ = 0.851, respectively). Instability after RSA can be successfully treated with revision surgery using the reliable treatment-guiding classification scheme presented herein. However, more understanding is needed for patients with greater risk of recurrent instability after revision surgery. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Bony defects in chronic anterior posttraumatic dislocation of the shoulder: Is there a correlation between humeral and glenoidal lesions?

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Ciais, Grégoire; Klouche, Shahnaz; Fournier, Alexandre; Rousseau, Benoit; Bauer, Thomas; Hardy, Philippe

2016-08-01

The prevalence of combined humeral and glenoid defects varies between 79 and 84 % in case of chronic posttraumatic anterior shoulder instability. The main goal of this study was to evaluate the relationship between humeral and glenoid defects based on quantitative radiological criteria. A retrospective study was performed between 2000 and 2011 including patients who underwent primary surgical shoulder stabilization for chronic posttraumatic anterior shoulder instability, with bone defects in both the glenoid and humerus and a healthy contralateral shoulder. The following measurements were taken: D/R ratio (Hill-Sachs lesion depth/humeral head radius) on an AP X-ray in internal rotation and the D1/D2 ratio [diameter of the involved glenoid articular surfaces (D1)/the healthy one (D2)] on a comparative Bernageau glenoid profile view. Measurements were taken by two observers. Correlations were determined by the Spearman correlation coefficients (r), Bland and Altman diagrams, and intra-class correlation coefficients (ICC). A sample size calculation was done. Thirty patients were included, 25 men/5 women, mean age 29.8 ± 11.2 years. The mean D/R was 23 ± 12 % for observer 1 and 23 ± 10 % for observer 2. The mean D1/D2 was 95 ± 4 % for observer 1 and 94 ± 6 % for observer 2. No significant correlation was found between humeral and glenoid bone defects by observer 1 (r = 0.23, p = 0.22) or observer 2 (r = 0.05, p = 0.78). Agreement of the observers for the D/R ratio was excellent (ICC = 0.89 ± 0.04, p < 0.00001) and good for the D1/D2 ratio (ICC = 0.54 ± 0.14, p = 0.006). Humeral and glenoid bone defects were not correlated. Inter-observer reliability was excellent for the D/R ratio and good for the D1/D2 ratio. Nonconsecutive Patients, Diagnostic Study, Level III.

Rugby and Shoulder Trauma: A Systematic Review.

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Papalia, R; Tecame, A; Torre, G; Narbona, P; Maffulli, N; Denaro, V

2015-01-01

Rugby is a popular contact sport worldwide. Collisions and tackles during matches and practices often lead to traumatic injuries of the shoulder. This review reports on the epidemiology of injuries, type of lesions and treatment of shoulder injuries, risk factors, such as player position, and return to sport activities. Electronic searches through PubMed (Medline), EMBASE, and Cochrane Library retrieved studies concerning shoulder injuries in rugby players. Data regarding incidence, type and mechanisms of lesion, risk factors and return to sport were extracted and analyzed. The main reported data were incidence, mechanism of injury and type of lesion. Most of the studies report tackle as the main event responsible for shoulder trauma (between 50% and 85%), while the main lesions reported were Bankart lesions, Superior Labral tear from Anterior to Posterior (SLAP tears), anterior dislocation and rotator cuff tears. Open or arthroscopic repair improve clinical outcomes. Shoulder lesions are common injuries in rugby players. Surgical treatment seems to be effective in for rotator cuff tears and shoulder instability. More and better designed studies are needed for a higher Level of Evidence analysis of this topic.

Brachial plexus injury in anterior dislocation of shoulder -case report ...

African Journals Online (AJOL)

Brachial plexus injury in anterior dislocation of shoulder -case report and literature review. D Dhar. Abstract. No Abstract. Nigerian Journal of Orthopaedics and Trauma Vol. 6 () 2007: pp. 37-38. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

Clinical and Anatomic Predictors of Outcomes After the Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Combined Glenoid and Humeral Bone Defects.

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Mook, William R; Petri, Maximilian; Greenspoon, Joshua A; Horan, Marilee P; Dornan, Grant J; Millett, Peter J

2016-06-01

The Latarjet procedure for the treatment of recurrent anterior shoulder instability is highly successful, but reasons for failure are often unclear. Measurements of the "glenoid track" have not previously been evaluated as potential predictors of postoperative stability. There are clinical and anatomic characteristics, including the glenoid track, that are predictive of outcomes after the Latarjet procedure. Case series; Level of evidence, 4. Patients who underwent the Latarjet procedure for anterior shoulder instability with glenoid bone loss before October 2012 were assessed for eligibility. Patient-reported subjective data that were prospectively collected and retrospectively reviewed included demographic information, patient satisfaction, pain measured on a visual analog scale (VAS), questions regarding instability, Single Assessment Numeric Evaluation (SANE) scores, American Shoulder and Elbow Surgeons (ASES) scores, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, and Short Form-12 Physical Component Summary (SF-12 PCS) scores. Anatomic measurements were performed of the coracoid size (surface area and width), width of the conjoined tendon and subscapularis tendon, estimated glenoid defect surface area, Hill-Sachs interval (HSI), and projected postoperative glenoid track engagement. Failure was defined as the necessity for revision stabilization or continued instability (dislocation or subjective subluxation) at a minimum of 2 years postoperatively. A total of 38 shoulders in 38 patients (33 men, 5 women) with a mean age of 26 years (range, 16-43 years) were included. The mean follow-up for 35 of 38 patients (92%) was 3.2 years (range, 2.0-7.9 years); 25 of 38 had undergone prior stabilization surgery, and 6 had workers' compensation claims. All mean subjective outcome scores significantly improved (P instability. Patients with moderate or higher preoperative pain scores (VAS ≥3) had a negative correlation with postoperative SF-12 PCS

Immobilization in external rotation combined with abduction reduces the risk of recurrence after primary anterior shoulder dislocation.

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Heidari, Kamran; Asadollahi, Shadi; Vafaee, Reza; Barfehei, Abbas; Kamalifar, Hossein; Chaboksavar, Zein Alabedin; Sabbaghi, Mohammad

2014-06-01

We aimed to compare the effectiveness of immobilization in abduction and external rotation vs immobilization in adduction and internal rotation after primary anterior dislocation of the shoulder. The study randomized 102 patients (age range, 15-55 years) with the diagnosis of primary anterior dislocation of the shoulder to receive immobilization in adduction and internal rotation (AdIR, n = 51) using sling and swathe bandage or immobilization in abduction and external rotation (AbER, n = 51) with a stabilizer brace. Patients received a rehabilitation program 3 weeks after the intervention. After a 24-month follow-up, 33.3% in the AdIR group and 3.9% in the AbER group had recurrence (P patients in the AbER group (19.6%) and 3 in the AdIR group (5.8%) discontinued shoulder immobilization before 3 weeks (P = .03). In patients without recurrence, the anterior apprehension test was positive in 6 of 34 in the AdIR group (17.6%) and in 4 of 49 in the AbER group (8.1%, P = .19). Immobilization with the shoulder joint in abduction and external rotation is an effective method to reduce the risk of recurrence after primary anterior shoulder dislocations and should be preferred to the traditional method of immobilization in adduction and internal rotation in clinical practice. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Editorial Commentary: In a World of Endless Options, Is There a Single Solution? Management Options for Failed Anterior Instability Surgery in Athletes.

Science.gov (United States)

Matzkin, Elizabeth

2018-05-01

There are many options to manage anterior instability of the shoulder. The management of athletes who have failed previous operative stabilization can make choosing a treatment solution difficult. A modified Latarjet without capsulolabral repair has been demonstrated to be a good choice when treating failed stabilization in a high-risk population with sufficient return to play and outcomes. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Neurovascular complications due to the Hippocrates method for reducing anterior shoulder dislocations.

Science.gov (United States)

Regauer, Markus; Polzer, Hans; Mutschler, Wolf

2014-01-18

In spite of the fact that the Hippocrates method hardly has been evaluated in a scientific manner and numerous associated iatrogenic complications have been reported, this method remains to be one of the most common techniques for reducing anterior shoulder dislocations. We report the case of a 69-year-old farmer under coumarin anticoagulant therapy who sustained acute first time anterior dislocation of his dominant right shoulder. By using the Hippocrates method with the patient under general anaesthesia, the brachial vein was injured and an increasing hematoma subsequently caused brachial plexus paresis by pressure. After surgery for decompression and vascular suturing, symptoms declined rapidly, but brachial plexus paresis still was not fully reversible after 3 mo of follow-up. The hazardousness of using the Hippocrates method can be explained by traction on the outstretched arm with force of the operator's body weight, direct trauma to the axillary region by the physician's heel, and the topographic relations of neurovascular structures and the dislocated humeral head. As there is a variety of alternative reduction techniques which have been evaluated scientifically and proofed to be safe, we strongly caution against the use of the Hippocrates method as a first line technique for reducing anterior shoulder dislocations, especially in elder patients with fragile vessels or under anticoagulant therapy, and recommend the scapular manipulation technique or the Milch technique, for example, as a first choice.

Shoulder instability syndrome: comparison of CT, arthrography and MR findings

International Nuclear Information System (INIS)

Ortiz, L.; Alcaraz, M.; Preciados, J.L.G.; Garcia Alvarez, A.; Castello, J.

1995-01-01

Currently, the two most reliable explorations for diagnosing the lesions that produce shoulder instability are computerized tomography with arthrography and magnetic resonance following intraarticular injection of gadolinium. Dynamic CT arthrography is considered the best method to assess these lesions; MR is a similar procedure but involves certain drawbacks, among them, its cost. The techniques applied in these explorations are reviewed, as are the anatomy of the different components of this joint and the radiological findings leading to a diagnosis of the pathology underlying its instability. (Author)

Arthroscopic coracoid transfer in the treatment of recurrent shoulder instability: a systematic review of early results.

Science.gov (United States)

Butt, Usman; Charalambous, Charalambos P

2013-04-01

Systematic review of the literature to characterize safety profile and complication rates associated with arthroscopic coracoid transfer procedures. We conducted a combined search of Medline, EMBASE, and the CINAHL databases from 1985 to November 2012. Articles were selected and data extracted according to standard criteria. Only 3 studies met the inclusion criteria, and these originated from the pioneers of this technique. These studies described the results of 172 arthroscopic coracoid transfer procedures with an overall complication rate of 19.8% ± 5.6%. Conversion to open surgery was necessary in 6/172 (3.5%) patients. Repeated surgery was described in 5/172 (2.9% ± 2.5%) cases, all for screw removal. The overall rate of recurrent instability was 3/172 cases (1.7% ± 2%). Hardware-related complications occurred in 4/172 patients (2.3% ± 2.3%). Coracoid grafts failed to unite in 14/172 patients (8.1% ± 4.1%); graft osteolysis was seen in 7/172 patients (4.1% ± 2.6%). The coracoid graft fractured in 2/172 cases (1.2% ± 1.6%); one of these occurred intraoperatively and one occurred early postoperatively. There was one transient nerve palsy (0.6% ± 1.1%). Results of arthroscopic coracoid transfer surgery for anterior shoulder instability are sparse, with the available studies originating from the pioneers of this technique. Early results suggest that arthroscopic coracoid transfer is a technically feasible procedure that is able to restore shoulder stability. However, this technique seems to be associated with a high complication rate and a steep learning curve. Results from the wider orthopaedic shoulder arthroscopic community are awaited. Extensive cadaveric training and experience with the open technique is recommended before performing the arthroscopic procedure. Systematic review of Level IV studies. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Intra-articular lignocaine as a means of analgesia during manual reduction of acute anterior shoulder dislocation

Directory of Open Access Journals (Sweden)

Manoj Kadel

2016-11-01

Full Text Available Background & Objectives: Acute anterior shoulder dislocation needs prompt reduction of the dislocation. The ideal reduction method should be simple, fast, effective and non- traumatic, with minimal pain, and should not cause further injury to the affected shoulder. Intra-articular local lignocaine injection is a means of achieving analgesia with less complication, and allowing prompt patient discharge of patient after reduction. The study was conducted with objective to evaluate the effectiveness of intra-articular lignocaine for reduction of acute anterior shoulder dislocation.Materials & Methods: Twenty- one cases of acute anterior shoulder dislocation were reduced using intra-articular local lignocaine injection as a method of analgesia by modified Hippocrates method.Results: The mean age was 44.71 years ± SD 20.14 while 11 cases were reduced with one to six hours of injury. Pain assessed through application of a visual analogue scale during the maneuver revealed scores ranging from two to eight with mean score of 4.29 ± SD 1.55.Conclusion: This method is not only safe and effective but also reduces hospital stay and has negligible adverse effects making it a popular choice for most orthopedists.

MR imaging of subscapularis tendon injury in the setting of anterior shoulder dislocation

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Gyftopoulos, Soterios; Carpenter, Elizabeth; Kazam, Jonathan; Babb, James; Bencardino, Jenny [NYU Hospital for Joint Diseases, New York, NY (United States)

2012-11-15

To evaluate the degree and location patterns of subscapularis tendon injury in patients with prior anterior shoulder dislocation (ASD). Forty-five consecutive MR shoulder examinations in patients with a history of ASD and 20 consecutive MR examinations in patients without prior dislocation were reviewed. Two readers assessed for the presence and location of tendinosis and tearing in the subscapularis tendon, which was divided into three segments: superior, middle, and inferior. The readers also documented the presence of anterior labral tears, osseous Bankart defects and Hill-Sachs lesions. Fisher's exact tests were performed to analyze the different types of pathology and their locations. Subscapularis tendinosis, and partial thickness and full thickness tears were more common in patients with a history of ASD. Tendinosis was found in 60-64.4% of the dislocation patients compared with 40% of the non-dislocation group. When stratified by location, the middle and inferior thirds were the most commonly affected with statistical significance (p < 0.05) found in tearing of the inferior third. Anterior labral tears, osseous Bankart defects, and Hill-Sachs lesions were more common in the dislocation group with statistically significant associations with tendinosis in the middle and inferior thirds and tearing of the middle third (p < 0.05). Our study suggests an association between middle and inferior subscapularis tendon pathology and prior anterior shoulder dislocation. Based on our results, careful MR assessment of the subscapularis tendon by the radiologist is indicated in the setting of ASD as injury of this structure can be symptomatic and may be amenable to treatment. (orig.)

MR imaging of subscapularis tendon injury in the setting of anterior shoulder dislocation

International Nuclear Information System (INIS)

Gyftopoulos, Soterios; Carpenter, Elizabeth; Kazam, Jonathan; Babb, James; Bencardino, Jenny

2012-01-01

To evaluate the degree and location patterns of subscapularis tendon injury in patients with prior anterior shoulder dislocation (ASD). Forty-five consecutive MR shoulder examinations in patients with a history of ASD and 20 consecutive MR examinations in patients without prior dislocation were reviewed. Two readers assessed for the presence and location of tendinosis and tearing in the subscapularis tendon, which was divided into three segments: superior, middle, and inferior. The readers also documented the presence of anterior labral tears, osseous Bankart defects and Hill-Sachs lesions. Fisher's exact tests were performed to analyze the different types of pathology and their locations. Subscapularis tendinosis, and partial thickness and full thickness tears were more common in patients with a history of ASD. Tendinosis was found in 60-64.4% of the dislocation patients compared with 40% of the non-dislocation group. When stratified by location, the middle and inferior thirds were the most commonly affected with statistical significance (p < 0.05) found in tearing of the inferior third. Anterior labral tears, osseous Bankart defects, and Hill-Sachs lesions were more common in the dislocation group with statistically significant associations with tendinosis in the middle and inferior thirds and tearing of the middle third (p < 0.05). Our study suggests an association between middle and inferior subscapularis tendon pathology and prior anterior shoulder dislocation. Based on our results, careful MR assessment of the subscapularis tendon by the radiologist is indicated in the setting of ASD as injury of this structure can be symptomatic and may be amenable to treatment. (orig.)

Clinical Validation of the Glenoid Track Concept in Anterior Glenohumeral Instability.

Science.gov (United States)

Shaha, James S; Cook, Jay B; Rowles, Douglas J; Bottoni, Craig R; Shaha, Steven H; Tokish, John M

2016-11-16

Glenoid and humeral bone loss are well-described risk factors for failure of arthroscopic shoulder stabilization. Recently, consideration of the interactions of these types of bone loss (bipolar bone loss) has been used to determine if a lesion is "on-track" or "off-track." The purpose of this study was to study the relationship of the glenoid track to the outcomes of arthroscopic Bankart reconstructions. Over a 2-year period, 57 shoulders that were treated with an isolated, primary arthroscopic Bankart reconstruction performed at a single facility were included in this study. The mean patient age was 25.5 years (range, 20 to 42 years) at the time of the surgical procedure, and the mean follow-up was 48.3 months (range, 23 to 58 months). Preoperative magnetic resonance imaging was used to determine glenoid bone loss and Hill-Sachs lesion size and location and to measure the glenoid track to classify the shoulders as on-track or off-track. Outcomes were assessed according to shoulder stability on examination and subjective outcome. There were 10 recurrences (18%). Of the 49 on-track patients, 4 (8%) had treatment that failed compared with 6 (75%) of 8 off-track patients (p = 0.0001). Six (60%) of 10 patients with recurrence of instability were off-track compared with 2 (4%) of 47 patients in the stable group (p = 0.0001). The positive predictive value of an off-track measurement was 75% compared with 44% for the predictive value of glenoid bone loss of >20%. The application of the glenoid track concept to our cohort was superior to using glenoid bone loss alone with regard to predicting postoperative stability. This method of assessment is encouraged as a routine part of the preoperative evaluation of all patients under consideration for arthroscopic anterior stabilization. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Open inferior capsular shift for multidirectional shoulder instability in adolescents with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome.

Science.gov (United States)

Vavken, Patrick; Tepolt, Frances A; Kocher, Mininder S

2016-06-01

The objective of this study was to assess the outcome of open inferior capsular shift for multidirectional shoulder instability in patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome. Data were obtained for 18 open inferior capsular shift surgeries in 15 adolescent patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome with a mean follow-up of 7.5 years. End points were subjective clinical outcome (pain, stability, satisfaction, return to sport), objective clinical outcome (recurrence, complications), and functional outcome scores (American Shoulder and Elbow Surgeons, 11-item version of the Disabilities of Arm, Shoulder and Hand). Thirteen patients (87%) reported improved pain and stability and were satisfied with the procedure. Nine patients (64%) were able to return to sports. One patient (7%) was dissatisfied with continuous pain and recurrent instability and considered a surgical failure. Seven patients (47%) reported no further episodes of instability. The mean American Shoulder and Elbow Surgeons score at a mean of 7.5 years of follow-up was 88 ± 10 points, and the mean score for the 11-item version of the Disabilities of Arm, Shoulder and Hand was 14 ± 14 points. The management of multidirectional shoulder instability in adolescent patients with generalized ligamentous hyperlaxity or Ehlers-Danlos syndrome is challenging. Open inferior capsular shift results in improvement in subjective and objective shoulder function and stability in adolescent patients with ligamentous hyperlaxity or Ehlers-Danlos who have failed nonoperative treatment. We found no effect of the recalled number of prior dislocations, laterality, and type of hyperlaxity on subjective and objective clinical outcomes. Level IV; Case Series; Treatment Study. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial.

Science.gov (United States)

Tamaoki, Marcel Jun Sugawara; Faloppa, Flavio; Wajnsztejn, André; Archetti Netto, Nicola; Matsumoto, Marcelo Hide; Belloti, João Carlos

2012-01-01

Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp). From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. Forty-two patients were included: 20 in the group without analgesia (control group) and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0), standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P < 0.001) and the fifth minute (respectively: mean 1.0; 0 to 3.0; SD = 1.0 versus mean 4.0; 1.0 to 6.0; SD = 1.4; P < 0.001). There was one failure in the control group. There were no other complications in either group. Reduction of anterior shoulder dislocation using intra-articular lidocaine injection is effective, since it is safe and diminishes the pain. ISRCTN27127703.

The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football.

Science.gov (United States)

Dickens, Jonathan F; Owens, Brett D; Cameron, Kenneth L; DeBerardino, Thomas M; Masini, Brendan D; Peck, Karen Y; Svoboda, Steven J

2017-07-01

There is no consensus on the optimal method of stabilization (arthroscopic or open) in collision athletes with anterior shoulder instability. To examine the effect of "subcritical" bone loss and football-specific exposure on the rate of recurrent shoulder instability after arthroscopic stabilization in an intercollegiate American football population. Case-control study; Level of evidence, 3. Fifty intercollegiate football players underwent primary arthroscopic stabilization for anterior shoulder instability and returned to football for at least a single season. Preoperatively, 32 patients experienced recurrent subluxations, and 18 patients experienced a single or recurrent dislocation. Shoulders with glenoid bone loss >20%, an engaging Hill-Sachs lesion, an off-track lesion, and concomitant rotator cuff repair were excluded from the study. The primary outcome of interest was the ability to return to football without subsequent instability. Patients were followed for time to a subsequent instability event after return to play using days of exposure to football and total follow-up time after arthroscopic stabilization. Fifty consecutive patients returned to American football for a mean 1.5 seasons (range, 1-3) after arthroscopic stabilization. Three of 50 (6%; 95% CI, 1.3%-16.5%) patients experienced recurrent instability. There were no subsequent instability events after a mean 3.2 years of military service. All shoulders with glenoid bone loss >13.5% (n = 3) that underwent arthroscopic stabilization experienced recurrent instability upon returning to sport, while none of the shoulders with football ( X 2 = 15.80, P 13.5% glenoid bone loss had an incidence rate of 5.31 cases of recurrent instability per 1000 athlete-exposures of football. In 72,000 athlete-exposures to football with football players with <13.5% glenoid bone loss provides reliable outcomes and low recurrence rates.

Shoulder Magnetic Resonance Arthrography: A Prospective Randomized Study of Anterior and Posterior Ultrasonography-Guided Contrast Injections

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Koivikko, M.P.; Mustonen, A.O.T. (Dept. of Radiology, Helsinki Univ. Central Hospital, Helsinki (Finland))

2008-10-15

Background: Magnetic resonance (MR) arthrography is an accurate imaging method for internal shoulder derangements and rotator cuff pathologies. Both anterior and posterior contrast injection techniques, under palpatory, fluoroscopic, or ultrasonographic guidance have been described in the literature. However, clinical comparisons of the injection techniques remain few. Purpose: To compare the performance of anterior and posterior ultrasonography (US)-guided arthrography injections of the shoulder regarding patient discomfort and influence on diagnostic MR reading, and to illustrate the typical artifacts resulting from contrast leakage in the respective techniques. Material and Methods: 43 MR arthrographies were prospectively randomized into anterior and posterior US-guided contrast injections and performed by two radiologists, with the study of artifacts from contrast leakage. Pain from the injections was assessed by a survey utilizing a 100-mm visual analogue scale (VAS). Results: Of the 23 anterior injections, nine caused contrast artifacts in the subscapular tendon, and in three the leakage extended further anteriorly. Of the 20 posterior injections, 12 showed injection artifacts of the rotator cuff, extending outside the cuff in seven. Two of the anterior and none of the posterior artifacts compromised diagnostic quality. In posterior injections, the leakage regularly occurred at the caudal edge of the infraspinatus muscle and was easily distinguishable from rotator cuff tears. All patients completed the pain survey. Mean VAS scores were 25.0 (median 18, SD 22) for anterior, and 25.4 (median 16, SD 25) for posterior injections. The two radiologists achieved different mean VAS scores but closely agreed as to anterior and posterior VAS scores. Conclusion: Arthrography injections were fairly simple to perform under US guidance. Patient discomfort for anterior and posterior injections was equally minor. A tailored approach utilizing anterior or posterior injections

Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial

Directory of Open Access Journals (Sweden)

Marcel Jun Sugawara Tamaoki

Full Text Available CONTEXT AND OBJECTIVE: Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. DESIGN AND SETTING: Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp. METHODS: From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. RESULTS: Forty-two patients were included: 20 in the group without analgesia (control group and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0, standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P < 0.001 and the fifth minute (respectively: mean 1.0; 0 to 3.0; SD = 1.0 versus mean 4.0; 1.0 to 6.0; SD = 1.4; P < 0.001. There was one failure in the control group. There were no other complications in either group. CONCLUSION: Reduction of anterior shoulder dislocation using intra-articular lidocaine injection is effective, since it is safe and diminishes the pain. CLINICAL TRIAL REGISTRATION: ISRCTN27127703.

Management of the athlete with a failed shoulder instability procedure.

Science.gov (United States)

Gwathmey, F Winston; Warner, Jon J P

2013-10-01

The athlete with a failed instability procedure requires a thoughtful and systematic approach to achieve a good outcome. Goals of treatment should be defined and realistic expectations should be set. Revision stabilization has a high rate of recurrent instability, low rates of return to play, and low clinical outcome scores. Fundamental to successful revision surgery is choosing the correct procedure. The decision is straightforward in athletes with clear factors that predict recurrence (significant glenoid bone loss, engaging Hill-Sachs lesions) because only a bony procedure can restore the articular arc of the glenoid. Arthroscopic revision Bankart repair may be appropriate in those athletes who have an obvious Bankart tear and no bone loss after a traumatic reinjury. The challenge for the shoulder surgeon is identifying the best surgery for the athlete who does not have such clear-cut indications. Each factor that has the potential to lead to a poor outcome needs to be collected and calculated. Patient factors (age, laxity, type and level of sport), injury factors (mechanism of injury, capsulolabral injury, glenoid bone loss, Hill-Sachs lesion), and technical factors (previous surgery performed, integrity of repair, scarring) must be integrated into the treatment algorithm. Based on this collection of factors, the shoulder surgeon should be prepared to provide the athlete with the surgery that provides the best chance to return to playing sports and the lowest risk of recurrent instability. Copyright © 2013 Elsevier Inc. All rights reserved.

Relationship of physical examination test of shoulder instability to arthroscopic findings in dogs.

Science.gov (United States)

Devitt, Chad M; Neely, Marlon R; Vanvechten, Brian J

2007-10-01

To determine the diagnostic validity of commonly used physical examination maneuvers for shoulder instability. Retrospective study. Dogs (n=24) referred for shoulder arthroscopy. Results of physical maneuvers and arthroscopic findings were recorded and sensitivity, specificity, positive likelihood ratios (LR+), and negative likelihood ratios (LR-) were calculated for each of 4 physical examination test findings for arthroscopic changes in the medial, lateral, cranial, or caudal compartments of the shoulder joint viewed in dorsal recumbency by lateral and craniomedial portals. Distribution of compartment changes was: medial (17 dogs), caudal (15), cranial (12), and lateral (5). The biceps test had a moderate effect (LR+=9) on post-test probability of cranial compartment changes and a small effect on post-test probability of lateral and caudal compartment changes (LR+=3 and 2.4, respectively). Hyperabduction had a minimal effect and mediolateral instability test had a small effect (LR+=1.64 and 2.68, respectively) on post-test probability of medial compartment changes. Craniocaudal instability test had little to no effect on post-test probability of changes in any compartment. Physical examination tests evaluated were limited in their ability to predict the type of arthroscopic pathology in this study population. Clinicians should understand that a diagnostic test performs inconsistently based on prevalence of a condition in a given patient population. The use of likelihood ratios can assist clinicians in determining the probability of intraarticular changes from a group with a differing prevalence than the patient population presented.

Multimodality imaging of the postoperative shoulder

Energy Technology Data Exchange (ETDEWEB)

Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany)

2007-12-15

Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography, computed tomography (CT), CT arthrography, and ultrasound. Target-oriented evaluation of the postoperative shoulder necessitates familiarity with surgical techniques, their typical complications and sources of failure, knowledge of normal and abnormal postoperative findings, awareness of the advantages and weaknesses with the different radiologic techniques, and clinical information on current symptoms and function. This article reviews the most commonly used surgical procedures for treatment of anterior glenohumeral instability, lesions of the labral-bicipital complex, subacromial impingement, and rotator cuff lesions and highlights the significance of imaging findings with a view to detection of recurrent lesions and postoperative complications in a multimodality approach. (orig.)

Arthroscopic management of posterior instability: evolution of technique and results.

Science.gov (United States)

Savoie, Felix H; Holt, M Shaun; Field, Larry D; Ramsey, J Randall

2008-04-01

The purpose of this study was to evaluate the effectiveness of arthroscopic posterior shoulder reconstruction. We treated 136 shoulders in 131 patients with a diagnosis of primary posterior instability who failed 6 months of vigorous rehabilitation by operative stabilization between 1989 and 2001. Inclusion criterion was primary posterior instability that failed an extensive rehabilitative program with functional impairment and pain. Exclusion criterion was less than 12 months of follow-up and Suretac (Smith & Nephew, Andover, MA) or laser stabilization, leaving 92 shoulders in 90 patients available for the study (69 male, 21 female). Follow-up ranged from 12 to 132 months (average, 28 months). Each patient underwent diagnostic arthroscopy and surgical repair at the same time using one of several primary procedures. The procedure used was based on the pathologic entity noted at the time of surgery. At an average follow-up of 28 months, 97% of the shoulders were stable and considered a success based on the Neer-Foster rating scale. Posterior pathology varied, and a reverse Bankart lesion alone was found 51% of the time, a stretched posterior capsule 67% of the time, and a combination of a reverse Bankart lesion and capsular stretching 16% of the time. The rotator interval was obviously damaged in 61% of cases. Multiple accompanying lesions were found, including anterior-superior labral tears and SLAP tears (20%), superior glenohumeral ligament injury (7%), middle glenohumeral ligament injury (38%), anteroinferior glenohumaral ligament injury (37%), and an enlarged axillary pouch (20%). No essential lesion is present for posterior instability. Multiple varied pathologies will be present in a shoulder presenting with posterior instability. Arthroscopic surgery allows inspection of the joint and anatomic-specific repairs based on pathology. Careful attention to all the supporting structures of the shoulder, including the rotator interval, the anterior-superior labrum

Recurrent anterior shoulder instability: accuracy of estimations of glenoid bone loss with computed tomography is insufficient for therapeutic decision-making

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Huijsmans, Polydoor Emile [Haga Hospital, Department of Orthopedic Surgery, The Hague (Netherlands); Witte, Pieter Bas de [Leiden University Medical Center, Department of Orthopedic Surgery, Leiden (Netherlands); Villiers, Richard V.P. de; Kruger, Niel Ruben [Van Wageningen and Partners, Radiology Department, Somerset West (South Africa); Wolterbeek, Derk Willem; Warmerdam, Piet [Haga Hospital, Department of Radiology, The Hague (Netherlands); Beer, Joe F. de [Cape Shoulder Institute, Department of Orthopedic Surgery, Cape Town (South Africa)

2011-10-15

To evaluate the reliability of glenoid bone loss estimations based on either axial computed tomography (CT) series or single sagittal (''en face'' to glenoid) CT reconstructions, and to assess their accuracy by comparing with actual CT-based bone loss measurements, in patients with anterior glenohumeral instability. In two separate series of patients diagnosed with recurrent anterior glenohumeral instability, glenoid bone loss was estimated on axial CT series and on the most lateral sagittal (en face) glenoid view by two blinded radiologists. Additionally, in the second series of patients, glenoid defects were measured on sagittal CT reconstructions by an independent observer. In both series, larger defects were estimated when based on sagittal CT images compared to axial views. In the second series, mean measured bone loss was 11.5% (SD = 6.0) of the total original glenoid area, with estimations of 9.6% (SD = 7.2) and 7.8% (SD = 4.2) for sagittal and axial views, respectively. Correlations of defect estimations with actual measurements were fair to poor; glenoid defects tended to be underestimated, especially when based on axial views. CT-based estimations of glenoid bone defects are inaccurate. Especially for axial views, there is a high chance of glenoid defect underestimation. When using glenoid bone loss quantification in therapeutic decision-making, measuring the defect instead of estimating is strongly advised. (orig.)

[Results of revision after failed surgical treatment for traumatic anterior shoulder instability].

Science.gov (United States)

Lópiz-Morales, Y; Alcobe-Bonilla, J; García-Fernández, C; Francés-Borrego, A; Otero-Fernández, R; Marco-Martínez, F

2013-01-01

Persistent or recurrent glenohumeral instability after a previous operative stabilization can be a complex problem. Our aim is to establish the incidence of recurrence and its revision surgery, and to analyse the functional results of the revision instability surgery, as well as to determine surgical protocols to perform it. A retrospective analysis was conducted on 16 patients with recurrent instability out of 164 patients operated on between 1999 and 2011. The mean follow-up was 57 months and the mean age was 29 years. To evaluate functional outcome we employed Constant, Rowe, UCLA scores and the visual analogue scale. Of the 12 patients who failed the initial arthroscopic surgery, 6 patients underwent an arthroscopic antero-inferior labrum repair technique, 4 using open labrum repair techniques, and 2 coracoid transfer. The two cases of open surgery with recurrences underwent surgery for coracoid transfer. Results of the Constant score were excellent or good in 64% of patients. Surgical revision of instability is a complex surgery essentially for two reasons: the difficulty in recognising the problem, and the technical demand (greater variety and the increasingly complex techniques). Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

Measurement of muscle thickness of the serratus anterior and lower trapezius using ultrasound imaging in competitive recreational adult swimmers, with and without current shoulder pain.

Science.gov (United States)

McKenna, Leanda J; de Ronde, Mandy; Le, Minyang; Burke, William; Graves, Anna; Williams, Sian A

2018-02-01

To compare serratus anterior and lower trapezius muscle thickness between swimmers with and without current shoulder pain, and between sides when measured by real-time ultrasound imaging. A single blinded age and gender-matched case-control study with 26 symptomatic and 26 asymptomatic recreational swimmers. Muscle thickness of serratus anterior and lower trapezius were measured using previously validated real-time ultrasound imaging protocols. Serratus anterior thickness was measured in side lying with 90° of glenohumeral flexion at rest and during a scapular protraction contraction. Lower trapezius thickness was measured in prone with 145° of glenohumeral abduction whilst at rest and when holding the weight of the arm. There was no statistically significant difference between the muscle thickness of serratus anterior and lower trapezius between the symptomatic shoulder and the dominance-matched shoulder in the asymptomatic group of swimmers. There was also no significant difference in muscle thickness between the symptomatic side and asymptomatic side within the symptomatic group. There appears to be no difference in serratus anterior and lower trapezius thickness between swimmers who have mild to moderate shoulder pain, who continue to swim and those who do not have shoulder pain. When imaging the serratus anterior and lower trapezius in swimmers with mild shoulder pain, clinicians should expect no differences between sides. If muscle thickness differences between sides are detected in recreational swimmers, this may indicate that the swimmer is participating in other asymmetrical activities or has a higher level of shoulder pain. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

The Influence of Surgical Stabilization on Glenohumeral Abduction Using 3-Dimensional Computed Tomography in Patients With Shoulder Instability.

Science.gov (United States)

Bakshi, Neil K; Jameel, Omar F; Merrill, Zachary F; Debski, Richard E; Sekiya, Jon K

2016-08-01

This study compared the amount of glenohumeral abduction during arm abduction in the affected and unaffected shoulders of 3 groups of patients with shoulder instability: failed surgical stabilization, successful surgical stabilization, and unstable shoulder with no prior surgical intervention. All patients underwent bilateral shoulder computed tomography scans in 3 positions: 0° of abduction and 0° of external rotation (0-0 position), 30° of abduction and 30° of external rotation (30-30 position), and arms maximally abducted (overhead position). Three-dimensional computed tomography reconstruction was performed for both shoulders in all 3 positions. A specialized coordinate system marked specific points and directions on the humerus and glenoid of each model. These coordinates were used to calculate the glenohumeral abduction for the normal and affected sides in the 0-0, 30-30, and overhead positions. Thirty-nine patients with shoulder instability were included, of whom 14 had failed surgical repairs, 10 had successful surgical repairs, and 15 had unstable shoulders with no prior surgical intervention. In the overhead position, patients with failed surgical intervention had significantly less glenohumeral abduction in the failed shoulder (95.6° ± 12.7°) compared with the normal shoulder (101.5° ± 12.4°, P = .02). Patients with successfully stabilized shoulders had significantly less glenohumeral abduction in the successfully stabilized shoulder (93.6° ± 10.8°) compared with the normal shoulder (102.1° ± 12.5°, P = .03). Unstable shoulders with no prior surgical intervention (102.1° ± 10.3°) did not differ when compared with the normal shoulders (101.9° ± 10.9°, P = .95). Surgical intervention, regardless of its success, limits the amount of abduction at the glenohumeral joint. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Open MR imaging of the unstable shoulder in the apprehension test position: description and evaluation of an alternative MR examination position

International Nuclear Information System (INIS)

Wintzell, G.; Larsson, S.; Larsson, H.; Zyto, K.

1999-01-01

The aim of this study was to describe and evaluate an alternative MR assessment procedure for analysis of unstable shoulders. Twelve patients with unilateral recurrent anterior shoulder dislocation had both shoulders examined. Magnetic resonance imaging was performed with an open-MR system in the apprehension position with the shoulder in 90 of abduction and maximum tolerable external rotation. Contrast enhancement was achieved with intravenous gadolinium. Correlations were made to the findings at operation. In 10 of 12 unstable shoulders the inferior glenohumeral ligament labral complex (IGHLLC) was detached from the glenoid as seen on MR and later verified during surgery. In one shoulder MR was unable to show a capsulolabral detachment that was verified at surgery, whereas in one shoulder both MR and surgical assessment revealed no soft tissue detachment (accuracy 92 %). A Hill-Sachs lesion was visualized and verified in all unstable shoulders, whereas the stable controls revealed normal IGHLLC and no Hill-Sachs lesion. Open-MRI evaluation of the shoulder in the apprehension test position may become a useful tool for the evaluation of anterior shoulder instability. (orig.)

Shoulder instability

African Journals Online (AJOL)

2011-09-02

Sep 2, 2011 ... Rotator cuff tears are rare in the younger patient, but as a rule of ... of patients who have sustained an anterior dislocation tear the anterior labrum. Fig. 1. Arthroscopic view of a Bankart lesion. Line 1 is the edge of the avulsed labrum. Line .... and abnormal firing patterns of muscle. This results in pain or the ...

Impingement syndrome of the shoulder

International Nuclear Information System (INIS)

Mayerhoefer, M.E.; Breitenseher, M.J.

2004-01-01

The impingement syndrome is a clinical entity characterized by shoulder pain due to primary or secondary mechanical irritation of the rotator cuff. The primary factors for the development of impingement are a curved or hook-shaped anterior acromion as well as subacromial osteophytes, which may lead to tearing of the supraspinatus tendon. Secondary impingement is mainly caused by calcific tendinopathy, glenohumeral instability, os acromiale and degenerative changes of the acromioclavicular joint. Conventional radiographs are initially obtained, mainly for evaluation of the bony structures of the shoulder. If available, sonography can be used for detection of lesions and tears of the rotator cuff. Finally, MR-imaging provides detailed information about the relationship of the acromion and the acromioclavicular joint to the rotator cuff itself. In many cases however, no morphologic cause for impingement syndrome can be found. While patients are initially treated conservatively, chronic disease usually requires surgical intervention. (orig.) [de

Resultados do procedimento artroscópico de "remplissage" na luxação anterior recidivante do ombro Results from filling "remplissage" arthroscopic technique for recurrent anterior shoulder dislocation

Directory of Open Access Journals (Sweden)

Mauro Emilio Conforto Gracitelli

2011-01-01

Full Text Available OBJETIVO: Avaliar o resultado clínico da técnica de "remplissage" associada ao reparo da lesão de Bankart (BK para o tratamento da luxação anterior recidivante do ombro. MÉTODOS: Nove pacientes (10 ombros, com seguimento médio de 13,7 meses, apresentaram luxação traumática anterior recidivante do ombro. Todos tinham lesão de BK associada à lesão de Hill e Sachs (HS, com sinal do "encaixe". O defeito das lesões de HS foi medido e apresentava em média 17,3% (7,7% a 26,7% de perda óssea em relação ao diâmetro da cabeça do úmero. Todos foram submetidos ao reparo artroscópico da lesão de BK associado ao preenchimento ("remplissage" da lesão de HS pela tenodese do infraespinal. RESULTADOS: O escore de Rowe variou de 22,5 (10 a 45 no período pré-operatório para 80,5 (5 a 100 no período pós operatório (p OBJECTIVE: To evaluate the clinical result from the filling ("remplissage" technique in association with Bankart lesion repair for treating recurrent anterior shoulder dislocation. METHODS: Nine patients (10 shoulders, with a mean follow-up of 13.7 months, presented traumatic recurrent anterior shoulder dislocation. All of them had a Bankart lesion, associated with a Hill-Sachs lesion showing the "engaging" sign. The Hill-Sachs lesion defect was measured and showed an average bone loss of 17.3% (7.7% to 26.7% in relation to the diameter of the humeral head. All the cases underwent arthroscopic repair of the Bankart lesion, together with filling of the Hill-Sachs lesion by means of tenodesis of the infraspinatus. RESULTS: The Rowe score ranged from 22.5 (10 to 45 before the operation to 80.5 (5 to 100 after the operation (p < 0.001. The UCLA score ranged from 18.0 (8 to 29 to 31.1 (21 to 31 (p < 0.001. The measurements of external and internal rotation at abduction of 90º after the operation were 63.5º (45º to 90º and 73º (50º to 92º respectively. Two patients presented recurrence (one with dislocation and the other

Superior labrum anterior to posterior lesion type II with accompanied findings: assessment of shoulder MR arthrographic findings

International Nuclear Information System (INIS)

Choi, Sun Young; Chun, Kyung Ah; Kwon, Oh Soo; Kim, Ki Tae

2006-01-01

To describe the pattern of various shoulder abnormalities with an associated superior labrum anterior to posterior (SLAP) lesion type II using magnetic resonance (MR) arthrography, and to assess the clinical significance of the associated abnormalities. A retrospective review of the MR arthrographic findings of 92 cases of a shoulder with an arthroscopically confirmed SLAP lesion type II was performed. The MR arthrography images were reviewed and analyzed. MR arthrographic analysis noted the presence of a rotator cuff abnormality, acromioclavicular arthritis, adhesive capsulitis, glenohumeral arthritis, a labral abnormality besides the SLAP lesion, and a paralabral cyst. The patients with SLAP lesions were divided into two age groups: those over 40 years of age and those forty years old or younger. Statistical analysis was performed to evaluate the influence of age on the various shoulder abnormalities with associated SLAP lesion. Of the 92 SLAP lesions type II, there were 7 cases (8%) of isolated SLAP lesions without any associated any shoulder abnormality. Eighty-five (92%) SLAP lesions were associated with various shoulder abnormalities including rotator cuff tendinosis (30/92, 33%), partial-thickness tear (36/92, 39%), full-thickness tear (2/92, 2%), acromioclavicular arthritis (46/92, 50%), adhesive capsulitis (7/92, 8%), glenohumeral arthritis (15/92, 16%), labral abnormality (26/92, 28%) and paralabral cyst (7/92, 8%). The SLAP lesions (60/92, 65%) in patients over forty years of age were accompanied by a significantly high number of rotator cuff abnormalities (ρ < 0.001), glenohumeral osteoarthritis (ρ = 0.001), and acromioclavicular osteoarthritis (ρ < 0.001). In contrast, the SLAP lesions (32/92, 35%) in patients forty years old or younger had a significantly high number of anterior or posterior labral lesions (ρ < 0.001). Isolated SLAP lesions type II without other associated shoulder abnormalities are uncommon, and the age of the patient influences

Superior labrum anterior to posterior lesion type II with accompanied findings: assessment of shoulder MR arthrographic findings

Energy Technology Data Exchange (ETDEWEB)

Choi, Sun Young; Chun, Kyung Ah; Kwon, Oh Soo; Kim, Ki Tae [The Catholic University of Korea, Uijeongbu St. Mary' s Hospital, Uijeongbu (Korea, Republic of)

2006-12-15

To describe the pattern of various shoulder abnormalities with an associated superior labrum anterior to posterior (SLAP) lesion type II using magnetic resonance (MR) arthrography, and to assess the clinical significance of the associated abnormalities. A retrospective review of the MR arthrographic findings of 92 cases of a shoulder with an arthroscopically confirmed SLAP lesion type II was performed. The MR arthrography images were reviewed and analyzed. MR arthrographic analysis noted the presence of a rotator cuff abnormality, acromioclavicular arthritis, adhesive capsulitis, glenohumeral arthritis, a labral abnormality besides the SLAP lesion, and a paralabral cyst. The patients with SLAP lesions were divided into two age groups: those over 40 years of age and those forty years old or younger. Statistical analysis was performed to evaluate the influence of age on the various shoulder abnormalities with associated SLAP lesion. Of the 92 SLAP lesions type II, there were 7 cases (8%) of isolated SLAP lesions without any associated any shoulder abnormality. Eighty-five (92%) SLAP lesions were associated with various shoulder abnormalities including rotator cuff tendinosis (30/92, 33%), partial-thickness tear (36/92, 39%), full-thickness tear (2/92, 2%), acromioclavicular arthritis (46/92, 50%), adhesive capsulitis (7/92, 8%), glenohumeral arthritis (15/92, 16%), labral abnormality (26/92, 28%) and paralabral cyst (7/92, 8%). The SLAP lesions (60/92, 65%) in patients over forty years of age were accompanied by a significantly high number of rotator cuff abnormalities ({rho} < 0.001), glenohumeral osteoarthritis ({rho} = 0.001), and acromioclavicular osteoarthritis ({rho} < 0.001). In contrast, the SLAP lesions (32/92, 35%) in patients forty years old or younger had a significantly high number of anterior or posterior labral lesions ({rho} < 0.001). Isolated SLAP lesions type II without other associated shoulder abnormalities are uncommon, and the age of the patient

A simple method for quantitative evaluation of the missing area of the anterior glenoid in anterior instability of the glenohumeral joint

Energy Technology Data Exchange (ETDEWEB)

Barchilon, Vidal S. [Sapir Medical Center, Department of Orthopedic Surgery, Shoulder Service, Kfar-Saba (Israel); Kotz, Eugene [Sapir Medical Center, Department of Imaging, Kfar-Saba (Israel); Barchilon Ben-Av, Mercedes [Achva College of Education, Department of Mathematics, MP Shikmim (Israel); Glazer, Ernesto [Rabin Medical Center, Department of Imaging, Petah Tikva (Israel); Nyska, Meir [Sapir Medical Center, Department of Orthopedic Surgery, Kfar-Saba (Israel)

2008-08-15

The objective of this study was to describe and validate a simple method to quantitatively calculate the missing area of the anterior part of the glenoid in anterior glenohumeral instability. The calculations were developed from three-dimensional (3D)-reconstructed computerized tomography en face images of the glenoid with 'subtraction' of the humeral head in 13 consecutive cases with known anterior glenohumeral joint instability diagnosed by history and clinical examination. The inferior portion of the glenoid was approximated to a true circle whose center was determined by means of a femoral head gauge. The eroded anterior area was calculated as the ratio between the depth (a perpendicular line from the center of the circle to the eroded edge of the anterior glenoid) and the radius of the inferior glenoid circle. This data was then compared to the results obtained by two additional different methods: direct computerized measurements of the missing area and direct computerized measurement of the ratio between the radius and depth, on two dimensional computed tomography (CT) en face view reconstructions of the glenoid. We provide a function that correlates the ratio between depth and radius of the inferior glenoid circle and the area of the missing anterior glenoid. The results obtained by three different methods were comparable. Simple trigonometric calculations showed that a 5% area defect corresponds to 0.8 (12.5%) of the radius of the inferior glenoid, while a 20% area defect corresponds to 0.5 (50%) of the same radius. Using this simple method and the function provided, the eroded area of the anterior part of the glenoid in anterior glenohumeral instability can be calculated preoperatively using a 3D CT reconstruction of the glenoid with 'subtraction' of the humeral head, obviating the need for sophisticated software to obtain this critical information for preoperative decision making. (orig.)

Painful glenohumeral joint instability in athletes

International Nuclear Information System (INIS)

Rossi, F.; Dragoni, S.; Giombini, A.

1991-01-01

Instability of the glenohumeral joints is a common cause of chronic shoulder pain and disability in athletes using repetitive arm movements in elevation and external rotation. A series of 29 athletes with persistent shoulder discomfort for transient subluxation was evaluated with plain radiography and tomography in right axillary projection. The purpose was to detect abnormalities in the osseous glenoid rim. Twenty-six patients (89.6% of all cases studied) had various degrees of skeletal damage, including 18 fractures (69.2%) of the anterior rim, 2 (7.6%) of the posterior rim, and 6 cases (23.07%) of local degenerative changes; 3 cases were negative for skeletal damages. The results of this study demontrate conventional radiography to be useful in the diagnostic assessment of shoulder pain in athletes, where similar problems must be promptly detected and not ignored

Comparative analysis of anterior and posterior contrast injection approaches for shoulder MR arthrograms in adolescents

Energy Technology Data Exchange (ETDEWEB)

Gupton, Theodore B.; Cahill, Anne M. [The Children' s Hospital of Philadelphia, Division of Interventional Radiology, Department of Radiology, Philadelphia, PA (United States); Delgado, Jorge [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Jaramillo, Diego [Stanford University Medical Center, Diagnostic Radiology, Palo Alto, CA (United States); Chauvin, Nancy A. [The Children' s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Musculoskeletal Imaging, Department of Radiology, Philadelphia, PA (United States)

2016-12-15

There is no consensus in the literature concerning the optimal approach for performing a fluoroscopically guided shoulder arthrogram injection in a pediatric population. To compare adequacy of capsular injection and radiation doses between fluoroscopically guided anterior and posterior glenohumeral joint contrast injections in adolescents. We evaluated imaging in 67 adolescents (39 boys, 28 girls; mean age 16.0 years; range 11.7-19.1 years) who underwent an anterior approach glenohumeral contrast injection with subsequent MR imaging, and 67 age- and gender-matched subjects (39 boys, 28 girls; mean age 16.0 years; range 11.1-19.2 years) who underwent a posterior approach injection during the period June 2010 to September 2015. Two pediatric radiologists independently evaluated all MR shoulder arthrograms to assess adequacy of capsular distention and degree of contrast extravasation. We recorded total fluoroscopic time, dose-area product (DAP) and cumulative air kerma (CAK). There were no significant differences in age, gender, height, weight or body mass index between the populations (P-values > 0.6). The amount of contrast extravasation between the groups was not significantly different (P = 0.27). Three anterior injections (4.5%) and one posterior (1.5%) were suboptimal (P = 0.62). Fluoroscopy time was not different: 1.1 min anterior and 1.3 min posterior (P = 0.14). There was a significant difference in CAK (0.7 mGy anterior and 1.1 mGy posterior; P = 0.007) and DAP (5.3 μGym{sup 2} anterior and 9.4 μGym{sup 2} posterior; P = 0.008). Inter-rater agreement was excellent (Cohen kappa >0.81). Both techniques were technically successful. There was no difference in the fluoroscopy time for either approach. The radiation dose was higher with the posterior approach but this is of questionable clinical significance. (orig.)

Anterior Interosseous Nerve Neuropraxia Secondary to Shoulder Arthroscopy and Open Subpectoral Long Head Biceps Tenodesis

Directory of Open Access Journals (Sweden)

Jeremiah T. Steed

2017-01-01

Full Text Available Arthroscopic rotator cuff tendon repair is a common elective procedure performed by trained orthopaedic surgeons with a relatively low complication rate. Specifically, isolated neuropraxia of the anterior interosseous nerve (AIN is a very rare complication of shoulder arthroscopy. An analysis of peer-reviewed published literature revealed only three articles reporting a total of seven cases that describe this specific complication following standard shoulder arthroscopic procedures. This article reports on three patients diagnosed with AIN neuropraxia following routine shoulder arthroscopy done by a single surgeon within a three-year period. All three patients also underwent open biceps tenodesis immediately following completion of the arthroscopic procedures. The exact causal mechanism of AIN neuropraxia following shoulder arthroscopy with biceps tenodesis is not known. This case report reviews possible mechanisms with emphasis on specific factors that make a traction injury the most likely etiology in these cases. We critically analyze our operating room setup and patient positioning practices in light of the existing biomechanical and cadaveric research to propose changes to our standard practices that may help to reduce the incidence of this specific postoperative complication in patients undergoing elective shoulder arthroscopy with biceps tenodesis.

Pneumarthro-CT in diagnosis of recurrent shoulder dislocations and instability

International Nuclear Information System (INIS)

Mayr, B.; Siuda, S.; Will, A.; Frenzl, G.; Habermeier, P.; Muenchen Univ.; Muenchen Univ.

1991-01-01

32 patients in whom recurrent dislocations or instability of the shoulder had been diagnosed, were examined via CT. Air was used as contrast agent. The results of pneumarthro-CT were re-checked 28 times by surgery and 6 times by arthroscopy. In all cases, Hill-Sachs defects and bony Bankart lesions had been correctly diagnosed. There were no faulty findings. Rate of accuracy of CT in detecting ruptures of the joint capsule from the neck of the scapula was 94%, in detecting lesions of the labrum glenoidale 88%, and in imaging an extended joint capsule 84%. (orig.) [de

Management of the failed posterior/multidirectional instability patient.

Science.gov (United States)

Forsythe, Brian; Ghodadra, Neil; Romeo, Anthony A; Provencher, Matthew T

2010-09-01

Although the results of operative treatment of posterior and multidirectional instability (P-MDI) of the shoulder have improved, they are not as reliable as those treated for anterior instability of the shoulder. This may be attributed to the complexities in the classification, etiology, and physical examination of a patient with suspected posterior and multidirectional instability. Failure to address the primary and concurrent lesion adequately and the development of pain and/or stiffness are contributing factors to the failure of P-MDI procedures. Other pitfalls include errors in history and physical examination, failure to recognize concomitant pathology, and problems with the surgical technique or implant failure. Patulous capsular tissues and glenoid version also play in role management of failed P-MDI patients. With an improved understanding of pertinent clinical complaints and physical examination findings and the advent of arthroscopic techniques and improved implants, successful strategies for the nonoperative and operative management of the patient after a failed posterior or multidirectional instability surgery may be elucidated. This article highlights the common presentation, physical findings, and radiographic workup in a patient that presents after a failed P-MDI repair and offers strategies for revision surgical repair.

Virtual MR arthroscopy of the shoulder: image gallery with arthroscopic correlation of major pathologies in shoulder instability.

Science.gov (United States)

Stecco, A; Volpe, D; Volpe, N; Fornara, P; Castagna, A; Carriero, A

2008-12-01

The purpose of this study was to compare virtual MR arthroscopic reconstructions with arthroscopic images in patients affected by shoulder joint instability. MR arthrography (MR-AR) of the shoulder is now a well-assessed technique, based on the injection of a contrast medium solution, which fills the articular space and finds its way between the rotator cuff (RC) and the glenohumeral ligaments. In patients with glenolabral pathology, we used an additional sequence that provided virtual arthroscopy (VA) post-processed views, which completed the MR evaluation of shoulder pathology. We enrolled 36 patients, from whom MR arthrographic sequence data (SE T1w and GRE T1 FAT SAT) were obtained using a GE 0.5 T Signa--before any surgical or arthroscopic planned treatment; the protocol included a supplemental 3D, spoiled GE T1w positioned in the coronal plane. Dedicated software loaded on a work-station was used to elaborate VAs. Two radiologists evaluated, on a semiquantitative scale, the visibility of the principal anatomic structures, and then, in consensus, the pathology emerging from the VA images. These images were reconstructed in all patients, except one. The visualization of all anatomical structures was acceptable. VA and MR arthrographic images were fairly concordant with intraoperative findings. Although in our pilot study the VA findings did not change the surgical planning, the results showed concordance with the surgical or arthroscopic images.

Anatomy of the capsulolabral complex and rotator interval related to glenohumeral instability.

Science.gov (United States)

Itoigawa, Yoshiaki; Itoi, Eiji

2016-02-01

The glenohumeral joint with instability is a common diagnosis that often requires surgery. The aim of this review was to present an overview of the anatomy of the glenohumeral joint with emphasis on instability based on the current literature and to describe the detailed anatomy and anatomical variants of the glenohumeral joint associated with anterior and posterior shoulder instability. A review was performed using PubMed/MEDLINE using key words: Search terms were "glenohumeral", "shoulder instability", "cadaver", "rotator interval", "anatomy", and "anatomical study". During the last decade, the interest in both arthroscopic repair techniques and surgical anatomy of the glenohumeral ligament (superior, middle, and inferior), labrum, and rotator interval has increased. Understanding of the rotator interval and attachment of the inferior glenohumeral ligament on the glenoid or humeral head have evolved significantly. The knowledge of the detailed anatomy and anatomical variations is essential for the surgeon in order to understand the pathology, make a correct diagnosis of instability, and select proper treatment options. Proper understanding of anatomical variants can help us avoid misdiagnosis. Level of evidence V.

Muscle recruitment patterns of the subscapularis, serratus anterior and other shoulder girdle muscles during isokinetic internal and external rotations.

Science.gov (United States)

Gaudet, Sylvain; Tremblay, Jonathan; Begon, Mickael

2018-05-01

The aims of this study were to investigate the differences in peak muscle activity and recruitment patterns during high- and low-velocity, concentric and eccentric, internal and external isokinetic shoulder rotations. Electromyographic activity of the rotator cuff and eight superficial muscles of the shoulder girdle was recorded on 25 healthy adults during isokinetic internal and external shoulder rotation at 60°/s and 240°/s. Peak muscle activity, electromyographic envelopes and peak isokinetic moments were analyzed using three-factor ANOVA and statistical parametric mapping. The subscapularis and serratus anterior showed moderate to high peak activity levels during each conditions, while the middle and posterior deltoids, upper, middle and lower trapezius, infraspinatus and supraspinatus showed higher peak activity levels during external rotations (+36.5% of maximum voluntary activation (MVA)). The pectoralis major and latissimus dorsi were more active during internal rotations (+40% of MVA). Only middle trapezius and pectoralis major electromyographic activity decreased with increasing velocity. Peak muscle activity was similar or lower during eccentric contractions, although the peak isokinetic moment increased by 35% on average. The subscapularis and serratus anterior appear to be important stabilizers of the glenohumeral joint and scapula. Isokinetic eccentric training at high velocities may allow for faster recruitment of the shoulder girdle muscles, which could improve joint stability during shoulder internal and external rotations.

Failed anterior cruciate ligament reconstruction: analysis of factors leading to instability after primary surgery.

Science.gov (United States)

Ma, Yong; Ao, Ying-Fang; Yu, Jia-Kuo; Dai, Ling-Hui; Shao, Zhen-Xing

2013-01-01

Revision anterior cruciate ligament (ACL) surgery can be expected to become more common as the number of primary reconstruction keeps increasing. This study aims to investigate the factors causing instability after primary ACL reconstruction, which may provide an essential scientific base to prevent surgical failure. One hundred and ten revision ACL surgeries were performed at our institute between November 2001 and July 2012. There were 74 men and 36 women, and the mean age at the time of revision was 27.6 years (range 16 - 56 years). The factors leading to instability after primary ACL reconstruction were retrospectively reviewed. Fifty-one knees failed because of bone tunnel malposition, with too anterior femoral tunnels (20 knees), posterior wall blowout (1 knee), vertical femoral tunnels (7 knees), too posterior tibial tunnels (12 knees), and too anterior tibial tunnels (10 knees). There was another knee performed with open surgery, where the femoral tunnel was drilled through the medial condyle and the tibial tunnel was too anterior. Five knees were found with malposition of the fixation. One knee with allograft was suspected of rejection and a second surgery had been made to take out the graft. Three knees met recurrent instability after postoperative infection. The other factors included traumatic (48 knees) and unidentified (12 knees). Technical errors were the main factors leading to instability after primary ACL reconstructions, while attention should also be paid to the risk factors of re-injury and failure of graft incorporation.

Recurrent anterior glenohumeral instability: the quantification of glenoid bone loss using magnetic resonance imaging

International Nuclear Information System (INIS)

Martins e Souza, Patricia; Brandao, Bruno Lobo; Motta, Geraldo; Monteiro, Martim; Brown, Eduardo; Marchiori, Edson

2014-01-01

To investigate the accuracy of conventional magnetic resonance imaging (MRI) in determining the severity of glenoid bone loss in patients with anterior shoulder dislocation by comparing the results with arthroscopic measurements. Institutional review board approval and written consent from all patients were obtained. Thirty-six consecutive patients (29 men, seven women; mean age, 34.5 [range, 18-55] years) with recurrent anterior shoulder dislocation (≥3 dislocations; mean, 37.9; range, 3-200) and suspected glenoid bone loss underwent shoulder MRI before arthroscopy (mean interval, 28.5 [range, 9-73] days). Assessments of glenoid bone loss by MRI (using the best-fit circle area method) and arthroscopy were compared. Inter- and intrareader reproducibility of MRI-derived measurements was evaluated using arthroscopy as a comparative standard. Glenoid bone loss was evident on MRI and during arthroscopy in all patients. Inter- and intrareader correlations of MRI-derived measurements were excellent (intraclass correlation coefficient = 0.80-0.82; r = 0.81-0.86). The first and second observers' measurements showed strong (r = 0.76) and moderate (r = 0.69) interreader correlation, respectively, with arthroscopic measurements. Conventional MRI can be used to measure glenoid bone loss, particularly when employed by an experienced musculoskeletal radiologist. (orig.)

Recurrent anterior glenohumeral instability: the quantification of glenoid bone loss using magnetic resonance imaging

Energy Technology Data Exchange (ETDEWEB)

Martins e Souza, Patricia [Fleury Medicina e Saude and Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ (Brazil); Brandao, Bruno Lobo; Motta, Geraldo; Monteiro, Martim [Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ (Brazil); Brown, Eduardo [Grupo Fleury Medicina Diagnostica, Rio de Janeiro, RJ (Brazil); Marchiori, Edson [Universidade Federal do Rio de Janeiro, Petropolis, RJ (Brazil)

2014-08-15

To investigate the accuracy of conventional magnetic resonance imaging (MRI) in determining the severity of glenoid bone loss in patients with anterior shoulder dislocation by comparing the results with arthroscopic measurements. Institutional review board approval and written consent from all patients were obtained. Thirty-six consecutive patients (29 men, seven women; mean age, 34.5 [range, 18-55] years) with recurrent anterior shoulder dislocation (≥3 dislocations; mean, 37.9; range, 3-200) and suspected glenoid bone loss underwent shoulder MRI before arthroscopy (mean interval, 28.5 [range, 9-73] days). Assessments of glenoid bone loss by MRI (using the best-fit circle area method) and arthroscopy were compared. Inter- and intrareader reproducibility of MRI-derived measurements was evaluated using arthroscopy as a comparative standard. Glenoid bone loss was evident on MRI and during arthroscopy in all patients. Inter- and intrareader correlations of MRI-derived measurements were excellent (intraclass correlation coefficient = 0.80-0.82; r = 0.81-0.86). The first and second observers' measurements showed strong (r = 0.76) and moderate (r = 0.69) interreader correlation, respectively, with arthroscopic measurements. Conventional MRI can be used to measure glenoid bone loss, particularly when employed by an experienced musculoskeletal radiologist. (orig.)

Low-Cost Alternative External Rotation Shoulder Brace and Review of Treatment in Acute Shoulder Dislocations

Directory of Open Access Journals (Sweden)

Lacy, Kyle

2015-01-01

Full Text Available Traumatic dislocations of the shoulder commonly present to emergency departments (EDs. Immediate closed reduction of both anterior and posterior glenohumeral dislocations is recommended and is frequently performed in the ED. Recurrence of dislocation is common, as anteroinferior labral tears (Bankart lesions are present in many anterior shoulder dislocations.14,15,18,23 Immobilization of the shoulder following closed reduction is therefore recommended; previous studies support the use of immobilization with the shoulder in a position of external rotation, for both anterior and posterior shoulder dislocations.7-11,19 In this study, we present a technique for assembling a low-cost external rotation shoulder brace using materials found in most hospitals: cotton roll, stockinette, and shoulder immobilizers. This brace is particularly suited for the uninsured patient, who lacks the financial resources to pay for a pre-fabricated brace out of pocket. We also performed a cost analysis for our low-cost external rotation shoulder brace, and a cost comparison with pre-fabricated brand name braces. At our institution, the total materials cost for our brace was $19.15. The cost of a pre-fabricated shoulder brace at our institution is $150 with markup, which is reimbursed on average at $50.40 according to our hospital billing data. The low-cost external rotation shoulder brace is therefore a more affordable option for the uninsured patient presenting with acute shoulder dislocation. [West J Emerg Med. 2015;16(1:114–120.

Shoulder reflexes

DEFF Research Database (Denmark)

Diederichsen, L.; Krogsgaard, M.; Voigt, Michael

2002-01-01

long latency (300 ms) excitatory reflex has been found when nerves in the capsule were stimulated electrically during shoulder surgery. In addition, when the anterior-inferior capsule was excited in conscious humans with modest amplitude electrical stimuli during muscle activity, a strong inhibition...... activity around the shoulder. This has implications for rehabilitation and shoulder surgery.......Dynamic shoulder stability is dependent on muscular coordination and sensory inputs. In the shoulder, mechanoreceptors are found in the coracoacromial ligament, the rotator cuff tendons, the musculotendinous junctions of the rotator cuff and in the capsule. The number of receptors in the capsule...

Reduction of Anterior Shoulder Dislocation in Emergency Department; Is Entonox® Effective?

Directory of Open Access Journals (Sweden)

Babak Mahshidfar

2011-12-01

Full Text Available Introduction: An appropriate procedural sedation and analgesia (PSA is crucial to reduce a dislocated shoulder successfully in emergency department. This study compares sedative effect of inhalational Entonox® (En to intra-venous (IV Midazolam plus Fentanyl (F+M. Methods: 120 patients with recurrent anterior shoulder dislocation were randomly assigned into two groups. 60 patients (group F+M received 0.1 mg/kg IV Midazolam plus 3µg/kg IV Fentanyl and 60 patients (group En received Entonox® with self administration face mask on an on-demand basis. Traction/counter-traction method was used to reduce the dislocated shoulder joint in both groups. Results: 48 out of 60 (80% patients in group F+M and 6 out of 60 (10% patients in group En had successful reduction (p < 0.0001. The mean pain score reduction was 6.3 ± 1.2 for group F+M and 3 ± 0.9 for group En (p < 0.0001. There was a statistically significant difference in mean patient satisfaction (assessed with Likert score between two groups (4.45 ± 0.6 for group F+M and 2.3 ± 1 for group En; p < 0.0001. Duration of entire procedure (since the beginning of PSA up to the end of successful or unsuccessful reduction was shorter in Group F+M, but successful reductions occurred earlier in group En. No major side effect such as airway compromise, retracted respiratory depression, or circulatory failure was occurred in any group. Conclusion: Entonox® may not be an appropriate agent to help reducing a dislocated shoulder.

Magnetic resonance imaging of the shoulder

International Nuclear Information System (INIS)

Ziemianski, A.; Romanowski, L.

1994-01-01

The technique of the own method of shoulder examination was presented. Anatomy and the most common diseases of the shoulder are discussed. The diseases of the shoulder diagnosed on the basis of the MR are: rotator cuff disease, impingement syndrome and instability. MR findings occurred in these entities were demonstrated. The most common MR finding of the rotator cuff disease was higher signal intensity within the supraspinatus tendon, while in shoulder instability was labral abnormality. Impingement syndrome is the previous syndrome of the full MR imaging of the rotator cuff disease. (author)

Suprascapular block associated with supraclavicular block: An alternative to isolated interscalene block for analgesia in shoulder instability surgery?

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Trabelsi, W; Ben Gabsia, A; Lebbi, A; Sammoud, W; Labbène, I; Ferjani, M

2017-02-01

Interscalene brachial plexus block (ISB) is the gold standard for postoperative pain management in shoulder surgery. However, this technique has side effects and potentially serious complications. The aim of this study was to compare the combinations of ultrasound-guided suprascapular (SSB) associated with supraclavicular nerve block (SCB) and ultrasound-guided ISB for postoperative analgesia after shoulder instability surgery. Sixty ASA physical status I-II patients scheduled to undergo shoulder instability surgery were included. Two groups: (i) the SSB+SCB group (n=30) in which the patients received a combination of US-guided SSB (15mL of bupivacaine 0.25%) and US-guided SCB (15mL of bupivacaine 0.25%) and (ii) the ISB group (n=30) in which the patients received US-guided ISB with 30mL of bupivacaine 0.25%. General anesthesia was administered to all patients. During the first 24h, the variables assessed were time to administer the anesthesia, duration of the analgesia, onset and duration of motor and sensory blockade, opioid consumption, cardiovascular stability, complications, and patient satisfaction. Anesthesia induction took more time for the SSB+SCB group than for the ISB group. However, the onset time of motor and sensory blockade was similar in the two groups. Statistical analysis of the visual analog postoperative pain scoring at H0, H6, H12, and H24 showed nonsignificant differences between the groups. Analgesia, the first request for morphine, and total morphine consumption during the first 24h was similar in both groups. No complication was recorded in the SSB+SCB group. However, phrenic nerve block occurred in all patients in the ISB group. US-guided SCB combined with US-guided SSB was as effective as ISB for postoperative analgesia after shoulder instability surgery without decreasing potential side effects. NCT identifier: NCT02397330. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

[Stability versus mobility of the shoulder. Biomechanical aspects in athletes].

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Pastor, M F; Smith, T; Struck, M; Wellmann, M

2014-03-01

The demand profile of athletes shoulders is high. On the one hand the shoulder has to provide a maximum active range of motion that allows rapid movements of the arm and on the other hand it has to be sufficiently stabilized to decelerate rapid movements and to neutralize the resulting translational forces. Two general types of instability can be differentiated in athletes shoulders: the macroinstability typically occurring in athletes involved in contact sports and the microinstability occurring in athletes involved in overhead sports.Repetitive abduction and external rotation movements of athletes involved in overhead sports lead to adaptation of the glenohumeral joint capsule and ligaments. The anterior capsule becomes stretched while the posterior capsule develops tightness. These adaptations can result in an anterior microinstability as well as posterosuperior impingement (PSI) which implicates a pathological contact of the posterosuperior rotator cuff with the posterior glenoid and which is also associated with SLAP lesions. In contrast the shoulders of swimmers are prone to anterosuperior impingement because the arm stroke involves a forceful combined anteflexion, adduction and internal rotation of the arm.The macroinstability of contact athletes is caused by sufficient trauma and characterized by a structural lesion of capsulolabral or bony lesion. While the empirical recurrence risk of young contact athletes is already high, it can be further impaired by bony defects of the glenoid. In suspected cases, critical glenoid defects should be quantified by computed tomography (CT) scans and treated by bony augmentation of the glenoid.

Nerve supply of the subscapularis during anterior shoulder surgery: definition of a potential risk area.

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Leschinger, Tim; Hackl, Michael; Zeifang, Felix; Scaal, Martin; Müller, Lars Peter; Wegmann, Kilian

2017-01-01

The purpose of the study was to evaluate the position of the subscapular nerves relative to surgical landmarks during exposure and to analyze the pattern of innervation of the subscapularis to avoid injury during anterior shoulder surgery. 20 embalmed human cadaveric shoulder specimens were used in the study. The muscular insertions of the subscapular nerves were marked and their closest branches to the musculotendinous junction and the coracoid process were measured in horizontal and vertical distances. In addition, the innervation pattern of each specimen was documented. 14/20 specimens showed an innervation of the subscapularis with an upper, middle and lower subscapular nerve branch. Even though the nerve branches were in average more than 2 cm medial to the musculotendinous junction, minimal distances of 1.1-1.3 cm were found. The mean vertical distance as measured from the medial base of the coracoid to the nerve innervation point into the muscle was 0.7 cm for the upper nerve branch, 2.2 cm for the middle nerve branch and 4.4 cm for the lower nerve branch. The subscapularis has a variable nerve supply, which increases the risk of muscle denervation during open shoulder surgery. Dissection or release should be avoided at the anterior aspect of the subscapularis muscle more than 1 cm medial to the musculotendinous junction. In approaches with a horizontal incision of the subscapularis, splitting should be performed at a vertical distance of 3.2-3.6 cm to the coracoid base to avoid iatrogenic subscapular nerve injuries.

Subscapulais injuries associated with acromiohumeral instability in patients with shoulder impingement syndrome

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Moon, Tae Young; Jeong, Hee Seok; Lee, Seung Jun; Jeong, Yeo Jin [Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

2017-07-15

To evaluate the association of subscapularis (SSC) injuries with acromiohumeral instability (AHI) in patients with shoulder impingement syndrome with supraspinatus (SSP) tears. Pre-operative shoulder magnetic resonance images of 106 patients with subsequent arthroscopic confirmation of shoulder impingement syndrome were reviewed retrospectively. Patients with SSC injuries were divided into the following 3 groups: 1) those with no injury symbolized to the SSC[0] (n = 38), 2) those with partial injuries to the SSC[1] (n = 41), and 3) those with complete disruption of the SSC[2] (n = 27). AHI was categorized into 5 stages depending on the SSP lesions: partial tear or pretear tendinosis symbolized to the SSP[0] (n = 24) and according to retraction severity of the SSP tendon with complete tear such as SSP[1] (n = 19), SSP[2] (n = 27), SSP[3] (n = 29), and SSP[4] (n = 7). Also, AHI was divided into two groups such as the mild group summed with SSP plus SSP plus SSP and the severe group summed with SSP plus SSP, including 70 patients and 36 patients, respectively. Twenty-nine patients (63.0%) among 46 patients with SSC[0] and thirty-two patients (78.0%) among 41 patients with SSC[1] were related to mild AHI. Eighteen patients (66.7%) among 27 patients with SSC[2] were associated with severe AHI. The SSC injury groups were statistically significantly associated with AHI (estimate 0.207, standard error 0.057, p < 0.01). SSC injuries could be related to AHI in patients with shoulder impingement syndrome.

Identification of suitable reference genes for gene expression studies of shoulder instability.

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Mariana Ferreira Leal

Full Text Available Shoulder instability is a common shoulder injury, and patients present with plastic deformation of the glenohumeral capsule. Gene expression analysis may be a useful tool for increasing the general understanding of capsule deformation, and reverse-transcription quantitative polymerase chain reaction (RT-qPCR has become an effective method for such studies. Although RT-qPCR is highly sensitive and specific, it requires the use of suitable reference genes for data normalization to guarantee meaningful and reproducible results. In the present study, we evaluated the suitability of a set of reference genes using samples from the glenohumeral capsules of individuals with and without shoulder instability. We analyzed the expression of six commonly used reference genes (ACTB, B2M, GAPDH, HPRT1, TBP and TFRC in the antero-inferior, antero-superior and posterior portions of the glenohumeral capsules of cases and controls. The stability of the candidate reference gene expression was determined using four software packages: NormFinder, geNorm, BestKeeper and DataAssist. Overall, HPRT1 was the best single reference gene, and HPRT1 and B2M composed the best pair of reference genes from different analysis groups, including simultaneous analysis of all tissue samples. GenEx software was used to identify the optimal number of reference genes to be used for normalization and demonstrated that the accumulated standard deviation resulting from the use of 2 reference genes was similar to that resulting from the use of 3 or more reference genes. To identify the optimal combination of reference genes, we evaluated the expression of COL1A1. Although the use of different reference gene combinations yielded variable normalized quantities, the relative quantities within sample groups were similar and confirmed that no obvious differences were observed when using 2, 3 or 4 reference genes. Consequently, the use of 2 stable reference genes for normalization, especially

A comparison of magnetic resonance arthrography and arthroscopic findings in the assessment of anterior shoulder dislocations

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Jordan, R.W.; Naeem, R.; Srinivas, K.; Shyamalan, G. [Birmingham Heartlands Hospital, Birmingham (United Kingdom)

2015-05-01

The aim of this study is to establish the sensitivity and specificity of MRA in the investigation of patients with traumatic anterior shoulder dislocations. A retrospective analysis of consecutive patients undergoing both magnetic resonance arthrography and arthroscopic assessment after a traumatic anterior shoulder dislocation between January 2011 and 2014 was performed. Demographic data were collected from electronic records. Images were interpreted by 8 musculoskeletal radiologists and patients were treated by 8 consultant orthopaedic surgeons. Arthroscopic findings were obtained from surgical notes and these findings were used as a reference for MRA. The sensitivity, specificity, and positive predictive value were calculated for the different injuries. Sixty-nine patients underwent both an MRA and shoulder arthroscopy during the study period; however, clinical notes were unavailable in 9 patients. Fifty-three patients (88 %) were male, the mean age was 28 years (range 18 to 50) and 16 subjects (27 %) had suffered a primary dislocation. The overall sensitivity and specificity of MRA to all associated injuries was 0.9 (CI 0.83-0.95) and 0.94 (CI 0.9-0.96) retrospectively. The lowest sensitivity was seen in osseous Bankart 0.8 (CI 0.44-0.96) and superior labral tear (SLAP) lesions 0.5 (CI 0.14-0.86). The overall positive predictive value was 0.88 (CI 0.76-0.91) with the lowest values found in rotator cuff 0.4 (CI 0.07-0.83) and glenohumeral ligament (GHL) lesions 0.29 (CI 0.05-0.7). Magnetic resonance angiography has a high sensitivity when used to identify associated injuries in shoulder dislocation, although in 8 patients (13 %) arthroscopy identified an additional injury. The overall agreement between MRA and arthroscopic findings was good, but the identification of GHL and rotator cuff injuries was poor. (orig.)

A comparison of magnetic resonance arthrography and arthroscopic findings in the assessment of anterior shoulder dislocations

International Nuclear Information System (INIS)

Jordan, R.W.; Naeem, R.; Srinivas, K.; Shyamalan, G.

2015-01-01

The aim of this study is to establish the sensitivity and specificity of MRA in the investigation of patients with traumatic anterior shoulder dislocations. A retrospective analysis of consecutive patients undergoing both magnetic resonance arthrography and arthroscopic assessment after a traumatic anterior shoulder dislocation between January 2011 and 2014 was performed. Demographic data were collected from electronic records. Images were interpreted by 8 musculoskeletal radiologists and patients were treated by 8 consultant orthopaedic surgeons. Arthroscopic findings were obtained from surgical notes and these findings were used as a reference for MRA. The sensitivity, specificity, and positive predictive value were calculated for the different injuries. Sixty-nine patients underwent both an MRA and shoulder arthroscopy during the study period; however, clinical notes were unavailable in 9 patients. Fifty-three patients (88 %) were male, the mean age was 28 years (range 18 to 50) and 16 subjects (27 %) had suffered a primary dislocation. The overall sensitivity and specificity of MRA to all associated injuries was 0.9 (CI 0.83-0.95) and 0.94 (CI 0.9-0.96) retrospectively. The lowest sensitivity was seen in osseous Bankart 0.8 (CI 0.44-0.96) and superior labral tear (SLAP) lesions 0.5 (CI 0.14-0.86). The overall positive predictive value was 0.88 (CI 0.76-0.91) with the lowest values found in rotator cuff 0.4 (CI 0.07-0.83) and glenohumeral ligament (GHL) lesions 0.29 (CI 0.05-0.7). Magnetic resonance angiography has a high sensitivity when used to identify associated injuries in shoulder dislocation, although in 8 patients (13 %) arthroscopy identified an additional injury. The overall agreement between MRA and arthroscopic findings was good, but the identification of GHL and rotator cuff injuries was poor. (orig.)

The shoulder in baseball pitching: biomechanics and related injuries-part 1.

Science.gov (United States)

Park, Samuel S; Loebenberg, Mark L; Rokito, Andrew S; Zuckerman, Joseph D

The extreme range of motion at the shoulder, the high angular velocities and torques, and the repetitious nature of the pitching motion combine to make the shoulder vulnerable to injury during the baseball pitch. An understanding of the biomechanics that contribute to shoulder injuries during each phase of the pitching motion can facilitate the athlete's diagnosis, treatment, and rehabilitation. Common injuries that occur during the late cocking and acceleration phases of the pitch include anterior instability and impingement, bicipital tendinitis, and subacromial impingement. Nonoperative treatment consisting of an initial period of rest and NSAIDS, followed by physical therapy and a gradual return to activity, is usually successful. When this approach fails, surgical intervention, either arthroscopic or open, may be necessary. Physical therapy and rehabilitation are directed toward restoring the integrity and strength of the dynamic and static stabilizers of the shoulder joint, yet preserving the range of motion necessary for performance. Through rehabilitation, the dedicated athlete can often return to the pitching mound at his previous level of performance.

Eponymous terms in anterior shoulder stabilization surgery

NARCIS (Netherlands)

Somford, M. P.; van der Linde, J. A.; Wiegerinck, J. I.; Hoornenborg, D.; van den Bekerom, M. P. J.; van Deurzen, D. F. P.

2017-01-01

Shoulder dislocation and its treatment are probably as old as time. Surgical treatment has gained acceptance recently, especially in recurrent cases. Within roughly the last 100 years, numerous treatment strategies have been developed and questions elucidated regarding the entity of shoulder

Evaluation of instability after transtrochanteric anterior rotational osteotomy for nontraumatic osteonecrosis of the femoral head

International Nuclear Information System (INIS)

Hiranuma, Yasunari; Atsumi, Takashi; Kajiwara, Toshihisa; Tamaoki, Satoshi; Asakura, Yasuhiro

2009-01-01

Transtrochanteric anterior rotational osteotomy results in improvement of joint congruity and prevention of progressive collapse and osteoarthritic changes in patients with femoral head osteonecrosis. However, this procedure remains controversial for patients with extensive collapse due to potential osteoarthritis caused by postoperative instability. The purpose of this study was to evaluate hip instability after osteotomy and determine the relation between instability and radiological and clinical outcomes. In all, 27 hips of 24 patients that were followed up for a mean period of 3.8 years were included. Instability was defined as more than 1 mm translation of the femoral head in transverse computed tomography scans obtained at 0 deg and 45 deg flexion of the hip joint. Hips were divided into instability and stability groups. Eleven hips (40%) developed instability after surgery. Osteophytes on the femoral head in 10 hips of the instability group and 2 hips of the stability group had increased in size at follow-up. There was a significant relation between postoperative instability and osteophyte formation. Joint space narrowing was not seen in any of the cases. There was no significant difference between the groups in either the postoperative intact ratio of the femoral head or the Japanese Orthopaedic Association hip score. Neither instability nor osteophyte formation on the femoral head after transtrochanteric anterior rotational osteotomy correlated with progressive osteoarthritic changes or clinical outcome in the presence of an adequate femoral head intact ratio facing the weight-bearing area. (author)

Is external rotation the correct immobilisation for acute shoulder dislocation? An MRI study.

Science.gov (United States)

Siegler, J; Proust, J; Marcheix, P S M; Charissoux, J L; Mabit, C; Arnaud, J P

2010-06-01

Anterior dislocation of the shoulder is frequent, with high rates of recurrence. Immobilization in external rotation (ER) seems to improve results, although few studies have actually demonstrated this. The present MRI study examined the impact of ER on labral and capsular ligamentous complex lesions after primary dislocation. A prospective study was started up on January 1st, 2007. Inclusion criteria were: acute initial anteromedial dislocation of the shoulder, without past history of shoulder trauma. There were 23 such patients, with a mean age of 37 years. Early MRI scan used the following protocol: one acquisition in internal rotation followed by one in ER. Study criteria were: hemarthrosis, ER amplitude, rotator cuff status, bone lesion, and labral lesion stage (Habermeyer's classification) and displacement (Itoi criteria). There were 12 right and 11 left shoulders. Mean time to MRI was 3.7 days. There were three rotator cuff tears, no glenal lesions, and 14 humeral notches. Hemarthrosis was almost systematically present, with its distribution modified by ER in 75% of cases; three patients showed no posterior hemarthrosis, in whatever rotation. Mean ER was 37 degrees. On Habermeyer's classification, there were 12 stage-1 lesions, and 10 stage-2; one patient had no labral lesion. All separated labra were reduced in ER, five (21%) totally. In six cases, labral displacement changed according to rotation. All anterior joint effusion was reduced in ER, in three cases totally. According to Itoi among others, immobilization in ER is the way to reduce recurrence of anterior dislocation. The present study confirmed that labral reduction was systematic with ER, but it was by no means always complete. ER seemed more effective in reducing the separation. Results further confirmed that ER reduced anterior capsule volume, a recurrence factor. ER reduced hemarthrosis, anterior capsule detachment and labral lesions, and never the contrary. The interest of immobilization in ER

Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic findings and results of anatomical reconstruction

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Swierstra Bart A

2011-09-01

Full Text Available Abstract Background The arthroscopic findings in patients with chronic anterior syndesmotic instability that need reconstructive surgery have never been described extensively. Methods In 12 patients the clinical suspicion of chronic instability of the syndesmosis was confirmed during arthroscopy of the ankle. All findings during the arthroscopy were scored. Anatomical reconstruction of the anterior tibiofibular syndesmosis was performed in all patients. The AOFAS score was assessed to evaluate the result of the reconstruction. At an average of 43 months after the reconstruction all patients were seen for follow-up. Results The syndesmosis being easily accessible for the 3 mm transverse end of probe which could be rotated around its longitudinal axis in all cases during arthroscopy of the ankle joint, confirmed the diagnosis. Cartilage damage was seen in 8 ankles, of which in 7 patients the damage was situated at the medial side of the ankle joint. The intraarticular part of anterior tibiofibular ligament was visibly damaged in 5 patients. Synovitis was seen in all but one ankle joint. After surgical reconstruction the AOFAS score improved from an average of 72 pre-operatively to 92 post-operatively. Conclusions To confirm the clinical suspicion, the final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle. Cartilage damage to the medial side of the tibiotalar joint is often seen and might be the result of syndesmotic instability. Good results are achieved by anatomic reconstruction of the anterior syndesmosis, and all patients in this study would undergo the surgery again if necessary.

Assessment of rotatory instability after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft

International Nuclear Information System (INIS)

Tashiro, Yasutaka; Okazaki, Ken; Miura, Hiromasa

2010-01-01

Anatomically oriented anterior cruciate ligament (ACL) reconstruction has been advocated recently, but its effect on rotatory instability remains to be cleared objectively. The purpose of this study was to quantitatively evaluate rotatory instability in ACL reconstructed knees with a bone-patellar tendon-bone (BTB) graft using an open MRI system. Eighteen subjects underwent arthroscopic ACL reconstruction with a BTB graft. The tibial tunnel was placed in the center of the ACL footprint. The femoral tunnel was drilled transtibially at the 10:00 to 10:30-o'clock position for the right knees. Subjects were examined using a Slocum anterolateral rotatory instability test in open MRI. Anterior tibial translation was measured at the medial and lateral compartments by evaluating sagittal images. Anterior knee stability was evaluated using the KT-2000 arthrometer. The clinical knee function was assessed with the Lysholm and Tegner scoring scales before and after the surgery. Side-to-side differences of anterolateral tibial translation was 0.1 mm. Side-to-side difference on KT-2000 arthrometer measurement was 1.8 mm. The Lysholm score improved to 96 and the latest Tegner score reached substantially the preinjury level. ACL reconstruction with a BTB graft was successful in restoring rotatory stability as well as anterior stability and knee function. (author)

[Treatment of dislocation of shoulder with manipulation of proneposition modified hippocrates method].

Science.gov (United States)

Zhao, Hong-Sheng; Jing, Guang-Wu; Zhang, Jian-Jun

2012-03-01

To explore the method of reduction of anterior dislocation of shoulder joint, evaluate the clinical effects of proneposition modified Hippocrates methods. From February 1998 to April 2011, 1 028 patients, 689 males and 339 females, with anterior dislocation of shoulder joint were treated with manipulation of proneposition modified Hippocrates methods. The average age was 38.3 years (ranged from 11 to 86 years). Thirty-two cases by Hippocrates method failure to reset success, 86 cases combined with geater tuberosity tore of humerus. One thousand and twenty-seven example applications, it took average 50 s, 1 case was cured due to a combination of humerus surgical neck fracture. Eighty-six cases combined with greater tuberosity tore of humerus, 84 cases reached anatomical reattachment or nearly anatomical reattachment, 2 cases of large bone pieces instability were reduced by percutaneous needle. According to Neer score, there are 1 012 excellent cases, 15 good cases. Proneposition modified Hippocrates method is better than Hippocrates. It has the advantage of anesthesia, lower expense, short replacement, less pain, easier to master, and worth applying widely.

3D-MR vs. 3D-CT of the shoulder in patients with glenohumeral instability

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Stillwater, Laurence; Koenig, James; Maycher, Bruce; Davidson, Michael [University of Manitoba, Winnipeg (Canada)

2017-03-15

To determine whether 3D-MR osseous reformats of the shoulder are equivalent to 3D-CT osseous reformats in patients with glenohumeral instability. Patients with glenohumeral instability, who were to be imaged with both CT and MRI, were prospectively selected. CT and MR were performed within 24 h of one another on 12 shoulders. Each MR study included an axial 3D isotropic VIBE sequence. The image data from the isotropic VIBE sequence were post-processed using subtraction and 3D software. CT data were post-processed using 3D software. The following measurements were obtained for both 3D-CT and 3D-MR post-processed images: height and width of the humeral head and glenoid, Hill-Sachs size and percent humeral head loss (if present), size of glenoid bone loss and percent glenoid bone loss (if present). Paired t-tests and two one-sided tests for equivalence were used to assess the differences between imaging modalities and equivalence. The measurement differences from the 3D-CT and 3D-MR post-processed images were not statistically significant. The measurement differences for humeral height, glenoid height and glenoid width were borderline statistically significant; however, using any adjustment for multiple comparisons, this failed to be significant. Using an equivalence margin of 1 mm for measurements and 1.5% for percent bone loss, the 3D-MR and 3D-CT post-processed images were equivalent. Three-dimensional-MR osseous models of the shoulder using a 3D isotropic VIBE sequence were equivalent to 3D-CT osseous models, and the differences between modalities were not statistically significant. (orig.)

Comparison of Bristow procedure and Bankart arthroscopic method as the treatment of recurrent shoulder instability

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Abolghasem Zarezade

2014-01-01

Full Text Available Background: Anterior shoulder dislocation is the most common major joint dislocation. In patients with recurrent shoulder dislocation, surgical intervention is necessary. In this study, two methods of treatment, Bankart arthroscopic method and open Bristow procedure, were compared. Materials and Methods: This clinical trial survey had been done in the orthopedic department of Alzahra and Kashani hospitals of Isfahan during 2008-2011. Patients with recurrent anterior shoulder dislocation who were candidates for surgical treatment were randomly divided into two groups, one treated by Bankart arthroscopic technique and the other treated by Bristow method. All the patients were assessed after the surgery using the criteria of ROWE, CONSTANT, UCLA, and ASES. Data were analyzed by SPSS software. Results: Six patients (16.22% had inappropriate condition with ROWE score (score less than 75; of them, one had been treated with Bristow and five with Bankart (5.26 vs. 27.78. Nine patients (24.32% had appropriate condition, which included six from Bristow group and three treated by Bankart technique (31.58 vs. 16.67. Finally, 22 patients (59.46% showed great improvement with this score, which included 12 from Bristow and 10 from Bankart groups (63.16 vs. 55.56. According to Fisher′s exact test, there were no significant differences between the two groups (P = 0.15. Conclusion: The two mentioned techniques did not differ significantly, although some parameters such as level of performance, pain intensity, use of analgesics, and range of internal rotation showed more improvement in Bristow procedure. Therefore, if there is no contraindication for Bristow procedure, it is preferred to use this method.

Concurrent Rotator Cuff Tear and Axillary Nerve Palsy Associated with Anterior Dislocation of the Shoulder and Large Glenoid Rim Fracture: A “Terrible Tetrad”

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Fumiaki Takase

2014-01-01

Full Text Available We present a case of concurrent rotator cuff tear and axillary nerve palsy resulting from anterior dislocation of the shoulder and a large glenoid rim fracture—a “terrible tetrad.” A 61-year-old woman fell on her right shoulder. Radiographs showed anterior dislocation of the shoulder with a glenoid rim fracture, and an MRI two months after injury revealed a rotator cuff tear. Upon referral to our hospital, physical and electrophysiological examinations revealed axillary nerve palsy. The axillary nerve palsy was incomplete and recovering, and displacement of the glenoid rim fracture was minimal and already united; therefore, we surgically repaired only the rotator cuff tear three months after injury. The patient recovered satisfactorily following the operation. In patients whose axillary nerve palsy is recovering, surgeons should consider operating on rotator cuff tears in an attempt to prevent rotator cuff degeneration.

Subscapularis slide correction of the shoulder internal rotation contracture after brachial plexus birth injury: technique and outcomes.

Science.gov (United States)

Immerman, Igor; Valencia, Herbert; DiTaranto, Patricia; DelSole, Edward M; Glait, Sergio; Price, Andrew E; Grossman, John A I

2013-03-01

Internal rotation contracture is the most common shoulder deformity in patients with brachial plexus birth injury. The purpose of this investigation is to describe the indications, technique, and results of the subscapularis slide procedure. The technique involves the release of the subscapularis muscle origin off the scapula, with preservation of anterior shoulder structures. A standard postoperative protocol is used in all patients and includes a modified shoulder spica with the shoulder held in 60 degrees of external rotation and 30 degrees of abduction, aggressive occupational and physical therapy, and subsequent shoulder manipulation under anesthesia with botulinum toxin injections as needed. Seventy-one patients at 2 institutions treated with subscapularis slide between 1997 and 2010, with minimum follow-up of 39.2 months, were identified. Patients were divided into 5 groups based on the index procedure performed: subscapularis slide alone (group 1); subscapularis slide with a simultaneous microsurgical reconstruction (group 2); primary microsurgical brachial plexus reconstruction followed later by a subscapularis slide (group 3); primary microsurgical brachial plexus reconstruction followed later by a subscapularis slide combined with tendon transfers for shoulder external rotation (group 4); and subscapularis slide with simultaneous tendon transfers, with no prior brachial plexus surgery (group 5). Full passive external rotation equivalent to the contralateral side was achieved in the operating room in all cases. No cases resulted in anterior instability or internal rotation deficit. Internal rotation contracture of the shoulder after brachial plexus birth injury can be effectively managed with the technique of subscapularis slide.

Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy.

Science.gov (United States)

Cho, Jae Ho; Lee, Doo Hyung; Song, Hyung Keun; Bang, Joon Young; Lee, Kyung Tai; Park, Young Uk

2016-04-01

Clinicians frequently diagnose chronic ankle instability using the manual anterior drawer test and stress radiography. However, both examinations can yield incorrect results and do not reveal the extent of ankle instability. Stress ultrasound has been reported to be a new diagnostic tool for the diagnosis of chronic ankle instability. The purpose of this study was to assess the diagnostic value of stress ultrasound for chronic ankle instability compared to the manual anterior drawer test, stress radiography, magnetic resonance imaging (MRI), and arthroscopy. Twenty-eight consecutive patients who underwent ankle arthroscopy and subsequent modified Broström repair for treatment of chronic ankle instability were included. The arthroscopic findings were used as the reference standard. A standardized physical examination (manual anterior drawer test), stress radiography, MRI, and stress ultrasound were performed to assess the anterior talofibular ligament (ATFL) prior to operation. Ultrasound images were taken in the resting position and the maximal anterior drawer position. Grade 3 lateral instability was verified arthroscopically in all 28 cases with a clinical diagnosis (100%). Twenty-two cases showed grade III instability on the manual anterior drawer test (78.6%). Twenty-four cases displayed anterior translation exceeding 5 mm on stress radiography (86%), and talar tilt angle exceeded 15° in three cases (11 %). Nineteen cases displayed a partial chronic tear (change in thickness or signal intensity), and nine cases displayed complete tear on MRI (100%). Lax and wavy ATFL was evident on stress ultrasound in all cases (100 %). The mean value of the ATFL length was 2.8 ± 0.3 cm for the stressed condition and 2.1 ± 0.2 cm for the resting condition (p radiography. III.

Arthroscopic anterior talofibular ligament repair for chronic ankle instability with a suture anchor technique.

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Kim, Eung Soo; Lee, Kyung Tai; Park, Jun Sic; Lee, Young Koo

2011-04-11

The goal of this study was to retrospectively evaluate the clinical outcomes of arthroscopic repair for chronic ankle instability using a bioabsorbable anchor with 2 sutures. We evaluated the results of 28 ankles treated with arthroscopic anterior talofibular ligament repair using bioabsorbable anchors with a FiberWire and TigerWire suture (Arthrex, Inc, Naples, Florida) placed on the fibula from March 2008 to January 2009. Average follow-up was 15.9 months (range, 13-25 months). Patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot ankle score and stress radiographs. Mean AOFAS hindfoot ankle score was 92.48 ± 6.14 at last follow-up compared to the mean preoperative score of 60.78 ± 16.38 (P=.041). Mean postoperative anterior draw test score difference between 2 ankles was 0.61 ± 0.75 compared to the mean preoperative score difference of 3.59 ± 0.68 (P=.00). There was a 14% complication rate, including 3 cases of portal site irritation and 1 case of superficial infection. Stress radiographs revealed 3 cases of anterior displacement >3 mm compared to the other side. All patients returned to their previous activity level.Arthroscopic ligament reconstruction for chronic lateral ankle instability using suture anchors is effective in returning patients to their preinjury function levels. Good clinical results were obtained with some minor complications. This minimally invasive technique is a reasonable alternative to other open surgical procedures for chronic ankle instability. Copyright 2011, SLACK Incorporated.

Irreducible Traumatic Posterior Shoulder Dislocation

Directory of Open Access Journals (Sweden)

Blake Collier

2017-01-01

Full Text Available History of present illness: A 22-year-old male presented to the Emergency Department complaining of right shoulder pain after a motocross accident. He was traveling at approximately 10 mph around a turn when he lost control and was thrown over the handlebars, landing directly on his right shoulder. On arrival, he was holding his arm in adduction and internal rotation. An area of swelling was noted over his anterior shoulder. He was unable to abduct his shoulder. No humeral gapping was noted. He had normal neuro-vascular status distal to the injury. Significant findings: Radiographs demonstrated posterior displacement of the humeral head on the “Y” view (see white arrow and widening of the glenohumeral joint space on anterior-posterior view (see red arrow. The findings were consistent with posterior dislocation and a Hill-Sachs type deformity. Sedation was performed and reduction was attempted using external rotation, traction counter-traction. An immediate “pop” was felt during the procedure. Post-procedure radiographs revealed a persistent posterior subluxation with interlocking at posterior glenoid. CT revealed posterior dislocation with acute depressed impaction deformity medial to the biceps groove with the humeral head perched on the posterior glenoid, interlocked at reverse Hill-Sachs deformity (see blue arrow. Discussion: Posterior shoulder dislocations are rare and represent only 2% of all shoulder dislocations. Posterior shoulder dislocations are missed on initial diagnosis in more than 60% of cases.1 Posterior shoulder dislocations result from axial loading of the adducted and internally rotated shoulder, violent muscle contractions (resulting from seizures or electrocution, a direct posterior force applied to the anterior shoulder.1 Physical findings include decreased anterior prominence of the humeral head, increased palpable posterior prominence of the humeral head below the acromion, increased palpable prominence of the

Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults.

LENUS (Irish Health Repository)

Wakai, Abel

2012-01-31

BACKGROUND: There is conflicting evidence regarding the use of intra-articular lignocaine injection for the closed manual reduction of acute anterior shoulder dislocations. A systematic review may help cohere the conflicting evidence. OBJECTIVES: To compare the clinical efficacy and safety of intra-articular lignocaine and intravenous analgesia (with or without sedation) for reduction of acute anterior shoulder dislocation. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), and EMBASE (1980 to March 2010). We searched Current Controlled Trials metaRegister of Clinical Trials (compiled by Current Science) (March 2010). We imposed no language restriction. SELECTION CRITERIA: Randomized controlled trials comparing intra-articular lignocaine (IAL) with intravenous analgesia with or without sedation (IVAS) in adults aged 18 years and over for reduction of acute anterior shoulder dislocation. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. Where possible, data were pooled and relative risks (RR) and mean differences (MD), each with 95% confidence intervals (CI), were computed using the Cochrane Review Manager statistical package (RevMan). MAIN RESULTS: Of 1041 publications obtained from the search strategy, we examined nine studies. Four studies were excluded, and five studies with 211 participants were eligible for inclusion. There was no difference in the immediate success rate of IAL when compared with IVAS in the closed manual reduction of acute anterior shoulder dislocation (RR 0.95; 95% CI 0.83 to 1.10). There were significantly fewer adverse effects associated with IAL compared with IVAS (RR 0.16; 95% CI 0.06 to 0.43). The mean time spent in the emergency department was significantly less with IAL compared with IVAS (MD 109.46 minutes; 95% CI 84.60 to 134.32). One trial reported significantly less time for

Translation, adaptation and measurement properties of an electronic version of the Danish Western Ontario Shoulder Instability Index (WOSI)

DEFF Research Database (Denmark)

Eshoj, Henrik; Bak, Klaus; Blønd, Lars

2017-01-01

OBJECTIVES: To translate and adapt the Western Ontario Shoulder Instability (WOSI) questionnaire into Danish and, to evaluate measurement properties of an electronic Danish WOSI version. METHODS: The Swedish WOSI version was used for translation and adaptation into Danish followed by examination...... Shoulder Score (OSS). Reproducibility was evaluated with Intraclass correlations (ICC), Standard Error of Measurement (SEM), minimal detectable change (MDC) and limits of agreement (LOA). Validity was evaluated with Pearson's (r) and Concordance Correlation Coefficients (CCC). RESULTS: 41 subjects (median...... presented excellent test-retest reproducibility and acceptable measurement errors. Also, concurrent validity between paper and electronic version was highly satisfactory as was the construct validity. Surprisingly, though, the NPRS correlated more with WOSI than OSS....

Ventricular tachycardia during arthroscopic shoulder surgery: a report of two cases.

Science.gov (United States)

Cho, Seung Hyun; Yi, Jin Woong; Kwack, Yoon Ho; Park, Sung Wook; Kim, Mi Kyeong; Rhee, Yong Girl

2010-03-01

We routinely have performed arthroscopic shoulder surgery under general anesthesia in the beach chair position using epinephrine (0.33 mg/L) saline irrigation. At a 2-week interval, two patients, a 19-year-old man scheduled to undergo an arthroscopic Bankart repair for left traumatic anterior instability and a 49-year-old woman scheduled for an arthroscopic rotator cuff repair for a left rotator cuff tear, were resuscitated by chest compression and defibrillation due to a sudden developed cardiogenic shock following ventricular tachycardia at the time of arthroscopic shoulder surgery. They were transferred to the intensive care unit because their emergent echocardiogram showed significantly decreased cardiac functions. They were fully recovered and then discharged. Epinephrine was considered to be the cause of ventricular tachycardia because the two patients showed no anaphylactic reaction to drugs or symptoms of air embolism related to the beach chair position. In addition, according to our observation of epinephrine flow patterns, it was more likely that highly concentrated epinephrine was rapidly infused into the body. This complication is very rare. However, thorough understanding of the side effects and their development of epinephrine during arthroscopic shoulder surgery should neither be overemphasized nor disregarded.

Bony Reconstruction of the Anterior Glenoid Rim.

Science.gov (United States)

Willemot, Laurent B; Elhassan, Bassem T; Verborgt, Olivier

2018-04-13

Recurrent anterior shoulder instability is associated with glenohumeral bone loss. Glenoid deficiency compromises the concavity-compression mechanism. Medial Hill-Sachs lesions can result in an off-track humeral position. Anterior glenoid reconstruction or augmentation prevents recurrence by addressing the pathomechanics. In Bristow and Latarjet procedures, the coracoid process is harvested for conjoint tendon transfer, capsular reinforcement, and glenoid rim restoration. Complications and the nonanatomic nature of the procedure have spurred research on graft sources. The iliac crest is preferred for autogenous structural grafts. Tricortical, bicortical, and J-bone grafts have shown promising results despite the historical association of Eden-Hybinette procedures with early degenerative joint disease. Allogeneic osteochondral grafts may minimize the risk of arthropathy and donor site morbidity. Tibial plafond and glenoid allografts more closely match the native glenoid geometry and restore the articular chondral environment, compared with conventional grafts. Graft availability, cost, risk of disease transmission, and low chondrocyte viability have slowed the acceptance of osteochondral allografts.

Posture and isokinetic shoulder strength in female water polo players

African Journals Online (AJOL)

Kathryn van Boom

pathological injuries, such as rotator cuff tendinitis, shoulder instability and shoulder ... and specific postural characteristics, which will be useful in future studies. ... concentric and eccentric IR and ER shoulder muscle strength in 15 club-level ...

The diabetic frozen shoulder: arthroscopic release.

Science.gov (United States)

Ogilvie-Harris, D J; Myerthall, S

1997-02-01

Seventeen patients who were diabetics developed frozen shoulders which failed to respond to conservative management. They had persistent pain, stiffness, and limited function. An arthroscopic release was performed by progressively releasing the anterior structures from superior to inferior. Starting from the interval area we progressed to the anterior superior glenohumeral ligament, the intra-articular portion of the subscapularis, the anterior capsule, and the inferior capsule. Postoperatively physiotherapy was carried out daily to maintain the range of movement. At a follow up of 1 to 5 years the patients were assessed using the American Shoulder Society scheme. In addition the patients were assessed preoperatively and postoperatively on four criteria; pain, external rotation, abduction, and function. We found that the patients were statistically significantly improved in all four categories. Thirteen of the 17 patients had no pain, full range of motion compared with the opposite side, and full function. There was one poor result with no improvement. The remaining three patients had improved but still had residual abnormalities. We consider arthroscopic release to be an effective treatment for the resistant diabetic frozen shoulder.

Prevalência das lesões associadas na luxação recidivante traumática do ombro Prevalence of lesions associated with traumatic recurrent shoulder dislocation

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Oreste Lemos Carrazzone

2011-01-01

Full Text Available OBJETIVO: Avaliar a prevalência das lesões associadas à instabilidade anterior traumática do ombro e a relação entre o número de episódios e o tempo do início dos sintomas com a prevalência destas lesões. MÉTODO: Foram selecionados 57 pacientes com instabilidade anterior traumática do ombro, entre 18 e 40 anos, com mais de um episódio de luxação do ombro e com no mínimo, seis meses da primeira luxação, que necessitaram de cirurgia para tratamento da instabilidade. Foi realizada inspeção artroscópica em todos os pacientes para avaliação das lesões associadas. RESULTADOS: Foi avaliada a prevalência das lesões, sendo a lesão de Bankart a mais prevalente seguida pela lesão de Hill-Sachs e as lesões do manguito rotador as menos prevalentes. Não houve correlação comparando o número de episódios de luxação com a prevalência de lesões associadas. Já em relação ao tempo de sintomas, os pacientes com maior tempo de sintomas tiveram menos lesão de Hill-Sachs. CONCLUSÃO: Não foi possível afirmar que, em pacientes com instabilidade crônica do ombro, as lesões associadas aumentam com o tempo de sintomas ou com o número de episódios de luxação.OBJECTIVE: To evaluate the prevalence of lesions associated with traumatic anterior shoulder instability and the relationships between the prevalence of these lesions and the number of episodes and time since symptoms started. METHOD: Fifty-seven patients aged 18 to 40 years, with traumatic anterior shoulder instability, more than one episode of shoulder dislocation and at least six months since the first dislocation, who required surgery to treat the instability, were selected. Arthroscopic inspection was performed on all the patients to assess any associated lesions. RESULTS: The prevalence of lesions was assessed, and Bankert lesions were the most prevalent, followed by Hill-Sachs lesions, while rotator cuff injuries were the least prevalent. There was no correlation

Video Analysis of Primary Shoulder Dislocations in Rugby Tackles.

Science.gov (United States)

Maki, Nobukazu; Kawasaki, Takayuki; Mochizuki, Tomoyuki; Ota, Chihiro; Yoneda, Takeshi; Urayama, Shingo; Kaneko, Kazuo

2017-06-01

Characteristics of rugby tackles that lead to primary anterior shoulder dislocation remain unclear. To clarify the characteristics of tackling that lead to shoulder dislocation and to assess the correlation between the mechanism of injury and morphological damage of the glenoid. Case series; Level of evidence, 4. Eleven elite rugby players who sustained primary anterior shoulder dislocation due to one-on-one tackling between 2001 and 2014 were included. Using an assessment system, the tackler's movement, posture, and shoulder and head position were evaluated in each phase of tackling. Based on 3-dimensional computed tomography, the glenoid of the affected shoulder was classified into 3 types: intact, erosion, and bone defect. Orientation of the glenoid defect and presence of Hill-Sachs lesion were also evaluated. Eleven tackles that led to primary shoulder dislocation were divided into hand, arm, and shoulder tackle types based on the site at which the tackler contacted the ball carrier initially. In hand and arm tackles, the tackler's shoulder joint was forcibly moved to horizontal abduction by the impact of his upper limb, which appeared to result from an inappropriate approach to the ball carrier. In shoulder tackles, the tackler's head was lowered and was in front of the ball carrier at impact. There was no significant correlation between tackle types and the characteristics of bony lesions of the shoulder. Although the precise mechanism of primary anterior shoulder dislocation could not be estimated from this single-view analysis, failure of individual tackling leading to injury is not uniform and can be caused by 2 main factors: failure of approach followed by an extended arm position or inappropriate posture of the tackler at impact, such as a lowered head in front of the opponent. These findings indicate that injury mechanisms should be assessed for each type of tackle, as it is unknown whether external force to the glenoid is different in each mechanism

Myositis ossificans around shoulder following military training programme

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Mustafa C Kir

2011-01-01

Full Text Available The myositis ossificans around shoulder in military recruits are not reported yet. Three young male soldiers presented with complaints of palpable mass at the anterior aspect of shoulder; tenderness around the superior part of deltopectoral groove close to acromioclavicular joint; and restriction of shoulder motion. They also noticed ecchymosis and pain around the coracoid process and anterior shoulder region during regular firing exercises. Plain X-rays and computerized tomography showed extra-capsular, dense, irregular structure in the space between pectoralis and deltoid muscles which correlated with heterotopic bone. One patient refused surgical intervention because of the completion of his military serving period. Surgical excision was performed for the other two patients. During surgical exploration, both ossified masses were found in deltopectoral region and mostly in fibers of clavicular and acromial parts of deltoid muscle. Pathological reports confirmed the structure of masses as mature trabecular bone. Postoperatively indomethacin treatment and active shoulder exercises were started until the full range of motion was regained. Mini soft bag was used on the rifle contact area of the shoulder. No complications or recurrences were observed during the 24 months of followup period.

Complications of shoulder arthroscopy.

Science.gov (United States)

Moen, Todd C; Rudolph, Glen H; Caswell, Kyle; Espinoza, Christopher; Burkhead, Wayne Z; Krishnan, Sumant G

2014-07-01

Over the past 20 to 30 years, arthroscopic shoulder techniques have become increasingly popular. Although these techniques have several advantages over open surgery, surgical complications are no less prevalent or devastating than those associated with open techniques. Some of the complications associated with arthroscopic shoulder surgery include recurrent instability, soft-tissue injury, and neurapraxia. These complications can be minimized with thoughtful consideration of the surgical indications, careful patient selection and positioning, and a thorough knowledge of the shoulder anatomy. Deep infection following arthroscopic shoulder surgery is rare; however, the shoulder is particularly susceptible to Propionibacterium acnes infection, which is mildly virulent and has a benign presentation. The surgeon must maintain a high index of suspicion for this infection. Thromboemoblic complications associated with arthroscopic shoulder techniques are also rare, and studies have shown that pharmacologic prophylaxis has minimal efficacy in preventing these complications. Because high-quality studies on the subject are lacking, minimal evidence is available to suggest strategies for prevention. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

[Shoulder injuries in golf].

Science.gov (United States)

Liem, D; Gosheger, G; Schmidt, C

2014-03-01

Due to its growing popularity golf has now come into the focus of orthopedic sports medicine. With a wide range of age groups and playing levels, orthopedic surgeons will encounter a wide range of musculoskeletal problems which are usually the result of overuse rather than trauma. The shoulder joint plays an important role in the golf swing whereby not only the muscles around the glenohumeral joint but also the scapula stabilizing muscles are extremely important for an effective golf swing. Golf is strictly not considered to be an overhead sport; however, the extreme peak positions of the golf swing involve placing the shoulder joint in maximum abduction and adduction positions which can provoke impingement, lesions of the pulley system or even a special form of posterior shoulder instability. Even after complex shoulder operations, such as rotator cuff repair or shoulder arthroplasty, a return to the golf course at nearly the same level of play can be expected.

Abduction and external rotation (ABER) MR arthrography of the shoulder. Benefits and limitations

International Nuclear Information System (INIS)

Mostafa, A.; Gokan, Takehiko; Munechika, Hirotsugu; Ogawa, Takashi; El-Feky, A.A.

2001-01-01

The purpose of this study was to show the benefits and limitations of using abduction and external rotation (ABER) positions of the arm during MR arthrography of the shoulder in the evaluation of the rotator-cuff tendon, the capsulolabral complex and the shoulder joint after surgery. Forty-seven patients complaining of either shoulder instability, chronic shoulder pain, pain of unknown cause or pain following shoulder surgery were studied using the direct MR arthrography technique in both the standard neutral position with the arm adducted as well as with the arm in the ABER position. A correlation was obtained between the MR arthrography findings and the surgical findings in 10 reports and clinical presentations of the examined patients. Three patients [6%] were unable to perform ABER positioning. ABER oblique axial images were better than standard oblique coronal images in revealing undersurface tears of the rotator cuff particularly of the grade I type. Four tears were missed in standard images. Oblique axial images were better than standard axial images in demonstrating non-displaced anterior labral tears. One tear was missed and two tears were suspected in the standard images. Oblique axial images were less sensitive than oblique coronal images in the diagnosis of superior labral tears. Two tears were missed in ABER images. The ABER oblique axial MR arthrogram is a useful adjunct to the standard axial and oblique coronal MR arthrograms for assessment of capsulolabral abnormalities and rotator-cuff tendon tears despite some limitations. (author)

MR imaging in sports-related glenohumeral instability

International Nuclear Information System (INIS)

Woertler, Klaus; Waldt, Simone

2006-01-01

Sports-related shoulder pain and injuries represent a common problem. In this context, glenohumeral instability is currently believed to play a central role either as a recognized or as an unrecognized condition. Shoulder instabilities can roughly be divided into traumatic, atraumatic, and microtraumatic glenohumeral instabilities. In athletes, atraumatic and microtraumatic instabilities can lead to secondary impingement syndromes and chronic damage to intraarticular structures. Magnetic resonance (MR) arthrography is superior to conventional MR imaging in the diagnosis of labro-ligamentous injuries, intrinsic impingement, and SLAP (superior labral anteroposterior) lesions, and thus represents the most informative imaging modality in the overall assessment of glenohumeral instability. This article reviews the imaging criteria for the detection and classification of instability-related injuries in athletes with special emphasis on the influence of MR findings on therapeutic decisions. (orig.)

Integridade do músculo subescapular após a cirurgia aberta para tratamento da luxação recidivante glenoumeral: avaliação clínica e radiológica Integrity of the subscapularis tendon after open surgery for the treatment of anterior shoulder instability: a clinical and radiological evaluation

Directory of Open Access Journals (Sweden)

Osvandré Lech

2009-10-01

Full Text Available OBJETIVO: Avaliar a integridade do músculo subescapular através da força, função e ressonância nuclear magnética após acesso deltopeitoral para tratamento da luxação glenoumeral anterior recidivante. MÉTODOS: Foram avaliados 20 pacientes com luxação recidivante do ombro. Todos os casos possuíam seguimento mínimo de 12 meses, com média de 40 meses. Os pacientes eram todos do sexo masculino, com média de idade de 29 anos (20-42 anos. Os pacientes foram submetidos a exame físico para avaliar mobilidade, força muscular, "Belly" Teste e teste de Gerber. A força isocinética em rotação interna e externa, em velocidades angulares de 60º/s e 180º/s, em ambos os ombros, foi medida utilizando-se um dinamômetro. Em 15 pacientes foi realizada ressonância nuclear magnética (RNM em ambos os ombros para avaliação da espessura, área e possível hipotrofia do músculo subescapular. RESULTADOS: Houve diferença significativa entre os picos de torque para a velocidade de 60º/s para as rotações interna (p = 0,036 e externa (p = 0,008. Porém, para a velocidade de 180º/s a situação se inverte (rotação interna: p = 0,133; rotação externa: p = 0,393. A espessura e a área do subescapular são significativamente menores que as do lado normal, com déficit de 19% e 23%, respectivamente. De acordo com os escores de Rowe e da UCLA, observamos excelentes e bons resultados na maioria dos pacientes, com média de 88 e 31,6 pontos, respectivamente. CONCLUSÃO: Apesar dos bons resultados funcionais, a cirurgia aberta pode restringir a força, bem como reduzir a espessura e a área da seção transversal do músculo subescapular. Os melhores resultados ocorreram no lado dominante.OBJECTIVE: To evaluate the integrity of the subscapularis tendon by strength, function and magnetic resonance imaging after deltopectoralis access for anterior shoulder instability. METHODS: 20 patients with anterior shoulder instability have been evaluated

Restoring a functional and mobile shoulder following reconstruction of the sternoclavicular joint with a free vascularized fibular flap

Directory of Open Access Journals (Sweden)

Abby Choke

2018-06-01

Full Text Available Infection of the sternoclavicular joint (SCJ is rare and often missed at early stage. In extensive disease with bony and soft tissue destruction, radical excision is indicated. The loss of SCJ results in exposure of vital structures of the anterior mediastinum and instability of the shoulder girdle. SCJ reconstruction using locoregional muscle flaps like the pectoralis major or latissimus dorsi flap has been well described. While these options can provide soft tissue coverage, they do not restore the structural framework of the SCJ which is important for shoulder excursion and chest wall movement. We describe a case of SCJ reconstruction using a free vascularized fibular flap following the resection of sternoclavicular tubercular osteomyelitis. The fibula bone was used to restore the clavicular strut by anchoring it to the remaining manubrium with a steel wire and by plating the lateral end to the remnant clavicle. The steel wire served as a “defunctioning” cerclage that allowed motion of the joint to induce fibrous union. A strict post-operative rehabilitation protocol keeping the shoulder adducted at the initial phase was prescribed. At one year follow up, the patient achieved good shoulder function with 140 degrees of shoulder abduction and 110 degrees flexion.

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

DEFF Research Database (Denmark)

Suder, P.A.; Frich, Lars Henrik; Hougaard, K.

1995-01-01

. 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....

Postoperative imaging of the shoulder

International Nuclear Information System (INIS)

Woertler, K.; Rummeny, E.J.

2004-01-01

Correct interpretation of imaging findings in the postoperative shoulder is impaired by surgical distortion of normal anatomy and possible artifacts. Advanced postoperative imaging of the shoulder in addition to the selection of the best suited modality necessitates familiarity with the surgical procedure that has been performed and its consecutive morphological changes. This article reviews the most common arthroscopic and open techniques used for treatment of shoulder instability, lesions of the superior labral-bicipital complex, primery impingement, and rotator cuff tears, their typical postoperative imaging findings, as well as the diagnostic performance of cross sectional imaging techniques in the detection of recurrent lesions and complications. (orig.) [de

MR arthrography including abduction and external rotation images in the assessment of atraumatic multidirectional instability of the shoulder

Energy Technology Data Exchange (ETDEWEB)

Schaeffeler, Christoph [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Kantonsspital Graubuenden, Musculoskeletal Imaging, Chur (Switzerland); Waldt, Simone; Bauer, Jan S.; Rummeny, Ernst J.; Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Kirchhoff, Chlodwig [Technische Universitaet Muenchen, Department of Traumatology, Munich (Germany); Haller, Bernhard [Technische Universitaet Muenchen, Institute for Medical Statistics and Epidemiology, Munich (Germany); Schroeder, Michael [Center for Sports Orthopedics and Medicine, Orthosportiv, Munich (Germany); Imhoff, Andreas B. [Technische Universitaet Muenchen, Department of Orthopedic Sports Medicine, Munich (Germany)

2014-06-15

To evaluate diagnostic signs and measurements in the assessment of capsular redundancy in atraumatic multidirectional instability (MDI) of the shoulder on MR arthrography (MR-A) including abduction/external rotation (ABER) images. Twenty-one MR-A including ABER position of 20 patients with clinically diagnosed MDI and 17 patients without instability were assessed by three radiologists. On ABER images, presence of a layer of contrast between the humeral head (HH) and the anteroinferior glenohumeral ligament (AIGHL) (crescent sign) and a triangular-shaped space between the HH, AIGHL and glenoid (triangle sign) were evaluated; centring of the HH was measured. Anterosuperior herniation of the rotator interval (RI) capsule and glenoid version were determined on standard imaging planes. The crescent sign had a sensitivity of 57 %/62 %/48 % (observers 1/2/3) and specificity of 100 %/100 %/94 % in the diagnosis of MDI. The triangle sign had a sensitivity of 48 %/57 %/48 % and specificity of 94 %/94 %/100 %. The combination of both signs had a sensitivity of 86 %/90 %/81 % and specificity of 94 %/94 %/94 %. A positive triangle sign was significantly associated with decentring of the HH. Measurements of RI herniation, RI width and glenoid were not significantly different between both groups. Combined assessment of redundancy signs on ABER position MR-A allows for accurate differentiation between patients with atraumatic MDI and patients with clinically stable shoulders; measurements on standard imaging planes appear inappropriate. (orig.)

Periarthritis of the shoulder-MRI findings

Energy Technology Data Exchange (ETDEWEB)

Hirano, Mako; Nomura, Kazutoshi; Hashimoto, Noburo; Fukumoto, Tetsuya; Oshima, Suguru; Katahira, Kazuhiro [Kumamoto National Hospital (Japan)

1997-09-01

We examined MRI findings in patients with periarthritis of the shoulder. We excluded cuff tears, calcified tendinitis, instability of the shoulder, fracture and impingement syndrome of young patients. Subjects comprised 36 cases, 38 shoulders (25 men and 11 women), with an average age of 59.1 years (42-75). Scanning was performed on a Gyroscan T5-II 0.5-T (Philips). T1-weighted and T2-weighted sequences in the coronal oblique plane, T2-weighted sequences in the coronal sagittal plane and horizontal plane were taken. Twelve shoulders showed some change in the humeral heads. Degeneration of the rotator cuff was observed in 15 shoulders. Joint fluid collection was observed in the gleno-humeral joints of 15 shoulders, in the subacromial bursa of 11 shoulders and in the acromio-clavicular joints of 7 shoulders. Twenty four shoulders had fluid collection in the sheath of the long head of the biceps long tendon. Localized high signal area was observed around the inferior pouch in 11 shoulders. We studied the relationship between MRI findings and clinical symptoms. There was no significant relationship but the shoulders with night pain and severe contractures had a higher positive rate of joint fluid collection on MRI than the shoulders without night pain and with less contractures. (author)

Periarthritis of the shoulder-MRI findings

International Nuclear Information System (INIS)

Hirano, Mako; Nomura, Kazutoshi; Hashimoto, Noburo; Fukumoto, Tetsuya; Oshima, Suguru; Katahira, Kazuhiro

1997-01-01

We examined MRI findings in patients with periarthritis of the shoulder. We excluded cuff tears, calcified tendinitis, instability of the shoulder, fracture and impingement syndrome of young patients. Subjects comprised 36 cases, 38 shoulders (25 men and 11 women), with an average age of 59.1 years (42-75). Scanning was performed on a Gyroscan T5-II 0.5-T (Philips). T1-weighted and T2-weighted sequences in the coronal oblique plane, T2-weighted sequences in the coronal sagittal plane and horizontal plane were taken. Twelve shoulders showed some change in the humeral heads. Degeneration of the rotator cuff was observed in 15 shoulders. Joint fluid collection was observed in the gleno-humeral joints of 15 shoulders, in the subacromial bursa of 11 shoulders and in the acromio-clavicular joints of 7 shoulders. Twenty four shoulders had fluid collection in the sheath of the long head of the biceps long tendon. Localized high signal area was observed around the inferior pouch in 11 shoulders. We studied the relationship between MRI findings and clinical symptoms. There was no significant relationship but the shoulders with night pain and severe contractures had a higher positive rate of joint fluid collection on MRI than the shoulders without night pain and with less contractures. (author)

[Shoulder injuries in overhead sports].

Science.gov (United States)

Wörtler, K

2010-05-01

Overhead sport places great demands on the shoulder joint. Shoulder pain in overhead athletes and throwers can in the majority of cases be attributed to lesions resulting from chronic overuse of tendons and capsuloligamentous structures or to sequels of microinstability and secondary impingement. Due to its great impact on therapeutic decisions, imaging in athletes with unclear shoulder pain is a challenge. In this connection, magnetic resonance (MR) arthrography represents the cross-sectional imaging modality of first choice, as it allows depiction and exclusion of pathologic alterations of all relevant joint structures with sufficient confidence.This article reviews the biomechanical and clinical aspects and MR arthrographic features of the most common shoulder pathologies in overhead athletes, including biceps tendinopathy, superior labral anterior-posterior (SLAP) lesions, rotator cuff lesions, as well as extrinsic and intrinsic impingement syndromes.

Diaphragm-Sparing Nerve Blocks for Shoulder Surgery.

Science.gov (United States)

Tran, De Q H; Elgueta, Maria Francisca; Aliste, Julian; Finlayson, Roderick J

Shoulder surgery can result in significant postoperative pain. Interscalene brachial plexus blocks (ISBs) constitute the current criterion standard for analgesia but may be contraindicated in patients with pulmonary pathology due to the inherent risk of phrenic nerve block and symptomatic hemidiaphragmatic paralysis. Although ultrasound-guided ISB with small volumes (5 mL), dilute local anesthetic (LA) concentrations, and LA injection 4 mm lateral to the brachial plexus have been shown to reduce the risk of phrenic nerve block, no single intervention can decrease its incidence below 20%. Ultrasound-guided supraclavicular blocks with LA injection posterolateral to the brachial plexus may anesthetize the shoulder without incidental diaphragmatic dysfunction, but further confirmatory trials are required. Ultrasound-guided C7 root blocks also seem to offer an attractive, diaphragm-sparing alternative to ISB. However, additional large-scale studies are needed to confirm their efficacy and to quantify the risk of periforaminal vascular breach. Combined axillary-suprascapular nerve blocks may provide adequate postoperative analgesia for minor shoulder surgery but do not compare favorably to ISB for major surgical procedures. One intriguing solution lies in the combined use of infraclavicular brachial plexus blocks and suprascapular nerve blocks. Theoretically, the infraclavicular approach targets the posterior and lateral cords, thus anesthetizing the axillary nerve (which supplies the anterior and posterior shoulder joint), as well as the subscapular and lateral pectoral nerves (both of which supply the anterior shoulder joint), whereas the suprascapular nerve block anesthetizes the posterior shoulder. Future randomized trials are required to validate the efficacy of combined infraclavicular-suprascapular blocks for shoulder surgery.

Initial results of shoulder MRI in external rotation after primary shoulder dislocation and after immobilization in external rotation

International Nuclear Information System (INIS)

Pennekamp, W.; Nicolas, V.; Gekle, C.; Seybold, D.

2006-01-01

Purpose: A change in the strategy for treating primary anterior traumatic dislocation of the shoulder has occurred. To date, brief fixation of internal rotation via a Gilchrist bandage has been used. Depending on the patient's age, a redislocation is seen in up to 90% of cases. This is due to healing of the internally rotated labrum-ligament tear in an incorrect position. In the case of external rotation of the humerus, better repositioning of the labrum ligament complex is achieved. Using MRI of the shoulder in external rotation, the extent of the improved labrum-ligament adjustment can be documented, and the indication of immobilization of the shoulder in external rotation can be derived. The aim of this investigation is to describe the degree of position changing of the labrum-ligament tear in internal and external rotation. Materials and Methods: 10 patients (9 male, 1 female, mean age 30.4 years, range 15-43 years) with a primary anterior dislocation of the shoulder without hyper laxity of the contra lateral side and labrum-ligament lesion substantiated by MRI were investigated using a standard shoulder MRI protocol (PD-TSE axial fs, PD-TSE coronar fs, T2-TSE sagittal, T1-TSE coronar) by an axial PD-TSE sequence in internal and external rotation. The dislocation and separation of the anterior labrum-ligament complex were measured. The shoulders were immobilized in 10 external rotation for 3 weeks. After 6 weeks a shoulder MRI in internal rotation was performed. Results: In all patients there was a significantly better position of the labrum-ligament complex of the inferior rim in external rotation, because of the tension of the ventral capsule and the subscapular muscle. In the initial investigation, the separation of the labrum-ligament complex in internal rotation was 0.44±0.27 mm and the dislocation was 0.45±0.33 mm. In external rotation the separation was 0.01±0.19 mm and the dislocation was -0.08±0.28 mm. After 6 weeks of immobilization in 10 external

Anterior-Posterior Instability of the Knee Following ACL Reconstruction with Bone-Patellar Tendon-Bone Ligament in Comparison with Four-Strand Hamstrings Autograft

Directory of Open Access Journals (Sweden)

A. G. Angoules

2013-01-01

Full Text Available Purpose. To evaluate anterior-posterior knee laxity using two different autografts. Material-Methods. 40 patients, (34 males and 6 women, 17–54 years old (mean: 31, were included in the present study. Group A (4SHS = 20 underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20 underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group. Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed. Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability.

Shoulder injuries in overhead sports

International Nuclear Information System (INIS)

Woertler, K.

2010-01-01

Overhead sport places great demands on the shoulder joint. Shoulder pain in overhead athletes and throwers can in the majority of cases be attributed to lesions resulting from chronic overuse of tendons and capsuloligamentous structures or to sequels of microinstability and secondary impingement. Due to its great impact on therapeutic decisions, imaging in athletes with unclear shoulder pain is a challenge. In this connection, magnetic resonance (MR) arthrography represents the cross-sectional imaging modality of first choice, as it allows depiction and exclusion of pathologic alterations of all relevant joint structures with sufficient confidence. This article reviews the biomechanical and clinical aspects and MR arthrographic features of the most common shoulder pathologies in overhead athletes, including biceps tendinopathy, superior labral anterior-posterior (SLAP) lesions, rotator cuff lesions, as well as extrinsic and intrinsic impingement syndromes. (orig.) [de

Cadaveric Study of the Articular Branches of the Shoulder Joint.

Science.gov (United States)

Eckmann, Maxim S; Bickelhaupt, Brittany; Fehl, Jacob; Benfield, Jonathan A; Curley, Jonathan; Rahimi, Ohmid; Nagpal, Ameet S

This cadaveric study investigated the anatomic relationships of the articular branches of the suprascapular (SN), axillary (AN), and lateral pectoral nerves (LPN), which are potential targets for shoulder analgesia. Sixteen embalmed cadavers and 1 unembalmed cadaver, including 33 shoulders total, were dissected. Following dissections, fluoroscopic images were taken to propose an anatomical landmark to be used in shoulder articular branch blockade. Thirty-three shoulders from 17 total cadavers were studied. In a series of 16 shoulders, 16 (100%) of 16 had an intact SN branch innervating the posterior head of the humerus and shoulder capsule. Suprascapular sensory branches coursed laterally from the spinoglenoid notch then toward the glenohumeral joint capsule posteriorly. Axillary nerve articular branches innervated the posterolateral head of the humerus and shoulder capsule in the same 16 (100%) of 16 shoulders. The AN gave branches ascending circumferentially from the quadrangular space to the posterolateral humerus, deep to the deltoid, and inserting at the inferior portion of the posterior joint capsule. In 4 previously dissected and 17 distinct shoulders, intact LPNs could be identified in 14 (67%) of 21 specimens. Of these, 12 (86%) of 14 had articular branches innervating the anterior shoulder joint, and 14 (100%) of 14 LPN articular branches were adjacent to acromial branches of the thoracoacromial blood vessels over the superior aspect of the coracoid process. Articular branches from the SN, AN, and LPN were identified. Articular branches of the SN and AN insert into the capsule overlying the glenohumeral joint posteriorly. Articular branches of the LPN exist and innervate a portion of the anterior shoulder joint.

Intraarticular findings in the chronically painful shoulder. A study of 32 posttraumatic cases

DEFF Research Database (Denmark)

Suder, P.A.; Hougaard, K.; Frich, Lars Henrik

1994-01-01

the head activities. Symptoms of a "dead arm" and instability were also present. Patients with previous dislocations, traumas or radiographic signs of degenerative shoulder lesions were excluded. The patients had a decreased active range of motion and positive signs of apprehension and impingement......32 consecutive patients suffering from chronic shoulder pain for more than 6 months after a single, nondislocating shoulder trauma were examined clinically and by special radiographs, dynamic sonography, MRI and arthroscopy. Typical complaints were pain during loading, especially during over......, but only 4 had clinical signs of shoulder instability. Diagnostic evaluation identified labral tears, partial and total rotator cuff lesions with subacromial impingement and tendinitis of the biceps tendon. Surgery was performed in 24 patients, using capsulolabral and rotator cuff reconstruction...

Methods on simple radiogaphy of impingement syndrome in shoulder joint

International Nuclear Information System (INIS)

Kweon, Dae Cheol; Kim, Moon Sun; Kim, Yong Seob; Chung, Kyung Mo

2000-01-01

To evaluation of patients who have shoulder impingement syndrome is by diagnostic radiography. Shoulder impingement is a problem which occurs in young, active individuals as well as older individuals. In fact, the pain is probably caused by repetitive stress placed on the shoulder joint either through recreational activities of your occupation. Impingement series approach to radiographic examination of the shoulder is take five projections. First anteroposterior oblique projection. Second standard anteroposterior projection. Third superoinferior axial projection. Fourth supraspinatus outlet projection offers a view of the outlet of the supraspinatus tendon unit as it passes under the coraacromial arch. Fifth anteroposterior 30 deg caudal projection will adequately demonstrate the anterior acromial spur or ossification in the coraacromial ligament and more reliable to demonstrate spurring of the anterior acromion than supraspinatus outlet projection. This decreased the need for additional radiographic veiws, reduces the patient's exposure to x-ray radiation and decreases use of film. This can lower the cost of the evaluation and improve patient satisfaction.=20

Methods on simple radiogaphy of impingement syndrome in shoulder joint

Energy Technology Data Exchange (ETDEWEB)

Kweon, Dae Cheol; Kim, Moon Sun; Kim, Yong Seob; Chung, Kyung Mo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

2000-06-01

To evaluation of patients who have shoulder impingement syndrome is by diagnostic radiography. Shoulder impingement is a problem which occurs in young, active individuals as well as older individuals. In fact, the pain is probably caused by repetitive stress placed on the shoulder joint either through recreational activities of your occupation. Impingement series approach to radiographic examination of the shoulder is take five projections. First anteroposterior oblique projection. Second standard anteroposterior projection. Third superoinferior axial projection. Fourth supraspinatus outlet projection offers a view of the outlet of the supraspinatus tendon unit as it passes under the coraacromial arch. Fifth anteroposterior 30 deg caudal projection will adequately demonstrate the anterior acromial spur or ossification in the coraacromial ligament and more reliable to demonstrate spurring of the anterior acromion than supraspinatus outlet projection. This decreased the need for additional radiographic veiws, reduces the patient's exposure to x-ray radiation and decreases use of film. This can lower the cost of the evaluation and improve patient satisfaction.=20.

Arthroscopic Shoulder Surgery in Female Professional Tennis Players: Ability and Timing to Return to Play.

Science.gov (United States)

Young, Simon W; Dakic, Jodie; Stroia, Kathleen; Nguyen, Michael L; Safran, Marc R

2017-07-01

To assess the outcome and time to return to previous level of competitive play after shoulder surgery in professional tennis players. Retrospective case series. Tertiary academic centre. The records of all female tennis players on the Women's Tennis Association (WTA) professional circuit between January 2008 and June 2010 were reviewed to identify players who underwent shoulder surgery on their dominant (serving) shoulder. Primary outcomes were the ability and time to return to professional play and if they were able to return to their previous level of function as determined by singles ranking. Preoperative and postoperative singles rankings were used to determine rate and completeness of return to preoperative function. During the study period, 8 professional women tennis players from the WTA tour underwent shoulder surgery on their dominant arm. Indications included rotator cuff debridement or repair, labral reconstruction for instability or superior labral anterior posterior lesion, and neurolysis of the suprascapular nerve. Seven players (88%) returned to professional play. The mean time to return to play was 7 months after surgery. However, only 25% (2 of 8) players achieved their preinjury singles rank or better by 18 months postoperatively. In total, 4 players returned to their preinjury singles ranking, with their peak singles ranking being attained at a mean of 2.4 years postoperatively. In professional female tennis players, a high return to play rate after arthroscopic shoulder surgery is associated with a prolonged and often incomplete return to previous level of performance. Thus, counseling the patient to this fact is important to manage expectations. Level IV-Case Series.

How do deltoid muscle moment arms change after reverse total shoulder arthroplasty?

Science.gov (United States)

Walker, David R; Struk, Aimee M; Matsuki, Keisuke; Wright, Thomas W; Banks, Scott A

2016-04-01

Although many advantages of reverse total shoulder arthroplasty (RTSA) have been demonstrated, a variety of complications indicate there is much to learn about how RTSA modifies normal shoulder function. This study used a subject-specific computational model driven by in vivo kinematic data to assess how RTSA affects deltoid muscle moment arms after surgery. A subject-specific 12 degree-of-freedom musculoskeletal model was used to analyze the shoulders of 26 individuals (14 RTSA and 12 normal). The model was modified from the work of Holzbaur to directly input 6 degree-of-freedom humeral and scapular kinematics obtained using fluoroscopy. The moment arms of the anterior, lateral, and posterior aspects of the deltoid were significantly different when RTSA and normal cohorts were compared at different abduction angles. Anterior and lateral deltoid moment arms were significantly larger in the RTSA group at the initial elevation of the arm. The posterior deltoid was significantly larger at maximum elevation. There was large intersubject variability within the RTSA group. Placement of implant components during RTSA can directly affect the geometric relationship between the humerus and scapula and the muscle moment arms in the RTSA shoulder. RTSA shoulders maintain the same anterior and posterior deltoid muscle moment-arm patterns as healthy shoulders but show much greater intersubject variation and larger moment-arm magnitudes. These observations provide a basis for determining optimal implant configuration and surgical placement to maximize RTSA function in a patient-specific manner. Published by Elsevier Inc.

Evaluation and treatment of failed shoulder instability procedures.

Science.gov (United States)

Ho, Anthony G; Gowda, Ashok L; Michael Wiater, J

2016-09-01

Management of the unstable shoulder after a failed stabilization procedure can be difficult and challenging. Detailed understanding of the native shoulder anatomy, including its static and dynamic restraints, is necessary for determining the patient's primary pathology. In addition, evaluation of the patient's history, physical exam, and imaging is important for identifying the cause for failure after the initial procedure. Common mistakes include under-appreciation of bony defects, failure to recognize capsular laxity, technical errors, and missed associated pathology. Many potential treatment options exist for revision surgery, including open or arthroscopic Bankart repair, bony augmentation procedures, and management of Hill Sachs defects. The aim of this narrative review is to discuss in-depth the common risk factors for post-surgical failure, components for appropriate evaluation, and the different surgical options available for revision stabilization. Level of evidence Level V.

[Shoulder dystocia: Quality of retranscription in medical files].

Science.gov (United States)

Martin, E; Bouet, P-E; Sentilhes, L; Legendre, G

2016-03-01

Shoulder dystocia is a rare obstetrical event and potentially serious. Apart from possible psychological implications, it may be responsible for maternal (haemorrhage and perineal tear) and neonatal complications (brachial plexus) leading to complaints and even lawsuits. The transcription of this event in medical files is essential as it is a reflection of the work in an emergency. It allows the obstetrician to defend him in case of trial. Our objective was to assess the quality of the transcription of shoulder dystocia situations in medical files. Retrospective chart study conducted in a university hospital with maternity type III. The primary objective was the rate of comprehensive records (name maneuvers and order of maneuvers of the anterior shoulder hand, time between the expulsion of the head and body, Apgar score). Between 2007 and 2015, 54 cases of shoulder dystocia requiring a second line maneuver after vaginal delivery (Wood and/or Jacquemier) were included. In all, 98.2% of the files were incomplete. The maneuvers and their order were noted in 100% of cases. However, the operation was not correctly described in 16.7% of cases. The anterior shoulder was noted in 16.7% of cases. The time between the expulsion of the head and the body was noted in one single files. Neither broken collarbone nor brachial plexus were observed. To improve the management of dystocia shoulder and transcription of data in files, simulation sessions and the creation of a standardized form would be needed. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Outcomes of arthroscopic "Remplissage": capsulotenodesis of the engaging large Hill-Sachs lesion

Directory of Open Access Journals (Sweden)

Mayo Lee

2011-06-01

Full Text Available Abstract Background A Hill-Sachs lesion of the humeral head after a shoulder dislocation is clinically insignificant in most cases. However, a sizable defect will engage with the anterior rim of the glenoid and cause instability even after anterior glenoid reconstruction. The purpose of this study was to evaluate the outcome of arthroscopic capsulotenodesis of the posterior capsule and infraspinatus tendon ("remplissage" to seal a large engaging Hill-Sachs lesion in an unstable shoulder. Methods This was a prospective follow-up study of patients who underwent arthroscopic surgery for recurrent shoulder instability with a large engaging Hill-Sachs lesion from 2007 to 2009. The clinical results were measured preoperatively and postoperatively with the Simple Shoulder test (SST and the Rowe score for instability. Results Eleven patients met the inclusion criteria of this study. The mean follow-up time was 30 months (range 24 to 35 months. At the last follow-up, significant improvement was observed in both scores with no recurrent dislocations. The mean SST improved from 6.6 to 11 (p Conclusions Arthroscopic remplissage for shoulder instability is an effective soft tissue technique to seal a large engaging Hill-Sachs lesion with respect to recurrence rate, range of motion and shoulder function.

Magnetic resonance imaging of the shoulder: Rationale and current applications

International Nuclear Information System (INIS)

Holt, R.G.; Helms, C.A.; Steinbach, L.; Neumann, C.; Munk, P.L.; Genant, H.K.

1990-01-01

Because it can demonstrate a wide range of tissue contrast with excellent resolution, magnetic resonance (MR) imaging has revolutionized imaging in many areas of the musculoskeletal system and has generated excitement among those interested in the painful shoulder. Shoulder impingement syndrome and glenohumeral instability constitute the two major categories of shoulder derangements. Correct diagnosis requires the use of appropriate pulse sequences and imaging planes, proper patient positioning, and a satisfactory surface coil. In addition the imager must have a thorough understanding of shoulder anatomy and pathology. We present a summary of the current status of MR imaging of the shoulder including technical, anatomic, and pathologic considerations and a review of the pertinent literature. (orig.)

Axillary artery injury after an anterior shoulder fracture dislocation and “periosteal sleeve avulsion of the rotator cuff” (SARC. Case report and review of the literature

Directory of Open Access Journals (Sweden)

Ash Chehata

2017-04-01

Full Text Available We present the rare complication of an axillary artery injury associated with an anterior dislocation of the humerus and what we believe to be the first reported periosteal sleeve avulsion of the entire rotator cuff (SARC. We review the literature and discuss the cause of this unusual injury pattern. Keywords: Axillary artery, Shoulder fracture dislocation, Periosteal sleeve avulsion, SARC

Imaging of the shoulder after surgery

International Nuclear Information System (INIS)

McMenamin, Drew; Koulouris, George; Morrison, William B.

2008-01-01

Postoperative imaging of the shoulder is challenging. This article reviews the radiologic evaluation following surgery for subacromial impingment, rotator cuff lesions and glenohumeral instability, including the common surgical procedures, the expected postoperative findings and potential complications. A specific emphasis is made on magnetic resonance imaging

Imaging of the shoulder after surgery

Energy Technology Data Exchange (ETDEWEB)

McMenamin, Drew [Department of Radiology, University of Washington, Box 354755, 4245 Roosevelt Way NE, Seattle, WA 98105 (United States)], E-mail: drewmcm@u.washington.edu; Koulouris, George [Gold Coast Medical Imaging, 123 Nerang Street, Southport, QLD 4215 (Australia); Morrison, William B. [Thomas Jefferson University Hospital, 132 South 10th Street, Suite 1079a, Philadelphia, PA 19107 (United States)

2008-10-15

Postoperative imaging of the shoulder is challenging. This article reviews the radiologic evaluation following surgery for subacromial impingment, rotator cuff lesions and glenohumeral instability, including the common surgical procedures, the expected postoperative findings and potential complications. A specific emphasis is made on magnetic resonance imaging.

New developments for the surgical treatment of shoulder problems

International Nuclear Information System (INIS)

Anderl, W.

2004-01-01

Tremendous advancement has been made in the surgical treatment of the shoulder within the last years. Arthroscopic techniques for treatment of rotator cuff lesions, instability problems and biceps tendon lesions are today established because of significant improvement of instruments, suture materials and anchor techniques. The 4th generation of shoulder prosthesis systems guarantee today anatomical and biomechanical advantages with significant functional improvement for the patient. (orig.) [de

The influence of experimentally induced pain on shoulder muscle activity

DEFF Research Database (Denmark)

Diederichsen, L.P.; Winther, A.; Dyhre-Poulsen, P.

2009-01-01

healthy men (range 22-27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0A degrees......Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function. Eleven...... muscles. EMG was recorded before pain, during pain and after pain had subsided and pain intensity was continuously scored on a visual analog scale (VAS). During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper...

Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes.

Science.gov (United States)

Nakagawa, Shigeto; Mae, Tatsuo; Sato, Seira; Okimura, Shinichiro; Kuroda, Miki

2017-09-01

Several risk factors for the postoperative recurrence of instability after arthroscopic Bankart repair have been reported, but there have been few detailed investigations of the specific risk factors in relation to the type of sport. This study investigated the postoperative recurrence of instability after arthroscopic Bankart repair without additional reinforcement procedures in competitive athletes, including athletes with a large glenoid defect. The purpose of this study was to investigate risk factors related to the postoperative recurrence of instability in athletes. Case-control study; Level of evidence, 3. A total of 115 athletes (123 shoulders) were classified into 5 groups according to type of sport: rugby (41 shoulders), American football (32 shoulders), other collision sports (18 shoulders), contact sports (15 shoulders), and overhead sports (17 shoulders). First, the recurrence rate in each sporting category was investigated, with 113 shoulders followed up for a minimum of 2 years. Then, factors related to postoperative recurrence were investigated in relation to the type of sport. Postoperative recurrence of instability was noted in 23 of 113 shoulders (20.4%). The recurrence rate was 33.3% in rugby, 17.2% in American football, 11.1% in other collision sports, 14.3% in contact sports, and 12.5% in overhead sports. The most frequent cause of recurrence was tackling, and recurrence occurred with tackling in 12 of 16 athletes playing rugby or American football. Reoperation was completed in 11 shoulders. By univariate analysis, significant risk factors for postoperative recurrence of instability included playing rugby, age between 10 and 19 years at surgery, preoperative glenoid defect, small bone fragment of bony Bankart lesion, and capsular tear. However, by multivariate analysis, the most significant factor was not the type of sport but younger age at operation and a preoperative glenoid defect with small or no bone fragment. Compared with the other

MRI of the postoperative shoulder

International Nuclear Information System (INIS)

Zlatkin, Michael B.

2002-01-01

Performing and interpreting MRI of the shoulder in patients after surgery is a difficult task. The normal anatomic features are distorted by the surgical alterations as well as the artifacts that result from metal and other materials used in the surgical procedures. This article reviews the common surgical procedures undertaken in patients with rotator cuff disease and shoulder instability, and how they affect the appearance of the relevant anatomic structures on MRI examination. It also reviews the more common causes for residual and recurrent abnormalities seen in such patients and how MRI can be used to diagnose such lesions, thus aiding the orthopedic surgeon in treating these difficult clinical problems. (orig.)

Spectrum of shoulder injuries in the baseball pitcher

Energy Technology Data Exchange (ETDEWEB)

Ouellette, Hugue; Bredella, Miriam; Palmer, William E.; Sheah, Kenneth; Torriani, Martin [Massachusetts General Hospital, Boston, Massachusetts (United States); Labis, John [Methodist Hospital, Houston, Texas (United States)

2008-06-15

This review describes a range of shoulder injuries experienced by baseball pitchers. It is estimated that more than 57% of pitchers suffer some form of shoulder injury during a playing season. Knowledge of the overhead throwing cycle is crucial for our understanding of these shoulder injuries. Baseball pitchers are prone to rotator cuff tears from tensile overload and impingement. Glenoid labrum degeneration or tears are also common, due to overuse syndrome (micro-instability), internal impingement and microtrauma. An understanding of the lesions involved in overhead throwing is crucial in baseball pitchers, as long-term disability can result from these injuries, sometimes with severe financial consequences to the player. (orig.)

Spectrum of shoulder injuries in the baseball pitcher

International Nuclear Information System (INIS)

Ouellette, Hugue; Bredella, Miriam; Palmer, William E.; Sheah, Kenneth; Torriani, Martin; Labis, John

2008-01-01

This review describes a range of shoulder injuries experienced by baseball pitchers. It is estimated that more than 57% of pitchers suffer some form of shoulder injury during a playing season. Knowledge of the overhead throwing cycle is crucial for our understanding of these shoulder injuries. Baseball pitchers are prone to rotator cuff tears from tensile overload and impingement. Glenoid labrum degeneration or tears are also common, due to overuse syndrome (micro-instability), internal impingement and microtrauma. An understanding of the lesions involved in overhead throwing is crucial in baseball pitchers, as long-term disability can result from these injuries, sometimes with severe financial consequences to the player. (orig.)

Effects of external rotation on anteroposterior translations in the shoulder: a pilot study.

Science.gov (United States)

Brown, Andrew J; Debski, Richard E; Voycheck, Carrie A; McMahon, Patrick J

2014-08-01

Using physical examination to make the diagnosis of shoulder instability can be difficult, because typical examination maneuvers are qualitative, difficult to standardize, and not reproducible. Measuring shoulder translation is especially difficult, which is a particular problem, because measuring it inaccurately may result in improper treatment of instability. The objective of this study was to use a magnetic motion tracking system to quantify the effects of external rotation of the abducted shoulder on a simulated simple translation test in healthy subjects. Specifically, we hypothesized that (1) increasing external rotation of the abducted shoulder would result in decreasing translation; (2) intraobserver repeatability would be less than 2 mm at all external rotation positions; and (3) mean side-to-side differences would be less than 2 mm at all external rotation positions. The intraobserver repeatability and side-to-side differences of AP translation were quantified with a noninvasive magnetic motion tracking system and automated data analysis routine in nine healthy subjects at four positions of external rotation with the arm abducted. A shoulder positioning apparatus was used to maintain the desired arm position. No differences in translations between the positions of external rotation were found (p = 0.48). Intraobserver repeatability was 1.1 mm (SD, 0.8 mm) and mean side-to-side differences were small: 2.7 mm (SD, 2.8 mm), 2.8 mm (SD, 1.8 mm), 2.5 mm (SD, 1.8 mm), and 4.0 mm (SD, 2.6 mm) at 0°, 20°, 40°, and 60° of external rotation, respectively. The intraobserver repeatability was strong and the side-to-side differences in translation were small with the magnetic motion tracking system, which is encouraging for development of an improved quantitative test to assess shoulder translation for fast and low-cost diagnosis of shoulder instability. Clinicians may not have to position the contralateral, normal, abducted shoulder in precisely the same position

Effects of augmented trunk stabilization with external compression support on shoulder and scapular muscle activity and maximum strength during isometric shoulder abduction.

Science.gov (United States)

Jang, Hyun-jeong; Kim, Suhn-yeop; Oh, Duck-won

2015-04-01

The aim of the present study was to investigate the effects of augmented trunk stabilization with external compression support (ECS) on the electromyography (EMG) activity of shoulder and scapular muscles and shoulder abductor strength during isometric shoulder abduction. Twenty-six women volunteered for the study. Surface EMG was used to monitor the activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and middle deltoid (MD), and shoulder abductor strength was measured using a dynamometer during three experimental conditions: (1) no external support (condition-1), (2) pelvic support (condition-2), and (3) pelvic and thoracic supports (condition-3) in an active therapeutic movement device. EMG activities were significantly lower for UT and higher for MD during condition 3 than during condition 1 (p strength was significantly higher during condition 3 than during condition 1 (p isometric shoulder abduction and increasing shoulder abductor strength. Copyright © 2014 Elsevier Ltd. All rights reserved.

Measurement Properties of the Smartphone-Based B-B Score in Current Shoulder Pathologies

Directory of Open Access Journals (Sweden)

Claude Pichonnaz

2015-10-01

Full Text Available This study is aimed at the determination of the measurement properties of the shoulder function B-B Score measured with a smartphone. This score measures the symmetry between sides of a power-related metric for two selected movements, with 100% representing perfect symmetry. Twenty healthy participants, 20 patients with rotator cuff conditions, 23 with fractures, 22 with capsulitis, and 23 with shoulder instabilities were measured twice across a six-month interval using the B-B Score and shoulder function questionnaires. The discriminative power, responsiveness, diagnostic power, concurrent validity, minimal detectable change (MDC, minimal clinically important improvement (MCII, and patient acceptable symptom state (PASS were evaluated. Significant differences with the control group and significant baseline—six-month differences were found for the rotator cuff condition, fracture, and capsulitis patient groups. The B-B Score was responsive and demonstrated excellent diagnostic power, except for shoulder instability. The correlations with clinical scores were generally moderate to high, but lower for instability. The MDC was 18.1%, the MCII was 25.2%, and the PASS was 77.6. No floor effect was observed. The B-B Score demonstrated excellent measurement properties in populations with rotator cuff conditions, proximal humerus fractures, and capsulitis, and can thus be used as a routine test to evaluate those patients.

Measurement Properties of the Smartphone-Based B-B Score in Current Shoulder Pathologies

Science.gov (United States)

Pichonnaz, Claude; Duc, Cyntia; Gleeson, Nigel; Ancey, Céline; Jaccard, Hervé; Lécureux, Estelle; Farron, Alain; Jolles, Brigitte M.; Aminian, Kamiar

2015-01-01

This study is aimed at the determination of the measurement properties of the shoulder function B-B Score measured with a smartphone. This score measures the symmetry between sides of a power-related metric for two selected movements, with 100% representing perfect symmetry. Twenty healthy participants, 20 patients with rotator cuff conditions, 23 with fractures, 22 with capsulitis, and 23 with shoulder instabilities were measured twice across a six-month interval using the B-B Score and shoulder function questionnaires. The discriminative power, responsiveness, diagnostic power, concurrent validity, minimal detectable change (MDC), minimal clinically important improvement (MCII), and patient acceptable symptom state (PASS) were evaluated. Significant differences with the control group and significant baseline—six-month differences were found for the rotator cuff condition, fracture, and capsulitis patient groups. The B-B Score was responsive and demonstrated excellent diagnostic power, except for shoulder instability. The correlations with clinical scores were generally moderate to high, but lower for instability. The MDC was 18.1%, the MCII was 25.2%, and the PASS was 77.6. No floor effect was observed. The B-B Score demonstrated excellent measurement properties in populations with rotator cuff conditions, proximal humerus fractures, and capsulitis, and can thus be used as a routine test to evaluate those patients. PMID:26506355

Protocol for Shoulder function training reducing musculoskeletal pain in shoulder and neck: a randomized controlled trial

DEFF Research Database (Denmark)

Andersen, Christoffer H; Andersen, Lars L; Mortensen, Ole S

2011-01-01

treated by physical therapists. The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments. Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct...... training of the painful area. Our study investigates the effect of the latter approach. METHODS/DESIGN: A randomized controlled trial of 10 weeks duration is currently being conducted. Employed office workers with severe neck-shoulder pain are randomized to 3 × 20 min shoulder function training...... with training supervision or to a reference group receiving advice to stay physically active. Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius.An announcement was sent to the administrative section of the university...

Ulnar nerve injury due to lateral traction device during shoulder arthroscopy: Was it avoidable?

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Vivek Pandey

2017-01-01

Full Text Available Most of the nerve injuries reported during shoulder arthroscopy in a beach chair, or lateral position is related to inappropriate patient positioning or excess traction. The lateral decubitus position is more vulnerable for traction-related neuropraxia. The present case serves as an important lesson from an avoidable situation of “having a one track mind” of the surgical team during the arthroscopic repair of shoulder instability performed in the lateral decubitus position. The operating surgeon must supervise the appropriate positioning of the patient on operation table and adequate padding of vulnerable bony points before beginning of shoulder arthroscopy to prevent any position-related nerve injuries. This is probably the first case to illustrate an unusual cause of ulnar nerve compression particularly related to the use of an additional traction device in the arthroscopic repair of shoulder instability performed in lateral decubitus position, which has not been previously defined.

Shoulder muscle fatigue during repetitive tasks as measured by electromyography and near-infrared spectroscopy.

Science.gov (United States)

Ferguson, Sue A; Allread, W Gary; Le, Peter; Rose, Joseph; Marras, William S

2013-12-01

The objective of this study was to quantify shoulder muscle fatigue during repetitive exertions similar to motions found in automobile assembly tasks. Shoulder musculoskeletal disorders (MSDs) are a common and costly problem in automotive manufacturing. Ten subjects participated in the study. There were three independent variables: shoulder angle, frequency, and force. There were two types of dependent measures: percentage change in near-infrared spectroscopy (NIRS) measures and change in electromyography (EMG) median frequency. The anterior deltoid and trapezius muscles were measured for both NIRS and EMG. Also, EMG was collected on the middle deltoid and biceps muscles. The results showed that oxygenated hemoglobin decreased significantly due to the main effects (shoulder angle, frequency, and force). The percentage change in oxygenated hemoglobin had a significant interaction attributable to force and repetition for the anterior deltoid muscle, indicating that as repetition increased, the magnitude of the differences between the forces increased. The interaction of repetition and shoulder angle was also significant for the percentage change in oxygenated hemoglobin. The median frequency decreased significantly for the main effects; however, no interactions were statistically significant. There was significant shoulder muscle fatigue as a function of shoulder angle, task frequency, and force level. Furthermore, percentage change in oxygenated hemoglobin had two statistically significant interactions, enhancing our understanding of these risk factors. Ergonomists should examine interactions of force and repetition as well as shoulder angle and repetition when evaluating the risk of shoulder MSDs.

Joint instability and osteoarthritis.

Science.gov (United States)

Blalock, Darryl; Miller, Andrew; Tilley, Michael; Wang, Jinxi

2015-01-01

Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA). Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

Winging of scapula due to serratus anterior tear

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Varun Singh Kumar

2014-10-01

Full Text Available 【Abstract】Winging of scapula occurs most commonly due to injury to long thoracic nerve supplying serratus anterior muscle. Traumatic injury to serratus anterior muscle itself is very rare. We reported a case of traumatic winging of scapula due to tear of serratus anterior muscle in a 19-year-old male. Winging was present in neutral position and in extension of right shoulder joint but not on "push on wall" test. Patient was managed conservatively and achieved satisfactory result. Key words: Serratus anterior tear; Scapula; Wounds and injuries

Uso de fijador externo en la inestabilidad de la pared torácica anterior (volet esternal: Presentación de un caso Use of the external fixative in the instability of the anterior thoraxic wall (sternal volet: A case report

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Orestes N Mederos Curbelo

2005-03-01

Full Text Available Se presenta un paciente con inestabilidad de la pared torácica anterior y esternón tratado previamente con un dispositivo creado por los autores en 1995 para el volet costal. Las costillas artificiales externas del dispositivo, diseñado para el cerclaje subperióstico, actúan como elemento de fijación y han conseguido resultados satisfactorios. Se presenta un paciente, que producto de un accidente automovilístico, sufre lesiones en cráneo, tórax, abdomen y extremidades, entre las que resaltan contusión cerebral, lesión hepática, fractura de fémur e inestabilidad de la pared torácica anterior. Esta última requirió de prioridad extrema, pues habría llevado rápidamente al paciente a la insuficiencia respiratoria de no ser solucionado el problema. Se realizó la estabilización externa mediante un equipo que se utiliza en nuestro hospital, reutilizable y aplicable en cualquier inestabilidad torácica independientemente de la localización de esta. El fijador se confecciona con láminas de duraluminio maleables que permiten su adaptabilidad e introduce una forma de tratamiento en las lesiones torácicas bilaterales con inestabilidad esternal, situación compleja en la que puede resultar un instrumento valioso de tratamientoA patient with instability of the anterior thoracic wall and sternum previously treated with a device created by the authors in 1995 for the costal volet, is presented. The artificial external ribs of the device designed for subperiosteous cerclage act as a fixation element with satisfactory results. The case of a patient that due to a car accident suffers from lesions in the cranium, thorax, abdomen and limbs, among which cerebral contusion, liver lesion, femur fracture and instability of the anterior thoracic wall stand out, is reported. Maximum priority was given to the instability of the anterior thoracic wall, since it could have rapidly led to respiratory failure if the problem would have not been solved. The

Joint Instability and Osteoarthritis

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Darryl Blalock

2015-01-01

Full Text Available Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA. Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

Axillary artery injury secondary to inferior shoulder dislocation.

Science.gov (United States)

Plaga, Brad R; Looby, Peter; Feldhaus, Steven J; Kreutzmann, Karl; Babb, Aaron

2010-11-01

Dislocation injuries of the glenohumeral joint are common in the general public and generally are corrected without complication. One serious complication with shoulder dislocations, or the subsequent reduction, is a lesion to the axillary artery. This specific complication is most frequently seen in the elderly population, where vascular structures have become less flexible. Also, these injuries are most common in association with anterior dislocations of the shoulder. To bring awareness to the possibility of axillary artery injury with inferior dislocation of the shoulder, the treatment options, and a review. We report a 15-year-old male athlete who inferiorly dislocated his shoulder during wrestling practice. The injury was reduced at the scene with manual traction and the patient was transferred to our clinic for evaluation. The patient was determined to have a pseudoaneurysm of the axillary artery, and the history and treatment of the illness are presented. Axillary artery injuries secondary to shoulder dislocations are rare, especially in the young athlete, and proper recognition and treatment offer patients a full recovery. Copyright © 2010. Published by Elsevier Inc.

Impingement syndrome of the shoulder; Schulterimpingement

Energy Technology Data Exchange (ETDEWEB)

Mayerhoefer, M.E. [Klinische Abteilung fuer Osteologie, Klinik fuer Radiodiagnostik der Universitaet Wien (Austria); Klinische Abteilung Radiodiagnostik fuer chirurgische Faecher, Klinik fuer Radiodiagnostik der Universitaet Wien (Austria); Klinische Abteilung fuer Osteologie, Klinik fuer Radiodiagnostik der Universitaet, Waehringer Guertel 18-20, 1090, Wien (Austria); Breitenseher, M.J. [Klinische Abteilung fuer Osteologie, Klinik fuer Radiodiagnostik der Universitaet Wien (Austria); Waldviertelklinikum Horn (Austria)

2004-06-01

The impingement syndrome is a clinical entity characterized by shoulder pain due to primary or secondary mechanical irritation of the rotator cuff. The primary factors for the development of impingement are a curved or hook-shaped anterior acromion as well as subacromial osteophytes, which may lead to tearing of the supraspinatus tendon. Secondary impingement is mainly caused by calcific tendinopathy, glenohumeral instability, os acromiale and degenerative changes of the acromioclavicular joint. Conventional radiographs are initially obtained, mainly for evaluation of the bony structures of the shoulder. If available, sonography can be used for detection of lesions and tears of the rotator cuff. Finally, MR-imaging provides detailed information about the relationship of the acromion and the acromioclavicular joint to the rotator cuff itself. In many cases however, no morphologic cause for impingement syndrome can be found. While patients are initially treated conservatively, chronic disease usually requires surgical intervention. (orig.) [German] Das Impingementsyndrom ist ein klinisches Krankheitsbild multifaktorieller Genese, bei dem es primaer oder sekundaer zu einer schmerzhaften mechanischen Beeintraechtigung der Rotatorenmanschette kommt. Als primaere Faktoren gelten ein gebogener oder hakenfoermiger Vorderrand des Akromions oder von diesem entspringende Osteophyten, was zu Laesionen der Supraspinatussehne fuehren kann. Zu den sekundaeren Faktoren zaehlt man v. a. eine Tendinitis calcarea, eine glenohumerale Instabilitaet, ein Os acromiale sowie degenerative Veraenderungen im Bereich des Akromioklavikulargelenks. Bildgebend steht an erster Stelle ein Nativroentgen, mit dem sich die knoechernen Strukturen gut darstellen lassen. Falls vorhanden, kann in weiterer Folge die Sonographie Auskunft ueber den Zustand der Rotatorenmanschette geben. Mit der MRT schliesslich laesst sich die Beziehung von Akromion und gelenkassoziierten Strukturen zur Rotatorenmanschette

Efficacy of labral repair, biceps tenodesis, and diagnostic arthroscopy for SLAP Lesions of the shoulder: a randomised controlled trial

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Mowinckel Petter

2010-10-01

Full Text Available Abstract Background Surgery for type II SLAP (superior labral anterior posterior lesions of the shoulder is a promising but unproven treatment. The procedures include labral repair or biceps tenodesis. Retrospective cohort studies have suggested that the benefits of tenodesis include pain relief and improved function, and higher patient satisfaction, which was reported in a prospective non-randomised study. There have been no completed randomised controlled trials of surgery for type II SLAP lesions. The aims of this participant and observer blinded randomised placebo-controlled trial are to compare the short-term (6 months and long-term (2 years efficacy of labral repair, biceps tenodesis, and placebo (diagnostic arthroscopy for alleviating pain and improving function for type II SLAP lesions. Methods/Design A double-blind randomised controlled trial are performed using 120 patients, aged 18 to 60 years, with a history for type II SLAP lesions and clinical signs suggesting type II SLAP lesion, which were documented by MR arthrography and arthroscopy. Exclusion criteria include patients who have previously undergone operations for SLAP lesions or recurrent shoulder dislocations, and ruptures of the rotator cuff or biceps tendon. Outcomes will be assessed at baseline, three, six, 12, and 24 months. Primary outcome measures will be the clinical Rowe Score (1988-version and the Western Ontario Instability Index (WOSI at six and 24 months. Secondary outcome measures will include the Shoulder Instability Questionnaire (SIQ, the generic EuroQol (EQ-5 D and EQ-VAS, return to work and previous sports activity, complications, and the number of reoperations. Discussion The results of this trial will be of international importance and the results will be translatable into clinical practice. Trial Registration [ClinicalTrials.gov NCT00586742

Results of Latarjet Coracoid Transfer to Revise Failed Arthroscopic Instability Repairs

OpenAIRE

Nicholson, Gregory P.; Rahman, Zain; Verma, Nikhil N.; Romeo, Anthony A.; Cole, Brian J.; Gupta, Anil Kumar; Bruce, Benjamin

2014-01-01

Objectives: Arthroscopic instability repair has supplanted open techniques to anatomically reconstruct anteroinferior instability pathology. Arthroscopic technique can fail for a variety of reasons. We have utilized the Latarjet as a revision option in failed arthroscopic instability repairs when there is altered surgical anatomy, capsular deficiency and/or glenoid bone compromise and recurrent glenohumeral instability. Methods: We reviewed 51 shoulders (40 ?, 11?) that underwent Latarjet cor...

The influence of experimentally induced pain on shoulder muscle activity

DEFF Research Database (Denmark)

Diederichsen, L.P.; Winther, A.; Dyhre-Poulsen, P.

2009-01-01

muscles. EMG was recorded before pain, during pain and after pain had subsided and pain intensity was continuously scored on a visual analog scale (VAS). During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper......-105A degrees) at a speed of approximately 120A degrees/s, controlled by a metronome. During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder...... trapezius and the infraspinatus and an increase in activity of lower trapezius and latissimus dorsi muscles. Following subacromial injection a significantly increased muscle activity was seen in the lower trapezius, the serratus anterior and the latissimus dorsi muscles. In conclusion, this study shows...

Glyceryl trinitrate patches—An alternative treatment for shoulder impingement syndrome

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Yusuf Assem

2015-01-01

Full Text Available Transdermal glyceryl trinitrate patches have been investigated as an alternative therapeutic intervention for a range of tendinopathies, due to the ease of titration of dosage and the ease of their application. Glyceryl trinitrate has been inferred to reduce pain and inflammation secondary to their nitric oxide-producing action. Shoulder impingement syndrome is a soft tissue condition that manifests as anterior shoulder pain, weakness, and difficulty in daily activities. This review will evaluate the efficacy of glyceryl trinitrate patches in treating a variety of rotator cuff tendinopathies related to shoulder impingement, based on human and animal trials, and suggest its practical application in future trials and management.

Reverse Total Shoulder Arthroplasty as Treatment for Rotator Cuff-Tear Arthropathy and Shoulder Dislocations in an Elderly Male with Parkinson’s Disease

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John G. Skedros

2017-01-01

Full Text Available We report the case of a 70-year-old male with Parkinson’s disease (PD and recurrent traumatic left shoulder dislocations. This case is rare because (1 he had a massive irreparable rotator cuff tear and end-stage arthritis (i.e., rotator cuff-tear arthropathy of the same shoulder and (2 his shoulder was ultimately reconstructed with a reverse total shoulder arthroplasty (RTSA. His first dislocation occurred after a fall. Recurrent shoulder dislocations occurred despite successful closed reduction and physical therapy. Initial surgical treatment included an open capsular-labral reconstruction; RTSA was not an ideal option because of the presumed risk of failure from PD-related dyskinesias. However, the capsular-labral reconstruction failed after he lost balance and stumbled but did not fall. A RTSA was then done which restored the patient’s shoulder stability and greatly improved his pain. At final follow-up two years later, he reported pain relief and improved function. This was partially attributed to the fact that he had moved to an assisted living center. He also began using an electric wheelchair one year after the RTSA. We report this case because of the unusual set of conditions and circumstances, namely, the implantation of a RTSA in a patient with PD and shoulder instability.

Magnetic resonance imaging of the shoulder: a review of potential sources of diagnostic errors

International Nuclear Information System (INIS)

Carroll, K.W.; Helms, C.A.

2002-01-01

Shoulder magnetic resonance (MR) imaging and MR arthrography are frequently utilized in the evaluation of shoulder pain and instability. The clinical scenario and imaging findings may be confusing to clinicians and radiologists and may present diagnostic challenges for those involved in evaluating and treating shoulder pathology. Often rotator cuff and labral abnormalities may be coexistent, clinical manifestations of denervation syndromes may be confusing to clinicians, and normal anatomic variations, imaging pitfalls, and various artifacts may cause dilemmas for the radiologist. This article will review the most frequently encountered mimickers and pitfalls of MR imaging of the shoulder. (orig.)

Shoulder injuries in overhead sports; Schultergelenkverletzungen bei Ueberkopfsportarten

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Woertler, K. [Technische Universitaet Muenchen (Germany). Institut fuer Roentgendiagnostik

2010-05-15

Overhead sport places great demands on the shoulder joint. Shoulder pain in overhead athletes and throwers can in the majority of cases be attributed to lesions resulting from chronic overuse of tendons and capsuloligamentous structures or to sequels of microinstability and secondary impingement. Due to its great impact on therapeutic decisions, imaging in athletes with unclear shoulder pain is a challenge. In this connection, magnetic resonance (MR) arthrography represents the cross-sectional imaging modality of first choice, as it allows depiction and exclusion of pathologic alterations of all relevant joint structures with sufficient confidence. This article reviews the biomechanical and clinical aspects and MR arthrographic features of the most common shoulder pathologies in overhead athletes, including biceps tendinopathy, superior labral anterior-posterior (SLAP) lesions, rotator cuff lesions, as well as extrinsic and intrinsic impingement syndromes. (orig.) [German] Ueberkopfsportarten stellen grosse Anforderungen an das Schultergelenk. Schulterbeschwerden bei Ueberkopf- und Wurfsportlern koennen in der Mehrzahl der Faelle auf eine chronische Ueberlastung von Sehnen und Kapsel-Band-Strukturen oder auf die Folgen einer Mikroinstabilitaet und sekundaerer Impingementsyndrome zurueckgefuehrt werden. Wegen ihres grossen Einflusses auf die Therapieentscheidung stellt die Bildgebung bei Athleten mit unklaren Schulterbeschwerden eine Herausforderung dar. Die MR-Arthrographie ist in diesem Zusammenhang als Schnittbildverfahren der ersten Wahl anzusehen, da sie den Nachweis bzw. Ausschluss pathologischer Veraenderungen aller relevanten Gelenkstrukturen mit ausreichender Sicherheit ermoeglicht. Dieser Artikel gibt eine Uebersicht ueber biomechanische und klinische Aspekte sowie MR-arthrographische Befunde der haeufigsten Schultergelenkpathologien bei Ueberkopfsportlern, wie Bizepstendinopathie, Superior-labral-anterior-posterior- (SLAP-)Laesionen, Laesionen der

Diagnosis of Ehlers-Danlos syndrome after a first shoulder dislocation.

Science.gov (United States)

Nourissat, Geoffroy; Vigan, Marie; Hamonet, Claude; Doursounian, Levon; Deranlot, Julien

2018-01-01

Shoulder dislocation is often the first symptom of Ehlers-Danlos syndrome (EDS). Whether it occurs in early-onset EDS is unknown. In most cases, surgical failure leads to the diagnosis. We aimed to determine whether clinical symptoms can signal the presence of EDS at a first dislocation. In this retrospective study, we analyzed clinical and radiologic data for 27 patients with EDS and shoulder instability and a control population of 40 consecutive non-EDS patients undergoing surgery for an unstable shoulder. Data were collected on gender, age, single or bilateral disease, general hyperlaxity, shoulder hyperlaxity, number of dislocations or subluxations, nontraumatic onset, and pain specificity. Nerve and vascular injuries, joint disorders, and family history were recorded, and radiologic data were reported. Age 85°) did not differ between the groups. After a first dislocation in a young girl with global hyperlaxity but not necessarily shoulder hyperlaxity, painless atraumatic dislocation with pain after reduction can suggest EDS. Copyright © 2018. Published by Elsevier Inc.

Revision of failed shoulder hemiarthroplasty to reverse total arthroplasty: analysis of 157 revision implants.

Science.gov (United States)

Merolla, Giovanni; Wagner, Eric; Sperling, John W; Paladini, Paolo; Fabbri, Elisabetta; Porcellini, Giuseppe

2018-01-01

There remains a paucity of studies examining the conversion of failed hemiarthroplasty (HA) to reverse total shoulder arthroplasty (RTSA). Therefore, the purpose of this study was to examine a large series of revision HA to RTSA. A population of 157 patients who underwent conversion of a failed HA to a revision RTSA from 2006 through 2014 were included. The mean follow-up was 49 months (range, 24-121 months). The indications for revision surgery included instability with rotator cuff insufficiency (n = 127) and glenoid wear (n = 30); instability and glenoid wear were associated in 38 cases. Eight patients with infection underwent 2-stage reimplantation. Patients experienced significant improvements in their preoperative to postoperative pain and shoulder range of motion (P surgeries, secondary to glenoid component loosening (n = 3), instability (n = 3), humeral component disassembly (n = 2), humeral stem loosening (n = 1), and infection (n = 2). Implant survivorship was 95.5% at 2 years and 93.3% at 5 years. There were 4 reoperations including axillary nerve neurolysis (n = 2), heterotopic ossification removal (n = 1), and hardware removal for rupture of the metal cerclage for an acromial fracture (n = 1). At final follow-up, there were 5 "at-risk" glenoid components. Patients experience satisfactory pain relief and recovery of reasonable shoulder function after revision RTSA from a failed HA. There was a relatively low revision rate, with glenoid loosening and instability being the most common causes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

MR and MR arthrography to identify degenerative and posttraumatic diseases in the shoulder joint

International Nuclear Information System (INIS)

Lee, Shi-Uk; Lang, Philipp

2000-01-01

MR imaging provides a comprehensive evaluation of a wide spectrum of both intraarticular and extraarticular pathology of the shoulder. MR imaging enables the detection or exclusion of degenerative and posttraumatic diseases of the shoulder with a reasonable accuracy. MR arthrography is useful in the visualization of subtle anatomic details and further improves the differentiation. In this article, findings of MR imaging and MR arthrography of degenerative and posttraumatic shoulder diseases (impingement syndrome, rotator cuff tears, and glenohumeral instability) has been reviewed

Timing and Activation Intensity of Shoulder Muscles during Handball Penalty Throwing in Subjects with and without Shoulder Impingement

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Zahra Zonnor

2017-08-01

Full Text Available Introduction: Shoulder injuries are common among athletes in sports that involve overhead throwing of the ball such as handball. The objectives of this study were to evaluate the timing and activation intensity of shoulder muscles during handball penalty throwing in individuals with shoulder pain and in control subjects. Materials and Methods: Using BTS FREE EMG 300 system with bipolar surface electrodes, the timing (onset and intensity of the activation of the shoulder muscles were measured including upper trapezius, anterior, middle and posterior deltoid, latissimus dorsi, pectoralis major, supraspinatus and triceps during penalty throwing. Multivariate analysis of variance (ANOVA was used for between group comparisons with the significance level P< 0.05. Results: The activation intensity of upper trapezius and latissimus dorsi muscles in the healthy individuals were about 50.74% and 43.42% higher than in patients. Middle deltoid in healthy individuals was about 38.05% smaller than that in patients. In control group, supraspinatus muscle started earlier (23.5 ms than the shoulder motion initiation. Triceps muscle was activated about 18.5 ms later than shoulder motion initiation. In patients, supraspinatus muscle started sooner (11 ms and triceps brachialis muscle started later than the other muscles (22.16 ms. Conclusion: The coordination of shoulder muscles i.e. the onset and intensity of muscle activity is disturbed in the patient group during throwing. Hence, strength and stretching programs are recommended for athletes to reduce the risk of shoulder pain syndrome. The rehabilitation program can be focused on modifying the pattern of activity in upper trapezius, supraspinatus, latissimus dorsi and deltoid muscles in addition to pain control in the rehabilitation centers.

High origin of the anterior band of the inferior glenohumeral ligament: MR arthrography with anatomic and histologic correlation in cadavers

International Nuclear Information System (INIS)

Ramirez Ruiz, Francisco Alejandro; Baranski Kaniak, Beatriz Cristina; Trudell, Debra; Resnick, Donald L.; Haghighi, Parviz

2012-01-01

The anterior band of the inferior glenohumeral ligament has been described to arise from the anteroinferior labrum, but we have observed that in some persons its origin is from the anterior or anterosuperior labrum, creating diagnostic difficulties. Ten fresh unembalmed cadaveric shoulders underwent magnetic resonance arthrography (MRA) using a posterior approach with a 1.5 T GE magnet, with the following sequences: T1-weighted fast spin-echo in axial, coronal and sagittal planes, and T1 fat-suppressed spin-echo in the axial plane (TR/TE 600/20, section thickness 2.5 mm, 0.5 mm interslice space, number of signals acquired, two, field of view 12 x 12 cm, and matrix 512 x 256 pixels). Following imaging, the shoulders were frozen and later sectioned using a band saw into 3-mm sections corresponding to the axial imaging plane. Histological analysis was also performed to determine the origin of the anterior band. Four of the ten shoulders had an origin of the anterior band above or at the 3 o'clock position: one at the 1 o'clock position, two at the 2 o'clock position, and one at the 3 o'clock position. In another shoulder, the anterior band of the inferior glenohumeral ligament originated from the middle glenohumeral ligament, and in five other shoulders, the anterior band originated from the anteroinferior labrum as has been described in the literature. This finding is of clinical significance as a high origin of the anterior band of the inferior glenohumeral ligament leads to MR arthrographic finding that can simulate those of labral tears or detachments. (orig.)

Magnetic resonance imaging (MR) of the shoulder

International Nuclear Information System (INIS)

Heuck, A.; Appel, M.; Lehner, K.; Luttke, G.; Technische Univ. Muenchen; Muenchen Univ.

1990-01-01

In order to test the criteria for abnormalities of the shoulder as seen on MR, 30 normal shoulders were examined. The examination included T 1 , proton and T 2 -weighted SE sequences and T 2 * -weighted FE sequences, using transverse, oblique coronary and oblique sagittal planes. In 57% there was increased signal intensity in the tendon of the rotator cuff; this might have been interpreted as a rupture of the cuff or tendinitis. Anatomical examination suggests that the finding is due to a normal layer between the long head of the biceps and the tendon joint complex. The anterior glenoid labrum could not be clearly delineated in 57% and the posterior labrum in 5%. In two cases there was a superior, postero-lateral defect in the head of the humerus. The currently accepted criteria for the MRT diagnosis of shoulder abnormalities need to be critically re-evaluated. (orig.) [de

How sensitive is the deltoid moment arm to humeral offset changes with reverse total shoulder arthroplasty?

Science.gov (United States)

Walker, David R; Kinney, Allison L; Wright, Thomas W; Banks, Scott A

2016-06-01

Reverse total shoulder arthroplasty commonly treats cuff-deficient or osteoarthritic shoulders not amenable to rotator cuff repair. This study investigates deltoid moment arm sensitivity to variations in the joint center and humeral offset of 3 representative reverse total shoulder arthroplasty subjects. We hypothesized that a superior joint implant placement may exist, indicated by muscle moment arms, compared with the current actual surgical implant configuration. Moment arms for the anterior, lateral, and posterior aspects of the deltoid muscle were determined for 1521 perturbations of the humeral offset location away from the surgical placement in a subject-specific musculoskeletal model with motion defined by subject-specific in vivo abduction kinematics. The humeral offset was varied from its surgical position ±4 mm in the anterior/posterior direction, ±12 mm in the medial/lateral direction, and -10 to 14 mm in the superior/inferior direction. The anterior deltoid moment arm varied in humeral offset and center of rotation up to 20 mm, primarily in the medial/lateral and superior/inferior directions. The lateral deltoid moment arm varied in humeral offset up to 20 mm, primarily in the medial/lateral and anterior/posterior directions. The posterior deltoid moment arm varied up to 15 mm, primarily in early abduction, and was most sensitive to humeral offset changes in the superior/inferior direction. High variations in muscle moment arms were found for all 3 deltoid components, presenting an opportunity to dramatically change the deltoid moment arms through surgical placement of the reverse shoulder components and by varying the overall offset of the humerus. Basic Science Study; Computer Modeling. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Radiographic analysis of shoulder anatomical arthroplasty

Energy Technology Data Exchange (ETDEWEB)

Merolla, Giovanni [Unit of Shoulder and Elbow Surgery, ' D. Cervesi' Hospital, L. Van Beethoven 46 Street, 47841 Cattolica (Italy)], E-mail: gmerolla@shouldertech.it; Di Pietto, Francesco; Romano, Stefania [Department of Diagnostic Imaging, ' A. Cardarelli' Hospital, Naples (Italy); Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe [Unit of Shoulder and Elbow Surgery, ' D. Cervesi' Hospital, L. Van Beethoven 46 Street, 47841 Cattolica (Italy)

2008-10-15

Arthroplasty is the standard treatment for advanced shoulder osteoarthritis. Modern prostheses designs have modular features whose size, shaft/head and body morphology can be adjusted. Total Shoulder Arthroplasty (TSA) provides better results. A complete X-ray follow-up is essential to assess the results and evaluate the survival rates of a shoulder prosthesis. Antero-posterior at 40 deg. in both internal and external rotation (true AP view) and axillary view are recommended to assess the following parameters: orientation and translation of the humeral component, offset, size and height of the humeral head, acromio-humeral distance, distribution and fixation of the cement, stress shielding and cortical resorption, radiolucent lines, subsidence and tilt, glenoid wear and 'bone stock', prostheses instability, glenoid component shift. Shoulder hemiarthroplasty can lead to glenoid wear; the true AP film at 40 deg. of internal rotation provides the best profile of gleno-humeral joint to depict glenoid erosion. Shift of the glenoid component in TSA is identified as tilting or medial migration on true AP and axillary views in the early postoperative period (1-2 months) and at minimum of 2 years. An exhaustive radiographic analysis remains essential to monitor the prosthetic implant and detect early and late complications or risk factors of prosthetic loosening.

All-Arthroscopic Revision Eden-Hybinette Procedure for Failed Instability Surgery: Technique and Preliminary Results.

Science.gov (United States)

Giannakos, Antonios; Vezeridis, Peter S; Schwartz, Daniel G; Jany, Richard; Lafosse, Laurent

2017-01-01

To describe the technique of an all-arthroscopic Eden-Hybinette procedure in the revision setting for treatment of a failed instability procedure, particularly after failed Latarjet, as well as to present preliminary results of this technique. Between 2007 and 2011, 18 shoulders with persistent instability after failed instability surgery were treated with an arthroscopic Eden-Hybinette technique using an autologous bicortical iliac crest bone graft. Of 18 patients, 12 (9 men, 3 women) were available for follow-up. The average follow-up was 28.8 months (range, 15 to 60 months). A Latarjet procedure was performed as an index surgery in 10 patients (83%). Two patients (17%) had a prior arthroscopic Bankart repair. Eight patients (67%) obtained a good or excellent result, whereas 4 patients (33%) reported a fair or poor result. Seven patients (58%) returned to sport activities. A positive apprehension test persisted in 5 patients (42%), including 2 patients (17%) with recurrent subluxations. The Rowe score increased from 30.00 to 78.33 points (P Instability Index score showed a good result of 28.71% (603 points). The average anterior flexion was 176° (range, 150° to 180°), and the average external rotation was 66° (range, 0° to 90°). Two patients (16.67%) showed a progression of glenohumeral osteoarthritic changes, with each patient increasing by one stage in the Samilson-Prieto classification. All 4 patients (33%) with a fair or poor result had a nonunion identified on postoperative computed tomography scan. An all-arthroscopic Eden-Hybinette procedure in the revision setting for failed instability surgery, although technically demanding, is a safe, effective, and reproducible technique. Although the learning curve is considerable, this procedure offers all the advantages of arthroscopic surgery and allows reconstruction of glenoid defects and restoration of shoulder stability in this challenging patient population. In our hands, this procedure yields good

Arthroscopic treatment of refractory adhesive capsulitis of the shoulder

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Marcos Rassi Fernandes

Full Text Available OBJECTIVE: to evaluate the results of arthroscopic treatment of refractory adhesive capsulitis of the shoulder associated as for improved range of motion after a minimum follow up of six years. METHODS: from August 2002 to December 2004, ten patients with adhesive capsulitis of the shoulder resistant to conservative treatment underwent arthroscopic surgery. One interscalene catheter was placed for postoperative analgesia before the procedure. All were in Phase II, with a minimum follow up of two years. The mean age was 52.9 years (39-66, predominantly female (90%, six on the left shoulder. The time between onset of symptoms and surgical treatment ranged from six to 20 months. Four adhesive capsulitis were found to be primary (40% and six secondary (60%. RESULTS: the preoperative mean of active anterior elevation was 92°, of external rotation was 10.5° of the L5 level internal rotation; the postoperative ones were 149°, 40° and T12 level, respectively. Therefore, the average gain was 57° for the anterior elevation, 29.5° for external rotation in six spinous processes. There was a significant difference in movements' gains between the pre and post-operative periods (p<0.001. By the Constant Score (range of motion, there was an increase of 13.8 (average pre to 32 points (average post. CONCLUSION: the arthroscopic treatment proved effective in refractory adhesive capsulitis of the shoulder resistant to conservative treatment, improving the range of joint movements of patients evaluated after a minimum follow up of six years.

Posterior axilla sling traction for shoulder dystocia: case review and a new method of shoulder rotation with the sling.

Science.gov (United States)

Cluver, Catherine Anne; Hofmeyr, G Justus

2015-06-01

The purpose of this study was to report on all cases in which posterior axilla sling traction (PAST) has been used to deliver cases of intractable shoulder dystocia and to describe a new method of shoulder rotation with the sling. A record of all published and known cases was collected that included information on preliminary obstetric techniques that were used and how the PAST technique was performed. Maternal outcomes that included maternal injury and length of hospital stay and fetal outcomes, which included birthweight, Apgar scores, nerve injuries, fractures, hospital stay, and outcome, were documented. We have recorded 19 cases where PAST has been used. In 5 cases, the babies had died in utero. Ten were assisted deliveries. PAST was successful in 18 cases. In one case, it was partially successful because it enabled delivery of the posterior shoulder with digital axillary traction. The most commonly used material was suction tubing. Once the posterior shoulder was delivered, the shoulder dystocia was resolved in all cases. Time from insertion to delivery was dystocia fail. Advantages are that it is easy to use (even by someone who has not seen it used previously), that the sling material is readily available, and that it is inserted quickly with 2 fingers. This is the first report of its use to rotate the posterior shoulder to the anterior position for delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

ANALYSIS OF LEVEL OF BOTH SHOULDERS IN PHYSICAL THERAPY STUDENTS

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Ghazala Noor Nizami

2017-09-01

Full Text Available Background: During lectures, usually students sit in an awkward position, for prolonged period of time and that may cause postural instability. For a good posture, bilateral landmarks should be on same level, when viewed from front or behind. Therefore, both shoulders should also be on same level as well. Any alteration in level of shoulders in healthy individual may lead to deformity in spine or extremity. The objective of this study was to analyze the level of both shoulders in the physical therapy students and to find its correlation with the perception of students about their shoulder balance. Methods: An observational (cross – sectional study was conducted on students of Doctor in Physical Therapy (DPT from colleges of Physical Therapy, Karachi. 100 Students were selected by Simple Random Sampling technique. Data from students was collected by administering a questionnaire. It includes close-ended questions. Afterwards, the level of both shoulders of the students, were assessed by using Scoliosis Meter. Results: Response from students showed that 79% of them assumed that both shoulders are in same level. When level of shoulder of students was assessed by scoliosis meter, it showed that 37% students have absolute level shoulder. Spearman’s Correlation coefficient (r = 0.046, p= 0.65 showed a weak, positive correlation between perception of the students about shoulder level and assessment of shoulder tilt. Conclusion: This showed that the perception of students about level of both shoulders was not correlated to the actual levels of the shoulders. Hence, as they were not assuming it uneven, so they may not pay any attention to keep themselves straight.

Double oblique MR images of the shoulder. Comparison with conventional images

International Nuclear Information System (INIS)

Sasaki, Taisuke; Saito, Yoko; Yodono, Hiraku; Miura, Hiroyuki; Shinohara, Atsushi; Abe, Shuichiro

1998-01-01

Because the scapula is not only slanted on transverse sections but also inclines on sagittal sections, we now perform shoulder MR imaging using double oblique images (DOI), which are planes perpendicular or parallel to the long axis of the scapula obtained with oblique sagittal scout imaging. The purpose of this study was to evaluate the usefulness of double oblique shoulder MR imaging. MR images of shoulders with operatively or arthroscopically proven lesions (20 cases) that had been examined on both conventional images (CI) and DOI were retrospectively reviewed. DOI were compared with CI not only in terms of diagnostic performance but also in their ability to identify the details of shoulder anatomy. All MR studies were done with a shoulder coil on a high-field (1.5 T) unit. Although the accuracy of DOI in diagnosing shoulder disorders such as rotator cuff tear and labrum injury was not as good as that of CI, DOI were better for identifying or discriminating muscles and tendons of the rotator cuff, labralbicipital junction and anterior band of the inferior gleno-humeral ligament, and for recognizing the correct position of the glenoid labrum. MR double oblique imaging of the shoulder provides more detailed information about shoulder anatomy and disorders than conventional imaging. (author)

The Superior Labrum, Anterior-to-Posterior ’SLAP’ Lesion

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2006-10-01

motion and equal sensation bilaterally. Testing was negative for impingement, rotator cuff disease, biceps tendon pathology, acromioclavicular ...impingement syndrome, acromioclavicular joint pain, bicipital tendonitis or symptomatic shoulder instability. The original description of SLAP

Management of type II superior labrum anterior posterior lesions: a review of the literature

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Xinning Li

2010-02-01

Full Text Available Superior labrum anterior and posterior lesions were first described in 1985 by Andrews et al. and later classified into four types by Synder et al. The most prevalent is type II which is fraying of the superior glenoid labrum with detachment of the biceps anchor. Superior labrum anterior posterior (SLAP lesions can also be associated with other shoulder pathology. Both MRI and MRA can be utilized in making the diagnosis with the coronal images being the most sensitive. The mechanism of injury can be either repetitive stress or acute trauma with the superior labrum most vulnerable to injury during the late cocking phase of throwing. A combination of the modified dynamic labral shear and O’Brien test can be used clinically in making the diagnosis of SLAP lesion. However, the most sensitive and specific test used to diagnosis specifically a type II SLAP lesion is the Biceps Load Test II. The management of type II SLAP lesions is controversial and dependent on patient characteristics. In the young high demanding overhead athlete, repair of the type II lesion is recommended to prevent glenohumeral instability. In middle-aged patients (age 25-45, repair of the type II SLAP lesion with concomitant treatment of other shoulder pathology resulted in better functional outcomes and patient satisfaction. Furthermore, patients who had a distinct traumatic event resulting in the type II SLAP tear did better functionally than patients who did not have the traumatic event when the lesion was repaired. In the older patient population (age over 45 years, minimum intervention (debridement, biceps tenodesis/tenotomy to the type II SLAP lesion results in excellent patient satisfaction and outcomes.

Dynamic ultrasound of peroneal tendon instability.

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Pesquer, Lionel; Guillo, Stéphane; Poussange, Nicolas; Pele, Eric; Meyer, Philippe; Dallaudière, Benjamin

2016-07-01

Ankle snapping may be caused by peroneal tendon instability. Anterior instability occurs after traumatic superior peroneal retinaculum injury, whereas peroneal tendon intrasheath subluxation is atraumatic. Whereas subluxation is mainly dynamic, ultrasound allows for the diagnosis and classification of peroneal instability because it allows for real-time exploration. The purpose of this review is to describe the anatomic and physiologic bases for peroneal instability and to heighten the role of dynamic ultrasound in the diagnosis of snapping.

Direct MR-arthrography of the shoulder with maximum capsular distension for surgical planning

International Nuclear Information System (INIS)

Drescher, R.; Rothenburg, T. von; Koester, O.; Schmid, G.; Ludwig, J.

2004-01-01

Purpose: To evaluate the effectiveness of direct MR arthrography of the glenohumeral joint with maximum distension of the joint capsule in patients with glenohumeral instability for preoperative diagnosis and for determining the method of surgical intervention. Materials and Methods: MR arthrography of the shoulder joint was performed on a 1.5 T system in 38 patients. All patients suffered from anterior or bidirectional instability. Using a fluoroscopically guided posterior approach, a 1% dilution of dimeglumine gadopentetate (5 mmol Gd-DTPA/l) was injected until full capsular stretching was achieved. MR imaging protocol included fat-saturated transversal, oblique-coronal and oblique-sagittal T1-weighted spin-echo, T1-weighted 3-D and transversal T2-weighted Flash-2D. Results: MR imaging revealed significant capsule distention in 22 patients and ventral capsule defects in 9 patients. Labral lesions were depicted in 25 patients, bicipital tendon lesions in 4 patients and partial ruptures of the rotator cuff in 3 patients. 15 of the 38 patients underwent surgery. Areas of pathologic laxity of the glenohumeral capsule were correctly described in all cases. In 12 of 15 patients, the best method of intervention could be determined prospectively. In 3 of 15 patients, the necessary operation was overestimated. Regarding labral ruptures, MRI had a sensitivity of 88%, a specificity of 86%, and a diagnostic accuracy of 87%. (orig.)

High-resolution MR imaging of glenohumeral instability lesions

International Nuclear Information System (INIS)

Rafii, M.; Firooznia, H.; Sherman, O.; Minkoff, J.; Sherman, M.; Golimbu, C.

1991-01-01

This paper determines the accuracy of conventual MR imaging in the diagnosis of glenohumeral instabilities and evaluates various pathologic aspects of these lesions. Records were reviewed in 80 consecutive patients with known or suspected instability who underwent MR imaging. The routine shoulder protocol included a proton density- or T2-weighted sequence. Surgical correlation was available in 31 cases. Diagnosis of glenohumeral instability was based on the presence of a combination of findings of appropriately located tear, osseous abnormality of glenoid margin, capsular abnormalities and Hill-Sachs deformity. In 28 surgically correlated patients with glenohumeral instability an accurate diagnosis was made in all but 1 case of posterior instability. A false diagnosis of instability was suggested in 3 cases by signal abnormality of the labrum and/or a prominent capsule

Shoulder, hip, and knee arthrography needle placement using fluoroscopic guidance: practice patterns of musculoskeletal radiologists in North America

International Nuclear Information System (INIS)

Shortt, Conor P.; Morrison, William B.; Deely, Diane M.; Gopez, Angela G.; Zoga, Adam C.; Roberts, Catherine C.

2009-01-01

The aim of this study was to evaluate the range of techniques used by radiologists performing shoulder, hip, and knee arthrography using fluoroscopic guidance. Questionnaires on shoulder, hip, and knee arthrography were distributed to radiologists at a national radiology meeting. We enquired regarding years of experience, preferred approaches, needle gauge, gadolinium dilution, and volume injected. For each approach, the radiologist was asked their starting and end needle position based on a numbered and lettered grid superimposed on a radiograph. Sixty-eight questionnaires were returned. Sixty-eight radiologists performed shoulder and hip arthrography, and 65 performed knee arthrograms. Mean experience was 13.5 and 12.8 years, respectively. For magnetic resonance arthrography, a gadolinium dilution of 1/200 was used by 69-71%. For shoulder arthrography, an anterior approach was preferred by 65/68 (96%). The most common site of needle end position, for anterior and posterior approaches, was immediately lateral to the humeral cortex. A 22-gauge needle was used by 46/66 (70%). Mean injected volume was 12.7 ml (5-30). For hip arthrography, an anterior approach was preferred by 51/68 (75%). The most common site of needle end position, for anterior and lateral approaches, was along the lateral femoral head/neck junction. A 22-gauge needle was used by 53/68 (78%). Mean injected volume was 11.5 ml (5-20). For knee arthrography, a lateral approach was preferred by 41/64 (64%). The most common site of needle end position, for lateral and medial approaches, was mid-patellofemoral joint level. A 22-gauge needle was used by 36/65 (56%). Mean injected volume was 28.2 ml (5-60). Arthrographic approaches for the shoulder, hip, and knee vary among radiologists over a wide range of experience levels. (orig.)

Shoulder, hip, and knee arthrography needle placement using fluoroscopic guidance: practice patterns of musculoskeletal radiologists in North America

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Shortt, Conor P. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States); Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, PA (United States); Morrison, William B.; Deely, Diane M.; Gopez, Angela G.; Zoga, Adam C. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States); Roberts, Catherine C. [Mayo Clinic College of Medicine, Department of Radiology, Phoenix, AZ (United States)

2009-04-15

The aim of this study was to evaluate the range of techniques used by radiologists performing shoulder, hip, and knee arthrography using fluoroscopic guidance. Questionnaires on shoulder, hip, and knee arthrography were distributed to radiologists at a national radiology meeting. We enquired regarding years of experience, preferred approaches, needle gauge, gadolinium dilution, and volume injected. For each approach, the radiologist was asked their starting and end needle position based on a numbered and lettered grid superimposed on a radiograph. Sixty-eight questionnaires were returned. Sixty-eight radiologists performed shoulder and hip arthrography, and 65 performed knee arthrograms. Mean experience was 13.5 and 12.8 years, respectively. For magnetic resonance arthrography, a gadolinium dilution of 1/200 was used by 69-71%. For shoulder arthrography, an anterior approach was preferred by 65/68 (96%). The most common site of needle end position, for anterior and posterior approaches, was immediately lateral to the humeral cortex. A 22-gauge needle was used by 46/66 (70%). Mean injected volume was 12.7 ml (5-30). For hip arthrography, an anterior approach was preferred by 51/68 (75%). The most common site of needle end position, for anterior and lateral approaches, was along the lateral femoral head/neck junction. A 22-gauge needle was used by 53/68 (78%). Mean injected volume was 11.5 ml (5-20). For knee arthrography, a lateral approach was preferred by 41/64 (64%). The most common site of needle end position, for lateral and medial approaches, was mid-patellofemoral joint level. A 22-gauge needle was used by 36/65 (56%). Mean injected volume was 28.2 ml (5-60). Arthrographic approaches for the shoulder, hip, and knee vary among radiologists over a wide range of experience levels. (orig.)

Iatrogenic nerve injuries during shoulder surgery.

Science.gov (United States)

Carofino, Bradley C; Brogan, David M; Kircher, Michelle F; Elhassan, Bassem T; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

2013-09-18

The current literature indicates that neurologic injuries during shoulder surgery occur infrequently and result in little if any morbidity. The purpose of this study was to review one institution's experience treating patients with iatrogenic nerve injuries after shoulder surgery. A retrospective review of the records of patients evaluated in a brachial plexus specialty clinic from 2000 to 2010 identified twenty-six patients with iatrogenic nerve injury secondary to shoulder surgery. The records were reviewed to determine the operative procedure, time to presentation, findings on physical examination, treatment, and outcome. The average age was forty-three years (range, seventeen to seventy-two years), and the average delay prior to referral was 5.4 months (range, one to fifteen months). Seven nerve injuries resulted from open procedures done to treat instability; nine, from arthroscopic surgery; four, from total shoulder arthroplasty; and six, from a combined open and arthroscopic operation. The injury occurred at the level of the brachial plexus in thirteen patients and at a terminal nerve branch in thirteen. Fifteen patients (58%) did not recover nerve function after observation and required surgical management. A structural nerve injury (laceration or suture entrapment) occurred in nine patients (35%), including eight of the thirteen who presented with a terminal nerve branch injury and one of the thirteen who presented with an injury at the level of the brachial plexus. Nerve injuries occurring during shoulder surgery can produce severe morbidity and may require surgical management. Injuries at the level of a peripheral nerve are more likely to be surgically treatable than injuries of the brachial plexus. A high index of suspicion and early referral and evaluation should be considered when evaluating patients with iatrogenic neurologic deficits after shoulder surgery.

The imaging of the shoulder joint

International Nuclear Information System (INIS)

Hayamizu, Kyoko; Ito, Katsuhide; Naito, Akira

1988-01-01

Computed tomographic arthrography (arthro-CT) and rotator cuff sonography (RC-US) are new methods for investigating cases with shoulder disorders. We present details of these techniques and report normal and pathological findings of the shoulder joint composed of the glenoid lablum, glenoid, joint capsule and RC. Twenty nine cases with shoulder instability and RC tears were evaluated by arthro-CT. Arthro-CT findings were correlated with surgical ones in three operated cases. Arthro-CT has provided excellent visualizations of labral tears and capsular lesions and has been successfully utilized for detection of the spilled contrast material with RC tears. We examined RC-US in 9 cases who underwent surgery or arthrography on suspicion of rotator cuff tears, and 12 normal volunteers. RC-US findings indicative of the tears included (1) defect or focal thinning of the RC in 3 cases, (2) discontinuity in the homogenous echogenicity of the RC in 2 cases, (3) presence of the abnormal central echogenic band or echogenic foci in the RC in 6 cases. The defect or thinning of the RC represented full-thickness tears. RC-US is a rapid, noninvasive and reliable method of detecting RC tears. (author)

MRI of the posttraumatic shoulder

International Nuclear Information System (INIS)

Dimitrov, N.

2013-01-01

Full text: Abnormalities of the shoulder are common but still unclear for both GPs and the orthopedic surgeon in our community. Difficult and late these patients are directed to a specialist for diagnosis and treatment. Our goal is to address some of the key and most common problem conditions related to the complaints in this area. Incidence of symptomatic ruptures of the shoulder’s rotator cuff is difficult to be evaluated. But it is by no means rare, concerning the research in the world - historically and today. It is also known that ruptures can be asymptomatic. Despite the large percentage of them, many of them are at risk for progression of the symptoms. While, on the world, the authors explicitly state that dealing with a rotator cuff rupture is one of the top 10 issues that are most important for orthopedic surgeons, in our country the most common diagnosis for shoulder complaints is still periarthritis, without specifying of individual muscles pathology. Another major concern is shoulder instability associated with multiple incidents of luxation started either in adolescence with minor traumatic incident, such as recurrent dislocation, or started after severe trauma in older ages. It has to be specified diagnostic type of instability: front, rear or multidirection. Especially it is important to make the initial stabilization period of unavoidable long series of repeated dislocations in adolescents and young people, whether actively practicing sports or not. This point is often missed, and later for large lesions it leads to more invasive surgery. Not infrequently this condition is characterized by pain and limited movement without true dislocation. Then it is mandatory to assess the diagnostic changes in labrum, ligaments and muscles, not to leave the patient to reach first dislocation. Impingement syndrome (IC) is a common suffering, engaging soft tissues in the subacromial bursitis. IC characterizes by pain during the upper limb removal and the

Defining forces that are associated with shoulder dystocia: the use of a mathematic dynamic computer model.

Science.gov (United States)

Gonik, Bernard; Zhang, Ning; Grimm, Michele J

2003-04-01

A computer model was modified to study the impact of maternal endogenous and clinician-applied exogenous delivery loads on the contact force between the anterior fetal shoulder and the maternal symphysis pubis. Varying endogenous and exogenous loads were applied, and the contact force was determined. Experiments also examined the effect of pelvic orientation and the direction of load application on contact force behind the symphysis pubis. Exogenous loading forces (50-100 N) resulted in anterior shoulder contact forces of 107 to 127 N, with delivery accomplished at 100 N of applied load. Higher contact forces (147-272 N) were noted for endogenously applied loads (100-400 N), with delivery occurring at 400 N of maternal force. Pelvic rotation from lithotomy to McRoberts' positioning resulted in reduced contact forces. Downward lateral flexion of the fetal head led to little difference in contact force but required 30% more exogenous load to achieve delivery. Compared with clinician-applied exogenous force, larger maternally derived endogenous forces are needed to clear the impacted anterior fetal shoulder. This is associated with >2 times more contact force by the obstructing symphysis pubis. McRoberts' positioning reduces shoulder-symphysis pubis contact force. Lateral flexion of the fetal head results in the larger forces that are needed for delivery but has little effect on contact force. Model refinements are needed to examine delivery forces and brachial plexus stretching more specifically.

Visualization of the extra-articular portion of the long head of the biceps tendon during intra-articular shoulder arthroscopy.

Science.gov (United States)

Festa, Anthony; Allert, Jesse; Issa, Kimona; Tasto, James P; Myer, Jonathan J

2014-11-01

To quantify the amount of the extra-articular long head of the biceps tendon (LHBT) seen during intra-articular shoulder arthroscopy by pulling the tendon into the joint with a probe through an anterior portal while viewing through a standard posterior portal. Intra-articular shoulder arthroscopy was performed on 10 forequarter cadaveric specimens. The extra-articular portion of the LHBT was evaluated by pulling the tendon into the joint with an arthroscopic probe inserted through an anterior portal. The tendon was marked at the pulley insertion on the humerus with a vascular clip before and after the tendon was pulled into the joint. An open deltopectoral approach was performed, and the amount of extra-articular tendon visualized was calculated as an absolute amount and in relation to nearby anatomic structures. An additional 1.9 cm (range, 1.4 to 2.6 cm) of extra-articular LHBT was viewed by pulling the tendon into the joint with an arthroscopic probe through an anterior portal during shoulder arthroscopy. This represented 30.8% of the extra-articular portion of the tendon, 47.7% of tendon in the bicipital groove, and 76.3% of the tendon that lies under the area from the pulley insertion to the distal edge of the transverse humeral ligament. During intra-articular shoulder arthroscopy, the extra-articular portion of the LHBT is incompletely visualized by pulling the tendon into the joint with a probe placed through an anterior portal while viewing through a standard posterior portal. An additional extra-articular portion of the LHBT may be viewed by pulling the tendon into the joint with an arthroscopic probe during shoulder arthroscopy. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Dynamic Three-Dimensional Shoulder Mri during Active Motion for Investigation of Rotator Cuff Diseases.

Directory of Open Access Journals (Sweden)

Christine Tempelaere

Full Text Available MRI is the standard methodology in diagnosis of rotator cuff diseases. However, many patients continue to have pain despite treatment, and MRI of a static unloaded shoulder seems insufficient for best diagnosis and treatment. This study evaluated if Dynamic MRI provides novel kinematic data that can be used to improve the understanding, diagnosis and best treatment of rotator cuff diseases.Dynamic MRI provided real-time 3D image series and was used to measure changes in the width of subacromial space, superior-inferior translation and anterior-posterior translation of the humeral head relative to the glenoid during active abduction. These measures were investigated for consistency with the rotator cuff diseases classifications from standard MRI.The study included: 4 shoulders with massive rotator cuff tears, 5 shoulders with an isolated full-thickness supraspinatus tear, 5 shoulders with tendinopathy and 6 normal shoulders. A change in the width of subacromial space greater than 4mm differentiated between rotator cuff diseases with tendon tears (massive cuff tears and supraspinatus tear and without tears (tendinopathy (p = 0.012. The range of the superior-inferior translation was higher in the massive cuff tears group (6.4mm than in normals (3.4mm (p = 0.02. The range of the anterior-posterior translation was higher in the massive cuff tears (9.2 mm and supraspinatus tear (9.3 mm shoulders compared to normals (3.5mm and tendinopathy (4.8mm shoulders (p = 0.05.The Dynamic MRI enabled a novel measure; 'Looseness', i.e. the translation of the humeral head on the glenoid during an abduction cycle. Looseness was better able at differentiating different forms of rotator cuff disease than a simple static measure of relative glenohumeral position.

Intraarticular findings in the chronically painful shoulder. A study of 32 posttraumatic cases

DEFF Research Database (Denmark)

Suder, P.A.; Hougaard, K.; Frich, Lars Henrik

1994-01-01

the head activities. Symptoms of a "dead arm" and instability were also present. Patients with previous dislocations, traumas or radiographic signs of degenerative shoulder lesions were excluded. The patients had a decreased active range of motion and positive signs of apprehension and impingement......, arthroscopic labral resection and open subacromial decompression. In conclusion, patients with chronic posttraumatic shoulder pain have intraarticular injuries, especially tears of the glenoid labrum. History, clinical findings, radiography and sonography are seldom diagnostic. MRI is valuable, particularly...

Comparative shoulder kinematics during free standing, standing depression lifts and daily functional activities in persons with paraplegia: considerations for shoulder health.

Science.gov (United States)

Riek, L M; Ludewig, P M; Nawoczenski, D A

2008-05-01

Case series; nonparametric repeated-measures analysis of variance. To compare and contrast three-dimensional shoulder kinematics during frequently utilized upper extremity weight-bearing activities (standing depression lifts used in brace walking, weight-relief raises, transfers) and postures (sitting rest, standing in a frame) in spinal cord injury (SCI). Movement Analysis Laboratory, Department of Physical Therapy, Ithaca College, Rochester, NY, USA. Three female and two male subjects (39.2+/-6.1 years old) at least 12 months post-SCI (14.6+/-6.7 years old), SCI distal to T2 and with an ASIA score of A. The Flock of Birds magnetic tracking device was used to measure three-dimensional positions of the scapula, humerus and thorax during various activities. Standing in a frame resulted in significantly less scapular anterior tilt (AT) and greater glenohumeral external rotation (GHER) than standing depression lifts and weight-relief raises. Standing frame posture offers the most favorable shoulder joint positions (less scapular AT and greater GHER) when compared to sitting rest posture, weight-relief raises, transfers and standing depression lifts. Knowledge of kinematic patterns associated with each activity is an essential first step to understanding the potential impact on shoulder health. Choosing specific activities or modifying techniques within functional activities that promote favorable shoulder positions may preserve long-term shoulder health.

Arthroscopic management of the contact athlete with instability.

Science.gov (United States)

Harris, Joshua D; Romeo, Anthony A

2013-10-01

The shoulder is the most commonly dislocated joint in the body, with a greater incidence of instability in contact and collision athletes. In contact and collision athletes that have failed nonoperative treatment, the most important factors to consider when planning surgery are amount of bone loss (glenoid, humeral head); patient age; and shoulder hyperlaxity. Clinical outcomes, instability recurrence rate, and return to sport rate are not significantly different between arthroscopic suture anchor and open techniques. Lateral decubitus positioning with distraction and four portal (including seven-degree and 5-o’clock positions) techniques allow for 360-degree access to the glenoid rim, with placement of at least three sutures anchors below 3 o’clock for optimal results. In patients with significant glenoid bone loss (>20%-25%, inverted pear glenoid), open bone augmentation techniques are indicated and arthroscopic techniques are contraindicated. Copyright © 2013 Elsevier Inc. All rights reserved.

Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial Efetividade da injeção intrarticular de lidocaína na redução das luxações anteriores do ombro: ensaio clínico randomizado

Directory of Open Access Journals (Sweden)

Marcel Jun Sugawara Tamaoki

2012-01-01

Full Text Available CONTEXT AND OBJECTIVE: Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. DESIGN AND SETTING: Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp. METHODS: From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. RESULTS: Forty-two patients were included: 20 in the group without analgesia (control group and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0, standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P CONTEXTO E OBJETIVO: A luxação do ombro é a mais frequente luxação das grandes articulações. O objetivo foi comparar a efetividade da redução da luxação anterior aguda do ombro, com ou sem anestesia articular. TIPO DE ESTUDO E LOCAL: Ensaio clínico randomizado desenvolvido na Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp. MÉTODOS: De março de 2008 a dezembro de 2009 foram recrutados 42 pacientes com luxação anterior do ombro agudas. Foi comparada a redução de tração e contra-tração com e sem anestesia intra-articular com lidocaína. Como desfecho primário, a dor foi avaliada por meio da escala visual analógica antes da redução e um e cinco minutos após a

Clinical outcome of shoulder muscle transfer for shoulder deformities in obstetric brachial plexus palsy: A study of 150 cases

Directory of Open Access Journals (Sweden)

Mukund R Thatte

2011-01-01

Full Text Available Background: Residual muscle weakness, cross-innervation (caused by misdirected regenerating axons, and muscular imbalance are the main causes of internal rotation contractures leading to limitation of shoulder joint movement, glenoid dysplasia, and deformity in obstetric brachial plexus palsy. Muscle transfers and release of antagonistic muscles improve range of motion as well as halt or reverse the deterioration in the bony architecture of the shoulder joint. The aim of our study was to evaluate the clinical outcome of shoulder muscle transfer for shoulder abnormalities in obstetric brachial plexus palsy. Materials and Methods: One hundred and fifty patients of obstetric brachial plexus palsy with shoulder deformity underwent shoulder muscle transfer along with anterior shoulder release at our institutions from 1999 to 2007. Shoulder function was assessed both preoperatively and postoperatively using aggregate modified Mallet score and active and passive range of motion. The mean duration of follow-up was 4 years (2.5-8 years. Results: The mean preoperative abduction was 45° ± 7.12, mean passive external rotation was 10° ± 6.79, the mean active external rotation was 0°, and the mean aggregate modified Mallet score was 11.2 ± 1.41. At a mean follow-up of 4 years (2.5-8 years, the mean active abduction was 120° ± 18.01, the mean passive external rotation was 80° ± 10.26, while the mean active external rotation was 45° ± 3.84. The mean aggregate modified Mallet score was 19.2 ± 1.66. Conclusions: This procedure can thus be seen as a very effective tool to treat internal rotation and adduction contractures, achieve functional active abduction and external rotation, as well as possibly prevent glenohumeral dysplasia, though the long-term effects of this procedure may still have to be studied in detail clinico-radiologically to confirm this hypothesis. Level of evidence: Therapeutic level IV

The failed postoperative shoulder: Role of double contrast CT arthrography

International Nuclear Information System (INIS)

Singson, R.D.; Feldman, F.; Bigliani, L.

1986-01-01

Various types of reparative and corrective operations on the shoulder joint are being increasingly undertaken. Defining residual, new, or acutely acquired pathology in the postoperative period is exceedingly difficult because of extensive surgical alterations. Since patients may be symptomatic or recurrently symptomatic postoperatively, judgments must be made regarding the failure of the initial repair, or new superimposed insults. CT double-contrast arthrography, performed in a series of symptomatic patients after shoulder arthroplasty for instability, successfully demonstrated responsible residual or recurrent pathologic processes, including persistent Bankart lesions, glenoid rim fractures, improper hardware placement, and migration of metallic hardware. These and other examples of pathology are illustrated and discussed

Relationship Between Hand Contact Angle and Shoulder Loading During Manual Wheelchair Propulsion by Individuals with Paraplegia.

Science.gov (United States)

Requejo, Philip Santos; Mulroy, Sara J; Ruparel, Puja; Hatchett, Patricia E; Haubert, Lisa Lighthall; Eberly, Valerie J; Gronley, JoAnne K

2015-01-01

Shoulder loading during manual wheelchair propulsion (WCP) contributes to the development of shoulder pain in individuals with spinal cord injury (SCI). To use regression analysis to investigate the relationships between the hand contact angle (location of the hand on the pushrim at initial contact and release during the push phase of the WCP cycle) with propulsion characteristics, pushrim forces, and shoulder kinetics during WCP in individuals with paraplegia. Biomechanical data were collected from 222 individuals (198 men and 24 women) with paraplegia from SCI during WCP on a stationary ergometer at a self-selected speed. The average age of participants was 34.7 years (±9.3), mean time since SCI was 9.3 years (±6.1), and average body weight was 74.4 kg (±15.9). The majority (n = 127; 56%) of participants had lower level paraplegia (T8 to L5) and 95 (42%) had high paraplegia (T2 to T7). Increased push arc (mean = 75.3°) was associated with greater velocity (R = 0.384, P contact angle and hand release angles were equally associated with cycle distance and cadence, whereas a more anterior release angle was associated with greater velocity (R = 0.372, P contact angle was associated with greater posterior shoulder net joint force (R = 0.229, P = .001) and greater flexor net joint moment (R = 0.204, P = .002), whereas a more anterior hand release angle was significantly associated with increased vertical (R = 0.270, P contact and hand release must be considered in WCP training. It is recommended that participants should reach back to initiate contact with the pushrim to maximize push arc but avoid a more anterior hand position at release, because this could increase shoulder load during the push phase of WCP.

A 5-year Evaluation and Results of Treatment of Chronic Llocked Dislocations of the Shoulder Joint

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Syawash Mirsaid Ghazi

2008-11-01

Full Text Available Background:Chronic neglected dislocation of the shoulder joint can be defined as a neglected dislocation for more than a 3 week period.However, it has been shown that the negligence could range from a 24 hour period to 6 months1. Depending on age,signs, symptoms,etiology and types of dislocation, conservative treatment or surgical intervention could be considered.Methods: In this study, 16 patients (13 were male and 3 were female were treated with chronic shoulder dislocations, 3 of which had bilateral dislocations. The age of this group ranged from 13-65 years with a mean age of 34 years. These patients were treated by closed or open reduction, either anterior, posterior or both approaches. Of 19 dislocations, 6 were anterior unilateral, 7 posterior unilateral, 1 anterior bilateral and 2 posterior bilateral dislocations. The mean period between dislocations and treatments was 3 months (from 4 weeks to 11 months,And the mean follow up period was 40 months (from 21 months to 5 years.Results: This study has shown that treatment varies according to pathology. In  this study the mean size of head defects was 35% and the extent of severity determined the approach. Findings at the last follow up were assessed according to Rowe and Zarins score and of the 19 shoulders assessed, 9 showed good and 10 showed excellent results. There was no recurrence of the dislocation in any patient.Conclusion:In some selected instances, open reduction of a chronic locked neglected shoulder dislocation of a 6 months period or more in young patients is recommended.This method is, however, contraindicated in elderly patients; in such cases a shoulder prosthesis is indicated.  

Using simulation training to improve shoulder dystocia documentation.

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Goffman, Dena; Heo, Hye; Chazotte, Cynthia; Merkatz, Irwin R; Bernstein, Peter S

2008-12-01

To estimate whether shoulder dystocia documentation could be improved with a simulation-based educational experience. Obstetricians at our institution (n=71) participated in an unanticipated simulated shoulder dystocia followed by an educational debriefing session. A second shoulder dystocia simulation was completed at a later date. Delivery notes were a required component of each simulation. Notes were evaluated using a standardized checklist for 16 key components. One point was awarded for each element present. Wilcoxon signed rank tests were used to compare documentation between simulations. Participants consisted of 43 (61%) attending and 28 (39%) resident physicians. Ages ranged from 25-63 years (mean+/-standard deviation 37.0+/-9.0), and 75% were female. Years of obstetric experience for our attendings ranged from 4 to 31 years (14.5+/-8.1). Documentation scores were significantly improved after training. Attendings' baseline documentation scores were 8.5+/-2.2 and improved to 9.4+/-2.3, P=.03. Residents' documentation scores also improved (9.0+/-2.1 compared with 10.6+/-2.2, P=.001). In particular, improvement was seen in two components of documentation: 1) providers present for shoulder dystocia (P=.007) and 2) which shoulder was anterior (P<.001). No improvement was seen in standard delivery note components (eg, date, time) or infant characteristics (eg, weight, Apgar scores). Although we showed a significant improvement in the quality of documentation through this simulation program, notes were still suboptimal. Use of standardized forms for shoulder dystocia delivery notes may provide the best solution to ensure appropriate documentation. II.

The anterior glenohumeral joint capsule: macroscopic and MRI anatomy of the fasciculus obliquus or so-called ligamentum glenohumerale spirale

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Merila, M.; Eller, A.; Haviko, T. [Department of Orthopaedics, Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu (Estonia); Leibecke, T.; Gehl, H.B. [Institute of Diagnostic Radiology, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck (Germany); Busch, L.C. [Institute of Anatomy, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck (Germany); Russlies, M. [Clinic of Orthopaedics, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck (Germany); Kolts, I. [Institute of Anatomy, University of Tartu, Ravila 19, Biomedicum, 50411, Tartu (Estonia)

2004-08-01

The purpose of this study was to demonstrate the macroscopic and MRI anatomy of the fasciculus obliquus, otherwise known as the ligamentum glenohumerale spirale or spiral GHL of the anterior shoulder joint capsule. Conventional and MR arthrography (1.5-T device Somatom Symphony, Siemens with shoulder coil) images in standard planes were compared with gross anatomic dissection findings in six fresh shoulder specimens from three cadavers. The MR imaging protocol included T1, PD and DESS 3D WI sequences. The macroscopically recognisable band - the spiral GHL - was identified by anatomic dissection and MRI in all the specimens. It was best visualised by MR arthrography on axial and oblique sagittal planes (T1; PD WI) and appeared as a low signal intensity stripe within the superficial layer of the anterior joint capsule. The absence of the variable middle glenohumeral ligament did not influence the anatomic properties and the MR imaging of the spiral GHL. Diagnostic visualisation of the normal anatomic structures is a prerequisite to distinguish between normal and pathologic conditions. Anatomy of the spiral GHL can be used by radiologists for more detailed interpretation of the anterior shoulder joint capsule ligaments on MR images. (orig.)

Effect of power-assisted hand-rim wheelchair propulsion on shoulder load in experienced wheelchair users: A pilot study with an instrumented wheelchair.

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Kloosterman, Marieke G M; Buurke, Jaap H; de Vries, Wiebe; Van der Woude, Lucas H V; Rietman, Johan S

2015-10-01

This study aims to compare hand-rim and power-assisted hand-rim propulsion on potential risk factors for shoulder overuse injuries: intensity and repetition of shoulder loading and force generation in the extremes of shoulder motion. Eleven experienced hand-rim wheelchair users propelled an instrumented wheelchair on a treadmill while upper-extremity kinematic, kinetic and surface electromyographical data was collected during propulsion with and without power-assist. As a result during power-assisted propulsion the peak resultant force exerted at the hand-rim decreased and was performed with significantly less abduction and internal rotation at the shoulder. At shoulder level the anterior directed force and internal rotation and flexion moments decreased significantly. In addition, posterior and the minimal inferior directed forces and the external rotation moment significantly increased. The stroke angle decreased significantly, as did maximum shoulder flexion, extension, abduction and internal rotation. Stroke-frequency significantly increased. Muscle activation in the anterior deltoid and pectoralis major also decreased significantly. In conclusion, compared to hand-rim propulsion power-assisted propulsion seems effective in reducing potential risk factors of overuse injuries with the highest gain on decreased range of motion of the shoulder joint, lower peak propulsion force on the rim and reduced muscle activity. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

A retrospective, descriptive study of shoulder outcomes in outpatient physical therapy.

Science.gov (United States)

Millar, A Lynn; Lasheway, Philip A; Eaton, Wendy; Christensen, Frances

2006-06-01

A retrospective, descriptive study of clients with shoulder dysfunction referred to physical therapy. To (1) describe the clinical and functional outcomes of clients with shoulder dysfunction following outpatient physical therapy, and (2) to compare the outcomes by type of shoulder dysfunction. Although individuals with shoulder dysfunction are commonly referred to physical therapy few large descriptive studies regarding outcomes following physical therapy are available. Data for 878 clients (468 female, 410 male) were retrieved and analyzed. This database was developed between 1997 and 2000 and included 4 outpatient facilities from 1 healthcare system in the southwest corner of Michigan. Clients were classified by type of shoulder dysfunction, and standardized tests were performed upon admittance and discharge to physical therapy. Descriptive and inferential statistics were calculated for all data. Of all clients, 55.1% had shoulder impingement, while 18.3% had postoperative repair, 8.9% had a frozen shoulder, 7.6% had a rotator cuff tear, 3.0% had shoulder instability, 2.1% were post fracture, and the remaining 4.9% had miscellaneous diagnoses. The average (+/-SD) age of the patients was 53.6 +/- 16.4 years, with an average (+/-SD) number of treatment sessions of 13.7 +/- 11.0. All groups showed significant changes following physical therapy intervention. Clients with diverse types of shoulder dysfunction demonstrated improvement in both clinical and functional measures at the conclusion of physical therapy, although it is not possible to determine whether these changes were due to the interventions or due to time. The type of shoulder dysfunction appears to affect the prognosis, thus expected outcomes should be based upon initial diagnosis and specific measures.

Multidetector spiral CT arthrography of the shoulder

Energy Technology Data Exchange (ETDEWEB)

Lecouvet, Frederic E. [Departments of Radiology and Orthopaedic Surgery, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Hippocrate Avenue 10/2942, 1200 Brussels (Belgium)], E-mail: frederic.lecouvet@uclouvain.be; Simoni, Paolo; Koutaissoff, Sophie; Vande Berg, Bruno C.; Malghem, Jacques; Dubuc, Jean-Emile [Departments of Radiology and Orthopaedic Surgery, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Hippocrate Avenue 10/2942, 1200 Brussels (Belgium)

2008-10-15

Although MR imaging and MR arthrography are the first choice modalities for shoulder imaging, CT arthrography (CTA) may be used successfully to address many clinical questions. The advent of submillimeter multiple detector CT technology and subsequent excellent three-plane resolution has considerably increased the quality of CTA examinations and has propelled this technique to the forefront in a growing number of indications. The combined use of iodinated contrast material for fluoroscopic confirmation of the articular position of the needle before injection of gadolinium chelates for MR arthrography offers the unique opportunity to compare CTA and MRA findings in carefully selected cases. This paper illustrates capabilities and limits of CTA for the study of rotator cuff tears, shoulder instability, cartilage lesions, anatomical variants and abnormalities of the glenoid labrum, with correlations to MR arthrography and surgical findings.

Multidetector spiral CT arthrography of the shoulder

International Nuclear Information System (INIS)

Lecouvet, Frederic E.; Simoni, Paolo; Koutaissoff, Sophie; Vande Berg, Bruno C.; Malghem, Jacques; Dubuc, Jean-Emile

2008-01-01

Although MR imaging and MR arthrography are the first choice modalities for shoulder imaging, CT arthrography (CTA) may be used successfully to address many clinical questions. The advent of submillimeter multiple detector CT technology and subsequent excellent three-plane resolution has considerably increased the quality of CTA examinations and has propelled this technique to the forefront in a growing number of indications. The combined use of iodinated contrast material for fluoroscopic confirmation of the articular position of the needle before injection of gadolinium chelates for MR arthrography offers the unique opportunity to compare CTA and MRA findings in carefully selected cases. This paper illustrates capabilities and limits of CTA for the study of rotator cuff tears, shoulder instability, cartilage lesions, anatomical variants and abnormalities of the glenoid labrum, with correlations to MR arthrography and surgical findings

Elbow joint instability

DEFF Research Database (Denmark)

Olsen, Bo Sanderhoff; Henriksen, M G; Søjbjerg, Jens Ole

1994-01-01

The effect of simultaneous ulnar and radial collateral ligament division on the kinematics of the elbow joint is studied in a cadaveric model. Severance of the anterior part of the ulnar collateral ligament and the annular ligament led to significant elbow joint instability in valgus and varus...

Scapulohumeral rhythm in shoulders with reverse shoulder arthroplasty.

Science.gov (United States)

Walker, David; Matsuki, Keisuke; Struk, Aimee M; Wright, Thomas W; Banks, Scott A

2015-07-01

Little is known about kinematic function of reverse total shoulder arthroplasty (RTSA). Scapulohumeral rhythm (SHR) is a common metric for assessing muscle function and shoulder joint motion. The purpose of this study was to compare SHR in shoulders with RTSA to normal shoulders. Twenty-eight subjects, more than 12 months after unilateral RTSA, were recruited for an Institutional Review Board-approved study. Subjects performed arm abduction in the coronal plane with and without a 1.4-kg hand-held weight. Three-dimensional model-image registration techniques were used to measure orientation and position for the humerus and scapula from fluoroscopic images. Analysis of variance and Tukey tests were used to assess groupwise and pairwise differences. SHR in RTSA shoulders (1.3:1) was significantly lower than in normal shoulders (3:1). Below 30° abduction, RTSA and normal shoulders show a wide range of SHR (1.3:1 to 17:1). Above 30° abduction, SHR in RTSA shoulders was 1.3:1 for unweighted abduction and 1.3:1 for weighted abduction. Maximum RTSA shoulder abduction in weighted trials was lower than in unweighted trials. SHR variability in RTSA shoulders decreased with increasing arm elevation. RTSA shoulders show kinematics that are significantly different from normal shoulders. SHR in RTSA shoulders was significantly lower than in normal shoulders, indicating that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm. With these observations, it may be possible to improve rehabilitation protocols, with particular attention to the periscapular muscles, and implant design or placement to optimize functional outcomes in shoulders with RTSA. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Does a SLAP lesion affect shoulder muscle recruitment as measured by EMG activity during a rugby tackle?

Directory of Open Access Journals (Sweden)

Herrington Lee C

2010-02-01

Full Text Available Abstract Background The study objective was to assess the influence of a SLAP lesion on onset of EMG activity in shoulder muscles during a front on rugby football tackle within professional rugby players. Methods Mixed cross-sectional study evaluating between and within group differences in EMG onset times. Testing was carried out within the physiotherapy department of a university sports medicine clinic. The test group consisted of 7 players with clinically diagnosed SLAP lesions, later verified on arthroscopy. The reference group consisted of 15 uninjured and full time professional rugby players from within the same playing squad. Controlled tackles were performed against a tackle dummy. Onset of EMG activity was assessed from surface EMG of Pectorialis Major, Biceps Brachii, Latissimus Dorsi, Serratus Anterior and Infraspinatus muscles relative to time of impact. Analysis of differences in activation timing between muscles and limbs (injured versus non-injured side and non injured side versus matched reference group. Results Serratus Anterior was activated prior to all other muscles in all (P = 0.001-0.03 subjects. In the SLAP injured shoulder Biceps was activated later than in the non-injured side. Onset times of all muscles of the non-injured shoulder in the injured player were consistently earlier compared with the reference group. Whereas, within the injured shoulder, all muscle activation timings were later than in the reference group. Conclusions This study shows that in shoulders with a SLAP lesion there is a trend towards delay in activation time of Biceps and other muscles with the exception of an associated earlier onset of activation of Serratus anterior, possibly due to a coping strategy to protect glenohumeral stability and thoraco-scapular stability. This trend was not statistically significant in all cases

Does a SLAP lesion affect shoulder muscle recruitment as measured by EMG activity during a rugby tackle?

Science.gov (United States)

Horsley, Ian G; Herrington, Lee C; Rolf, Christer

2010-02-25

The study objective was to assess the influence of a SLAP lesion on onset of EMG activity in shoulder muscles during a front on rugby football tackle within professional rugby players. Mixed cross-sectional study evaluating between and within group differences in EMG onset times. Testing was carried out within the physiotherapy department of a university sports medicine clinic. The test group consisted of 7 players with clinically diagnosed SLAP lesions, later verified on arthroscopy. The reference group consisted of 15 uninjured and full time professional rugby players from within the same playing squad. Controlled tackles were performed against a tackle dummy. Onset of EMG activity was assessed from surface EMG of Pectorialis Major, Biceps Brachii, Latissimus Dorsi, Serratus Anterior and Infraspinatus muscles relative to time of impact. Analysis of differences in activation timing between muscles and limbs (injured versus non-injured side and non injured side versus matched reference group). Serratus Anterior was activated prior to all other muscles in all (P = 0.001-0.03) subjects. In the SLAP injured shoulder Biceps was activated later than in the non-injured side. Onset times of all muscles of the non-injured shoulder in the injured player were consistently earlier compared with the reference group. Whereas, within the injured shoulder, all muscle activation timings were later than in the reference group. This study shows that in shoulders with a SLAP lesion there is a trend towards delay in activation time of Biceps and other muscles with the exception of an associated earlier onset of activation of Serratus anterior, possibly due to a coping strategy to protect glenohumeral stability and thoraco-scapular stability. This trend was not statistically significant in all cases.

Arthroscopic treatment of secondary rotator cuff damage after shoulder hemiarthroplasty (case report

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S. Y. Dokolin

2015-01-01

Full Text Available Anatomical shoulder arthroplasty is an effective treatment for patients with primary deforming arthritis, rheumatoid arthritis and aseptic necrosis of the humeral head. However this kind of surgery is associated with high risk of complications, and within five-year follow-up the incidence of complications increases. The authors described a clinical case illustrating one of these complications - secondary rotator cuff damage after shoulder hemiarthroplasty. The tear was verified using radiological methods and arthroscopy. They performed arthroscopic rotator cuff repair using suture anchors in order to alleviate pain and preserve shoulder functions. If there are no signs of endoprosthetic instability and coracoacromial ligament is preserved, arthroscopic treatment of such damages extends the time of limb function preserving the endoprosthesis. Patients should not raise their arms above the horizontal level.

The effect of maneuvers for shoulder delivery on perineal trauma

DEFF Research Database (Denmark)

Aabakke, Anna J M; Willert, Hanne; Krebs, Lone

2016-01-01

-treated analysis. RESULTS: Between June 2013 and March 2015, 650 women were randomized, and 543 (posterior, n = 281; anterior, n = 262) were included in the final intention-to-treat analysis. Most group characteristics were similar. The frequency of any perineal trauma did not differ between the two groups......: This was a randomized single-blinded trial comparing primary delivery of either the anterior or posterior shoulder in women having their first vaginal delivery. Primary outcome was any perineal trauma. Results were analyzed according to the intention-to-treat principle and supplemented with a per-protocol and as...

Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial.

Science.gov (United States)

Schrøder, Cecilie Piene; Skare, Øystein; Reikerås, Olav; Mowinckel, Petter; Brox, Jens Ivar

2017-12-01

Labral repair and biceps tenodesis are routine operations for superior labrum anterior posterior (SLAP) lesion of the shoulder, but evidence of their efficacy is lacking. We evaluated the effect of labral repair, biceps tenodesis and sham surgery on SLAP lesions. A double-blind, sham-controlled trial was conducted with 118 surgical candidates (mean age 40 years), with patient history, clinical symptoms and MRI arthrography indicating an isolated type II SLAP lesion. Patients were randomly assigned to either labral repair (n=40), biceps tenodesis (n=39) or sham surgery (n=39) if arthroscopy revealed an isolated SLAP II lesion. Primary outcomes at 6 and 24 months were clinical Rowe score ranging from 0 to 100 (best possible) and Western Ontario Shoulder Instability Index (WOSI) ranging from 0 (best possible) to 2100. Secondary outcomes were Oxford Instability Shoulder Score, change in main symptoms, EuroQol (EQ-5D and EQ-VAS), patient satisfaction and complications. There were no significant between-group differences at any follow-up in any outcome. Between-group differences in Rowe scores at 2 years were: biceps tenodesis versus labral repair: 1.0 (95% CI -5.4 to 7.4), p=0.76; biceps tenodesis versus sham surgery: 1.6 (95% CI -5.0 to 8.1), p=0.64; and labral repair versus sham surgery: 0.6 (95% CI -5.9 to 7.0), p=0.86. Similar results-no differences between groups-were found for WOSI scores. Postoperative stiffness occurred in five patients after labral repair and in four patients after tenodesis. Neither labral repair nor biceps tenodesis had any significant clinical benefit over sham surgery for patients with SLAP II lesions in the population studied. ClinicalTrials.gov identifier: NCT00586742. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Diagnostic imaging of shoulder impingement

International Nuclear Information System (INIS)

Merl, T.; Weinhardt, H.; Oettl, G.; Lenz, M.; Riel, K.A.

1996-01-01

Magnetic resonance imaging is a method that has been advancing in the last few years to the modality of choice for diagnostic evaluation of the bone joints, as the method is capable of imaging not only the ossous but also the soft tissue components of the joint. MRI likewise has become an accepted method for diagnostic evaluation of syndromes of the shoulder, with high diagnostic accuracy in detecting rotator cuff lesions, or as an efficient MRI arthrography for evaluation of the instability or lesions of the labrocapsular complex. In the evaluation of early stages of shoulder impingement, the conventional MRI technique as a static technique yields indirect signs which in many cases do not provide the diagnostic certainty required in order to do justice to the functional nature of the syndrome. In these cases, functional MRI for imaging of the arm in abducted position and in rotational movement may offer a chance to early detect impingement and thus identify patients who will profit from treatment at an early stage [de

Integrity of the subscapularis tendon after open surgery for the treatment of anterior shoulder instability: a clinical and radiological evaluation

OpenAIRE

Lech, Osvandré; Piluski, Paulo; Tambani, Renato; Castro, Nero; Pimentel, Gilnei

2009-01-01

OBJETIVO: Avaliar a integridade do músculo subescapular através da força, função e ressonância nuclear magnética após acesso deltopeitoral para tratamento da luxação glenoumeral anterior recidivante. MÉTODOS: Foram avaliados 20 pacientes com luxação recidivante do ombro. Todos os casos possuíam seguimento mínimo de 12 meses, com média de 40 meses. Os pacientes eram todos do sexo masculino, com média de idade de 29 anos (20-42 anos). Os pacientes foram submetidos a exame físico para avaliar mo...

Primary degenerative joint disease of the shoulder in a colony of Beagles

International Nuclear Information System (INIS)

Morgan, J.P.; Pool, R.R.; Miyabayashi, T.

1987-01-01

Shoulder joints of 149 Beagles over 8 years old at the time of death (mean age, 13.8 years +/- 3.21), were examined radiographically throughout their life-times for the frequency of degenerative joint disease (DJD). Clinical histories revealed no underlying cause for DJD. The shoulder joints of a subgroup of 18 dogs were examined at necropsy, and thin sections of the joints were evaluated radiographically and histologically. Serial clinical radiographic studies indicated that normal shoulder joint development during the first year of life was followed by the appearance of subchondral bone sclerosis and bony remodeling of normal joint contour, and by the formation of periarticular osteophytes and enthesiophytes. All changes were progressive with age and typical for DJD in dogs. Bilateral involvement was common. Evaluation of specimens obtained at necropsy revealed: articular cartilage change with roughening of the surface layer, degeneration and death of superficial chondrocytes, exposure of deeper layers of chondrocytes that had proliferated with fissuring of the damaged cartilage, total cartilage loss with polishing of the exposed subchondral bone, mixed patterns of subchondral bone sclerosis and osteoporosis, change in contour of the articular surfaces, and formation of periarticular osteophytes and enthesiophytes. Joint capsule thickening, synovitis, pannus formation, and synovial chondroma formation were observed. Because of the available clinical information, in addition to the typical changes of DJD, it was thought that the changes were primary. Instability appeared to play a role in the pathogenesis of the joint disease described; however, it was not clear whether the instability caused abnormal forces on healthy cartilage or whether the primary cartilage wear caused the instability

Shoulder injuries in professional rugby: a retrospective analysis.

Science.gov (United States)

Horsley, Ian G; Fowler, Elizabeth M; Rolf, Christer G

2013-04-26

In the literature, little is known about the level and pattern of rugby injuries. Of the shoulder injuries reported, 51% of these are caused during a tackle, and 65% of all match injuries affected the shoulder. The study aims to describe a sport-specific unique intra-articular shoulder pathology of professional rugby players, who presented with persistent pain and dysfunction despite physiotherapeutic treatment and rest. This study is a retrospective analysis set at a university sports medicine clinic. Eighty-seven professional rugby players, referred by their professional medical team since they could no longer play, underwent shoulder arthroscopy between June 2001 and October 2007 due to persistent shoulder pain and dysfunction. All were full-time professional male rugby union and rugby league players. They all had failed conservative treatment for their complaint, and the diagnosis was unclear. Arthroscopic findings were used as a measure of main outcome. The primary mechanism of injury was reported as direct tackling (56%; n = 49) followed in succession by falling onto the arm (10%; n = 8). However, in 30% of the cases, no definite injury could be recalled. The main operative finding was that most patients exhibited multiple shoulder pathologies, with 75% of cases presenting with two or more pathologies. A superior labrum anterior to posterior (SLAP) lesion was evident at arthroscopy in 72 of the 87 cases (83%), while rotator cuff tears were evident in 43% of cases (n = 37). One-third of all cases had a Bankart tear (n = 29), despite none of them reporting previous dislocations, while other labral tears, excluding SLAP tears, to the inferior or posterior labrum were present in 34% (n = 30) of the cohort. Repeated tackling, which is clearly rugby specific, is most likely to be responsible for most of these shoulder injuries, which upon arthroscopic examination, showed signs of mixed pathology. We suggest that an early arthroscopic investigation is valuable in

Comparison of hand grip strength and upper limb pressure pain threshold between older adults with or without non-specific shoulder pain

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Cesar Calvo Lobo

2017-02-01

Full Text Available Background There is a high prevalence of non-specific shoulder pain associated with upper limb functional limitations in older adults. The purpose of this study was to determine the minimal clinically important differences (MCID of grip strength and pressure pain threshold (PPT in the upper limb between older adults with or without non-specific shoulder pain. Methods A case-control study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE criteria. A sample of 132 shoulders (mean ± SD years with (n = 66; 76.04 ± 7.58 and without (n = 66; 75.05 ± 6.26 non-specific pain were recruited. The grip strength and PPT of the anterior deltoid and extensor carpi radialis brevis (ECRB muscles were assessed. Results There were statistically significant differences (mean ± SD; P-value for anterior deltoid PPT (2.51 ± 0.69 vs 3.68 ± 0.65, kg/cm2; P < .001, ECRB PPT (2.20 ± 0.60 vs 3.35 ± 0.38 kg/cm2; P < .001 and grip strength (20.78 ± 10.94 vs 24.63 ± 9.38 kg; P = .032 between shoulders with and without non-specific pain, respectively. Discussion The MCID of 1.17 kg/cm2, 1.15 kg/cm2 and 3.84 kg were proposed for anterior deltoid PPT, ECRB PPT and grip strength, respectively, to assess the upper limb of older adults with non-specific shoulder pain after treatment. In addition, univariate and multivariate (linear regression and regression trees analyses may be used to consider age distribution, sex, pain intensity, grip strength and PPT in older adults including clinical and epidemiological studies with non-specific shoulder pain.

Shoulder replacement - discharge

Science.gov (United States)

Total shoulder arthroplasty - discharge; Endoprosthetic shoulder replacement - discharge; Partial shoulder replacement - discharge; Partial shoulder arthroplasty - discharge; Replacement - shoulder - discharge; Arthroplasty - shoulder - discharge

Anterior internal impingement of the shoulder in rugby players and other overhead athletes

Directory of Open Access Journals (Sweden)

Siddharth R. Shah, MBBS, MSc Sports Medicine (UK, MRCS-Ed

2017-04-01

Conclusion: This series of anterior internal impingement, which we believe is the largest in the literature to date, demonstrates the value of an to assess and successfully treat overhead athletes with anterior impingement syndrome.

Arthroscopic Suture Anchor Fixation of Bony Bankart Lesions: Clinical Outcome, Magnetic Resonance Imaging Results, and Return to Sports.

Science.gov (United States)

Plath, Johannes E; Feucht, Matthias J; Bangoj, Robert; Martetschläger, Frank; Wörtler, Klaus; Seppel, Gernot; Aboalata, Mohamed; Tischer, Thomas; Imhoff, Andreas B; Vogt, Stephan

2015-08-01

The purpose of this study was to evaluate the outcome, return to sporting activity, and postoperative articular cartilage and bony morphology of shoulders that underwent arthroscopic suture anchor repair of bony Bankart lesions. The inclusion criteria for this retrospective study were anterior glenoid rim fractures after traumatic shoulder instability that were treated with arthroscopic suture anchor repair. Patients were surveyed by a questionnaire including sport-specific outcome, Rowe score, Western Ontario Shoulder Instability Index, and Oxford Instability Score. Three-tesla magnetic resonance imaging could be performed in 30 patients to assess osseous integration, glenoid reconstruction, and signs of osteoarthritis. From November 1999 to April 2010, 81 patients underwent an anterior bony Bankart repair in our department (50 arthroscopic suture anchor repairs, 5 arthroscopic screw fixations, and 26 open repairs). The 55 arthroscopic repairs comprised a consecutive cohort of patients treated by a single surgeon. Of the 50 patients in the suture anchor group, 45 (90%) were available for evaluation. At 82 ± 31 months postoperatively, the mean Rowe score was 85.9 ± 20.5 points, the mean Western Ontario Shoulder Instability Index score was 89.4% ± 14.7%, and the mean Oxford Instability Score was 13.6 ± 5.4 points. Compared with the contralateral shoulder, all scores showed a significantly reduced outcome (P sporting activity after surgery. The number of sports disciplines (P < .001), duration (P = .005), level (P = .02), and risk category (P = .013) showed a significant reduction compared with the pretrauma condition. However, only 19% of patients reported that shoulder complaints were the reason for the reduction in activity. Nonunion occurred in 16.6%, with a higher frequency in patients with chronic lesions (P = .031). Anatomic reduction was achieved in 72%, the medial step-off in patients with nonanatomic reduction averaged 1.8 ± 0.9 mm, and the

Shoulder pain

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... exercises Rotator cuff - self-care Shoulder replacement - discharge Shoulder surgery - discharge Using your shoulder after replacement surgery Using your shoulder after surgery Images Impingement syndrome Rotator cuff muscles Heart attack ...

Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion.

Science.gov (United States)

Lee, Kwang Won; Kim, Yong In; Kim, Ha Yong; Yang, Dae Suk; Lee, Gyu Sang; Choy, Won Sik

2016-09-01

There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm.

Surgical treatment of chest instability

International Nuclear Information System (INIS)

Kitka, M.; Masek, M.

2015-01-01

Fractures of the ribs is the most common thoracic injury after blunt trauma. Chest wall instability (flail chest) is a common occurrence in the presence of multiple ribs fracture. Unilateral or bilateral fractures more ribs anteriorly or posteriorly will produce enough instability that paradoxical respiratory motion results in hypoventilation of an unacceptable degree. Open approach and surgical stabilisation of the chest preserved pulmonary function, improved pain control, minimized posttraumatic deformities and shorter back to work time. (author)

Functional Results of Unstable (Type 2 Distal Clavicle Fractures Treated with Superior Anterior Locking Plate

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Rajesh Govindasamy

2017-11-01

Full Text Available Background: The treatment of distal clavicle fracture is always a challenge, as it is mostly unstable and has higherrate of delayed union, malunion, non-union and associated acromioclavicular arthritis. So the management of thesefractures remains controversial. The purpose of this study is to evaluate the functional results of Type 2 distal endclavicle fractures treated with superior anterior locking plate.Methods: From June 2011 to August 2015 a retrospective study of12 male patients (mean age of 41.3 years 11 withunilateral and 1 with bilateral distal clavicle fractures treated with superior anterior locking plate was done. They wereevaluated at regular intervals with mean follow up of 14 months(12-18 months.Those with minimum one year followup were included in our study. All were evaluated for the functioning of the shoulder joint by both Oxford shoulder scoreand Quick DASH scores, rate of bone union, complications and earliest time for return to work.Results: All fractures union seen within 6-8 weeks (mean time: 7.1 weeks.All had good shoulder range of motion. Theaverage oxford shoulder and Quick DASH score were 46.2 and 6.5.There were no major complications in our studyviz. non-union, plate failure, secondary fracture. But one patient had superficial wound infection. All patients returned towork within 3 months of postoperative period.Conclusion: Displaced distal clavicle fractures treated with superior anterior locking plates achieved excellent resultsin terms of bony union with rarely any complications and demonstrate promising results with this novel technique.

Frozen shoulder

Science.gov (United States)

... your hormones, such as during menopause Shoulder injury Shoulder surgery Open heart surgery Cervical disk disease of the ... Instructions Rotator cuff exercises Rotator cuff - self-care Shoulder surgery - discharge Images Shoulder joint inflammation References Finnoff JT. ...

All-in-One Magnetic Resonance Arthrography of the Shoulder in a Vertically Open Magnetic Resonance Unit

Energy Technology Data Exchange (ETDEWEB)

Vandevenne, J.E.; Vanhoenacker, F.; Beaulieu, C.F.; Bergman, A.; Butts Pauly, K.; Dillingham, M.F.; Lang, P.K. (Dept. of Radiology, Univ. Hospital Antwerp, Edegem-Antwerp (Belgium))

2008-10-15

Background: Magnetic resonance (MR) arthrography frequently involves joint injection under imaging guidance followed by MR imaging in static positions. Purpose: To evaluate if MR arthrography of the shoulder joint can be performed in a comprehensive fashion combining the MR-guided injection procedure, static MR imaging, and dynamic motion MR imaging in a single test. Material and Methods: Twenty-three shoulder joints were injected with Gd-DTPA2- under MR guidance. Static MR imaging was performed and included a three-point Dixon method to achieve water-selective images. Dynamic motion MR imaging with and without applying pressure to the upper arm was used to evaluate glenohumeral joint instability. In 10 cases, surgical correlation was available. Results: The all-in-one MR arthrography technique was successful in all patients, and took an average time of 65 min. All but one glenohumeral injection procedure were performed with a single needle pass, and no complications were observed. Out of eight labrum tears seen with static MR imaging, seven were confirmed at surgery. In 10 cases, dynamic motion MR imaging correlated well with the surgeon's intraoperative evaluation for presence and direction of instability. Conclusion: MR arthrography of the shoulder joint using a vertically open magnet can be performed as a single comprehensive test, including the injection and the static and dynamic motion MR imaging. Good diagnostic accuracy for intraarticular lesions and glenohumeral instability was found in a small sample.

CLINICAL OUTCOME AFTER OPERATIVE TREATMENT IN FLOATING SHOULDER- A PROSPECTIVE STUDY

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Nabarun Saha

2017-06-01

Full Text Available BACKGROUND The ‘floating shoulder’ is a rare injury consisting of ipsilateral fractures of the clavicle and glenoid neck. Although it may appear to be bony injury, studies suggest that ligamentous disruption associated with ipsilateral clavicle fracture and scapular neck fracture contributes to such entity. More commonly floating shoulder is defined as double disruption of the superior shoulder suspensory complex. Open reduction and internal fixation of both the fractures is the treatment of choice. We have made this study to assess clinical outcome after operative treatment of floating shoulder by DASH score. MATERIALS AND METHODS This is a study of 10 cases of floating shoulder injury operated in the same sitting by anterior approach for fracture clavicle and Judet’s posterior approach for scapula fracture from Jan 2014 to Oct 2016. All cases were assessed with DASH score at the end of six months. RESULTS Results of our study shows that majority of patients had excellent to good results with improvement in DASH score from 92.8 to 16.8 at final follow up. No major complications. All patients had radiological signs of union at the end of 1 year. CONCLUSION Surgical intervention should be considered for all floating shoulder injuries. open reduction and internal fixation not only increases stability but also to improves functional outcome of the patient. DASH score is an effective method to assess clinicofunctional outcome in post-operative cases of floating shoulder.

Spondylolisthesis and Posterior Instability

International Nuclear Information System (INIS)

Niggemann, P.; Beyer, H.K.; Frey, H.; Grosskurth, D.; Simons, P.; Kuchta, J.

2009-01-01

We present the case of a patient with a spondylolisthesis of L5 on S1 due to spondylolysis at the level L5/S1. The vertebral slip was fixed and no anterior instability was found. Using functional magnetic resonance imaging (MRI) in an upright MRI scanner, posterior instability at the level of the spondylolytic defect of L5 was demonstrated. A structure, probably the hypertrophic ligament flava, arising from the spondylolytic defect was displaced toward the L5 nerve root, and a bilateral contact of the displaced structure with the L5 nerve root was shown in extension of the spine. To our knowledge, this is the first case described of posterior instability in patients with spondylolisthesis. The clinical implications of posterior instability are unknown; however, it is thought that this disorder is common and that it can only be diagnosed using upright MRI

Spondylolisthesis and Posterior Instability

Energy Technology Data Exchange (ETDEWEB)

Niggemann, P.; Beyer, H.K.; Frey, H.; Grosskurth, D. (Privatpraxis fuer Upright MRT, Koeln (Germany)); Simons, P.; Kuchta, J. (Media Park Klinik, Koeln (Germany))

2009-04-15

We present the case of a patient with a spondylolisthesis of L5 on S1 due to spondylolysis at the level L5/S1. The vertebral slip was fixed and no anterior instability was found. Using functional magnetic resonance imaging (MRI) in an upright MRI scanner, posterior instability at the level of the spondylolytic defect of L5 was demonstrated. A structure, probably the hypertrophic ligament flava, arising from the spondylolytic defect was displaced toward the L5 nerve root, and a bilateral contact of the displaced structure with the L5 nerve root was shown in extension of the spine. To our knowledge, this is the first case described of posterior instability in patients with spondylolisthesis. The clinical implications of posterior instability are unknown; however, it is thought that this disorder is common and that it can only be diagnosed using upright MRI.

The POLPSA lesion: MR imaging findings with arthroscopic correlation in patients with posterior instability

International Nuclear Information System (INIS)

Yu, Joseph S.; Ashman, Carol J.; Jones, Grant

2002-01-01

Objective. To evaluate the features of the posterior labrocapsular periosteal sleeve avulsion (POLPSA) lesion on MR imaging in athletes with posterior shoulder instability.Design and patients. Six male athletes (age range 19-43 years) with avulsion of the posterior glenoid periosteum were identified on MR imaging. There were four football players, one wrestler, and one competitive weightlifter. The weightlifter had a bilateral condition so that seven shoulders were evaluated. MR imaging was performed with a 1.5 T magnet utilizing conventional and fat-saturated fast spin-echo coronal oblique and sagittal oblique sequences and a 3D-GRE transaxial sequence. Surgical correlation was available in all shoulders.Results. All patients presented with pain and a joint effusion. The size of the periosteal sleeve and redundant joint recess was variable. Fibrous proliferation was noted arthroscopically in four shoulders beneath the sleeve. Although the posterior labrum was detached in all studies, only one labrum had a tear while two showed marked degeneration.Conclusion. The POLPSA lesion is an abnormality that can be associated with posterior instability. It differs from a reverse Bankart lesion because the periosteum, although detached, remains intact with the posterior capsule and detached posterior labrum. This lesion may represent an acute form of a Bennett lesion. (orig.)

Effect of scapular function training on chronic pain in the neck/shoulder region

DEFF Research Database (Denmark)

Andersen, Christoffer H; Andersen, Lars L; Zebis, Mette K

2014-01-01

avoiding direct training of the painful area. Our study investigates the effect of the latter approach. The purpose of this study was in a randomised controlled trial to investigate if intensive scapular function training (SFT)-in terms of training of the lower trapezius and the serratus anterior muscle...... while minimizing direct training of the upper trapezius-is effective in reducing pain in adults with chronic non-specific pain in the neck/shoulder region. METHODS: 47 office workers with chronic non-specific pain in the neck/shoulder region were randomized to 10 weeks 3 × 20 min SFT with training......PURPOSE: Neck and shoulder complaints are common among employees in occupations characterized by intensive computer use. Treatment has varied from passive rest to active treatments and active treatments have often been divided into either training of the painful area or the surrounding musculature...

Unusual inferior dislocation of shoulder: reduction by two-step maneuver: a case report

Directory of Open Access Journals (Sweden)

Patro Dilip K

2009-11-01

Full Text Available Abstract Dislocation of the shoulder is the commonest of all large joint dislocations. Inferior dislocation constitutes 0.5% of all shoulder dislocations. It characteristically presents with overhead abduction of the arm, the humerus being parallel to the spine of scapula. We present an unusual case of recurrent luxatio erecta in which the arm transformed later into an adducted position resembling the more common anterior shoulder dislocation. Such a case has not been described before in English literature. Closed reduction by the two-step maneuver was successful with a single attempt. MRI revealed posterior labral tear and a Hill-Sachs variant lesion on the superolateral aspect of humeral head. Immobilisation in a chest-arm bandage followed by physiotherapy yielded excellent results. The case is first of its kind; the unusual mechanism, unique radiological findings and alternate method of treatment are discussed.

Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment

Directory of Open Access Journals (Sweden)

Ioannis Polyzois

2016-04-01

Full Text Available Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (OA, the effects of delaying surgery and the optimal method of immobilisation. Extensive literature review was performed looking for previous publication addressing 4 points. i Natural history of primary shoulder dislocation ii Effect of surgical intervention on natural history iii Risk of long term osteoarthritis with and without surgical intervention iv Immobilisation techniques post reduction. Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces. Defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity.

Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery.

Science.gov (United States)

Yeranosian, Michael G; Arshi, Armin; Terrell, Rodney D; Wang, Jeffrey C; McAllister, David R; Petrigliano, Frank A

2014-02-01

An acute infection after arthroscopic shoulder surgery is a rare but serious complication. Previous studies estimating the incidence of infections after arthroscopic surgery have been conducted, but the majority of these had either relatively small study groups or were not specific to shoulder arthroscopic surgery. To investigate the incidence of acute infections after arthroscopic shoulder surgery and compare infection rates by age group, sex, geographic region, and specific procedures. Case series; Level of evidence, 4. A retrospective review of a large insurance company database was performed for all shoulder arthroscopic surgeries performed in the United States between 2004 and 2009 that required additional surgery for infections within 30 days. The data were stratified by sex, age group, and region. Data were also stratified for specific procedures (capsulorrhaphy, treatment for superior labrum anterior-posterior tears, claviculectomy, decompression, and rotator cuff repair) and used to assess the variation in the incidence of infections across different arthroscopic shoulder procedures. Linear regression was used to determine the significance of differences in the data from year to year. χ(2) analysis was used to assess the statistical significance of variations among all groups. Poisson regression analysis with exposure was used to determine significant differences in a pairwise comparison between 2 groups. The total number of arthroscopic shoulder surgeries performed was 165,820, and the number of infections requiring additional surgery was 450, resulting in an overall infection rate of 0.27%. The incidence of infections varied significantly across age groups (P shoulder procedures was 0.27%. The incidence was highest in elderly patients, in the South, and for rotator cuff repair. The incidence was lowest in young patients, in the Midwest, and for capsulorrhaphy. In general, shoulder arthroscopic surgery in this study population had a low rate of

[Neurobiological aspects of personality disorders and emotional instability].

Science.gov (United States)

Petrovic, Predrag

2016-12-06

Neurobiological aspects of personality disorders and emotional instability ADHD and mental disorders encompassing emotional instability such as emotionally unstable personality disorder and antisocial personality disorder can potentially be explained by a suboptimal regulation of information processing in the brain. ADHD involves suboptimal function of non-emotional attentional regulatory processes and emotional instability involves suboptimal emotional regulation. A network including prefrontal areas, anterior cingulate cortex, basal ganglia and specific neuromodulatory systems such as the dopamine system are dysfunctional in both ADHD and emotional instability. One might suggest that a dimensional view better describes these mental states than categorical diagnoses.

Bilateral agenesis of the anterior cruciate ligament: MRI evaluation

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Bedoya, Maria A.; Jaramillo, Diego [The Children' s Hospital of Philadelphia, Radiology Department, Philadelphia, PA (United States); McGraw, Michael H. [Hospitalof theUniversityof Pennsylvania, Divisionof Orthopaedics, Philadelphia, PA (United States); Wells, Lawrence [The Children' s Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA (United States)

2014-09-15

Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed. (orig.)

Usefulness of sono-guided needle puncture for MR arthrography of the shoulder

International Nuclear Information System (INIS)

Choi, Jae Woong; Hong, Suk Ju; Suh, San Il; Yong, Hwan Suk; Kim, Jung Hyuk; Park, Cheol Min; Suh, Won Hyuck; Kim, Myung Gyu

2000-01-01

To evaluate the usefulness of sono-guided needle puncture for MR arthrography of the shoulder to locate the path of access and to control the correct placement of the needle into the shoulder. Fifteen patients with suspicion of shoulder pathology were included in this study. Patients were laid in supine positions with the arm extended and slightly abducted, the palm of the hand facing upward. A sonographic unit with a high resolution transducer with 7.5 MHz linear array was used. Axial images in the anterior aspect of the shoulder were obtained to localize the coracoid process and the anteromedical portion of the humerus. Using an aseptic technique, a 21-guage needle was advanced into the shoulder joint under ultrasonographic guidance. When the needle made contract with the articular cartilage of the humeral head, the needle was tiled to position is point in the articular cavity. Solution of 0.1 ml gadopentetate dimeglumine in 25 ml of normal saline was prepared and 12-16 ml was injected into the joint cavity. The intra-articular position of the needle and the compete distension of the shoulder joint were again confirmed by sonography. The needle was accurately placed in 14 out of 15 patients without damage to neighboring structures. It took 10 to 15 minutes to complete the procedure in 14 patients. No side effects attributable to gadopentetate dimeglumine were found. Sono-guided needle puncture for the shoulder MR arthrography can be a substitutable method for fluoroscopic guidance, with easy access, advantages of lacking radiation hazard and eliminating the need for iodized contrast agents.

Shoulder muscular activity in individuals with low back pain and spinal cord injury during seated manual load transfer tasks.

Science.gov (United States)

Dickerson, Clark R; Alenabi, Talia; Martin, Bernard J; Chaffin, Don B

2018-03-08

This study aimed to compare the activity of four shoulder muscles in individuals with low back pain (LBP), spinal cord injuries (SCI) and a control group, during one-handed load transfer trials. Nine individuals with minimum one-year of LBP, eleven with thoracic/lumbar SCI and nine healthy controls participated in this study. The activations of anterior deltoid, upper trapezius, infraspinatus and pectoralis major were recorded by surface EMG during one-handed transferring of a cylinder from a home shelve to six spatially distributed target shelves. The integrated EMG values were compared using repeated measure ANOVA. Both LBPs and SCIs had higher anterior deltoid activation and LBPs required more upper trapezius activation than controls (p demands for these two muscles. The anterior deltoid and upper trapezius in LBP and SCI individuals are under higher demand during occupational load transfer tasks. Practitioner Summary: This study aimed to compare the activation of four shoulder muscles in individuals with low back pain, spinal cord injuries and healthy condition. EMG analysis showed that the injured groups required more upper trapezius and anterior deltoid activation during load transfer tasks, which may predispose them to muscle overexertion.

The painful shoulder

International Nuclear Information System (INIS)

Hartl, P.W.

1987-01-01

The painful shoulder syndrome is very common. Diagnosis and differential diagnosis may be difficult. Shoulder pain may be caused by local processes or systemic diseases or can be referred. Periarthritis humeroscapularis (frozen shoulder) is the most common cause of painful shoulder syndrome. Biomechanical factors concerning the rotator cuff are involved in the etiopathogenesis of these pain syndromes. The therapy of frozen shoulder includes physical treatment, antirheumatic drugs, or X-ray treatment. Surgical measures may become necessary. In the course of rheumatoid arthritis the shoulder may be involved. Milwaukee-shoulder-syndrome has been described recently in crystal deposit diseases. Shoulder pain may be referred by mechanical irritations of nerve roots in the course of degenerative lesions of the cervical spine and also in the course of internal diseases of the heart, the lungs, or the gastrointestinal tract. In cases of shoulder pain without pathological data from arthrological, radiological or laboratory studies, one should always consider localized fibromyalgia in the shoulder-neck-region. The precise diagnosis of shoulder pain is an important prerequisite for treatment, the success of which should not be judged as pessimistic as it has been commonly done in the past. (orig.) [de

Effect of shoulder stabilization on career length in national football league athletes.

Science.gov (United States)

Brophy, Robert H; Gill, Corey S; Lyman, Stephen; Barnes, Ronnie P; Rodeo, Scott A; Warren, Russell F

2011-04-01

Shoulder instability and surgical stabilization are common in college football athletes. The effect of shoulder stabilization during college on the length of an athlete's career in the National Football League (NFL) has not been well examined. Athletes with a history of shoulder stabilization before the NFL combine have a shorter career than do matched controls. Cohort study; Level of evidence, 3. A database containing the injury history and career NFL statistics of athletes from 1987 to 2000 was used to match athletes with a history of shoulder stabilization and no other surgery or significant injury to controls without a history of any previous surgery or significant injury. Athletes were matched by position, year drafted, round drafted, and additional minor injury history. Forty-two athletes with a history of shoulder stabilization were identified and matched with controls. A history of shoulder stabilization significantly reduced the length of career in terms of years (5.2 ± 3.9 vs 6.9 ± 3.6 years; P = .01) and games played (56 ± 53 vs 77 ± 50, P = .03) as compared with controls. By position, linemen and linebackers (20 athletes) with a history of shoulder stabilization had a significantly shorter career in years (4.7 ± 3.8 vs 6.7 ± 3.4 years; P = .049) and games played (51 ± 58 vs 81 ± 48; P = .046) than did controls. Among the other positions (22 athletes), the difference was not statistically significant in this small cohort. A history of shoulder stabilization shortens the expected career of a professional football player, particularly for linemen and linebackers. Further research is warranted to better understand how these injuries and surgeries affect an athlete's career and what can be done to improve the long-term outcome after treatment.

Use of the Composite Pedicled Pectoralis Minor Flap after Resection of Soft Tissue Sarcoma in Reconstruction of the Glenohumeral Joint

Directory of Open Access Journals (Sweden)

Michiel A. J. van de Sande

2014-01-01

Full Text Available The surgical repair of an extensive anterior glenohumeral soft tissue defect is complicated by glenohumeral instability and subsequent significant functional deficit. This surgical note offers a relatively simple reconstruction of the anterior capsule and subscapularis muscle using a pectoralis minor pedicle flap. This reconstruction is supplemented with functional reconstruction of the anterior glenohumeral joint. A conventional deltopectoral approach is utilized and pectoralis minor is freed from its coracoid insertion, released, and mobilized without compromising the pedicle entering from the dorsum and inferior one-third of the muscle. The mobilized pectoralis minor vascular pedicle has sufficient length for the pectoralis minor to be transferred to provide coverage of the anterior shoulder joint even in full external rotation, providing anterior stability. To further improve glenohumeral stability and shoulder function, the pectoralis major muscle can be split with the clavicular part reinserted lateral to the bicipital groove onto the lesser tuberosity replacing subscapularis function while stabilising the glenohumeral joint.

Incidental finding of unilateral isolated aplasia of serratus anterior muscle and winged scapula on chest radiograph: A case report

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Choi, Joon Sung; Park, Hyun Jin; Ko, Jeong Min [Dept. of Radiology, St. Vincent' s Hospital, College of Medicine, The Catholic University of Korea, Suwon (Korea, Republic of)

2014-10-15

The isolated aplasia of the serratus anterior muscle with winging of scapula is very rare, and only a few cases are reported. Here, we present a case of a 30-year-old Korean male who initially presented with a left flank pain. His physical exam did not show any significant finding in his right shoulder. However, his chest radiograph showed absence of right serratus anterior muscle and slightly elevated and medially rotated right scapula. Subsequent CT scan showed the right serratus anterior muscle aplasia and medial winging of the right scapula. This case is unique in two aspects. First, the combination of abnormalities is different from the typical congenital abnormalities involving shoulder girdle, such as Sprengel deformity or Poland syndrome. Secondly, this was incidentally diagnosed with chest radiograph, without clinical impression. Careful reading of chest radiograph can help the radiologists to detect such clinically silent abnormalities.

Incidental finding of unilateral isolated aplasia of serratus anterior muscle and winged scapula on chest radiograph: A case report

International Nuclear Information System (INIS)

Choi, Joon Sung; Park, Hyun Jin; Ko, Jeong Min

2014-01-01

The isolated aplasia of the serratus anterior muscle with winging of scapula is very rare, and only a few cases are reported. Here, we present a case of a 30-year-old Korean male who initially presented with a left flank pain. His physical exam did not show any significant finding in his right shoulder. However, his chest radiograph showed absence of right serratus anterior muscle and slightly elevated and medially rotated right scapula. Subsequent CT scan showed the right serratus anterior muscle aplasia and medial winging of the right scapula. This case is unique in two aspects. First, the combination of abnormalities is different from the typical congenital abnormalities involving shoulder girdle, such as Sprengel deformity or Poland syndrome. Secondly, this was incidentally diagnosed with chest radiograph, without clinical impression. Careful reading of chest radiograph can help the radiologists to detect such clinically silent abnormalities.

Shoulder dystocia.

Science.gov (United States)

Grobman, William

2013-03-01

The frequency of shoulder dystocia in different reports has varied, ranging 0.2-3% of all vaginal deliveries. Once a shoulder dystocia occurs, even if all actions are appropriately taken, there is an increased frequency of complications, including third- or fourth-degree perineal lacerations, postpartum hemorrhage, and neonatal brachial plexus palsies. Health care providers have a poor ability to predict shoulder dystocia for most patients and there remains no commonly accepted model to accurately predict this obstetric emergency. Consequently, optimal management of shoulder dystocia requires appropriate management at the time it occurs. Multiple investigators have attempted to enhance care of shoulder dystocia by utilizing protocols and simulation training. Copyright © 2013 Elsevier Inc. All rights reserved.

Six Sessions of Anterior-to-Posterior Ankle Joint Mobilizations Improve Patient-Reported Outcomes in Chronic Ankle Instability Patients: A Critically Appraised Topic.

Science.gov (United States)

Wikstrom, Erik A; Bagherian, Sajad; Cordero, Nicole B; Song, Kyeongtak

2018-01-24

Clinical Scenario: Chronic ankle instability (CAI) is a complex musculoskeletal condition that results in sensorimotor and mechanical alterations. Manual therapies, such as ankle joint mobilizations are known to improve clinician-oriented outcomes like dorsiflexion range of motion but their impact of patient-reported outcomes remains less clear. Focused Clinical Question: Do anterior-to-posterior ankle joint mobilizations improve patient reported outcomes in patients with CAI? Summary of Key Findings: Three studies (2 RCT, 1 Prospective cohort) quantified the effect of at least 2-weeks of anterior-to-posterior ankle joint mobilizations on improving patient reported outcomes immediately after the intervention and at a follow-up assessment. All three studies demonstrated significant improvements in at least one patient-reported outcome immediately after the intervention and at the follow-up assessment. Clinical Bottom Line: At least 2-weeks of ankle joint mobilization improves patient-reported outcomes in patients with CAI and these benefits are retained for at least a week following the termination of the intervention. Strength of Recommendation: Strength of recommendation is an A due to consistent good-quality patient-oriented evidence.

Impact of shoulder complaints after neck dissection on shoulder disability and quality of life

NARCIS (Netherlands)

Stuiver, Martijn M.; van Wilgen, Cornelis P.; de Boer, Erlijn M.; de Goede, Cees J. T.; Koolstra, Muriel; van Opzeeland, Anita; Venema, Piet; Sterken, Margriet W.; Vincent, Andrew; Dijkstra, Pieter U.

2008-01-01

To explore relationships between shoulder complaints after neck dissection, shoulder disability, and quality of life. To find clinical predictors for mid- to long-term shoulder disability. Prospective. Shoulder pain, shoulder mobility, and shoulder droop, as well as scores on shoulder disability

Isolated long thoracic nerve paralysis - a rare complication of anterior spinal surgery: a case report

Directory of Open Access Journals (Sweden)

Ameri Ebrahim

2009-06-01

Full Text Available Abstract Introduction Isolated long thoracic nerve injury causes paralysis of the serratus anterior muscle. Patients with serratus anterior palsy may present with periscapular pain, weakness, limitation of shoulder elevation and scapular winging. Case presentation We present the case of a 23-year-old woman who sustained isolated long thoracic nerve palsy during anterior spinal surgery which caused external compressive force on the nerve. Conclusion During positioning of patients into the lateral decubitus position, the course of the long thoracic nerve must be attended to carefully and the nerve should be protected from any external pressure.

Positioning of the patient during shoulder surgery: an inexpensive, safe and easy technique.

Science.gov (United States)

Van Tongel, Alexander; Hardeman, François; Karelse, Anne; de Wilde, Lieven

2013-01-01

The knowledge of shoulder pathology has improved tremendously in the last decades, and shoulder surgery is increasingly performed because of new treatment options and better operative results. Nowadays most surgical shoulder procedures are performed in the sitting or semi-sitting (beach chair) position. Stability of the patient and the ability to flex, extend and rotate the shoulder during surgery are crucial to improve exposure of the surgical field and lower the risk of perioperative complications. We developed an easy, safe and inexpensive surgical set-up providing a very good posterior, superior and anterior access to the shoulder in the sitting or semi-sitting position. In this technique, the patient is placed supine with the head at the foot end of the table and the body positioned slightly eccentrically with the back being supported by the leg plate contralateral to the operative side, avoiding any contact with the scapula of the operative side. A neck support is attached on an extra bar at the contralateral side and accommodated to the patient's lordosis. Next, the leg plate on the operative side is removed, and the head and the body are secured to the table with adhesive dressing. This way a stable positioning of the patient is obtained during the whole procedure, and the shoulder girdle is completely free. The set-up can accommodate patients of different stature and weight without the need to adapt the technique. This position also gives the possibility to provide an excellent radiographic view of the shoulder during operative fracture treatment. Our technique further allows a significant reduction in costs. A surgical table, extra bar, additional arm support and neck support are usually available and can be used in different settings, without the need for a specific shoulder table.

Shoulder MRI scan

Science.gov (United States)

... exercises Rotator cuff - self-care Shoulder replacement - discharge Shoulder surgery - discharge Using your shoulder after replacement surgery References Hanypsiak B, DeLong JM, Lowe WR. Scapulothoracic ...

Myofascial involvement of supra- and infraspinatus muscles contributes to ipsilateral shoulder pain after muscle-sparing thoracotomy and video-assisted thoracic surgery.

Science.gov (United States)

Ohmori, Aki; Iranami, Hiroshi; Fujii, Keisuke; Yamazaki, Akinori; Doko, Yukari

2013-12-01

This study examined the hypothesis that ipsilateral upper extremity elevation for muscle-sparing thoracotomy procedures contributes to the postoperative shoulder pain. Prospective observational study. Medical center. ASA physical status 1-2 patients undergoing elective lung surgeries including pneumonectomy, lobectomy, and segmentectomy performed through either the anterolateral approach or video-assisted thoracotomy surgery. Postoperative observation of ipsilateral shoulder pain. Postoperative examinations of sites of shoulder pain (clavicle, anterior, lateral,or posterior aspect of acromion, posterior neck, supraspinatus, infraspinatus, and these entire areas) with or without trigger points, visual analog scale score of wound pain, and requested counts of analgesics. The number of patients who suffered from postoperative shoulder pain was 37 of 70 (52.9%). Demographic data, anterolateral/VATS ratio, VAS scores, and requested counts of rescue analgesics requirement were similar in the groups of patients with and without postoperative shoulder pain. The segmentectomy caused a significantly higher incidence of postoperative shoulder pain compared with other procedures (p shoulder pain showed defined trigger points in their painful areas. These results supported the hypothesis that myofascial involvement contributed, to some extent, to shoulder pain after muscle-sparing thoracotomy with ipsilateral upper extremity elevation. Copyright © 2013 Elsevier Inc. All rights reserved.

The effect of electrical stimulation in combination with Bobath techniques in the prevention of shoulder subluxation in acute stroke patients.

Science.gov (United States)

Fil, Ayla; Armutlu, Kadriye; Atay, Ahmet Ozgur; Kerimoglu, Ulku; Elibol, Bulent

2011-01-01

To examine the efficiency of electrical stimulation in combination with Bobath techniques in the prevention of inferior and anterior shoulder subluxation in acute stroke patients. A prospective randomized controlled trial. Intensive care unit and inpatient clinics of neurology in a university hospital. Forty-eight patients with acute stroke, divided equally into control and study groups. Subjects in both groups were treated in accordance with the Bobath concept during the early hospitalization period. In addition to Bobath techniques, electrical stimulation was also applied to the supraspinatus muscle, mid and posterior portions of the deltoid muscle of patients in the study group. Two radiological methods were used to measure the horizontal, vertical and total asymmetry and vertical distance values of the shoulder joint. Motor functions of the arm were evaluated with the Motor Assessment Scale. The hospitalization period was 12.62 ± 2.24 days for the control group and 11.66 ± 1.88 days for the study group. Shoulder subluxation occurred in 9 (37.5%) subjects in the control group, whereas it was not observed in the study group. All shoulder joint displacement values were higher in the control group than in the study group (horizontal asymmetry P = 0.0001, vertical asymmetry P = 0.0001, total asymmetry P = 0.0001, vertical range P = 0.002). Application of electrical stimulation combined with the Bobath approach proved to be efficient in preventing inferior and anterior shoulder subluxation in the acute stages of stroke.

An investigation of shoulder forces in active shoulder tackles in rugby union football.

Science.gov (United States)

Usman, Juliana; McIntosh, Andrew S; Fréchède, Bertrand

2011-11-01

In rugby union football the tackle is the most frequently executed skill and one most associated with injury, including shoulder injury to the tackler. Despite the importance of the tackle, little is known about the magnitude of shoulder forces in the tackle and influencing factors. The objectives of the study were to measure the shoulder force in the tackle, as well as the effects of shoulder padding, skill level, side of body, player size, and experimental setting on shoulder force. Experiments were conducted in laboratory and field settings using a repeated measures design. Thirty-five participants were recruited to the laboratory and 98 to the field setting. All were male aged over 18 years with rugby experience. The maximum force applied to the shoulder in an active shoulder tackle was measured with a custom built forceplate incorporated into a 45 kg tackle bag. The overall average maximum shoulder force was 1660 N in the laboratory and 1997 N in the field. This difference was significant. The shoulder force for tackling without shoulder pads was 1684 N compared to 1635 N with shoulder pads. There was no difference between the shoulder forces on the dominant and non-dominant sides. Shoulder force reduced with tackle repetition. No relationship was observed between player skill level and size. A substantial force can be applied to the shoulder and to an opponent in the tackle. This force is within the shoulder's injury tolerance range and is unaffected by shoulder pads. Copyright © 2011 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Impact of shoulder complaints after neck dissection on shoulder disability and quality of life

NARCIS (Netherlands)

Stuiver, Martijn M.; van Wilgen, Cornelis P.; de Boer, Erlijn M.; de Goede, Cees J. T.; Koolstra, Muriel; van Opzeeland, Anita; Venema, Piet; Sterken, Margriet W.; Vincent, Andrew; Dijkstra, Pieter U.

OBJECTIVE: To explore relationships between shoulder complaints after neck dissection, shoulder disability, and quality of life. To find clinical predictors for mid- to long-term shoulder disability. STUDY DESIGN: Prospective. PATIENTS AND METHODS: Shoulder pain, shoulder mobility, and shoulder

Impact of shoulder complaints after neck dissection on shoulder disability and quality of life

NARCIS (Netherlands)

Stuiver, M.M.; van Wilgen, C.P.; de Boer, E.M.J.; de Goede, C.J.T.; Koolstra, M.; van Opzeeland, A.; Venema, P.; Sterken, M.W.; Vincent, A.; Dijkstra, P.U.

2008-01-01

Objective: To explore relationships between shoulder complaints after neck dissection, shoulder disability, and quality of life. To find clinical predictors for mid- to long-term shoulder disability. Study Design: Prospective. Patients and Methods: Shoulder pain, shoulder mobility, and shoulder

Dynamic high-resolution ultrasound of the shoulder: How we do it

Energy Technology Data Exchange (ETDEWEB)

Corazza, Angelo, E-mail: angelcoraz@libero.it [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via Alberti 4, 16132 Genova (Italy); Orlandi, Davide, E-mail: theabo@libero.it [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via Alberti 4, 16132 Genova (Italy); Fabbro, Emanuele, E-mail: emanuele.fabbro@gmail.com [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via Alberti 4, 16132 Genova (Italy); Ferrero, Giulio, E-mail: giulio.ferrero@gmail.com [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via Alberti 4, 16132 Genova (Italy); Messina, Carmelo, E-mail: carmelomessina.md@gmail.com [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Piazza Malan 2, 20097 San Donato Milanese (Italy); Sartoris, Riccardo, E-mail: riccardo.sartoris@hotmail.it [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via Alberti 4, 16132 Genova (Italy); Perugin Bernardi, Silvia, E-mail: silvy-86-@hotmail.it [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via Alberti 4, 16132 Genova (Italy); Arcidiacono, Alice, E-mail: a.arcidiacono84@gmail.com [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via Alberti 4, 16132 Genova (Italy); Silvestri, Enzo, E-mail: silvi.enzo@gmail.com [Dipartimento di Radiologia, Ospedale Evangelico Internazionale, Corso Solferino 29A, 16121 Genova (Italy); and others

2015-02-15

Highlights: • This paper shows how to apply US technique to image soft tissues around the shoulder. • Readers will learn to recognize normal US anatomy of tendons of the shoulder. • Readers will learn to apply dynamic maneuvers to improve rotator cuff visibility. - Abstract: Ultrasonography (US) is an established and well-accepted modality that can be used to evaluate articular and peri-articular structures around the shoulder. US has been proven to be useful in a wide range of rotator cuff diseases (tendon tears, tendinosis, and bursitis) as well as non-rotator cuff abnormalities (instability problems, synovial joint diseases, and nerve entrapment syndromes). Diagnostic accuracy of shoulder US when evaluating rotator cuff tears can reach 91–100% for partial and full thickness tears detection, respectively, having been reported to be as accurate as magnetic resonance imaging in experienced hands. US is cheap, readily available, capable to provide high-resolution images, and does not use ionizing radiations. In addition, US is the only imaging modality that allows performing dynamic evaluation of musculoskeletal structures, that may help to further increase diagnostic performance. In this setting, a standardized imaging protocol is essential for an exhaustive and efficient examination, also helping reducing the intrinsic dependence from operators of US. Furthermore, knowledge of pitfalls that can be encountered when examining the shoulder may help to avoid erroneous images interpretation. In this article we use detailed anatomic schemes and high-resolution US images to describe the normal US anatomy of soft tissues, articular, and para-articular structures located in and around the shoulder. Short video clips emphasizing the crucial role of dynamic maneuvers and dynamic real-time US examination of these structures are included as supplementary material.

Dynamic high-resolution ultrasound of the shoulder: How we do it

International Nuclear Information System (INIS)

Corazza, Angelo; Orlandi, Davide; Fabbro, Emanuele; Ferrero, Giulio; Messina, Carmelo; Sartoris, Riccardo; Perugin Bernardi, Silvia; Arcidiacono, Alice; Silvestri, Enzo

2015-01-01

Highlights: • This paper shows how to apply US technique to image soft tissues around the shoulder. • Readers will learn to recognize normal US anatomy of tendons of the shoulder. • Readers will learn to apply dynamic maneuvers to improve rotator cuff visibility. - Abstract: Ultrasonography (US) is an established and well-accepted modality that can be used to evaluate articular and peri-articular structures around the shoulder. US has been proven to be useful in a wide range of rotator cuff diseases (tendon tears, tendinosis, and bursitis) as well as non-rotator cuff abnormalities (instability problems, synovial joint diseases, and nerve entrapment syndromes). Diagnostic accuracy of shoulder US when evaluating rotator cuff tears can reach 91–100% for partial and full thickness tears detection, respectively, having been reported to be as accurate as magnetic resonance imaging in experienced hands. US is cheap, readily available, capable to provide high-resolution images, and does not use ionizing radiations. In addition, US is the only imaging modality that allows performing dynamic evaluation of musculoskeletal structures, that may help to further increase diagnostic performance. In this setting, a standardized imaging protocol is essential for an exhaustive and efficient examination, also helping reducing the intrinsic dependence from operators of US. Furthermore, knowledge of pitfalls that can be encountered when examining the shoulder may help to avoid erroneous images interpretation. In this article we use detailed anatomic schemes and high-resolution US images to describe the normal US anatomy of soft tissues, articular, and para-articular structures located in and around the shoulder. Short video clips emphasizing the crucial role of dynamic maneuvers and dynamic real-time US examination of these structures are included as supplementary material

Muscle activation when performing the chest press and shoulder press on a stable bench vs. a Swiss ball.

Science.gov (United States)

Uribe, Brandon P; Coburn, Jared W; Brown, Lee E; Judelson, Daniel A; Khamoui, Andy V; Nguyen, Diamond

2010-04-01

The aim of this study was to examine the effects of a stable surface (bench) vs. an unstable surface (Swiss ball) on muscle activation when performing the dumbbell chest press and shoulder press. Sixteen healthy men (24.19 +/- 2.17 years) performed 1 repetition maximum (1RM) tests for the chest press and shoulder press on a stable surface. A minimum of 48 hours post 1RM, subjects returned to perform 3 consecutive repetitions each of the chest press and shoulder press at 80% 1RM under 4 different randomized conditions (chest press on bench, chest press on Swiss ball, shoulder press on bench, shoulder press on Swiss ball). Electromyography was used to assess muscle activation of the anterior deltoid, pectoralis major, and rectus abdominus. The results revealed no significant difference in muscle activation between surface types for either exercise. This suggests that using an unstable surface neither improves nor impairs muscle activation under the current conditions. Coaches and other practitioners can expect similar muscle activation when using a Swiss ball vs. a bench.

The effect of primary delivery of the anterior compared with the posterior shoulder on perineal trauma

DEFF Research Database (Denmark)

Willer, Hanne; Aabakke, Anna J M; Krebs, Lone

2014-01-01

is that primary delivery of the posterior shoulder reduces the rate and degree of perineal trauma. METHODS/DESIGN: This is a single-centre, randomized controlled trial, with computer-generated randomization in a 1:1 allocation ratio. Women planning their first vaginal delivery (n = 650) are randomized to primary....... Recruitment started in January 2013 and the trial is planned to proceed for 24 months. DISCUSSION: Most delivery assistance techniques are based on tradition and heritage and lack objective evidence. This trial provides an example of how vaginal delivery techniques can be evaluated in a randomized controlled...... trial. The results of this trial will clarify the role that delivery of the shoulders has on perineal trauma and thereby provide knowledge to recommendations on birthing technique. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01937546....

Special physical examination tests for superior labrum anterior-posterior shoulder tears: an examination of clinical usefulness.

Science.gov (United States)

Sandrey, Michelle A

2013-01-01

Calvert E, Chambers GK, Regan W, Hawkins RH, Leith JM. Special physical examination tests for superior labrum anterior-posterior shoulder injuries are clinically limited and invalid: a diagnostic systematic review. J Clin Epidemiol. 2009;62(5):558-563. The systematic review focused on diagnostic accuracy studies to determine if evidence was sufficient to support the use of superior labrum anterior-posterior (SLAP) physical examination tests as valid and reliable. The primary question was whether there was sufficient evidence in the published literature to support the use of SLAP physical examination tests as valid and reliable diagnostic test procedures. Studies published in English were identified through database searches on MEDLINE, EMBASE, and the Cochrane database (1970-2004) using the search term SLAP lesions. The medical subject headings of arthroscopy, shoulder joint, and athletic injuries were combined with test or testing, physical examination, and sensitivity and specificity to locate additional sources. Other sources were identified by rereviewing the reference lists of included studies and review articles. Studies were eligible based on the following criteria: (1) published in English, (2) focused on the physical examination of SLAP lesions, and (3) presented original data. A study was excluded if the article was limited to a clinical description of 1 or more special tests without any research focus to provide clinical accuracy data or if it did not focus on the topic. The abstracts that were located through the search strategies were reviewed, and potentially relevant abstracts were selected. Strict epidemiologic methods were used to obtain and collate all relevant studies; the authors developed a study questionnaire to record study name, year of publication, study design, sample size, and statistics. Validity of the diagnostic test study was determined by applying the 5 criteria proposed by Calvert et al. If the study met the inclusion and validity

Shoulder Muscle Activation of Novice and Resistance Trained Women during Variations of Dumbbell Press Exercises

Science.gov (United States)

Luczak, Joshua; Bosak, Andy; Riemann, Bryan L.

2013-01-01

Previous research has compared the effects of trunk inclination angle on muscle activation using barbells and Smith machines in men. Whether similar effects occur with the use of dumbbells or in women remains unknown. The purpose was to compare upper extremity surface electromyographical (EMG) activity between dumbbell bench, incline, and shoulder presses. Dominate arm EMG data were recorded for collegiate-aged female resistance trained individuals (n = 12) and novice female resistance trained exercisers (n = 12) from which average EMG amplitude for each repetition phase (concentric, eccentric) was computed. No significant differences were found between experienced and novice resistance trained individuals. For the upper trapezius and anterior deltoid muscles, shoulder press activation was significantly greater than incline press which in turn was significantly greater than bench press across both phases. The bench and incline presses promoted significantly greater pectoralis major sternal activation compared to the shoulder press (both phases). While pectoralis major clavicular activation during the incline press eccentric phase was significantly greater than both the bench and shoulder presses, activation during the bench press concentric phase promoted significantly greater activation than the incline press which in turn was significantly greater than the shoulder press. These results provide evidence for selecting exercises in resistance and rehabilitation programs. PMID:26464884

Shoulder Muscle Activation of Novice and Resistance Trained Women during Variations of Dumbbell Press Exercises

Directory of Open Access Journals (Sweden)

Joshua Luczak

2013-01-01

Full Text Available Previous research has compared the effects of trunk inclination angle on muscle activation using barbells and Smith machines in men. Whether similar effects occur with the use of dumbbells or in women remains unknown. The purpose was to compare upper extremity surface electromyographical (EMG activity between dumbbell bench, incline, and shoulder presses. Dominate arm EMG data were recorded for collegiate-aged female resistance trained individuals ( and novice female resistance trained exercisers ( from which average EMG amplitude for each repetition phase (concentric, eccentric was computed. No significant differences were found between experienced and novice resistance trained individuals. For the upper trapezius and anterior deltoid muscles, shoulder press activation was significantly greater than incline press which in turn was significantly greater than bench press across both phases. The bench and incline presses promoted significantly greater pectoralis major sternal activation compared to the shoulder press (both phases. While pectoralis major clavicular activation during the incline press eccentric phase was significantly greater than both the bench and shoulder presses, activation during the bench press concentric phase promoted significantly greater activation than the incline press which in turn was significantly greater than the shoulder press. These results provide evidence for selecting exercises in resistance and rehabilitation programs.

Observational study on the pavement performance effects of shoulder rumble strip on shoulders

Directory of Open Access Journals (Sweden)

Sean Coffey

2016-07-01

Full Text Available Rumble strip implementation has shown a constant increase with its safety benefits. Rumble strips are milled into the roadway shoulder to produce noise and vibrations when driven on. With the milling process, the pavement performance is expected to be negatively impacted by the decreased depth, though not mathematically quantified. Using methods defined by the Long-Term Pavement Performance Program, the severity of the shoulder site’s distresses, with and without shoulder rumble strips, will be quantified. The quantification would permit the design to compensate for the impact. This design compensation allows the implementation of hard shoulder running, the use of shoulder as a travel lane during congestion, and retains the shoulder rumble strip safety instead of removing, as suggested by some proposed projects. While hard shoulder running would not impact specific time periods, the safety benefit of rumble strips could be needed at any time. This study aims to quantify the rumble strip impact to enable the full shoulder strength for hard shoulder running while retaining the safety benefits of rumble strips. Keywords: Rumble strips, Shoulder, Cracking, Pavement performance, Hard shoulder running

Comparison of Clinical and Radiological Results in the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without the Anterior Attachment of the Rotator Cable.

Science.gov (United States)

Cho, Nam Su; Moon, Seong Cheol; Hong, Se Jung; Bae, Seong Hae; Rhee, Yong Girl

2017-09-01

The anterior rotator cable is critical in force transmission of the rotator cuff. However, few clinical studies have examined the correlation between the integrity of the anterior supraspinatus tendon and surgical outcomes in patients with rotator cuff tears. To compare the clinical and structural outcomes of the arthroscopic repair of full-thickness rotator cuff tears with and without anterior disruption of the supraspinatus tendon. Cohort study; Level of evidence, 3. One hundred eighty-one shoulders available for magnetic resonance imaging (MRI) at least 6 months after arthroscopic rotator cuff repair, with a minimum 1-year follow-up, were enrolled. The anterior attachment of the rotator cable was disrupted in 113 shoulders (group A) and intact in 68 shoulders (group B). The mean age at the time of surgery in groups A and B was 59.6 and 59.2 years, respectively, and the mean follow-up period was 24.2 and 25.1 months, respectively. There were statistically significant differences in the preoperative tear size and pattern and muscle fatty degeneration between the 2 groups ( P = .004, P = .008, and P rotator cable, the mean 24-month follow-up demonstrated excellent pain relief and improvement in the ability to perform activities of daily living after arthroscopic rotator cuff repair. However, tears with anterior disruption of the rotator cable showed a significantly larger and more complex tear pattern and more advanced fatty degeneration. Additionally, the retear rate was significantly higher in patients with a tear involving the anterior attachment of the rotator cable.

Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study.

Science.gov (United States)

Koorevaar, Rinco C T; Van't Riet, Esther; Ipskamp, Marcel; Bulstra, Sjoerd K

2017-03-01

Frozen shoulder is a potential complication after shoulder surgery. It is a clinical condition that is often associated with marked disability and can have a profound effect on the patient's quality of life. The incidence, etiology, pathology and prognostic factors of postoperative frozen shoulder after shoulder surgery are not known. The purpose of this explorative study was to determine the incidence of postoperative frozen shoulder after various operative shoulder procedures. A second aim was to identify prognostic factors for postoperative frozen shoulder after shoulder surgery. 505 consecutive patients undergoing elective shoulder surgery were included in this prospective cohort study. Follow-up was 6 months after surgery. A prediction model was developed to identify prognostic factors for postoperative frozen shoulder after shoulder surgery using the TRIPOD guidelines. We nominated five potential predictors: gender, diabetes mellitus, type of physiotherapy, arthroscopic surgery and DASH score. Frozen shoulder was identified in 11% of the patients after shoulder surgery and was more common in females (15%) than in males (8%). Frozen shoulder was encountered after all types of operative procedures. A prediction model based on four variables (diabetes mellitus, specialized shoulder physiotherapy, arthroscopic surgery and DASH score) discriminated reasonably well with an AUC of 0.712. Postoperative frozen shoulder is a serious complication after shoulder surgery, with an incidence of 11%. Four prognostic factors were identified for postoperative frozen shoulder: diabetes mellitus, arthroscopic surgery, specialized shoulder physiotherapy and DASH score. The combination of these four variables provided a prediction rule for postoperative frozen shoulder with reasonable fit. Level II, prospective cohort study.

Resultado funcional do tratamento artroscópico da instabilidade do ombro sem a lesão do lábio da glenóide Functional results of arthroscopic treatment of shoulder instability without glenoid labral lesion

Directory of Open Access Journals (Sweden)

Waldo Lino Júnior

2007-07-01

Full Text Available OBJETIVO: Tratar a instabilidade anterior e ântero-inferior do ombro sem lesão do lábio da glenóide por via artroscópica por meio de capsulorrafia térmica e fechamento do espaço rotador e avaliar os resultados quanto à estabilidade e à melhora funcional. MÉTODOS: Entre janeiro de 1998 e junho de 2002, 11 pacientes foram submetidos a esse procedimento, imobilizados por cinco semanas e após tratados por fisioterapia. Todos os pacientes foram avaliados no pré e pós-operatório pelas escalas de Neer, Rower e UCLA e, no pós-operatório, pela escala de ASES. RESULTADOS: Durante o período de seguimento entre 46 e 97 meses média de 75,54 meses todos os ombros permaneceram estáveis. Comparando-se a evolução do pré ao pós-operatório, houve melhora de acordo com a escala de Neer, na qual nenhum paciente apresentou resultado satisfatório no pré-operatório e oito tiveram resultado satisfatório no pós-operatório. Segundo a escala de Rowe, a média pré-operatória foi de 36,8 e, no pós-operatório, de 81,6 pontos. Conforme a escala da UCLA, a média no pré-operatório foi de 23,45 e, no pós-operatório, de 31,18 pontos. De acordo com todas essas escalas houve melhora estatisticamente significativa (p = 0,05. A escala da ASES mostrou média pós-operatória de 77,2 pontos. CONCLUSÃO: O procedimento artroscópico analisado confere estabilidade e melhora funcional.OBJECTIVE: Anterior and anterior-lower instability of the shoulder without a glenoid labral lesion was arthroscopically treated by thermal capsulorrhaphy and closing of the rotator space, and results were evaluated for stability and functional improvement. METHODS: From January 1998 to June 2002, 11 patients were submitted to this procedure, immobilized for five weeks, and then treated by physiotherapy. All patients were evaluated pre- and post-operatively by the Neer, Rower, and UCLA scale, and in the post-operative period, by the ASES scale. RESULTS: During the follow

Anterior versus posterior, and rim-rent rotator cuff tears: prevalence and MR sensitivity

International Nuclear Information System (INIS)

Tuite, M.J.; Turnbull, J.R.; Orwin, J.F.

1998-01-01

Purpose. To determine the relative distribution of the locations of rotator cuff tears, and the sensitivity of anterior versus posterior tears on MR images. Patients and methods. We identified 110 consecutive patients who had a shoulder MR and either a partial-thickness or a small full-thickness rotator cuff tear diagnosed at arthroscopy. MR sensitivity and patient age were compared between patients with tears in the anterior and posterior halves of the cuff. In addition, in patients with partial tears less than 2 cm in diameter, an age comparison between those with tears in the critical zone and those with articular surface tears adjacent to the bony insertion (rim-rent tear) was performed. Results. The tear was centered in the anterior half of the rotator cuff in 79% of the patients younger than 36 years old, and in 89% of the patients 36 years old and over. The average age of the patients with tears in the anterior half (44 years) was not significantly different from the average age of those with posterior tears (40 years). The sensitivity of MR for anterior tears was 0.69, and for posterior tears it was 0.56. Five of the nine rim-rent tears (0.56) were interpreted correctly on the original MR report; two of the other tears were misinterpreted as intratendinous fluid but were diagnosable in retrospect. Conclusion. Even in patients less than 36 years old, most partial and small full-thickness rotator cuff tears are centered in the anterior half of the supraspinatus. Although our figure for MR sensitivity for these tears is lower than in recent articles, we found no significant difference between the sensitivity of MR for diagnosing posterior tears versus tears in the anterior half of the supraspinatus tendon. Rim-rent tears can be mistaken for intratendinous signal, and should be carefully looked for in younger patients with shoulder pain. (orig.)

Labral-Ligamentous Complex of the Shoulder. Evaluation with double oblique axial MR arthrography. Technical Note

International Nuclear Information System (INIS)

Sasaki, Taisuke; Saito, Y.; Yodono, H.; Prado, G.L.M.; Miura, H.; Itabashi, Y.; Ishibashi, Y.

2003-01-01

Purpose: To assess the ability of double oblique axial (DOA) MR arthrography in evaluating labral-ligamentous complex compared with conventional axial (CA) MR arthrography. Material and Methods: MR arthrography of 51 shoulders, subsequently examined with arthroscopy, were retrospectively reviewed. DOA imaging was performed in all 51 shoulders and both DOA and CA imaging in 37 using a 1.5 T unit with gradient recalled-echo T2*-weighted sequences. DOA imaging was performed using perpendicular planes to the long axis of the glenoid fossa obtained by an oblique sagittal scout image. We compared the ability of DOA with that of CA MR arthrography to assess labral injuries and to demonstrate the whole length of the anterior band of the inferior glenohumeral ligament (AIGHL), which were shown to be intact by arthroscopy. Results: For anterior labral injuries, sensitivity and specificity were 87% and 93% with CA, and 94% and 100% with DOA imaging, respectively. For posterior labral injuries, sensitivity and specificity were 47% and 100% with CA, and 79% and 96% with DOA imaging, respectively. There were no statistically significant differences between CA and DOA images, except for the ability to diagnose posterior labral injuries, where DOA imaging had a significant superior sensitivity (p = 0.0327). DOA images also demonstrated the whole length of the intact AIGHL in 10 of 11 shoulders, while CA imaging showed this in only 3 of 11. Conclusion: DOA imaging was equal or better than CA imaging for evaluating the labral-ligamentous complex

Superior labrum anterior-to-posterior tear.

Science.gov (United States)

Sum, Jonathan C; Omid, Reza

2012-12-01

The patient was a 25-year-old male college student with a chief complaint of right shoulder pain. The patient was initially diagnosed with bicipital tendinitis by his physician and had been treated for 4 weeks by a physical therapist. However, his symptoms did not improve and he was unable to return to his preinjury activity levels, so he sought the services of another physical therapist for a second opinion. Due to concern for a labrum tear, the physical therapist referred the patient to an orthopaedic surgeon. Magnetic resonance arthrography revealed findings consistent with a superior labrum anterior-to-posterior tear.

Risk of shoulder tendinitis in relation to shoulder loads in monotonous repetitive work

DEFF Research Database (Denmark)

Frost, P.; Bonde, J. P.; Mikkelsen, S.

2002-01-01

BACKGROUND: Few studies relate the occurrence of shoulder disorders to quantified ergonomic exposures. This study evaluates the hypothesis that shoulder loads in repetitive work might contribute to the occurrence of shoulder tendinitis. METHODS: This is a cross-sectional study of 1961 workers...... in repetitive work and 782 referents. Shoulder loads were quantified at task level and measures of exposures were assigned based on task distribution. Symptoms in combination with clinical criteria defined shoulder tendinitis. RESULTS: The prevalence of shoulder tendinitis was higher among exposed workers...

Shoulder External Rotation Fatigue and Scapular Muscle Activation and Kinematics in Overhead Athletes

Science.gov (United States)

Joshi, Mithun; Thigpen, Charles A.; Bunn, Kevin; Karas, Spero G.; Padua, Darin A.

2011-01-01

Context: Glenohumeral external rotation (GH ER) muscle fatigue might contribute to shoulder injuries in overhead athletes. Few researchers have examined the effect of such fatigue on scapular kinematics and muscle activation during a functional movement pattern. Objective: To examine the effects of GH ER muscle fatigue on upper trapezius, lower trapezius, serratus anterior, and infraspinatus muscle activation and to examine scapular kinematics during a diagonal movement task in overhead athletes. Setting: Human performance research laboratory. Design: Descriptive laboratory study. Patients or Other Participants: Our study included 25 overhead athletes (15 men, 10 women; age = 20 ± 2 years, height = 180 ± 11 cm, mass = 80 ± 11 kg) without a history of shoulder pain on the dominant side. Interventions: We tested the healthy, dominant shoulder through a diagonal movement task before and after a fatiguing exercise involving low-resistance, high-repetition, prone GH ER from 0° to 75° with the shoulder in 90° of abduction. Main Outcome Measure(s): Surface electromyography was used to measure muscle activity for the upper trapezius, lower trapezius, serratus anterior, and infraspinatus. An electromyographic motion analysis system was used to assess 3-dimensional scapular kinematics. Repeated-measures analyses of variance (phase × condition) were used to test for differences. Results: We found a decrease in ascending-phase and descending-phase lower trapezius activity (F1,25 = 5.098, P = .03) and an increase in descending-phase infraspinatus activity (F1,25 = 5.534, P = .03) after the fatigue protocol. We also found an increase in scapular upward rotation (F1,24 = 3.7, P = .04) postfatigue. Conclusions: The GH ER muscle fatigue protocol used in this study caused decreased lower trapezius and increased infraspinatus activation concurrent with increased scapular upward rotation range of motion during the functional task. This highlights the interdependence of scapular

MRI of symptomatic shoulders

International Nuclear Information System (INIS)

Kikukawa, Kenshi; Segata, Tateki; Kunitake, Katsuhiko; Morisawa, Keizo; Harada, Masataka; Hirano, Mako

2004-01-01

The purpose of this study was to determine the prevalence of cuff tear and acromioclavicular joint (ACJ) osteoarthrosis by magnetic resonance imaging (MRI) evaluation in symptomatic shoulders. MRI was performed on 124 shoulders in 115 patients whose age ranged from 16 to 83 years (average: 58.0 years). There were 74 men (79 shoulders) and 41 women (45 shoulders). The patients were divided into three groups according to age; A group (10 shoulders: 16-29 years), B group (43 shoulders: 30-59 years), and C group (71 shoulders: 60-83 years). Rotator cuff tears and ACJ osteoarthrosis were graded on scales 0 to 3 (normal, increased signal intensity, incomplete, complete), and 1 to 4 (none, mild, moderate, severe), respectively. There was a significant difference in the severity of the cuff tears and the ACJ osteoarthrosis with respect to age. Twenty percent of the shoulders were graded incomplete or complete cuff tears in group A, 88% in group B, and 93% in group C. No shoulders were graded moderate or severe ACJ changes in group A, 63% in group B, and 93% in group C. There was a definite correlation between the cuff tears and ACJ osteoarthrosis. MRI of the symptomatic shoulders indicated well correlation between the rotator cuff tears and ACJ osteoarthrosis. (author)

Shoulder arthroscopy

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... page: //medlineplus.gov/ency/article/007206.htm Shoulder arthroscopy To use the sharing features on this page, please enable JavaScript. Shoulder arthroscopy is surgery that uses a tiny camera called ...

Comparative study of open and arthroscopic coracoid transfer for shoulder anterior instability (Latarjet)-computed tomography evaluation at a short term follow-up. Part II.

Science.gov (United States)

Kordasiewicz, Bartłomiej; Kicinski, Maciej; Małachowski, Konrad; Wieczorek, Janusz; Chaberek, Sławomir; Pomianowski, Stanisław

2018-05-01

The aim of this study was to evaluate and to compare the radiological parameters after arthroscopic and open Latarjet technique via evaluation of computed tomography (CT) scans. Our hypothesis was that the radiological results after arthroscopic stabilisation remained in the proximity of those results achieved after open stabilisation. CT scan evaluation results of patients after primary Latarjet procedure were analysed. Patients operated on between 2006 and 2011 using an open technique composed the OPEN group and patients operated on arthroscopically between 2011 and 2013 composed the ARTHRO group. Forty-three out of 55 shoulders (78.2%) in OPEN and 62 out of 64 shoulders (95.3%) in ARTHRO were available for CT scan evaluation. The average age at surgery was 28 years in OPEN and 26 years in ARTHRO. The mean follow-up was 54.2 months in OPEN and 23.4 months in ARTHRO. CT scan evaluation was used to assess graft fusion and osteolysis. Bone block position and screw orientation were assessed in the axial and the sagittal views. The subscapularis muscle fatty infiltration was evaluated according to Goutallier classification. The non-union rate was significantly higher in OPEN than in ARTHRO: 5 (11.9%) versus 1 (1.7%) (p OPEN group: five cases (11.9%) versus zero in ARTHRO (p OPEN group (p > 0.05). These results should be evaluated very carefully due to significant difference in the follow-up of both groups. A significantly higher rate of partial graft osteolysis at the level of the superior screw was reported in ARTHRO with 32 patients (53.3%) versus 10 (23.8%) in OPEN (p OPEN had the coracoid bone block in an acceptable position (between 4 mm medially and 2 mm laterally). In the sagittal plane, the bone block was in an acceptable position between 2 and 5 o'clock in 86.7% of patients in ARTHRO and 90.2% in OPEN (p > 0.05). However, in the position between 3 and 5 o'clock there were 56.7% of the grafts in ARTHRO versus 87.8% in OPEN (p OPEN group

The use of ultrasound in the assessment of the glenoid labrum of the glenohumeral joint. Part II: Examples of labral pathologies

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Wojciech Krzyżanowski

2012-09-01

Full Text Available Labral pathologies of the glenohumeral joint are most commonly caused by trauma. The majority of lesions affect the anterior part of labrum, resulting from much higher frequency of anterior shoulder dislocations over posterior ones. Another subgroup of labral lesions, not directly related to joint instability, are SLAP tears. Other findings include degenerative changes of labrum and paralabral cysts. Diagnostic imaging is crucial for making a decision regarding operative treatment. Apart from a standard X-ray examination, the imaging mainly relies on magnetic resonance or computed tomography arthrography. Based on their own experience, the authors propose the use of ultrasound in the assessment of labral tears of the glenohumeral joint. Different signs indicating labral pathology may be discovered and assessed during ultrasound examination. They include permanent displacement of the labrum onto the glenoid, labral instability during dynamic examination, lack of the labrum in the anatomical position, hypoechoic zone at the base of the labrum >2 mm in width, residual or swollen labrum as well as paralabral cyst(s. The most frequent appearance of labral pathology is displacement of the anteroinferior labrum onto the external aspect of the glenoid typically seen after anterior shoulder dislocation. The another most important US feature is labral instability while dynamically examined. The swelling or reduced size of the labrum usually indicates degeneration. This article presents sonographic images of selected labral pathologies.

Intervention randomized controlled trials involving wrist and shoulder arthroscopy: a systematic review

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2014-01-01

Background Although arthroscopy of upper extremity joints was initially a diagnostic tool, it is increasingly used for therapeutic interventions. Randomized controlled trials (RCTs) are considered the gold standard for assessing treatment efficacy. We aimed to review the literature for intervention RCTs involving wrist and shoulder arthroscopy. Methods We performed a systematic review for RCTs in which at least one arm was an intervention performed through wrist arthroscopy or shoulder arthroscopy. PubMed and Cochrane Library databases were searched up to December 2012. Two researchers reviewed each article and recorded the condition treated, randomization method, number of randomized participants, time of randomization, outcomes measures, blinding, and description of dropouts and withdrawals. We used the modified Jadad scale that considers the randomization method, blinding, and dropouts/withdrawals; score 0 (lowest quality) to 5 (highest quality). The scores for the wrist and shoulder RCTs were compared with the Mann–Whitney test. Results The first references to both wrist and shoulder arthroscopy appeared in the late 1970s. The search found 4 wrist arthroscopy intervention RCTs (Kienböck’s disease, dorsal wrist ganglia, volar wrist ganglia, and distal radius fracture; first 3 compared arthroscopic with open surgery). The median number of participants was 45. The search found 50 shoulder arthroscopy intervention RCTs (rotator cuff tears 22, instability 14, impingement 9, and other conditions 5). Of these, 31 compared different arthroscopic treatments, 12 compared arthroscopic with open treatment, and 7 compared arthroscopic with nonoperative treatment. The median number of participants was 60. The median modified Jadad score for the wrist RCTs was 0.5 (range 0–1) and for the shoulder RCTs 3.0 (range 0–5) (p = 0.012). Conclusion Despite the increasing use of wrist arthroscopy in the treatment of various wrist disorders the efficacy of arthroscopically

MRI of the shoulder

Energy Technology Data Exchange (ETDEWEB)

Vahlensieck, M.

2000-02-01

Shoulder imaging is one of the major applications in musculoskeletal MRI. In order to analyze the images it is important to keep informed about anatomical and pathological findings and publications. In this article MRI technique, anatomy and pathology is reviewed. Technical considerations about MR sequences and examination strategy are only shortly discussed with emphasis on turbo spin echo and short T1 inversion recovery imaging. Basic anatomy as well as recent findings, including macroscopic aspects of the supraspinatus fat pad, composition of the supraspinatus muscle belly, and variability of the glenohumeral ligaments or coracoid ligament, are presented. Basic pathological conditions are described in detail, e. g. instability particularly problems in differentiating the various subtypes of labral pathology. Rotator cuff diseases are elucidated with emphasis on some rarer entities such as subscapularis calcifying tendinitis, coracoid impingement, chronic bursitis producing the double-line sign, prominent coraco-acromial ligament and the impingement due to an inflamed os acromiale. (orig.)

MRI of the shoulder

International Nuclear Information System (INIS)

Vahlensieck, M.

2000-01-01

Shoulder imaging is one of the major applications in musculoskeletal MRI. In order to analyze the images it is important to keep informed about anatomical and pathological findings and publications. In this article MRI technique, anatomy and pathology is reviewed. Technical considerations about MR sequences and examination strategy are only shortly discussed with emphasis on turbo spin echo and short T1 inversion recovery imaging. Basic anatomy as well as recent findings, including macroscopic aspects of the supraspinatus fat pad, composition of the supraspinatus muscle belly, and variability of the glenohumeral ligaments or coracoid ligament, are presented. Basic pathological conditions are described in detail, e. g. instability particularly problems in differentiating the various subtypes of labral pathology. Rotator cuff diseases are elucidated with emphasis on some rarer entities such as subscapularis calcifying tendinitis, coracoid impingement, chronic bursitis producing the double-line sign, prominent coraco-acromial ligament and the impingement due to an inflamed os acromiale. (orig.)

Limited capsular release and controlled manipulation under anaesthesia for the treatment of frozen shoulder.

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Bidwai, Amit S; Mayne, Alistair Iw; Nielsen, Maryke; Brownson, Peter

2016-01-01

In light of recent interest in the cost-effectiveness of the treatment options available for frozen shoulder, we aimed to determine the results of limited anterior capsular release and controlled manipulation under anaesthesia (MUA) in the treatment of primary frozen shoulder in terms of patient-related outcomes measure, range of motion and re-intervention rates. This single-surgeon series included prospectively collected data on all patients undergoing capsular release with MUA from March 2011 until June 2013, with a minimum follow-up of 6 months from the index procedure. Outcome measures included pre- and postoperative Oxford Shoulder Score (OSS), range of motion and need for re-intervention. Fifty-four procedures were performed in 52 patients. Mean age 50 years (range 42 years to 59 years); male: female ratio = 11: 41. There was a highly statistically significant improvement in both pain and function modules of the OSS (p patients were diabetics. There was no significant difference in pre-operative and postoperative OSS or range of motion between the diabetic group and the non-diabetic groups. No patients required surgical re-intervention. A combination of limited capsular release and MUA for the treatment of primary frozen shoulder is a safe and effective procedure resulting in marked improvement in pain, function and range of motion.

Prevalence and Impact of Glenoid Augmentation in American Football Athletes Participating in the National Football League Scouting Combine

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Knapik, Derrick M.; Gillespie, Robert J.; Salata, Michael J.; Voos, James E.

2017-01-01

Background: Bony augmentation of the anterior glenoid is used in athletes with recurrent shoulder instability and bone loss; however, the prevalence and impact of repair in elite American football athletes are unknown. Purpose: To evaluate the prevalence and impact of glenoid augmentation in athletes invited to the National Football League (NFL) Scouting Combine from 2012 to 2015. Study Design: Case series; Level of evidence, 4. Methods: A total of 1311 athletes invited to the NFL Combine from 2012 to 2015 were evaluated for history of either Bristow or Latarjet surgery for recurrent anterior shoulder instability. Athlete demographics, surgical history, imaging, and physical examination results were recorded using the NFL Combine database. Prospective participation data with regard to draft status, games played, games started, and status after the athletes’ first season in the NFL were gathered using publicly available databases. Results: Surgical repair was performed on 10 shoulders in 10 athletes (0.76%), with the highest prevalence in defensive backs (30%; n = 3). Deficits in shoulder motion were exhibited in 70% (n = 7) of athletes, while 40% (n = 4) had evidence of mild glenohumeral arthritis and 80% demonstrated imaging findings consistent with a prior instability episode (8 labral tears, 2 Hill-Sachs lesions). Prospectively, 40% (n = 4) of athletes were drafted into the NFL. In the first season after the combine, athletes with a history of glenoid augmentation were not found to be at significant risk for diminished participation with regard to games played or started when compared with athletes with no history of glenoid augmentation or athletes undergoing isolated shoulder soft tissue repair. After the conclusion of the first NFL season, 60% (n = 6 athletes) were on an active NFL roster. Conclusion: Despite being drafted at a lower rate than their peers, there were no significant limitations in NFL participation for athletes with a history of glenoid

Prevalence and Impact of Glenoid Augmentation in American Football Athletes Participating in the National Football League Scouting Combine.

Science.gov (United States)

Knapik, Derrick M; Gillespie, Robert J; Salata, Michael J; Voos, James E

2017-08-01

Bony augmentation of the anterior glenoid is used in athletes with recurrent shoulder instability and bone loss; however, the prevalence and impact of repair in elite American football athletes are unknown. To evaluate the prevalence and impact of glenoid augmentation in athletes invited to the National Football League (NFL) Scouting Combine from 2012 to 2015. Case series; Level of evidence, 4. A total of 1311 athletes invited to the NFL Combine from 2012 to 2015 were evaluated for history of either Bristow or Latarjet surgery for recurrent anterior shoulder instability. Athlete demographics, surgical history, imaging, and physical examination results were recorded using the NFL Combine database. Prospective participation data with regard to draft status, games played, games started, and status after the athletes' first season in the NFL were gathered using publicly available databases. Surgical repair was performed on 10 shoulders in 10 athletes (0.76%), with the highest prevalence in defensive backs (30%; n = 3). Deficits in shoulder motion were exhibited in 70% (n = 7) of athletes, while 40% (n = 4) had evidence of mild glenohumeral arthritis and 80% demonstrated imaging findings consistent with a prior instability episode (8 labral tears, 2 Hill-Sachs lesions). Prospectively, 40% (n = 4) of athletes were drafted into the NFL. In the first season after the combine, athletes with a history of glenoid augmentation were not found to be at significant risk for diminished participation with regard to games played or started when compared with athletes with no history of glenoid augmentation or athletes undergoing isolated shoulder soft tissue repair. After the conclusion of the first NFL season, 60% (n = 6 athletes) were on an active NFL roster. Despite being drafted at a lower rate than their peers, there were no significant limitations in NFL participation for athletes with a history of glenoid augmentation when compared with athletes without a history of shoulder

[Imaging evaluation on adaptability of proximal humeral anatomy after shoulder replacement with individualized shoulder prosthesis].

Science.gov (United States)

Shi, Youxing; Tang, Kanglai; Yuan, Chengsong; Tao, Xu; Wang, Huaqing; Chen, Bo; Guo, Yupeng

2015-03-24

Modern shoulder prosthesis has evolved through four generations. And the fourth generation technology has a core three-dimensional design of restoring 3D reconstruction of proximal humeral anatomy. Thus a new shoulder prosthesis is developed on the basis of the technology of 3D prosthesis. Assessment of whether shoulder prosthesis can restore individualized reconstruction of proximal humeral anatomy is based on the adaptability of proximal humeral anatomy. To evaluate the adaptability of proximal humeral anatomy through measuring the parameters of proximal humeral anatomy after shoulder replacement with individualized shoulder prosthesis and compare with normal data. The parameters of proximal humeral anatomy were analyzed and evaluated for a total of 12 cases undergoing shoulder replacement with individualized shoulder prosthesis. The relevant anatomical parameters included neck-shaft angle (NSA), retroversion angle (RA), humeral head height (HH) and humeral head diameter (HD). And the anatomical parameters were compared with the data from normal side. All underwent shoulder replacement with individualized shoulder prosthesis. The postoperative parameters of proximal humeral anatomy were compared with those of normal side. And the difference of NSA was 0.05). Individualized shoulder prosthesis has excellent adaptability to shoulder. All core parameters are freely adjustable and specification models may be optimized. With matching tools, individualized shoulder prosthesis improves the accuracy and reliability in shoulder replacement.

Measurements of three-dimensional glenoid erosion when planning the prosthetic replacement of osteoarthritic shoulders.

Science.gov (United States)

Terrier, A; Ston, J; Larrea, X; Farron, A

2014-04-01

The three-dimensional (3D) correction of glenoid erosion is critical to the long-term success of total shoulder replacement (TSR). In order to characterise the 3D morphology of eroded glenoid surfaces, we looked for a set of morphological parameters useful for TSR planning. We defined a scapular coordinates system based on non-eroded bony landmarks. The maximum glenoid version was measured and specified in 3D by its orientation angle. Medialisation was considered relative to the spino-glenoid notch. We analysed regular CT scans of 19 normal (N) and 86 osteoarthritic (OA) scapulae. When the maximum version of OA shoulders was higher than 10°, the orientation was not only posterior, but extended in postero-superior (35%), postero-inferior (6%) and anterior sectors (4%). The medialisation of the glenoid was higher in OA than normal shoulders. The orientation angle of maximum version appeared as a critical parameter to specify the glenoid shape in 3D. It will be very useful in planning the best position for the glenoid in TSR.

Quantification of the Exposure of the Glenohumeral Joint from the Minimally Invasive to More Invasive Subscapularis Approach to the Anterior Shoulder: a Cadaveric Study

Science.gov (United States)

2014-06-01

fractures to the glenoid or proximal humerus, shoulder resurfacing, total shoulder arthroplasty, and soft tissue repair around the shoulder, including...the labrum, rotator cuff, and cartilaginous surfaces of the glenohumeral joint.13,21 A surgical approach should have the parallel goals of providing...adequate exposure for safe performance of the desired procedure, allow for minimal disruption of soft tissue attachments to the region of interest, and

Kinematic analysis of dynamic shoulder motion in patients with reverse total shoulder arthroplasty.

Science.gov (United States)

Kwon, Young W; Pinto, Vivek J; Yoon, Jangwhon; Frankle, Mark A; Dunning, Page E; Sheikhzadeh, Ali

2012-09-01

Reverse total shoulder arthroplasty (rTSA) has been used to treat patients with irreparable rotator cuff dysfunction. Despite the proven clinical efficacy, there is minimal information regarding the underlying changes to the shoulder kinematics associated with this construct. Therefore, we sought to examine the kinematics of dynamic shoulder motion in patients with well-functioning rTSA. We tested 12 healthy subjects and 17 patients with rTSA. All rTSA patients were able to elevate their arms to at least 90° and received the implant as the primary arthroplasty at least 6 months before testing. On average, the rTSA patients elevated their arms to 112° ± 12° (mean ± SD) and reported an American Shoulder and Elbow Surgeons outcome score of 90.6 ± 6.3. A 3-dimensional electromagnetic motion capture device was used to detect the dynamic motion of the trunk, scapula, and humerus during bilateral active shoulder elevation along the sagittal, scapular, and coronal planes. In both healthy and rTSA shoulders, the majority of the humeral-thoracic motion was provided by the glenohumeral motion. Therefore, the ratio of glenohumeral to scapulothoracic (ST) motion was always greater than 1.62 during elevation along the scapular plane. In comparison to healthy subjects, however, the contribution of ST motion to overall shoulder motion was significantly increased in the rTSA shoulders. This increased contribution was noted in all planes of shoulder elevation and was maintained when weights were attached to the arm. Kinematics of the rTSA shoulders are significantly altered, and more ST motion is used to achieve shoulder elevation. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Assessment of shoulder position variation and its impact on IMRT and VMAT doses for head and neck cancer

Directory of Open Access Journals (Sweden)

Neubauer Emily

2012-02-01

Full Text Available Abstract Background For radiotherapy of the head and neck, 5-point mask immobilization is used to stabilize the shoulders. Still, the daily position of the shoulders during treatment may be different from the position in the treatment plan despite correct isocenter setup. The purpose of this study was to determine the interfractional displacement of the shoulders relative to isocenter over the course of treatment and the associated dosimetric effect of this displacement. Methods The extent of shoulder displacements relative to isocenter was assessed for 10 patients in 5-point thermoplastic masks using image registration and daily CT-on-rails scans. Dosimetric effects on IMRT and VMAT plans were evaluated in Pinnacle based on simulation CTs modified to represent shoulder shifts between 3 and 15 mm in the superior-inferior, anterior-posterior, and right-left directions. The impact of clinically observed shoulder shifts on the low-neck dose distributions was examined. Results Shoulder motion was 2-5 mm in each direction on average but reached 20 mm. Superior shifts resulted in coverage loss, whereas inferior shifts increased the dose to the brachial plexus. These findings were generally consistent for both IMRT and VMAT plans. Over a course of observed shifts, the dose to 99% of the CTV decreased by up to 101 cGy, and the brachial plexus dose increased by up to 72 cGy. Conclusions he position of the shoulder affects target coverage and critical structure dose, and may therefore be a concern during the setup of head and neck patients, particularly those with low neck primary disease.

Agreement between patient self-assessment and physician assessment of shoulder range of motion.

Science.gov (United States)

Uribe, Bastian; El Bitar, Youssef; Wolf, Brian R; Bollier, Matthew; Kuhn, John E; Hettrich, Carolyn M

2016-10-01

Shoulder outcome scores that include range of motion (ROM) and apprehension signs are limited by the need for direct involvement of the physician. Patient-reported outcome measures are patient centered and self-administered, and they can help physicians track the patient's progress between office visits and for long-term follow-up once the patient has been discharged. Thirty consecutive patients completed a form before their 6-month follow-up after surgery on the labrum or capsule as a result of instability or pain related to instability. The form included bilateral ROM, apprehension, and instability episodes. The same parameters were measured by the physician during the visit. The patient's and physician's responses were compared. The primary outcome was the percentage agreement with exact and approximate agreement. Exact agreement was moderate for forward elevation at 56.6%; fair for abduction and external rotation at 90° at 24.5% and 34%, respectively; and poor for internal rotation at 90° and external rotation with the arm at the side at 2.6% and 12%, respectively. Approximate agreement within a range of positive or negative 20° range was very good for forward elevation (94%), abduction (92%), and external rotation at 90° (87%); moderate for external rotation with the arm at the side; and fair for internal rotation at 90°. There was 70% agreement regarding apprehension, 93% regarding subluxation events, and 100% regarding redislocation events. Some measures of shoulder ROM showed a moderate to high level of agreement between patient-reported measurements and the physician's measurements. This method for short- and long-term follow-up could potentially replace routine clinic visits. Copyright © 2016. Published by Elsevier Inc.

Chronic ankle instability: evaluation with stress radiography, CT and CT arthrography

International Nuclear Information System (INIS)

Faure, Ch.; Deplus, F.; Bochu, M.; Besse, J.L.; Moyen, B.

1997-01-01

We retrospectively evaluated the anterior talo-fibular ligament and the tarsal sinus of 17 patients who had complained of chronic ankle external instability. This study based on both surgery and CT-arthrography findings shows the pathologic or normal aspects of the talo-fibular anterior ligament (normal, lax, fibrosis residue, ruptured). It confirms the good anatomic analysis of the tarsal sinus, i particular the anterior talo-calcaneal interosseous ligament and the search for fibrosis. We underline that capsular distension due to subtalar laxity is not detected with medical imaging. Compared with surgery (all patients), CT arthrography demonstrated the different aspects of the anterior talo fibular ligament injuries (normal, lax, discontinuous). (authors)

Non-contrast MR imaging of the glenohumeral joint. Part II. Glenohumeral instability and labrum tears

International Nuclear Information System (INIS)

Rafii, Mahvash

2004-01-01

MR imaging of the shoulder without contrast is frequently used for evaluation of glenohumeral instability in spite of the popularity of MR arthrography. With proper imaging technique, familiarity with normal anatomy and variants as well as knowledge of the expected pathologic findings high diagnostic accuracy may be achieved. (orig.)

Non-contrast MR imaging of the glenohumeral joint. Part II. Glenohumeral instability and labrum tears

Energy Technology Data Exchange (ETDEWEB)

Rafii, Mahvash [NYU School of Medicine, NYU Medical Center, Department of Radiology, New York (United States)

2004-11-01

MR imaging of the shoulder without contrast is frequently used for evaluation of glenohumeral instability in spite of the popularity of MR arthrography. With proper imaging technique, familiarity with normal anatomy and variants as well as knowledge of the expected pathologic findings high diagnostic accuracy may be achieved. (orig.)

Anaesthetic management of shoulder arthroscopic repair in Parkinson′s disease with deep brain stimulator

Directory of Open Access Journals (Sweden)

Ranju Gandhi

2014-01-01

Full Text Available We describe the anaesthetic management of arthroscopic repair for complete rotator cuff tear of shoulder in a 59-year-old female with Parkinson′s disease (PD with deep brain stimulator (DBS using a combination of general anaesthesia with interscalene approach to brachial plexus block. The DBS consists of implanted electrodes in the brain connected to the implantable pulse generator (IPG normally placed in the anterior chest wall subcutaneously. It can be programmed externally from a hand-held device placed directly over the battery stimulator unit. In our patient, IPG with its leads was located in close vicinity of the operative site with potential for DBS malfunction. Implications of DBS in a patient with PD for shoulder arthroscopy for anaesthesiologist are discussed along with a brief review of DBS.

Shoulder reflexes

DEFF Research Database (Denmark)

Diederichsen, Louise; Krogsgaard, Michael; Voigt, Michael

2002-01-01

Dynamic shoulder stability is dependent on muscular coordination and sensory inputs. In the shoulder, mechanoreceptors are found in the coracoacromial ligament, the rotator cuff tendons, the musculotendinous junctions of the rotator cuff and in the capsule. The number of receptors in the capsule...

Using your shoulder after surgery

Science.gov (United States)

Shoulder surgery - using your shoulder; Shoulder surgery - after ... rotator cuff surgery or other ligament or labral surgery, you need to be careful with your shoulder. Ask the surgeon what arm movements are safe ...

Pregnancy Complications: Shoulder Dystocia

Science.gov (United States)

... Home > Complications & Loss > Pregnancy complications > Shoulder dystocia Shoulder dystocia Now playing: E-mail to a friend Please ... women more likely than others to have shoulder dystocia? A pregnant woman may be at risk for ...

Complicações decorrentes do uso de âncoras metálicas em artroscopias de ombro Complications resulting from the use of metal anchors in shoulder arthroscopy

Directory of Open Access Journals (Sweden)

Glaydson Gomes Godinho

2009-04-01

Full Text Available OBJETIVO: Identificar as complicações referentes ao uso de âncoras metálicas nos procedimentos artroscópicos do ombro. MÉTODOS: No período de dezembro de 1997 a agosto de 2007, 28 ombros de 28 pacientes (23 do sexo masculino e cinco do feminino foram reoperados nos Hospitais Ortopédico, Belo Horizonte e da Polícia Militar, em Belo Horizonte, MG, devido a complicações como soltura de âncoras e âncoras proeminentes. As cirurgias primárias tiveram como objetivo tratar 20 instabilidades anteriores traumáticas (71,5%, uma instabilidade posterior (3,5%, uma lesão slap (3,5% e seis lesões do manguito rotador (21,5%. Foram utilizadas a classificação radiográfica de Samilson e Prieto e a artroscópica de Outerbridge na avaliação do grau de artrose dos pacientes. Na avaliação dos pacientes foram usados os critérios do índice da UCLA (University of Califórnia at Los Angeles. RESULTADOS: Em todos os pacientes tratava-se de revisões artroscópicas. Em dois casos, após a retirada das âncoras havia sinais clínicos de instabilidade, optando-se, então, pela estabilização aberta pela técnica de Latarjet-Patte. CONCLUSÕES: As complicações com âncoras de sutura metálicas são decorrentes do emprego inadequado da técnica cirúrgica em artroscopia.OBJECTIVES: to identify the complications concerning the use of metal anchors in shoulder arthroscopic procedures. METHODS: 28 shoulders of 28 patients (23 male and 5 female have been re-operated in the period between December 1997 and August 2007, at Hospital Ortopédico, Belo Horizonte Hospital and Military Police Hospital in Belo Horizonte, MG, as a result of complications such as loose anchors and prominent anchors. The primary surgeries intended to treat 20 anterior traumatic instabilities (71.5%, one posterior instability (3.5%, one slap injury (3.5%, six procedures for treating injuries on the rotator cuff (21.5%. We used the X-ray classification suggested by Samilson and

Upper Extremity Injured Workers Stratified by Current Work Status: An Examination of Health Characteristics, Work Limitations and Work Instability

Directory of Open Access Journals (Sweden)

D Pichora

2010-06-01

Full Text Available Background: Upper extremity injured workers are an under-studied population. A descriptive comparison of workers with shoulder, elbow and hand injuries reporting to a Canadian Workplace Safety and Insurance Board (WSIB clinic was undertaken. Objective: To determine if differences existed between injury groups stratified by current work status. Methods: All WSIB claimants reporting to our upper extremity clinic between 2003 and 2008 were approached to participate in this descriptive study. 314 working and 146 non-working WSIB claimants completed the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH; Short Form health survey (SF36; Worker’s Limitations Questionnaire and the Work Instability Scale. Various parametric and non-parametric analyses were used to assess significant differences between groups on demographic, work and health related variables. Results: Hand, followed by the shoulder and elbow were the most common site of injury. Most non-workers listed their current injury as the reason for being off work, and attempted to return to work once since their injury occurrence. Non-workers and a subset of workers at high risk for work loss showed significantly worse mental functioning. Workers identified physical demands as the most frequent injury-related on the job limitation. 60% of current workers were listed as low risk for work loss on the Work Instability Scale. Conclusions: Poorer mental functioning, being female and sustaining a shoulder injury were risk factors for work instability. Our cohort of injured non-workers were unable to return to work due to their current injury, reinforcing the need to advocate for modified duties, shorter hours and a work environment where stress and injury recurrence is reduced. Future studies examining pre-injury depression as a risk factor for prolonged work absences are warranted.

Low-field MR arthrography of the shoulder joint: technique, indications, and clinical results

International Nuclear Information System (INIS)

Kreitner, K.-F.; Thelen, M.; Loew, R.; Runkel, M.; Zoellner, J.

2003-01-01

In the age of cost containment and urgent reductions in health care expenditures, new options have to be explored to satisfy both diagnostic requirements and economic limitations. The introduction of low-field MR systems for assessment of joint disorders seemed to be an option for lower costs. The purpose of this article is to summarize available experiences with low-field MR arthrography of the glenohumeral joint with respect to image quality and diagnostic accuracy in detecting labral and rotator cuff lesions. Up to now, there has been only a limited number of studies available dealing with low-field MR arthrography of the glenohumeral joint. They reveal that, despite a minor image quality in comparison with high-field imaging, low-field MR arthrography of the shoulder allows for sufficient evaluation of intra- and extra-articular structures in the detection of major abnormalities such as glenohumeral instability or rotator cuff disease. Furthermore, open-configured MR scanners enable kinematic studies: Besides the analysis of normal motion, pathological findings in patients with instabilities and impingement syndrome can be delineated. They further offer the possibility for performing MR imaging-guided arthrography of the shoulder. This was first described using an open C-arm scanner with a vertically oriented magnetic field so that MR arthrography may be performed in one setting. (orig.)

AN ELECTROMYOGRAPHIC ANALYSIS OF THE SHOULDER COMPLEX MUSCULATURE WHILE PERFORMING EXERCISES USING THE BODYBLADE® CLASSIC AND BODYBLADE® PRO.

Science.gov (United States)

Escamilla, Rafael F; Yamashiro, Kyle; Dunning, Russell; Mikla, Tony; Grover, Matthew; Kenniston, Mike; Loera, Jesse; Tanasse, Travis; Andrews, James R

2016-04-01

In spite of the bodyblade (BB®) being used in clinical settings during shoulder and trunk rehabilitation and training for 24 years, there are only five known scientific papers that have described muscle recruitment patterns using the BB®. Moreover, there are no known studies that have examined muscle activity differences between males and females (who both use the bodyblade in the clinic) or between different BB® devices. The primary purposes of this investigation were to compare glenohumeral and scapular muscle activity between the Bodyblade® Pro (BB®P) and Bodyblade® Classic (BB®C) devices while performing a variety of exercises, as well as to compare muscle activity between males and females. It was hypothesized that glenohumeral and scapular muscle activity would be significantly greater in females compared to males, significantly greater while performing exercises with the BB®P compared to the BB®C, significantly different among various BB® exercises, and greater with two hand use compared to one hand use for the same exercise. Controlled laboratory study using a repeated-measures, counterbalanced design. Twenty young adults, 10 males and 10 females, performed seven BB® exercises using the BB®C and BB®P, which are: 1) BB®1 - one hand, up and down motion, arm at side; 2) BB®2 - one hand, front to back motion, shoulder flexed 90 °; 3) BB®3 - one hand, up and down motion, shoulder abducted 90 °; 4) BB®4 - one hand, side to side motion, shoulder and elbow flexed 45 °; 5) BB®5 - two hands, side to side motion, shoulders and elbows flexed 45 °; 6) BB®6 - two hands, up and down motion, shoulders flexed 90 °; and 7) BB®7 - two hands, front to back motion, shoulders flexed 90 °. EMG data were collected from anterior and posterior deltoids, sternal pectoralis major, latissimus dorsi, infraspinatus, upper and lower trapezius, and serratus anterior during 10 sec of continuous motion for each exercise, and then normalized using maximum

Success of torsional correction surgery after failed surgeries for patellofemoral pain and instability.

Science.gov (United States)

Stevens, Peter M; Gililland, Jeremy M; Anderson, Lucas A; Mickelson, Jennifer B; Nielson, Jenifer; Klatt, Joshua W

2014-04-01

Torsional deformities of the femur and/or tibia often go unrecognized in adolescents and adults who present with anterior knee pain, and patellar maltracking or instability. While open and arthroscopic surgical techniques have evolved to address these problems, unrecognized torsion may compromise the outcomes of these procedures. We collected a group of 16 consecutive patients (23 knees), with mean age of 17, who had undergone knee surgery before torsion was recognized and subsequently treated by means of rotational osteotomy of the tibia and/or femur. By follow-up questionnaire, we sought to determine the role of rotational correction at mean 59-month follow-up. We reasoned that, by correcting torsional alignment, we might be able to optimize long-term outcomes and avert repeated knee surgery. Knee pain was significantly improved after torsional treatment (mean 8.6 pre-op vs. 3.3 post-op, p instability, and 57 % could trust their knee after surgery. Activity level remained the same or increased in 78 % of patients after torsional treatment. Excluding planned rod removal, subsequent knee surgery for continued anterior knee pain was undertaken on only 3 knees in 2 patients. We believe that malrotation of the lower limb not only raises the propensity for anterior knee symptoms, but is also a under-recognized etiology in the failure of surgeries for anterior knee pain and patellar instability. Addressing rotational abnormalities in the index surgery yields better clinical outcomes than osteotomies performed after other prior knee surgeries.

Painful shoulder

Directory of Open Access Journals (Sweden)

Benno Ejnismann

2008-03-01

Full Text Available Many factors can be involved in the painful shoulder. Beyond articularcauses other pathologies such as artrosis, periarticular diseases as rotadorcuff tears, long head of the biceps tendinitis, adhesive capsulitis, calcifyingtendinitis, degenerative arthritis of the acromioclavicular joint, cervicalradiculopathy and nervous injuries can cause pain in the shoulder.

Outcomes of an anatomic total shoulder arthroplasty with a contralateral reverse total shoulder arthroplasty.

Science.gov (United States)

Cox, Ryan M; Padegimas, Eric M; Abboud, Joseph A; Getz, Charles L; Lazarus, Mark D; Ramsey, Matthew L; Williams, Gerald R; Horneff, John G

2018-06-01

It is common for patients to require staged bilateral shoulder arthroplasties. There is a unique cohort of patients who require an anatomic total shoulder arthroplasty (TSA) and a contralateral reverse shoulder arthroplasty (RSA). This study compared the outcomes of patients with a TSA in 1 shoulder and an RSA in the contralateral shoulder. Our institutional database was queried to identify all patients with a TSA and a contralateral RSA. Data collection included patient demographics, preoperative and latest follow-up shoulder range of motion, radiographic analysis, and postoperative complications. Identified patients were assessed at follow-up visits or contacted by phone for functional outcome scores. Nineteen patients met our inclusion/exclusion criteria. There was statistically significant greater internal rotation in the TSA shoulder (P= .044) but no significant difference in forward elevation (P = .573) or external rotation (P= .368). There was no radiographic evidence of humeral or glenoid component loosening of any arthroplasty implants. There were no significant differences between TSA and RSA shoulders for the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (P= .381), Simple Shoulder Test (P = .352), Single Assessment Numerical Evaluation (P = .709), and visual analog scale satisfaction (P= .448) or pain scores (P= .305). Thirteen patients (68.4%) preferred the RSA side, 1 patient (5.3%; z = 4.04, P < .001) patient preferred the TSA side, and 5 patients expressed no preference. Despite known limitations and differences between TSA and RSA designs, patients who have received both implants are highly satisfied with both. The only parameter in which the TSA had superior outcomes was internal rotation. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Evidence-based rehabilitation of athletes with glenohumeral instability.

Science.gov (United States)

Cools, Ann M; Borms, Dorien; Castelein, Birgit; Vanderstukken, Fran; Johansson, Fredrik R

2016-02-01

To give an overview of current knowledge and guidelines with respect to evidence-based rehabilitation of athletes with glenohumeral instability. This narrative review combines scientific evidence with clinical guidelines based on the current literature to highlight the different components of the rehabilitation of glenohumeral instability. Depending on the specific characteristics of the instability pattern, the severity, recurrence, and direction, the therapeutic approach may be adapted to the needs and demands of the athlete. In general, attention should go to (1) restoration of rotator cuff strength and inter-muscular balance, focusing on the eccentric capacity of the external rotators, (2) normalization of rotational range of motion with special attention to the internal rotation ROM, (3) optimization of the flexibility and muscle performance of the scapular muscles, and (4) gradually increasing the functional sport-specific load on the shoulder girdle. The functional kinetic chain should be implemented throughout all stages of the rehabilitation program. Return to play should be based on subjective assessment as well as objective measurements of ROM, strength, and function. This paper summarizes evidence-based guidelines for treatment of glenohumeral instability. These guidelines may assist the clinician in the prevention and rehabilitation of the overhead athlete. Expert opinion, Level V.

Biomechanical reposition techniques in anterior shoulder dislocation: a randomised multicentre clinical trial- the BRASD-trial protocol.

Science.gov (United States)

Baden, David N; Roetman, Martijn H; Boeije, Tom; Roodheuvel, Floris; Mullaart-Jansen, Nieke; Peeters, Suzanne; Burg, Mike D

2017-07-20

Glenohumeral (shoulder) dislocations are the most common large joint dislocations seen in the emergency department (ED). They cause pain, often severe, and require timely interventions to minimise discomfort and tissue damage. Commonly used reposition or relocation techniques often involve traction and/or leverage. These techniques have high success rates but may be painful and time consuming. They may also cause complications. Recently, other techniques-the biomechanical reposition techniques (BRTs)-have become more popular since they may cause less pain, require less time and cause fewer complications. To our knowledge, no research exists comparing the various BRTs. Our objective is to establish which BRT or BRT combination is fastest, least painful and associated with the lowest complication rate for adult ED patients with anterior glenohumeral dislocations (AGDs). Adults presenting to the participating EDs with isolated AGDs, as determined by radiographs, will be randomised to one of three BRTs: Cunningham, modified Milch or scapular manipulation. Main study parameters/endpoints are ED length of stay and patients' self-report of pain. Secondary study parameters/endpoints are procedure times, need for analgesic and/or sedative medications, iatrogenic complications and rates of successful reduction. Non-biomechanical AGD repositioning techniques based on traction and/or leverage are inherently painful and potentially harmful. We believe that the three BRTs used in this study are more physiological, more patient friendly, less likely to cause pain, more time efficient and less likely to produce complications. By comparing these three techniques, we hope to improve the care provided to adults with acute AGDs by reducing their ED length of stay and minimising pain and procedure-related complications. We also hope to define which of the three BRTs is quickest, most likely to be successful and least likely to require sedative or analgesic medications to achieve

Kinematics of the contralateral and ipsilateral shoulder: A possible relationship with post-stroke shoulder pain

NARCIS (Netherlands)

Niessen, M.H.M.; Janssen, T.W.J.; Meskers, C.G.M.; Koppe, P.; Konijnenbelt, M.; Veeger, H.E.J.

2008-01-01

Objective: Post-stroke shoulder pain is a common phenomenon in hemiplegia and impedes rehabilitation. The aim of this study was to identify a possible relationship between post-stroke shoulder pain, scapula resting position and shoulder motion. Methods: Shoulder kinematics of 27 patients after

Shoulder Problems in Athletes.

Science.gov (United States)

Clancy, William G., Jr.

A description is given of typical sport-related injuries to the shoulder area. These include: (1) brachial plexus injuries; (2) peripheral nerve injuries about the shoulder; (3) acromioclavicular injuries; (4) sternoclavicular injuries; (5) shoulder dislocations; (6) recurrent traumatic subluxation/dislocations; and (7) overuse injuries.…

Mid-term shoulder functional and quality of life outcomes after shoulder replacement in obese patients

OpenAIRE

Vincent, Heather K.; Struk, Aimee M.; Reed, Austin; Wright, Thomas W.

2016-01-01

Background Shoulder pain and loss of function are directly associated with obesity. Questions/purposes We hypothesized that significant interactions would exist between total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) and obesity status on functional and quality of life (QOL) outcomes over the long term. Clinical and QOL outcomes (American Shoulder and Elbow Surgeons Evaluation form, Shoulder Pain and Disability Index, University of California at Los Angeles Sho...

Risk of shoulder tendinitis in relation to shoulder loads in monotonous repetitive work

DEFF Research Database (Denmark)

Frost, P.; Bonde, J. P.; Mikkelsen, S.

2002-01-01

BACKGROUND: Few studies relate the occurrence of shoulder disorders to quantified ergonomic exposures. This study evaluates the hypothesis that shoulder loads in repetitive work might contribute to the occurrence of shoulder tendinitis. METHODS: This is a cross-sectional study of 1961 workers...

Anterior versus posterior, and rim-rent rotator cuff tears: prevalence and MR sensitivity

Energy Technology Data Exchange (ETDEWEB)

Tuite, M J; Turnbull, J R; Orwin, J F [Wisconsin Univ., Madison, WI (United States). Dept. of Radiology

1998-05-01

Purpose. To determine the relative distribution of the locations of rotator cuff tears, and the sensitivity of anterior versus posterior tears on MR images. Patients and methods. We identified 110 consecutive patients who had a shoulder MR and either a partial-thickness or a small full-thickness rotator cuff tear diagnosed at arthroscopy. From the arthroscopy videotapes, we classified the tears as centered in the anterior or posterior half of the cuff, and as either in the critical zone or adjacent to the bony insertion. The original MR interpretation was compared with the arthroscopic findings. MR sensitivity and patient age were compared between patients with tears in the anterior and posterior halves of the cuff. In addition, in patients with partial tears less than 2 cm in diameter, an age comparison between those with tears in the critical zone and those with articular surface tears adjacent to the bony insertion (rim-rent tear) was performed. Results. The tear was centered in the anterior half of the rotator cuff in 79% of the patients younger than 36 years old, and in 89% of the patients 36 years old and over. The average age of the patients with tears in the anterior half (44 years) was not significantly different from the average age of those with posterior tears (40 years)(P=0.23). The sensitivity of MR for anterior tears was 0.69, and for posterior tears it was 0.56 (P=0.17). The average age of the 9 patients with rim-rent tears was 31 years, while that of the 28 patients with similarly-sized partial tears not involving the insertion was 40 years old (P=0.048). Five of the nine rim-rent tears (0.56) were interpreted correctly on the original MR report; two of the other tears were misinterpreted as intratendinous fluid but were diagnosable in retrospect. Conclusion. Even in patients less than 36 years old, most partial and small full-thickness rotator cuff tears are centered in the anterior half of the supraspinatus. Although our figure for MR sensitivity

Complications of shoulder dystocia.

Science.gov (United States)

Dajani, Nafisa K; Magann, Everett F

2014-06-01

Complications of shoulder dystocia are divided into fetal and maternal. Fetal brachial plexus injury (BPI) is the most common fetal complication occurring in 4-40% of cases. BPI has also been reported in abdominal deliveries and in deliveries not complicated by shoulder dystocia. Fractures of the fetal humerus and clavicle occur in about 10.6% of cases of shoulder dystocia and usually heal with no sequel. Hypoxic ischemic brain injury is reported in 0.5-23% of cases of shoulder dystocia. The risk correlates with the duration of head-to-body delivery and is especially increased when the duration is >5 min. Fetal death is rare and is reported in 0.4% of cases. Maternal complications of shoulder dystocia include post-partum hemorrhage, vaginal lacerations, anal tears, and uterine rupture. The psychological stress impact of shoulder dystocia is under-recognized and deserves counseling prior to home discharge. Copyright © 2014 Elsevier Inc. All rights reserved.

Measurement of shoulder motion fraction and motion ratio

International Nuclear Information System (INIS)

Kang, Yeong Han

2006-01-01

This study was to understand about the measurement of shoulder motion fraction and motion ratio. We proposed the radiological criterior of glenohumeral and scapulothoracic movement ratio. We measured the motion fraction of the glenohumeral and scapulothoracic movement using CR (computed radiological system) of arm elevation at neutral, 90 degree, full elevation. Central ray was 15 .deg., 19 .deg., 22 .deg. to the cephald for the parallel scapular spine, and the tilting of torso was external oblique 40 .deg., 36 .deg., 22 .deg. for perpendicular to glenohumeral surface. Healthful donor of 100 was divided 5 groups by age (20, 30, 40, 50, 60). The angle of glenohumeral motion and scapulothoracic motion could be taken from gross arm angle and radiological arm angle. We acquired 3 images at neutral, 90 .deg. and full elevation position and measured radiographic angle of glenoheumeral, scapulothoracic movement respectively. While the arm elevation was 90 .deg., the shoulder motion fraction was 1.22 (M), 1.70 (W) in right arm and 1.31, 1.54 in left. In full elevation, Right arm fraction was 1.63, 1.84 and left was 1.57, 1.32. In right dominant arm (78%), 90 .deg. and Full motion fraction was 1.58, 1.43, in left (22%) 1.82, 1.94. In generation 20, 90 .deg. and Full motion fraction was 1.56, 1.52, 30' was 1.82, 1.43, 40' was 1.23, 1.16, 50' was 1.80, 1.28,60' was 1.24, 1.75. There was not significantly by gender, dominant arm and age. The criteria of motion fraction was useful reference for clinical diagnosis the shoulder instability

Comparison of the critical shoulder angle in radiographs and computed tomography

Energy Technology Data Exchange (ETDEWEB)

Bouaicha, Samy [University of British Columbia, Divison of Arthroscopic, Reconstructive Surgery and Joint Preservation, Department of Orthopaedics, Vancouver (Canada); Zurich University Hospital, Division of Trauma, Zurich (Switzerland); Ehrmann, Christine [University of British Columbia, Department of Radiology, Vancouver (Canada); Slankamenac, Ksenija [Zurich University Hospital, Division of Trauma, Zurich (Switzerland); Regan, William D. [University of British Columbia, Divison of Arthroscopic, Reconstructive Surgery and Joint Preservation, Department of Orthopaedics, Vancouver (Canada); Moor, Beat K. [Insel University Hospital, Department of Orthopaedics, Berne (Switzerland)

2014-08-15

The critical shoulder angle (CSA) is an indicator of degenerative shoulder pathologies. CSAs above 35 are associated with degenerative rotator cuff disease, whereas values below 30 are common in osteoarthritis of the glenohumeral joint. Measurements are usually performed on radiographs; however, no data have been reported regarding the reliability of CT scan measurements between different readers or the reproducibility of measurements from radiographs to CT scans. The purpose of our study was to clarify whether CSA measurements on radiographs and CT scans of the same patients show similar values. CSA measurements of 60 shoulders (59 patients) were performed on radiographs and multiplanar reconstructions of corresponding CT scans. Inter-reader reliability and inter-method correlation were calculated. The mean discrepancy between readers was only 0.2 (SD ±1.0 ) on radiographs. CT scan measurements showed a mean discrepancy of 0.3 (SD ±1.2 ). The inter-reader reliability was 0.993 for radiographs and 0.989 for CT scans. There was a very strong inter-method correlation between the CSA measured on radiographs and CT scans (Spearman's rho = 0.974). The mean differences between angles on radiographs and CT measurements were -0.05 (SD ±1.2 ) and 0.1 (SD ±1.2 ), respectively. Measurements of the CSA on anterior-posterior radiographs and CT scans are highly correlated, and inter-modality differences are negligible. (orig.)

Shoulder Arthroscopy Simulator Training Improves Shoulder Arthroscopy Performance in a Cadaver Model

Science.gov (United States)

Henn, R. Frank; Shah, Neel; Warner, Jon J.P.; Gomoll, Andreas H.

2013-01-01

Purpose The purpose of this study was to quantify the benefits of shoulder arthroscopy simulator training with a cadaver model of shoulder arthroscopy. Methods Seventeen first year medical students with no prior experience in shoulder arthroscopy were enrolled and completed this study. Each subject completed a baseline proctored arthroscopy on a cadaveric shoulder, which included controlling the camera and completing a standard series of tasks using the probe. The subjects were randomized, and nine of the subjects received training on a virtual reality simulator for shoulder arthroscopy. All subjects then repeated the same cadaveric arthroscopy. The arthroscopic videos were analyzed in a blinded fashion for time to task completion and subjective assessment of technical performance. The two groups were compared with students t-tests, and change over time within groups was analyzed with paired t-tests. Results There were no observed differences between the two groups on the baseline evaluation. The simulator group improved significantly from baseline with respect to time to completion and subjective performance (parthroscopy simulator training resulted in significant benefits in clinical shoulder arthroscopy time to task completion in this cadaver model. This study provides important additional evidence of the benefit of simulators in orthopaedic surgical training. Clinical Relevance There may be a role for simulator training in shoulder arthroscopy education. PMID:23591380

Shoulder arthroscopy simulator training improves shoulder arthroscopy performance in a cadaveric model.

Science.gov (United States)

Henn, R Frank; Shah, Neel; Warner, Jon J P; Gomoll, Andreas H

2013-06-01

The purpose of this study was to quantify the benefits of shoulder arthroscopy simulator training with a cadaveric model of shoulder arthroscopy. Seventeen first-year medical students with no prior experience in shoulder arthroscopy were enrolled and completed this study. Each subject completed a baseline proctored arthroscopy on a cadaveric shoulder, which included controlling the camera and completing a standard series of tasks using the probe. The subjects were randomized, and 9 of the subjects received training on a virtual reality simulator for shoulder arthroscopy. All subjects then repeated the same cadaveric arthroscopy. The arthroscopic videos were analyzed in a blinded fashion for time to task completion and subjective assessment of technical performance. The 2 groups were compared by use of Student t tests, and change over time within groups was analyzed with paired t tests. There were no observed differences between the 2 groups on the baseline evaluation. The simulator group improved significantly from baseline with respect to time to completion and subjective performance (P arthroscopy simulator training resulted in significant benefits in clinical shoulder arthroscopy time to task completion in this cadaveric model. This study provides important additional evidence of the benefit of simulators in orthopaedic surgical training. There may be a role for simulator training in shoulder arthroscopy education. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Can we predict shoulder dystocia?

Science.gov (United States)

Revicky, Vladimir; Mukhopadhyay, Sambit; Morris, Edward P; Nieto, Jose J

2012-02-01

To analyse the significance of risk factors and the possibility of prediction of shoulder dystocia. This was a retrospective cohort study. There were 9,767 vaginal deliveries at 37 and more weeks of gestation analysed during 2005-2007. Studied population included 234 deliveries complicated by shoulder dystocia. Shoulder dystocia was defined as a delivery that required additional obstetric manoeuvres to release the shoulders after gentle downward traction has failed. First, a univariate analysis was done to identify the factors that had a significant association with shoulder dystocia. Parity, age, gestation, induction of labour, epidural analgesia, birth weight, duration of second stage of labour and mode of delivery were studied factors. All factors were then combined in a multivariate logistic regression analysis. Adjusted odds ratios (Adj. OR) with 95% confidence intervals (CI) were calculated. The incidence of shoulder dystocia was 2.4% (234/9,767). Only mode of delivery and birth weight were independent risk factors for shoulder dystocia. Parity, age, gestation, induction of labour, epidural analgesia and duration of second stage of labour were not independent risk factors. Ventouse delivery increases the risk of shoulder dystocia almost 3 times, forceps delivery comparing to the ventouse delivery increases risk almost 3.4 times. Risk of shoulder dystocia is minimal with the birth weight of 3,000 g or less. It is difficult to foretell the exact birth weight and the mode of delivery, therefore occurrence of shoulder dystocia is highly unpredictable. Regular drills for shoulder dystocia and awareness of increased incidence with instrumental deliveries are important to reduce fetal and maternal morbidity and mortality.

Segmental lumbar spine instability at flexion-extension radiography can be predicted by conventional radiography

Energy Technology Data Exchange (ETDEWEB)

Pitkaenen, M.T.; Manninen, H.I.; Lindgren, K.-A.J.; Sihvonen, T.A.; Airaksinen, O.; Soimakallio, S

2002-07-01

AIM: To identify plain radiographic findings that predict segmental lumbar spine instability as shown by functional flexion-extension radiography. MATERIALS AND METHODS: Plain radiographs and flexion-extension radiographs of 215 patients with clinically suspected lumbar spine instability were analysed. Instability was classified into anterior or posterior sliding instability. The registered plain radiographic findings were traction spur, spondylarthrosis, arthrosis of facet joints, disc degeneration, retrolisthesis, degenerative spondylolisthesis, spondylolytic spondylolisthesis and vacuum phenomena. Factors reaching statistical significance in univariate analyses (P < 0.05) were included in stepwise multiple logistic regression analysis. RESULTS: Degenerative spondylolisthesis (P = 0.004 at L3-4 level and P = 0.017 at L4-5 level in univariate analysis and odds ratio 16.92 at L4-5 level in multiple logistic regression analyses) and spondylolytic spondylolisthesis (P = 0.003 at L5-S1 level in univariate analyses) were the strongest independent determinants of anterior sliding instability. Retrolisthesis (odds ratio 10.97), traction spur (odds ratio 4.45) and spondylarthrosis (odds ratio 3.20) at L3-4 level were statistically significant determinants of posterior sliding instability in multivariate analysis. CONCLUSION: Sliding instability is strongly associated with various plain radiographic findings. In mechanical back pain, functional flexion-extension radiographs should be limited to situations when symptoms are not explained by findings of plain radiographs and/or when they are likely to alter therapy. Pitkaenen, M.T. et al. (2002)

Segmental lumbar spine instability at flexion-extension radiography can be predicted by conventional radiography

International Nuclear Information System (INIS)

Pitkaenen, M.T.; Manninen, H.I.; Lindgren, K.-A.J.; Sihvonen, T.A.; Airaksinen, O.; Soimakallio, S.

2002-01-01

AIM: To identify plain radiographic findings that predict segmental lumbar spine instability as shown by functional flexion-extension radiography. MATERIALS AND METHODS: Plain radiographs and flexion-extension radiographs of 215 patients with clinically suspected lumbar spine instability were analysed. Instability was classified into anterior or posterior sliding instability. The registered plain radiographic findings were traction spur, spondylarthrosis, arthrosis of facet joints, disc degeneration, retrolisthesis, degenerative spondylolisthesis, spondylolytic spondylolisthesis and vacuum phenomena. Factors reaching statistical significance in univariate analyses (P < 0.05) were included in stepwise multiple logistic regression analysis. RESULTS: Degenerative spondylolisthesis (P = 0.004 at L3-4 level and P = 0.017 at L4-5 level in univariate analysis and odds ratio 16.92 at L4-5 level in multiple logistic regression analyses) and spondylolytic spondylolisthesis (P = 0.003 at L5-S1 level in univariate analyses) were the strongest independent determinants of anterior sliding instability. Retrolisthesis (odds ratio 10.97), traction spur (odds ratio 4.45) and spondylarthrosis (odds ratio 3.20) at L3-4 level were statistically significant determinants of posterior sliding instability in multivariate analysis. CONCLUSION: Sliding instability is strongly associated with various plain radiographic findings. In mechanical back pain, functional flexion-extension radiographs should be limited to situations when symptoms are not explained by findings of plain radiographs and/or when they are likely to alter therapy. Pitkaenen, M.T. et al. (2002)

Effects of inactivation of the anterior interpositus nucleus on the kinematic and dynamic control of multijoint movement.

Science.gov (United States)

Cooper, S E; Martin, J H; Ghez, C

2000-10-01

We previously showed that inactivating the anterior interpositus nucleus in cats disrupts prehension; paw paths, normally straight and accurate, become curved, hypometric, and more variable. In the present study, we determined the joint kinematic and dynamic origins of this impairment. Animals were restrained in a hammock and trained to reach and grasp a cube of meat from a narrow food well at varied heights; movements were monitored using the MacReflex analysis system. The anterior interpositus nucleus was inactivated by microinjection of the GABA agonist muscimol (0.25-0.5 microgram in 0.5 microliter saline). For each joint, we computed the torque due to gravity, inertial resistance (termed self torque), interjoint interactions (termed interaction torque), and the combined effects of active muscle contraction and passive soft tissue stretch (termed generalized muscle torque). Inactivation produced significant reductions in the amplitude, velocity, and acceleration of elbow flexion. However, these movements continued to scale normally with target height. Shoulder extension was reduced by inactivation but wrist angular displacement and velocity were not. Inactivation also produced changes in the temporal coordination between elbow, shoulder, and wrist kinematics. Dynamic analysis showed that elbow flexion both before and during inactivation was produced by the combined action of muscle and interaction torque, but that the timing depended on muscle torque. Elbow interaction and muscle torques were scaled to target height both before and during inactivation. Inactivation produced significant reductions in elbow flexor interaction and muscle torques. The duration of elbow flexor muscle torque was prolonged to compensate for the reduction in flexor interaction torque. Shoulder extension was produced by extensor interaction and muscle torques both before and during inactivation. Inactivation produced a reduction in shoulder extension, primarily by reduced interaction

Passage of an Anterior Odontoid Screw through Gastrointestinal Tract.

Science.gov (United States)

Leitner, L; Brückmann, C I; Gilg, M M; Bratschitsch, G; Sadoghi, P; Leithner, A; Radl, R

2017-01-01

Purpose . Anterior screw fixation has become a popular surgical treatment method for instable odontoid fractures. Screw loosening and migration are a rare, severe complication following anterior odontoid fixation, which can lead to esophagus perforation and requires revision operation. Methods . We report a case of screw loosening and migration after anterior odontoid fixation, which perforated the esophagus and was excreted without complications in a 78-year-old male patient. Results . A ventral dislocated anterior screw perforated through the esophagus after eight years after implantation and was excreted through the gastrointestinal (GI) tract. At a 6-month follow-up after the event the patient was asymptomatic. Conclusion . Extrusion via the GI tract is not safe enough to be considered as a treatment option for loosened screws. Some improvements could be implemented to prevent such an incident. Furthermore, this case is a fine example that recent preoperative imaging is mandatory before revision surgery for screw loosening.

Passage of an Anterior Odontoid Screw through Gastrointestinal Tract

Directory of Open Access Journals (Sweden)

L. Leitner

2017-01-01

Full Text Available Purpose. Anterior screw fixation has become a popular surgical treatment method for instable odontoid fractures. Screw loosening and migration are a rare, severe complication following anterior odontoid fixation, which can lead to esophagus perforation and requires revision operation. Methods. We report a case of screw loosening and migration after anterior odontoid fixation, which perforated the esophagus and was excreted without complications in a 78-year-old male patient. Results. A ventral dislocated anterior screw perforated through the esophagus after eight years after implantation and was excreted through the gastrointestinal (GI tract. At a 6-month follow-up after the event the patient was asymptomatic. Conclusion. Extrusion via the GI tract is not safe enough to be considered as a treatment option for loosened screws. Some improvements could be implemented to prevent such an incident. Furthermore, this case is a fine example that recent preoperative imaging is mandatory before revision surgery for screw loosening.

Anterior cruciate ligament reconstruction in a patient with Athetoid cerebral palsy: a case report

Directory of Open Access Journals (Sweden)

Tajima Takuya

2012-10-01

Full Text Available Abstract Recent years have seen ACL reconstruction performed in a broad range of patients, regardless of age, sex or occupation, thanks to great advances in surgical techniques, instrumentation and the basic research. Favorable results have been reported; however, we have not been able to locate any reports describing ACL reconstruction in patients with athetoid cerebral palsy. We present herein a previously unreported anterior cruciate ligament (ACL reconstruction performed in a patient with athetoid cerebral palsy. The patient was a 25-year-old woman with level II athetoid cerebral palsy according to the Gross Motor Function Classification System. She initially injured her right knee after falling off a bicycle. Two years later, she again experienced right-knee pain and a feeling of instability. A right-knee ACL tear and avulsion fracture was diagnosed upon physical examination and confirmed with magnetic resonance imaging (MRI and X-ray examination at that time. An ACL reconstruction using an autologous hamstring double-bundle graft was performed for recurrent instability nine years after the initial injury. Cast immobilization was provided for 3 weeks following surgery and knee extension was restricted for 3 months with the functional ACL brace to prevent hyperextension due to involuntary movement. Partial weight-bearing was started 1 week postoperatively, with full weight-bearing after 4 weeks. The anterior drawer stress radiography showed a 63% anterior displacement of the involved tibia on the femur six months following the surgery, while the contralateral knee demonstrated a 60% anterior displacement of the tibia. The functional ACL functional brace was then removed. A second-look arthroscopy was performed 13 months after the ACL reconstruction, and both the anteromedial and posterolateral bundles were in excellent position as per Kondo’s criteria. The Lachman and pivot shift test performed under anesthesia were also negative. An

Shoulder surgery - discharge

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000179.htm Shoulder surgery - discharge To use the sharing features on this page, please enable JavaScript. You had shoulder surgery to repair the tissues inside or around your ...

Shoulder pain in hemiplegia.

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Andersen, L T

1985-01-01

Development of a painful shoulder in the hemiplegic patient is a significant and serious problem, because it can limit the patient's ability to reach his or her maximum functional potential. Several etiologies of shoulder pain have been identified, such as immobilization of the upper extremity, trauma to the joint structures, including brachial plexus injuries, and subluxation of the gleno-humeral joint. A review of the literature explains the basic anatomy and kinesiology of the shoulder complex, the various etiologies of hemiplegic shoulder pain, and the pros and cons of specific treatment techniques. This knowledge is essential for the occupational therapist to evaluate effectively techniques used to treat the patient with hemiplegic shoulder pain. More effective management of this problem will facilitate the patient's ability to reach his or her maximum functional potential.

Failure of operative treatment for glenohumeral instability: etiology and management.

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Shah, Apurva S; Karadsheh, Mark S; Sekiya, Jon K

2011-05-01

Failure of primary shoulder stabilization procedures is often related to uncorrected anatomic pathology. Orthopaedic surgeons must recognize excessive capsular laxity or large glenohumeral bone defects preoperatively to avoid recurrence of instability. When history, physical examination, and radiographic evaluation are used in conjunction, patients at risk for failure can be identified. The instability severity index score permits precise identification of patients at risk. When treating patients in whom prior surgical intervention has failed, the success of revision procedures correlates to the surgeon's ability to identify the essential pathology and use lesion-specific treatment strategies. Revision procedures remain technically demanding. Keen preoperative and intraoperative judgment is required to avoid additional recurrence of instability after revision procedures, particularly because results deteriorate with each successive operation. Glenoid or humeral defects with greater than 25% bone loss compromise stability provided through the mechanism of concavity compression. These defects must be specifically addressed to avoid recurrence of instability. We prefer anatomic reconstruction techniques combined with capsulolabral repair and, if bone defects are present, anatomic reconstruction with osteochondral allograft. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Arthroscopic Anterior Shoulder Stabilization With Incorporation of a Comminuted Bony Bankart Lesion

OpenAIRE

Lansdown, Drew; Bernardoni, Eamon D.; Cotter, Eric J.; Romeo, Anthony A.; Verma, Nikhil N.

2017-01-01

Bony Bankart lesions are a common finding in patients with anterior glenohumeral dislocation. Although there are no defined guidelines, small bony Bankart fractures are typically treated arthroscopically with suture anchors. The 2 main techniques used are double- and single-row suture anchor stabilization, with debate over superiority. Biomechanical studies have shown improved reduction and stabilization with the double-row over the single-row suture anchor technique; however, this has not be...

Comparison of shoulder positions at MR arthrography: change of labroligamentous complex shape and diagnosis of labral tears

International Nuclear Information System (INIS)

Kwak, Jin Young; Ha, Doo Hoe; Kim, Jeung Sook; Lee, Young Soo

2001-01-01

To compare the neutral, internal, and external rotation positions of the glenohumeral joint during magnetic resonance (MR) arthrography performed to assess changes in the shape of the labroligamentous complex (LLC) and in the labral tear. MR arthrography of the shoulder was retrospectively evaluated in 36 patients aged 14-66 (mean, 40) years. Fourteen cases were confirmed by arthroscopic surgery (7 SLAP lesions, 2 Bankart lesions, 1 both SLAP and Bankart lesions). Axial fat-suppressed T1-weighted spin-echo images were acquired with each shoulder in the neutral position, and with internal and external rotations. In each position, we measured the angle of rotation between the perpendicular line on the glenoid fossa and the long axis of the humeral head, analyzing the relationship between the rotational angle and changes in the shape of the LLC at each internal and external rotation, relative to the neutral position. In addition, labral tears in 14 arthroscopically confirmed joints were evaluated in each position. Mean angles of rotation relative to the neutral position were 44.1 and 45.3 degrees in internal and external rotation, respectively. Changes in the anterior LLC occurred in 25 and 24 cases of internal and external rotation, respectively. There was a significantly meaningful relationship between rotational angle and changes in the shape of the anterior LLC during external rotation, and when this changes was noticed, the rotational angle was wider (p<0.05). The posterior LLC changed in shape in 13 and 16 cases of internal and external rotation, respectively, but changes according to the angle of rotation were not statistically significant. In arthroscopically confirmed joints, diagnosis of the eight SLAP lesions at external rotation tended to become more accurate, but no statistically significant differences were noted (p=0.07). Two Bankart lesions were interpreted as a tear in all three positions, and one other such lesion was interpreted as a tear in the

Recurrent shoulder dystocia: is it predictable?

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Kleitman, Vered; Feldman, Roi; Walfisch, Asnat; Toledano, Ronen; Sheiner, Eyal

2016-11-01

To examine the course and outcome of deliveries occurring in women who previously experienced shoulder dystocia. In addition, recurrent shoulder dystocia risk factors were assessed. A retrospective cohort analysis comparing all singleton deliveries with and without shoulder dystocia in their preceding delivery was conducted. Independent predictors of recurrent shoulder dystocia were investigated using a multiple logistic regression model. Of the 201,422 deliveries included in the analysis, 307 occurred in women with a previous shoulder dystocia (0.015 %). Women with a history of shoulder dystocia were more likely to be older, experienced higher rates of gestational diabetes mellitus, polyhydramnios, prolonged second stage, operative delivery and macrosomia (>4000 g) in the following delivery. Previous shoulder dystocia was found to be an independent risk factor for recurrent shoulder dystocia (OR = 6.1, 95 % CI 3.2-11.8, p value dystocia is an independent risk factor for recurrent shoulder dystocia. Deliveries in women with a history of shoulder dystocia are characterized by higher rates of operative delivery, prolonged second stage of labor and macrosomia.

Shoulder dystocia: definitions and incidence.

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Hansen, Alexandra; Chauhan, Suneet P

2014-06-01

Though subjective in nature, both the American College of Obstetricians and Gynecologists practice bulletin and the Royal College of Obstetricians and Gynaecologists green guideline are in agreement on the descriptor of shoulder dystocia: requirement of additional obstetric maneuvers when gentle downward traction has failed to affect the delivery of the shoulders. The rate of shoulder dystocia is about 1.4% of all deliveries and 0.7% for vaginal births. Compared to non-diabetics (0.6%), among diabetics, the rate of impacted shoulders is 201% higher (1.9%); newborns delivered by vacuum or forceps have 254% higher likelihood of shoulder dystocia than those born spontaneously (2.0% vs. 0.6%, respectively). When the birthweight is categorized as 4500 g, the likelihood of shoulder dystocia in the US vs. other countries varies significantly. Future studies should focus on lowering the rate of shoulder dystocia and its associated morbidities, without concomitantly increasing the rate of cesarean delivery. Copyright © 2014 Elsevier Inc. All rights reserved.

How often do surgeons intervene on shoulder labral lesions detected at MR examination? A retrospective review of MR examinations correlated with arthroscopy

Science.gov (United States)

2014-01-01

Objective: We report the prevalence of surgical intervention on shoulder labral lesions detected at MR examinations and how surgeons describe labral tears seen at MR examinations in their arthroscopy reports. Methods: A retrospective review of 100 consecutive patients aged 50 years or younger who had shoulder labral tears on MR and went on to have surgery performed. It was determined whether surgical intervention was performed on the MR lesions. Results: Of these 100 patients, 72 had superior labral anterior to posterior (SLAP) tears, 38 had posterior labral tears and 28 had anterior labral tears on MR examination. All 100 patients went on to arthroscopy. All lesions described on MRI were described on arthroscopy. Of the 72 SLAP tears, 64 were described as fraying on arthroscopy with 51 debrided. The remaining eight SLAP tears were tacked surgically. Of the 38 posterior labral tears, 36 were described as fraying on arthroscopy with 29 debrided and 2 had surgical tacking performed. Of the 28 anterior labral tears described on MR examination, 26 had surgical tacking performed and 2 were debrided. There were four SLAP tears, two anterior labral tears and three posterior labral tears seen on arthroscopy but not seen on MR examination. Conclusion: In this series, a high percentage of SLAP tears and posterior labral tears described on MR examination did not have surgical tacking. Most anterior labral tears had surgical tacking. Based on the above, our surgeons request we describe superior and posterior labral lesions as fraying and/or tearing, unless we can see a displaced tear. Most anterior labral lesions are treated with surgical tacking. Advances in knowledge: MRI allows for sensitive detection of labral tears. The tears often are not clinically significant. PMID:24712320

Shoulder Pain After Thoracic Surgery

DEFF Research Database (Denmark)

Blichfeldt-Eckhardt, Morten R; Andersen, Claus; Ørding, Helle

2017-01-01

OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark...... for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant...... shoulder pain. On postoperative day 4, 19 patients (32%) still suffered shoulder pain, but only 4 patients (7%) had clinically relevant pain. Four patients (8%) still suffered shoulder pain 12 months after surgery. In 26 patients (55%), the shoulder pain was classified as referred versus 21 patients (45...

Mechanism of injury and instability of cervical cord injuries without remarkable Xp evidence of injury

International Nuclear Information System (INIS)

Ueta, Takayoshi; Shiba, Keiichiro; Katsuki, Masaaki; Shirasawa, Kenzo; Murao, Tetsu; Mori, Eiji; Yoshimura, Toyoaki; Ishibashi, Yuichi; Ryu, Seiman

1989-01-01

In 27 patients with no radiographic evidence of injury, spinal cord injury was depicted as low signal intensity on MRI. In 4 patients who had spontaneous reduction of the anterior dislocation, remarkable instability was observed. Among the other 23 patients, two patients had each two injured sites, and the remaining patients had only one injuried site. Injured sites were not correlated with the development of spondylosis or the antero-posterior diameter of the spinal canal, but well correlated with ossification of the posterior longitudinal ligament. Many of the patients had surgical evidence of horizontal rupture of the anterior longitudinal ligament and intervertebral disk. In these cases, although the spinal cord was instable at the level of extension, it was stable at the level of midline flection. Excessively extended injury with no associated anterior longitudinal ligament was considered attributable to the strictured spinal canal. (Namekawa, K)

Inter-rater and intra-rater reliability of a movement control test in shoulder.

Science.gov (United States)

Rajasekar, S; Bangera, Rakshith K; Sekaran, Padmanaban

2017-07-01

Movement faults are commonly observed in patients with musculoskeletal pain. The Kinetic Medial Rotation Test (KMRT) is a movement control test used to identify movement faults of the scapula and gleno-humeral joints during arm movement. Objective tests such as the KMRT need to be reliable and valid for the results to be applied across different clinical settings and patient populations. The primary objective of the present study was to determine the intra-rater and inter-rater reliability of KMRT in subjects with and without shoulder pain. Sixty subjects were included in this study based on specific inclusion and exclusion criteria. Two musculoskeletal physiotherapists with different levels of clinical experience performed the tests. The intra-rater reliability was tested in twenty asymptomatic subjects by a single assessor at two week intervals. An equal number of subjects with and without shoulder pain were tested by both the assessors to determine the inter-rater reliability. Both components of the KMRT, the Gleno- Humeral Anterior Translation (GHAT) and the Scapular Forward Tilt (SCFT) were tested. The Kappa values for inter-rater reliability of the GHAT and SCFT were K = 0.68 & K = 0.65 respectively in subjects with shoulder pain. In asymptomatic subjects, the inter-rater reliability of GHAT was K = 0.61 and SCFT was K = 0.85. Intra-rater reliability ranged from K = 0.66 for GHAT to K = 0.87 for SCFT. Our study found substantial agreement in inter-rater reliability of KMRT in subjects with shoulder pain, whereas substantial to near perfect agreement was found in intra-rater and inter-rater reliability of KMRT in subjects without shoulder pain. Copyright © 2017 Elsevier Ltd. All rights reserved.

SU-F-T-396: Impact of Shoulder Deformation for Head and Neck VMAT

Energy Technology Data Exchange (ETDEWEB)

Uchida, Y; Tachibana, H [National Cancer Center, Kashiwa, Chiba (Japan)

2016-06-15

Purpose: For head and neck VMAT (HN-VMAT), variations of position and deformation of patient’s shoulders is a concern to affect inaccuracy of dose distribution. It has been reported that the setup error of the shoulders was variable from 5 mm – 1 cm. The beams of the HN-VMAT pass through the shoulders. We assessed the impact of shoulder deformation to dose distribution for HN-VMAT. Methods: One HN-VMAT plan was generated using a patient’s CT. The patient’s CT was deformed using ImSimQA (Oncology Systems Limited, Shrewsbury, Shropshire, UK) to generate several patterns of the shoulders’ deformations when the right and left humeral heads were shifted with 3, 6, and 15 mm in the superior and inferior directions (SI), 3, 5, and 15 mm in the anterior and posterior directions (AP), and 5 and 15 mm in the right or left direction (LR). DVH comparison was performed in the different deformation patterns. The dosimetric parameters of D95% for CTV70Gy, CTV60Gy and CTV54Gy and dmax for Spinal cord were also measured. Gamma index evaluation (Criteria: 3%/2mm) was performed to exhibit clinically tolerable area in the comparison. Results: DVH comparison shows similar for all structures. As the comparison for the dosimetric parameters, the variations of D95% in the LR and AP were within 1%. There were larger variations in the SI than those in the other directions, however were within 1.5%. In gamma index evaluation, the small spots with higher gamma index values were appeared when the shift was 6 mm, however the pass ratio was 99.13%. Conclusion: HN-VMAT should be robust for shoulder deformation and geometric accuracy within 6 mm from patient’s setup and image-guided radiotherapy may be clinically acceptable for target dose coverage or normal tissue dose sparing.

Activation of biceps femoris long head reduces tibiofemoral anterior shear force and tibial internal rotation torque in healthy subjects.

Science.gov (United States)

Azmi, Nur Liyana; Ding, Ziyun; Xu, Rui; Bull, Anthony M J

2018-01-01

The anterior cruciate ligament (ACL) provides resistance to tibial internal rotation torque and anterior shear at the knee. ACL deficiency results in knee instability. Optimisation of muscle contraction through functional electrical stimulation (FES) offers the prospect of mitigating the destabilising effects of ACL deficiency. The hypothesis of this study is that activation of the biceps femoris long head (BFLH) reduces the tibial internal rotation torque and the anterior shear force at the knee. Gait data of twelve healthy subjects were measured with and without the application of FES and taken as inputs to a computational musculoskeletal model. The model was used to investigate the optimum levels of BFLH activation during FES gait in reducing the anterior shear force to zero. This study found that FES significantly reduced the tibial internal rotation torque at the knee during the stance phase of gait (p = 0.0322) and the computational musculoskeletal modelling revealed that a mean BFLH activation of 20.8% (±8.4%) could reduce the anterior shear force to zero. At the time frame when the anterior shear force was zero, the internal rotation torque was reduced by 0.023 ± 0.0167 Nm/BW, with a mean 188% reduction across subjects (p = 0.0002). In conclusion, activation of the BFLH is able to reduce the tibial internal rotation torque and the anterior shear force at the knee in healthy control subjects. This should be tested on ACL deficient subject to consider its effect in mitigating instability due to ligament deficiency. In future clinical practice, activating the BFLH may be used to protect ACL reconstructions during post-operative rehabilitation, assist with residual instabilities post reconstruction, and reduce the need for ACL reconstruction surgery in some cases.