Sample records for amyloid shoulder nodulesin

  1. Shoulder MRI scan (United States)

    ... finding on an x-ray or bone scan Shoulder pain and fever Decreased motion of the shoulder joint ... of the shoulder joint Shoulder instability Shoulder weakness Shoulder pain and a history of cancer Shoulder pain that ...

  2. Dislocated Shoulder (United States)

    ... bruising Intense pain Inability to move the joint Shoulder dislocation may also cause numbness, weakness or tingling near the injury, such as in your neck or down your arm. The muscles in your shoulder may spasm from the disruption, ...

  3. Shoulder dystocia. (United States)

    Grobman, William


    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.

  4. Shoulder reflexes

    DEFF Research Database (Denmark)

    Diederichsen, Louise; Krogsgaard, Michael; Voigt, Michael


    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...... is small compared to the number in the other shoulder structures. Proprioceptive information from numerous receptors in muscles and tendons is mediated via fast conducting nervefibers and probably contribute more to kinaestethic sensation than information from capsule and ligaments. Therefore it seems...... likely that the joint receptors have a more distinct role for the kinaestethic sense than muscle receptors. In cats a direct reflex from the afferents innervating the shoulder to the muscles around the shoulder has been presented. The reflex had an extremely short latency (2.7-3.1 ms). In man, a very...

  5. Shoulder pain (United States)

    ... or damaged. This condition is called rotator cuff tendinitis or bursitis. Shoulder pain may also be caused ... recommend such exercises. If you are recovering from tendinitis, continue to do range-of-motion exercises to ...

  6. Shoulder Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Claudio Chillemi


    Full Text Available Osteoarthritis (OA is the most frequent cause of disability in the USA, affecting up to 32.8% of patients over the age of sixty. Treatment of shoulder OA is often controversial and includes both nonoperative and surgical modalities. Nonoperative modalities should be utilized before operative treatment is considered, particularly for patients with mild-to-moderate OA or when pain and functional limitations are modest despite more advanced radiographic changes. If conservative options fail, surgical treatment should be considered. Although different surgical procedures are available, as in other joints affected by severe OA, the most effective treatment is joint arthroplasty. The aim of this work is to give an overview of the currently available treatments of shoulder OA.

  7. Shoulder Osteoarthritis


    Claudio Chillemi; Vincenzo Franceschini


    Osteoarthritis (OA) is the most frequent cause of disability in the USA, affecting up to 32.8% of patients over the age of sixty. Treatment of shoulder OA is often controversial and includes both nonoperative and surgical modalities. Nonoperative modalities should be utilized before operative treatment is considered, particularly for patients with mild-to-moderate OA or when pain and functional limitations are modest despite more advanced radiographic changes. If conservative options fail, su...

  8. Floating shoulder


    B. de Pablo Márquez; P. Castillón Bernal; I. Fuentes López


    La fractura concomitante de clavícula y escápula es una entidad poco frecuente que puede ser una de las causas de afectación del complejo suspensorio del hombro también denominado hombro flotante (floating shoulder). Se relaciona frecuentemente con traumatismos de alta energía. Presentamos un caso de esta patología en un paciente varón de 28 años que consultó por caída en bicicleta con contusión sobre hombro izquierdo. Se describen las diferentes opciones terapéuticas planteadas, las imágenes...

  9. Evaluating shoulder instability treatment

    NARCIS (Netherlands)

    van der Linde, J.A.


    Shoulder instability common occurs. When treated nonoperatively, the resulting societal costs based on health care utilization and productivity losses are significant. Shoulder function can be evaluated using patient reported outcome measurements (PROMs). For shoulder instability, these include the

  10. Pregnancy Complications: Shoulder Dystocia (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 ...

  11. "Floating shoulder" injuries. (United States)

    Heng, Kenneth


    "Floating shoulder" is a rare injury complex resulting from high-energy blunt force trauma to the shoulder, resulting in scapulothoracic dissociation. It is commonly associated with catastrophic neurovascular injury. Two cases of motorcyclists with floating shoulder injuries are described.

  12. Floating shoulder

    Directory of Open Access Journals (Sweden)

    B. de Pablo Márquez


    Full Text Available La fractura concomitante de clavícula y escápula es una entidad poco frecuente que puede ser una de las causas de afectación del complejo suspensorio del hombro también denominado hombro flotante (floating shoulder. Se relaciona frecuentemente con traumatismos de alta energía. Presentamos un caso de esta patología en un paciente varón de 28 años que consultó por caída en bicicleta con contusión sobre hombro izquierdo. Se describen las diferentes opciones terapéuticas planteadas, las imágenes radiológicas y una revisión de la literatura.

  13. Shoulder separation - aftercare (United States)

    ... and top of your shoulder blade A severe shoulder separation You may need surgery right away if you have: Numbness in your fingers Cold fingers Muscle weakness in your arm Severe deformity of the joint

  14. 9. Painful shoulder complaints. (United States)

    Huygen, Frank; Patijn, Jacob; Rohof, Olav; Lataster, Arno; Mekhail, Nagy; van Kleef, Maarten; Van Zundert, Jan


    Painful shoulder complaints have a high incidence and prevalence. The etiology is not always clear. Clinical history and the active and passive motion examination of the shoulder are the cornerstones of the diagnostic process. Three shoulder tests are important for the examination of shoulder complaints: shoulder abduction, shoulder external rotation, and horizontal shoulder adduction. These tests can guide the examiner to the correct diagnosis. Based on this diagnosis, in most cases, primarily a conservative treatment with nonsteroidal anti-inflammatory drugs possibly in combination with manual and/or exercise therapy can be started. When conservative treatment fails, injection with local anesthetics and corticosteroids can be considered. In the case of frozen shoulder, a continuous cervical epidural infusion of local anesthetic and small doses of opioids or a pulsed radiofrequency treatment of the nervus suprascapularis can be considered.

  15. What Are Shoulder Problems? (United States)

    ... Surgery if tears are severe. Rotator Cuff Disease: Tendinitis and Bursitis In tendinitis of the shoulder, tendons become inflamed (red, sore, ... shoulder or by jobs with frequent overhead reaching. Tendinitis and bursitis may occur alone or at the ...

  16. Shoulder injuries in archery. (United States)

    Mann, D L; Littke, N


    Twenty-one elite-calibre archers (M = 12, F = 9) were investigated concerning all past and present archery-related shoulder injuries, using a questionnaire and physical examination. The questionnaire revealed that 11 of 21 archers had complained of significant shoulder injuries either currently or during their careers. While 9/12 men never had shoulder problems during an average of 13.5 years, only 4/9 women escaped injury during a mean 10.9 year competitive career. Deficits in training programs were noted, including lack of training and non-specific exercises. Clinical examination demonstrated shoulder asymmetry and decreased flexibility in the drawing arm (DA) shoulder. Functional testing revealed a positive impingement sign in 6/21 DA shoulders. Supraspinatus testing showed abnormalities in 4/21 DA shoulders. Pain was referred posteriorly with the impingement maneuver in 5/21 DA shoulders and abnormal external rotation testing was observed in 8/21 DA shoulders. Generally, the females had proportionally more signs and symptoms of shoulder injury than the men, especially involving the DA shoulder. Testing implicated supraspinatus impingement/tendonitis and infraspinatus/teres minor traction tendonitis. These clinical findings correlated with cadaver prosection observations.

  17. Shoulder Pain and Common Shoulder Problems (United States)

    ... into four major categories: • Tendon inflammation (bursitis or tendinitis) or tendon tear • Instability • Arthritis • Fracture (broken bone) ... o en occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become ...

  18. Complications of shoulder dystocia. (United States)

    Dajani, Nafisa K; Magann, Everett F


    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.

  19. Work related shoulder disorders

    DEFF Research Database (Denmark)

    Svendsen, Susanne Wulff; Bonde, Jens Peter; Mathiassen, S.E.


    Aims: To determine quantitative exposure-response relations between work with highly elevated arms and supraspinatus tendinitis, shoulder pain with disability, and shoulder pain without disability. Methods: A cross sectional study was conducted in a historical cohort of 1886 males from three.......39) for supraspinatus tendinitis, 1.16 (95% CI 1.08 to 1.24) for shoulder pain with disability, and 1.08 (95% CI 1.04 to 1.13) for shoulder pain without disability. The outcomes were not related to duration of employment in one of the three trades. Conclusions: Quantitative exposure-response relations were established...

  20. Shoulder instability; Schulterinstabilitaeten

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, Karl-Friedrich [Mainiz Univ. (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie


    In the shoulder, the advantages of range of motion are traded for the disadvantages of vulnerability to injury and the development of instability. Shoulder instability and the lesion it produces represent one of the main causes of shoulder discomfort and pain. 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 their causative factors as the pathogenesis of instability plays an important role with respect to treatment options: instabilities are classified in traumatic and atraumatic instabilities as part of a multidirectional instability syndrome, and in microtraumatic instabilities. Plain radiographs ('trauma series') are performed to document shoulder dislocation and its successful reposition. Direct MR arthrography is the most important imaging modality for delineation the different injury patterns on the labral-ligamentous complex and bony structures. Monocontrast CT-arthrography with use of multidetector CT scanners may be an alternative imaging modality, however, regarding the younger patient age, MR imaging should be preferred in the diagnostic work-up of shoulder instabilities. (orig.)

  1. Shoulder Joint Replacement (United States)

    ... Studies show that patients with osteoarthritis get better pain relief from total shoulder arthroplasty than from hemiarthroplasty. Resurfacing ... first, second or third day a er surgery. Pain Management A er surgery, you will feel some pain, ...

  2. Shoulder Impingement Treatment (United States)

    ... Causes include a rapid increase in overhead activity, weakness or strength imbalance in the rotator cuff or scapular muscles, postural abnormalities, shoulder joint instability, or improper training or technique. The ...

  3. Shoulder CT scan (United States)

    ... scanners can perform the exam without stopping.) A computer creates separate images of the shoulder area. These ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...


    Filho, Geraldo Motta; Galvão, Marcus Vinicius; Monteiro, Martim; Cohen, Marcio; Brandão, Bruno


    The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. Methodology: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. Results: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus fracture. 12% of the cases required total arthroplasties and 88% partial arthroplasties. Five major complications were observed on early postoperative period. Conclusion: Shoulder arthroplasties have become a common procedure in orthopaedic practice. Surgical records are important in evidencing progressive evolution and in enabling future clinical outcomes evaluation. PMID:26998463

  5. Recent advances in shoulder research


    Killian, Megan L; Cavinatto, Leonardo; Galatz, Leesa M.; Thomopoulos, Stavros


    Shoulder pathology is a growing concern for the aging population, athletes, and laborers. Shoulder osteoarthritis and rotator cuff disease represent the two most common disorders of the shoulder leading to pain, disability, and degeneration. While research in cartilage regeneration has not yet been translated clinically, the field of shoulder arthroplasty has advanced to the point that joint replacement is an excellent and viable option for a number of pathologic conditions in the shoulder. R...

  6. Arthroscopic Management of Shoulder Osteoarthritis


    George, Michael S


    Osteoarthritis (OA) can cause severe pain and dysfunction of the shoulder. When conservative treatment fails and operative treatments such as shoulder arthroplasty and open glenohumeral resurfacing are not advisable, shoulder arthroscopy may be used to treat shoulder OA. Arthroscopic treatment of concomitant pathology in the shoulder including subacromial decompression, labral repair, capsular release, microfracture, and distal clavicle excision have been shown to yield good results when comb...

  7. [Leading symptom shoulder pain]. (United States)

    Wittke, R


    Pain in the shoulder should prompt a systematic clinical examination that adheres closely to the functional anatomy. The basic examination of the shoulder joint comprises active and passive movements and isometric resistance tests with the aid of which external and internal rotation and abduction/adduction can be investigated. The results of these tests provide the physician with a "pattern of findings" which unequivocally identifies the pain-triggering structure. Accordingly, shoulder pain can be classified into four categories as proposed by Cyriax. As treatment, intra-articular injections of corticoids or local anesthetics as determined by findings, where necessary supported by physiotherapeutic measures. Rupture of a tendon, in particular in the case of an active patient, is an indication for surgery.

  8. Using your shoulder after replacement surgery (United States)

    Joint replacement surgery - using your shoulder; Shoulder replacement surgery - after ... You have had shoulder replacement surgery to replace the bones of your shoulder joint with artificial parts. The parts include a stem made of metal and a ...

  9. Mortality after shoulder arthroplasty

    DEFF Research Database (Denmark)

    Amundsen, Alexander; Rasmussen, Jeppe Vejlgaard; Olsen, Bo Sanderhoff


    BACKGROUND: The primary aim was to quantify the 30-day, 90-day, and 1-year mortality rates after primary shoulder replacement. The secondary aims were to assess the association between mortality and diagnoses and to compare the mortality rate with that of the general population. METHODS: The study...... included 5853 primary operations reported to the Danish Shoulder Arthroplasty Registry between 2006 and 2012. Information about deaths was obtained from the Danish Cause of Death Register and the Danish Civil Registration System. Age- and sex-adjusted control groups were retrieved from Statistics Denmark...

  10. Shoulder proprioception in baseball pitchers. (United States)

    Safran, M R; Borsa, P A; Lephart, S M; Fu, F H; Warner, J J


    We examined proprioceptive differences between the dominant and nondominant shoulders of 21 collegiate baseball pitchers without a history of shoulder instability or surgery. A proprioceptive testing device was used to measure kinesthesia and joint position sense. Joint position sense was significantly (P =.05) more accurate in the nondominant shoulder than in the dominant shoulder when starting at 75% of maximal external rotation and moving into internal rotation. There were no significant differences for proprioception in the other measured positions or with kinesthesia testing. Six pitchers with recent shoulder pain had a significant (P =.04) kinesthetic deficit in the symptomatic dominant shoulder compared with the asymptomatic shoulder, as measured in neutral rotation moving into internal rotation. The net effect of training, exercise-induced laxity, and increased external rotation in baseball pitchers does not affect proprioception, although shoulder pain, possibly due to rotator cuff inflammation or tendinitis, is associated with reduced kinesthetic sensation.

  11. The Danish Shoulder Arthroplasty Registry

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe; Jakobsen, John; Brorson, Stig


    The Danish Shoulder Arthroplasty Registry (DSR) was established in 2004. Data are reported electronically by the surgeons. Patient-reported outcome is collected 10-14 months postoperatively using the Western Ontario osteoarthritis of the shoulder index (WOOS). 2,137 primary shoulder arthroplasties......% reverse shoulder arthroplasties, and 3% total arthroplasties. Median WOOS was 59% (IQR: 37-82). 5% had been revised by the end of June 2010. The most frequent indications for revision were dislocation or glenoid attrition....

  12. Sleep position and shoulder pain. (United States)

    Zenian, John


    The overuse theory for musculoskeletal joint pain cannot explain adequately the occurrence of shoulder pain in those who do not engage in activities that involve repeated and stressful use of the shoulder since the percentage of the painful right shoulders usually does not match the percentage of dominant right arms in such individuals. An alternative hypothesis is presented to propose that shoulder pain is caused by postural immobility in the decubitus or side position during sleep. Prolonged pressure on the shoulder caused by the weight of the thorax can produce enough damage to cause subsequent shoulder pain. In order to test this hypothesis, a preliminary study was carried out to compare the laterality of shoulder pain with the laterality of sleep position. The calculated laterality ratios for sleep position and shoulder pain were found to be strikingly similar, suggesting a causal relationship between the two phenomena. However, the prevalence of shoulder pain in the general population was found to be smaller than the percentage of the time people would spend sleeping in the decubitus position. This discrepancy could be explained by the idea that in order for shoulder pain to develop subjects may have to spend longer times in the same decubitus position before changing to another position than the average person would. Additional evidence from published clinical studies also supports the postural theory of shoulder pain. More studies can be done to test this hypothesis by focusing on the sleep habits of patients with shoulder pain. According to the present hypothesis shoulder pain should for the most part occur on the side that the patient preferred to sleep on before the onset of shoulder pain. The postural theory of shoulder pain provides the possibility for a new and noninvasive method to treat shoulder pain by the modification of posture during sleep.

  13. Shoulder dystocia: definitions and incidence. (United States)

    Hansen, Alexandra; Chauhan, Suneet P


    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.

  14. Swimmer's Shoulder: Painful Shoulder in the Competitive Swimmer. (United States)

    Matzkin, Elizabeth; Suslavich, Kaytelin; Wes, David


    Swimmer's shoulder is a broad term often used to diagnose shoulder injury in swimmers. However, research has elucidated several specific shoulder injuries that often are incurred by the competitive swimmer. Hyperlaxity, scapular dyskinesis, subacromial impingement, labral damage, os acromiale, suprascapular nerve entrapment, and glenohumeral rotational imbalances all may be included within a differential diagnosis for shoulder pain in the competitive swimmer. An understanding of the mechanics of the swim stroke, in combination with the complex static and dynamic properties of the shoulder, is essential to the comprehension and identification of the painful swimmer's shoulder. It is important for the athlete, coach, and clinician to be aware of the discerning characteristics among these different injuries to ensure a proper diagnosis and treatment plan to aid the swimmer in his or her return to competition.

  15. Shoulder dystocia: prediction and management. (United States)

    Hill, Meghan G; Cohen, Wayne R


    Shoulder dystocia is a complication of vaginal delivery and the primary factor associated with brachial plexus injury. In this review, we discuss the risk factors for shoulder dystocia and propose a framework for the prediction and prevention of the complication. A recommended approach to management when shoulder dystocia occurs is outlined, with review of the maneuvers used to relieve the obstruction with minimal risk of fetal and maternal injury.

  16. Shoulder dystocia: management and documentation. (United States)

    Stitely, Michael L; Gherman, Robert B


    Shoulder dystocia is an obstetric emergency that occurs when the fetal shoulders become impacted at the pelvic inlet. Management is based on performing maneuvers to alleviate this impaction. A number of protocols and training mnemonics have been developed to assist in managing shoulder dystocia when it occurs. This article reviews the evidence regarding the performance, timing, and sequence of these maneuvers; reviews the mechanism of fetal injury in relation to shoulder dystocia; and discusses issues concerning documentation of the care provided during this obstetric emergency.

  17. Acupuncture Treatment of Shoulder Pain

    Institute of Scientific and Technical Information of China (English)


    @@ Case History Mr. Wen Senting, an Italian of 41 years old, paid his first visit on Mar. 17, 2004, with a chief complaint of the left shoulder pain for over a year. The patient stated that the pain resulted from an injury in his left shoulder one year before while playing the tennis. It was then diagnosed as soft tissue injury of the shoulder. The pain had been alleviated by massage treatment, but it would appear upon tiredness or exposure to cold, and had gradually impaired the shoulder movement. In recent half a year, the pain had gone worse, with obvious motor impairment.

  18. 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 droo

  19. Modeling amyloids in bacteria

    Directory of Open Access Journals (Sweden)

    Villar-Piqué Anna


    Full Text Available Abstract An increasing number of proteins are being shown to assemble into amyloid structures, self-seeding fibrillar aggregates that may lead to pathological states or play essential biological functions in organisms. Bacterial cell factories have raised as privileged model systems to understand the mechanisms behind amyloid assembly and the cellular fitness cost associated to the formation of these aggregates. In the near future, these bacterial systems will allow implementing high-throughput screening approaches to identify effective modulators of amyloid aggregation.

  20. Biomechanics of the shoulder. (United States)

    Bechtol, C O


    Man's shoulder girdle is of the general pattern of his tree-swinging ancestors. With assumption of the upright posture, man's thorax has flattened from anterior-posterior. This results in a rotation of the scapula to a position of 45 degrees with the sagittal plane. In addition to this, man's forearm is habitually used in a position of approximately 45 degrees of internal rotation. This places the biceps tendon "off its trolley" and leads to biceps tinosynovitis. Motions of the glenohumeral joints result from the force couple of the deltoid muscle plus the rotator cuff muscles. The rotator cuff alone can abduct the arm with 50% force throughout the full range of its motion. In the absence of the supraspinatus muscle, however, the force couple is disrupted. Although initiation of abduction is with full force, the force rapidly falls off to 90 degrees. Above 90 degrees the arm can barely support its own weight. Although the shoulder undergoes progressive degenerative changes with age, the necessity for a joint implant, either partial or total--although successful--is rare.

  1. [Symphysiotomy to relieve shoulder dystocia

    NARCIS (Netherlands)

    Mourad, S.M.; Nieuwenhof, H.P. van de; Biert, J.; Heidema, W.M.; Bekker, M.N.


    Symphysiotomy to manage shoulder dystocia is seldom used in the western world. For this reason, in well-resourced countries knowledge of its recuperation rate and the management of physical discomfort in the post-partum period is scarce. We describe two cases of symphysiotomy for shoulder dystocia.

  2. Cerebral amyloid angiopathy (United States)

    ... needed for weakness or clumsiness. This can include physical, occupational, or speech therapy. Sometimes, medicines that help improve memory, such as those for Alzheimer disease, are used. Seizures, also called amyloid spells, may ...

  3. Shoulder Pain After Thoracic Surgery

    DEFF Research Database (Denmark)

    Blichfeldt-Eckhardt, Morten R; Andersen, Claus; Ørding, Helle


    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....... PARTICIPANTS: Sixty patients for major lung resection. INTERVENTIONS: Postoperative observation of ipsilateral shoulder pain. MEASUREMENTS AND MAIN RESULTS: Postoperative numeric rating scale score of shoulder pain and thoracic pain and postoperative examination of the sites of shoulder pain...... 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...

  4. Contemporary management of shoulder dystocia. (United States)

    Gittens-Williams, Lisa


    Shoulder dystocia is an uncommon but potentially catastrophic intrapartum event. Although risk factors such as maternal diabetes, obesity and macrosomia can be identified, shoulder dystocia most frequently occurs in patients who lack risk factors. Many maneuvers have been described to assist the operator in the safe release of the shoulder and subsequent delivery; however, no prospective trials have compared these maneuvers in such a way to suggest that one maneuver is superior to another. This article describes the identification of patients at risk for shoulder dystocia, clinical management of the shoulder dystocia, event documentation and the contemporary use of drills and simulation training to improve team preparedness for this unpredictable and usually unavoidable event.

  5. Shoulder osteoarthritis: diagnosis and management. (United States)

    Millett, Peter J; Gobezie, Reuben; Boykin, Robert E


    Osteoarthritis of the shoulder is a gradual wearing of the articular cartilage that leads to pain and stiffness. As the joint surface degenerates, the subchondral bone remodels, losing its sphericity and congruity. The joint capsule also becomes thickened, leading to further loss of shoulder rotation. This painful condition is a growing problem in the aging population. In most cases, diagnosis of degenerative joint disease of the shoulder can be made with careful history, physical examination, and radiography. The symptoms and degree of shoulder arthritis visible on radiography determine the best treatment option. Mild degenerative joint disease can be treated with physical therapy and over-the-counter anti-inflammatory medications such as acetaminophen or nonsteroidal anti-inflammatory drugs. More advanced cases of osteoarthritis that are refractory to nonoperative management can be managed with corticosteroid injections. In severe cases, surgery is indicated. Surgical options include arthroscopic debridement, arthroscopic capsular release, and, in the most severe instances, hemiarthroplasty or total shoulder arthroplasty.

  6. Human Islet Amyloid Polypeptide

    DEFF Research Database (Denmark)

    Kosicka, Iga


    Diabetes mellitus type II is a metabolic disease affecting millions of people worldwide. The disease is associated with occurence of insoluble, fibrillar, protein aggregates in islets of Langerhans in the pancreas - islet amyloid. The main constituent of these protein fibers is the human islet...... of diabetes type II, while revealing the structure(s) of islet amyloid fibrils is necessary for potential design of therapeutic agents....

  7. Fluid collections and juxta-articular cystic lesions of the shoulder: spectrum of MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Mellado, J.M.; Salvado, E.; Camins, A.; Ramos, A.; Sauri, A. [Institut de Diagnostic per la Imatge, Hospital Joan XXIII, Tarragona (Spain); Merino, X. [Institut de Diagnostic per la Imatge, Hospital Vall' Ebron, Barcelona (Spain); Calmet, J. [Orthopaedic Surgery, Hospital Joan XXIII, Carrer Doctor Mallafre Guasch, Tarragona (Spain)


    The MR imaging features of fluid collections and juxta-articular cystic lesions of the shoulder are discussed, with special focus on those related to subacromial impingement and rotator cuff tears. Other more unusual fluid collections and cystic lesions are described, including rice-bodies bursitis, idiopathic synovial osteochondromatosis, dialysis-related amyloid arthropathy, hemophilic arthropathy, infectious conditions, non-infectious inflammatory arthritis, and paralabral cysts. (orig.)

  8. {beta} - amyloid imaging probes

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Jae Min [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    Imaging distribution of {beta} - amyloid plaques in Alzheimer's disease is very important for early and accurate diagnosis. Early trial of the {beta} -amyloid plaques includes using radiolabeled peptides which can be only applied for peripheral {beta} - amyloid plaques due to limited penetration through the blood brain barrier (BBB). Congo red or Chrysamine G derivatives were labeled with Tc-99m for imaging {beta} - amyloid plaques of Alzheimer patient's brain without success due to problem with BBB penetration. Thioflavin T derivatives gave breakthrough for {beta} - amyloid imaging in vivo, and a benzothiazole derivative [C-11]6-OH-BTA-1 brought a great success. Many other benzothiazole, benzoxazole, benzofuran, imidazopyridine, and styrylbenzene derivatives have been labeled with F-18 and I-123 to improve the imaging quality. However, [C-11]6-OH-BTA-1 still remains as the best. However, short half-life of C-11 is a limitation of wide distribution of this agent. So, it is still required to develop an Tc-99m, F-18 or I-123 labeled agent for {beta} - amyloid imaging agent.

  9. MRI of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Vahlensieck, M.


    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.)

  10. [Shoulder calcifying tendinitis]. (United States)

    Clavert, P; Sirveaux, F


    Calcifying tendinitis is a frequent shoulder disease but the surgical treatment is still debatable. The authors of this symposium reviewed retrospectively 450 patients treated by arthroscopal excision for calcifying tendinitis. Imaging were used to assess the cuff status in every case. The minimum follow-up was five years except for subscapularis and infraspinatus calcification (minimum two years). At the same time, we led a prospective study evaluating the prevalence of the calcifications on 1276 asymptomatic shoulders. The prevalence of rotator cuff calcification was 7.3%, with a female predominance specially in the operated group. Calcifications have been found as well in patients more than 70 years old. The inter- and intraobserver agreement for the A-B-C classification was poor, specially to differentiate the type A and B calcifications. The long-term follow-up allows to prove that the calcifying tendinitis is temporary without any relation with rotator cuff rupture. Recurrence of the calcific deposit after complete disappearance was never observed and the rate of full thickness tears was 3.9% at an average of nine years follow-up (mean age 56 years). These findings allowed to conclude than cuff suture after removing the deposit is not mandatory. However, the preoperative cuff status had a significant influence on the functional results at follow-up. Preoperative associated partial tear of the cuff or a preoperative positive Jobe test affected significantly the results and increased the rate of full thickness tear at follow-up. The subscapularis calcifications were rare (6% of the calcifications) and were associated with further deposit on the cuff. Infraspinatus calcifications were more frequent (20%), mostly associated to over tendons calcifications. The arthroscopic treatment obtained good results independently from the calcification location but the surgical approach should be adapted. Functional results were lower after removing a type C calcification

  11. Vaccination-related shoulder dysfunction. (United States)

    Bodor, Marko; Montalvo, Enoch


    We present two cases of shoulder pain and weakness following influenza and pneumococcal vaccine injections provided high into the deltoid muscle. Based on ultrasound measurements, we hypothesize that vaccine injected into the subdeltoid bursa caused a periarticular inflammatory response, subacromial bursitis, bicipital tendonitis and adhesive capsulitis. Resolution of symptoms followed corticosteroid injections to the subacromial space, bicipital tendon sheath and glenohumeral joint, followed by physical therapy. We conclude that the upper third of the deltoid muscle should not be used for vaccine injections, and the diagnosis of vaccination-related shoulder dysfunction should be considered in patients presenting with shoulder pain following a vaccination.

  12. Midterm results of Oxford shoulder hemiarthroplasty

    Directory of Open Access Journals (Sweden)

    Amitabh J Dwyer


    Conclusion: This study demonstrates shoulder hemiarthroplasty as reliable procedure for improvement of shoulder function as shown by the patients′ self reported outcome score (OSS in end stage glenohumeral arthritis with intact or reparable rotator cuff at midterm followup. Our results suggest successful outcome of the Oxford shoulder hemiarthroplasty (Corin, UK away from its originating center and in hospitals where fewer shoulder replacements are performed.

  13. Shoulder Stiffness : Current Concepts and Concerns

    NARCIS (Netherlands)

    Itoi, Eiji; Arce, Guillermo; Bain, Gregory I.; Diercks, Ronald L.; Guttmann, Dan; Imhoff, Andreas B.; Mazzocca, Augustus D.; Sugaya, Hiroyuki; Yoo, Yon-Sik


    Shoulder stiffness can be caused by various etiologies such as immobilization, trauma, or surgical interventions. The Upper Extremity Committee of ISAKOS defined the term "frozen shoulder" as idiopathic stiff shoulder, that is, without a known cause. Secondary stiff shoulder is a term that should be

  14. Quantifying shoulder rotation weakness in patients with shoulder impingement. (United States)

    Tyler, Timothy F; Nahow, Rachael C; Nicholas, Stephen J; McHugh, Malachy P


    The purpose of this study was to determine whether strength deficits could be detected in individuals with and without shoulder impingement, all of whom had normal shoulder strength bilaterally according to grading of manual muscle testing. Strength of the internal rotators and external rotators was tested isokinetically at 60 degrees /s and 180 degrees /s, as well as manually with a handheld dynamometer (HHD) in 17 patients and 22 control subjects. Testing was performed with the shoulder positioned in the scapular plane and in 90 degrees of shoulder abduction with 90 degrees of elbow flexion (90-90). The peak torque was determined for each movement. The strength deficit between the involved and uninvolved arms (patients) and the dominant and nondominant arms (control subjects) was calculated for each subject. Comparisons were made for the scapular-plane and 90-90 positions between isokinetic and HHD testing. Despite a normal muscle grade, patients had marked weakness (28% deficit, P weakness was not evident with isokinetic testing at the 90-90 position (60 degrees /s and 180 degrees /s, 0% deficit, P = .99). In control subjects, greater internal rotator strength in the dominant compared with the nondominant arm was evident with the HHD at the 90-90 position (11%, P muscle testing can quantify shoulder strength deficits that may not be apparent with isokinetic testing. By using an HHD during shoulder testing, clinicians can identify weakness that may have been presumed normal.

  15. [Symphysiotomy to relieve shoulder dystocia]. (United States)

    Mourad, Selma M; van de Nieuwenhof, Hedwig P; Biert, Jan; Heidema, Wieteke M; Bekker, Mireille N


    Symphysiotomy to manage shoulder dystocia is seldom used in the western world. For this reason, in well-resourced countries knowledge of its recuperation rate and the management of physical discomfort in the post-partum period is scarce. We describe two cases of symphysiotomy for shoulder dystocia. Both babies did very well in the postpartum period. The short-term 6-week and 6-month follow-up of both mothers is described. Short-term maternal complications were minor and based on prolonged immobilization. In accordance with the international literature, the short-term and long-term follow-up after symphysiotomy for shoulder dystocia was good and there were no major maternal or neonatal complications. We therefore wish to advocate symphysiotomy as a good and safe option to deliver a baby in cases of severe shoulder dystocia, when all other manoeuvres fail.

  16. Characterization of amyloid in equine recurrent uveitis as AA amyloid. (United States)

    Ostevik, L; de Souza, G A; Wien, T N; Gunnes, G; Sørby, R


    Two horses with chronic uveitis and histological lesions consistent with equine recurrent uveitis (ERU) were examined. Microscopical findings in the ciliary body included deposits of amyloid lining the non-pigmented epithelium, intracytoplasmic, rod-shaped, eosinophilic inclusions and intraepithelial infiltration of T lymphocytes. Ultrastructural examination of the ciliary body of one horse confirmed the presence of abundant extracellular deposits of non-branching fibrils (9-11 nm in diameter) consistent with amyloid. Immunohistochemistry revealed strong positive labelling for AA amyloid and mass spectrometry showed the amyloid to consist primarily of serum amyloid A1 in both cases. The findings suggest that localized, intraocular AA amyloidosis may occur in horses with ERU.

  17. Calcific tendinopathy of the shoulder. (United States)

    Bureau, Nathalie J


    This review article presents the current knowledge on the epidemiology and the pathogenesis of calcific tendinopathy of the shoulder and discusses the clinical presentation in relation to the stage of the disease process and the appearance of the calcific deposits. The outcome and the available treatment modalities for this common shoulder disorder are also examined, emphasizing the technique of percutaneous lavage and aspiration under ultrasound guidance.

  18. Arthroscopic findings after shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Medenica Ivica


    Full Text Available Background/Aim. Recurrent instability of the shoulder joint is frequently difficult to differentiate from diseased or injured rotator cuff or tendon of the forearm flexor (m. biceps brachii. Shoulder joint arthroscopy has been only recently introduced into instable shoulder joint lesion examination. The aim of this study was to present and analyze an arthroscopic finding on instable shoulder joint in order to determine causes and mechanisms of instability, as well as principles of surgical treatment. Methods. Arthroscopy of the shoulder joint was performed in 158 patients with at least one documented shoulder joint dislocation. These patients were divided into two groups. The group I included the patients with one to three dislocations, while the group II those with more than three dislocations. Preoperative diagnosis was based on anamnestic data and clinical examination using specific tests, and on the diagnosis of shoulder joint using radiography or computed tomography. Results. Out of the total number of the patients 138 (87.34% had injury of the anterior patellar brim, 119 (75.32% had failure of the anterior capsule, 126 (79.75% had compressive cartilage injury of the posterior part of the head of the upper arm bone (Hill-Sachs lesion, 102 (64.56% had insufficiency of glenohumeral tendon, 11 (6.96 had complete cut of the rotator cuff, 23 (14.56% had injury of the posterior patellar brim, 12 (7.59% had injury of the upper anterior-posterior patellar brim (SLAP. Conclusion. According to the obtained results it could be concluded that there is no a unique injury that leads to shoulder joint instability. It is necessary to point out to the significance of anamnesis and clinical examination in making diagnosis. Arthroscopic diagnostics is indicated in clinically unreliable findings as an additional method for determining operative treatment.

  19. Shoulder disorders in the elderly (a hospital study).


    Chard, M D; Hazleman, B L


    One hundred acute geriatric inpatients were assessed to investigate the prevalence of shoulder disorders; 21 had symptoms due to shoulder disease. Conditions included supraspinatus tendinitis (five), chronic rotator cuff rupture (seven), frozen shoulder (two), glenohumeral osteoarthritis (two), apatite related shoulder arthritis (one), stroke related shoulder disease (six). (Some patients had more than one shoulder condition.) The last group included painful stiff shoulders (three), glenohume...

  20. New concepts in restoring shoulder elevation in a stiff and painful shoulder patient. (United States)

    Donatelli, Robert; Ruivo, R M; Thurner, Michael; Ibrahim, Mahmoud Ibrahim


    The treatment and evaluation of a stiff and painful shoulder, characteristic of adhesive capsulitis and "frozen" shoulders, is a dilemma for orthopedic rehabilitation specialists. A stiff and painful shoulder is all-inclusive of Adhesive capsulitis and Frozen Shoulder diagnoses. Adhesive capsulitis and frozen shoulder will be referred to as a stiff and painful shoulder, throughout this paper. Shoulder motion occurs in multiple planes of movement. Loss of shoulder mobility can result in significant functional impairment. The traditional treatment approach to restore shoulder mobility emphasizes mobilization of the shoulder overhead. Forced elevation in a stiff and painful shoulder can be painful and potentially destructive to the glenohumeral joint. This manuscript will introduce a new biomechanical approach to evaluate and treat patients with stiff and painful shoulders.

  1. Nanomaterials for reducing amyloid cytotoxicity. (United States)

    Zhang, Min; Mao, Xiaobo; Yu, Yue; Wang, Chen-Xuan; Yang, Yan-Lian; Wang, Chen


    This review is intended to reflect the recent progress on therapeutic applications of nanomaterials in amyloid diseases. The progress on anti-amyloid functions of various nanomaterials including inorganic nanoparticles, polymeric nanoparticles, carbon nanomaterials and biomolecular aggregates, is reviewed and discussed. The main functionalization strategies for general nanoparticle modifications are reviewed for potential applications of targeted therapeutics. The interaction mechanisms between amyloid peptides and nanomaterials are discussed from the perspectives of dominant interactions and kinetics. The encapsulation of anti-amyloid drugs, targeted drug delivery, controlled drug release and drug delivery crossing blood brain barrier by application of nanomaterials would also improve the therapeutics of amyloid diseases.

  2. Editorial Commentary: Shoulder Arthroscopy, Shoulder Hemiarthroplasty, and Total Shoulder Arthroplasty for Glenohumeral Osteoarthritis. (United States)

    Lubowitz, James H


    Shoulder arthroscopy offers a safe, effective, and less invasive alternative to arthroplasty in patients under 60 years of age with glenohumeral arthritis. However, indications include joint space of greater than 2 mm. For patients who do not meet arthroscopic indications, total shoulder arthroplasty is more effective than hemiarthroplasty. Performance and publication bias may effect generalizability of these findings. Biologic treatment options seem on the horizon.

  3. Rheumatoid arthritis of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Dijkstra, J.; Dijkstra, P.F.; Klundert, W. v. d.


    The course of rheumatoid arthritis in the shoulder is evaluated in 143 patients. In a period of 29 years, 630 X-rays were taken of 286 shoulders. In this series 2 or more X-rays per shoulder were taken of 89 patients (29 male, 60 female). The various changes in the glenohumeral and acromioclavicular joints were described. Gross destruction appears to be rare, compared to the more frequently seen minor cystic changes. The progress of the disease is often slow or halting. One or both of the shoulders in some of the patients (15 male and 29 female) did not have any detectable X-rays changes, although some of them were followed up for more than 20 years. During our follow-up it became apparent that the acromioclavicular and glenohumeral joints do not follow the same course neither in time nor in severity of joint destruction. Therefore, we divided the shoulder joint into the acromioclavicular and glenohumeral joint. One normal stage and 5 stages of pathology are recognised to fit into previously published schemes of the other joints. Stage 5 appears to be a new phenomenon of neojoint formation, under the previous humeral head with the inferior glenoid rim. Joint disease in the acromioclavicular joint could be divided only into 3 stages.

  4. Heterotopic bone formation following total shoulder arthroplasty

    DEFF Research Database (Denmark)

    Kjaersgaard-Andersen, P.; Frich, Lars Henrik; Sjøbjerg, J.O.


    The incidence and location of heterotopic bone formation following total shoulder arthroplasty were evaluated in 58 Neer Mark-II total shoulder replacements. One year after surgery, 45% had developed some ectopic ossification. In six shoulders (10%) the ossifications roentgenographically bridged...... the glenohumeral and/or the glenoacromial space. There was no correlation between shoulder pain and the development of ossification. Shoulders with grade III heterotopic bone formation had a limited range of active elevation compared with shoulders without or with only a milder lesion. Men and patients...... with osteoarthritis of the shoulder joint were significantly disposed to the development of heterotopic bone. Heterotopic bone formation following total shoulder arthroplasty is frequent, but disabling heterotopic ossifications seem to be rare....

  5. Painful Shoulder in Swimmers: A Diagnostic Challenge. (United States)

    McMaster, William C.


    This article discusses the incidence, diagnosis, and treatment of painful shoulder in swimmers, including: regional problems that can cause shoulder pain; physical, clinical, and laboratory tests for diagnostic use; and approaches to management of the problem. (Author/CB)

  6. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (United States)


    ... uncemented prosthesis. 888.3690 Section 888.3690 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis is a device made of alloys, such as...

  7. 21 CFR 888.3680 - Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis. (United States)


    ... cemented prosthesis. 888.3680 Section 888.3680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis. (a) Identification. A shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis is a device that has a glenoid (socket)...

  8. An investigation of shoulder forces in active shoulder tackles in rugby union football. (United States)

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


    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.

  9. Shoulder fusion for paralyzed upper limb

    NARCIS (Netherlands)

    Emmelot, CH; Nielsen, HKL; Eisma, WH


    Fusion of the shoulder joint after a brachial plexus injury is a well known procedure in cases of flail shoulder in combination with normal motor and sensory function in the hand. However, in combination with modern orthoses to stabilize the elbow, fusion of the shoulder in cases of a totally flacci

  10. 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)


    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)

  11. Gimbaled-shoulder friction stir welding tool (United States)

    Carter, Robert W. (Inventor); Lawless, Kirby G. (Inventor)


    A gimbaled-shoulder friction stir welding tool includes a pin and first and second annular shoulders coupled to the pin. At least one of the annular shoulders is coupled to the pin for gimbaled motion with respect thereto as the tool is rotated by a friction stir welding apparatus.

  12. Throwing Injuries of the Shoulder. (United States)

    McCue, Frank C., III; and Others

    The majority of shoulder injuries occurring in throwing sports involve the soft tissue structures. Injuries often occur when the unit is overstretched to a point near its greatest length, involving the elastic tissues. The other injury mechanism involves the contractural unit of the muscle, which occurs near the midpoint of contractions, involving…

  13. Management of the frozen shoulder

    Directory of Open Access Journals (Sweden)

    van de Laar SM


    Full Text Available Suzanne Margaretha van de Laar, Peer van der Zwaal Department of Orthopaedic Surgery and Trauma, Medical Center Haaglanden, The Hague, the Netherlands Abstract: Frozen shoulder is a very common condition with a prevalence of 2%–5% in the general population. Decrease in joint volume as a result of fibrosis and hyperplasia of the joint capsule leads to painful and restricted glenohumeral motion. Frozen shoulder is a self-limiting disease with a chronic character, and is mostly treated in a primary care setting. In this review, we set out to address the current evidence-based literature on management of this disabling disease using a PubMed search. Many non-surgical and surgical therapeutic options are described, including supervised neglect, intra-articular corticosteroid injections, physical therapy, manipulation under anesthesia, capsular distension, and arthroscopic capsular release. In the literature, the long-term outcome shows a significant decrease in pain and improvement of shoulder function for all treatment modalities without clear evidence of superiority of one over the other. This possibly indicates that a self-limiting character is the most important factor in the course of the disease. Management of frozen shoulder is primarily conservative. Supervised neglect is combined with analgesia and stretching exercises as the pain subsides. In the early painful phase, intra-articular corticosteroid injections are recommended for pain relief. When the patient has persistent pain and glenohumeral stiffness after adequate conservative treatment, invasive options can be considered, like arthroscopic capsular release, manipulation under anesthesia, or capsular distension. Keywords: frozen shoulder, adhesive capsulitis, treatment, pathophysiology

  14. Complications of labor and delivery: shoulder dystocia. (United States)

    Anderson, Jane E


    This article reviews one of the less common but most dreaded complications of labor and delivery, shoulder dystocia, an infrequent but potentially devastating event that results from impaction of the fetal shoulders in the maternal pelvis. Shoulder dystocia occurs most commonly in patients without identified risk factors, and can result in both maternal and fetal morbidity. Because the vast majority of cases of shoulder dystocia are unpredictable, obstetric care providers must be prepared to recognize dystocia and respond appropriately in every delivery. Detailed documentation is essential after any delivery complicated by shoulder dystocia.

  15. Pathogenesis of cerebral amyloid angiopathy.

    NARCIS (Netherlands)

    Rensink, A.A.M.; Waal, R.M.W. de; Kremer, H.P.H.; Verbeek, M.M.


    Cerebral amyloid angiopathy (CAA) is the result of the deposition of an amyloidogenic protein in cortical and leptomeningeal vessels. The most common type of CAA is caused by amyloid beta-protein (Abeta), which is particularly associated with Alzheimer's disease (AD). Excessive Abeta-CAA formation c

  16. Extraskeletal problems and amyloid. (United States)

    Drüeke, T B


    The major clinical manifestations of dialysis-associated A beta 2M amyloidosis are chronic arthralgias, destructive arthropathy and the carpal tunnel syndrome. For dialysis patients who have been maintained on renal replacement therapy for more than 10-15 years, this complication may become a major physical handicap. It may even be life-threatening in some instances due to cervical cord compression. Amyloid deposits in joint areas precede clinical symptoms and signs by several years. Systemic deposits may also occur but their clinical manifestations are infrequent. The diagnosis of dialysis arthropathy associated with beta 2-microglobulin-associated (A beta 2M) amyloidosis mostly relies on indirect clinical and radiological evidence. Histologic proof is rarely obtained in vivo. The pathogenesis of the disease is complex. It includes reduced elimination of beta 2M and potentially also as impaired degradation of A beta 2M as well as enhanced production of A beta 2M amyloid fibrils. Non enzymatic modifications of beta 2M probably play a role, including beta 2M protein modification with advanced glycation end-products (AGE) and advanced oxidation protein products. Modified beta 2M, collagen and proteoglycans appear actively involved in the induction of a local inflammatory response and beta 2M amyloid formation. There is also evidence in favor of treatment-related factors such as the type of hemodialysis membrane and the purity of dialysis water. Hopefully, the translation of our improving knowledge of all the factors involved will lead to a better treatment and eventually to the prevention of this dramatic complication of dialysis.

  17. Hacking the code of amyloid formation: the amyloid stretch hypothesis. (United States)

    Pastor, M Teresa; Esteras-Chopo, Alexandra; Serrano, Luis


    Many research efforts in the last years have been directed towards understanding the factors determining protein misfolding and amyloid formation. Protein stability and amino acid composition have been identified as the two major factors in vitro. The research of our group has been focused on understanding the relationship between amino acid sequence and amyloid formation. Our approach has been the design of simple model systems that reproduce the biophysical properties of natural amyloids. An amyloid sequence pattern was extracted that can be used to detect amyloidogenic hexapeptide stretches in proteins. We have added evidence supporting that these amyloidogenic stretches can trigger amyloid formation by nonamyloidogenic proteins. Some experimental results in other amyloid proteins will be analyzed under the conclusions obtained in these studies. Our conclusions together with evidences from other groups suggest that amyloid formation is the result of the interplay between a decrease of protein stability, and the presence of highly amyloidogenic regions in proteins. As many of these results have been obtained in vitro, the challenge for the next years will be to demonstrate their validity in in vivo systems.

  18. The nerves around the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Blum, Alain, E-mail: [Service d’Imagerie GUILLOZ, CHU Nancy, Nancy 54000 (France); Lecocq, Sophie; Louis, Matthias; Wassel, Johnny; Moisei, Andreea; Teixeira, Pedro [Service d’Imagerie GUILLOZ, CHU Nancy, Nancy 54000 (France)


    Neuropathies of the shoulder are considered to be entrapment syndromes. They are relatively common, accounting for about 2% of cases of sport-related shoulder pain. Many instances involve suprascapular neuropathy, but the clinical diagnosis is often delayed because of nonspecific symptoms. Classically, EMG is the gold standard investigation but MRI currently reveals muscular abnormality in 50% of cases. Muscle edema, the most characteristic symptom, is nonspecific. In general, the topography of edema, the presence of a lesion compressing the nerve and clinical history contribute to the diagnosis. Although atrophy and fatty degeneration may persist after the disappearance of edema, they are rarely symptomatic. The main differential diagnosis is Parsonage–Turner syndrome. Evidence of a cyst pressing on a nerve may prompt puncture-infiltration guided by ultrasonography or CT-scan.

  19. Pathomechanics of the throwing shoulder. (United States)

    Kibler, W Ben; Thomas, Stephen J


    Many anatomic, physiological, and biomechanical alterations have been observed in overhead athletes who present with painful shoulders. This is probably due to the complex kinetic chain mechanics required in the overhead throwing or serving motion. Any alteration along the kinetic chain can result in deficits in force production or increase in joint loads in other parts of the chain. The "disabled throwing shoulder" (DTS) is a general term that describes the limitations in function that exist in symptomatic overhead athletes. DTS typically results from a "cascade to injury" with alterations in the kinetic chain. Evaluation of athletes with the DTS should include examination of the local and distant anatomic injuries and screening for physiological (muscle inflexibilities, weakness, or imbalances) or biomechanical (motions, positions) alterations.

  20. Bony instability of the shoulder. (United States)

    Bushnell, Brandon D; Creighton, R Alexander; Herring, Marion M


    Instability of the shoulder is a common problem treated by many orthopaedists. Instability can result from baseline intrinsic ligamentous laxity or a traumatic event-often a dislocation that injures the stabilizing structures of the glenohumeral joint. Many cases involve soft-tissue injury only and can be treated successfully with repair of the labrum and ligamentous tissues. Both open and arthroscopic approaches have been well described, with recent studies of arthroscopic soft-tissue techniques reporting results equal to those of the more traditional open techniques. Over the last decade, attention has focused on the concept of instability of the shoulder mediated by bony pathology such as a large bony Bankart lesion or an engaging Hill-Sachs lesion. Recent literature has identified unrecognized large bony lesions as a primary cause of failure of arthroscopic reconstruction for instability, a major cause of recurrent instability, and a difficult diagnosis to make. Thus, although such bony lesions may be relatively rare compared with soft-tissue pathology, they constitute a critically important entity in the management of shoulder instability. Smaller bony lesions may be amenable to arthroscopic treatment, but larger lesions often require open surgery to prevent recurrent instability. This article reviews recent developments in the diagnosis and treatment of bony instability.

  1. Familial amyloid polyneuropathy. (United States)

    Planté-Bordeneuve, Violaine; Said, Gerard


    Familial amyloid polyneuropathies (FAPs) are a group of life-threatening multisystem disorders transmitted as an autosomal dominant trait. Nerve lesions are induced by deposits of amyloid fibrils, most commonly due to mutated transthyretin (TTR). Less often the precursor of amyloidosis is mutant apolipoprotein A-1 or gelsolin. The first identified cause of FAP-the TTR Val30Met mutation-is still the most common of more than 100 amyloidogenic point mutations identified worldwide. The penetrance and age at onset of FAP among people carrying the same mutation vary between countries. The symptomatology and clinical course of FAP can be highly variable. TTR FAP typically causes a nerve length-dependent polyneuropathy that starts in the feet with loss of temperature and pain sensations, along with life-threatening autonomic dysfunction leading to cachexia and death within 10 years on average. TTR is synthesised mainly in the liver, and liver transplantation seems to have a favourable effect on the course of neuropathy, but not on cardiac or eye lesions. Oral administration of tafamidis meglumine, which prevents misfolding and deposition of mutated TTR, is under evaluation in patients with TTR FAP. In future, patients with FAP might benefit from gene therapy; however, genetic counselling is recommended for the prevention of all types of FAP.

  2. Serum amyloid P component scintigraphy in familial amyloid polyneuropathy: regression of visceral amyloid following liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Rydh, A.; Hietala, S.O.; Aahlstroem, K.R. [Department of Diagnostic Radiology, University Hospital of Northern Sweden, Umeaa (Sweden); Suhr, O. [Department of Internal Medicine, University Hospital of Northern Sweden, Umeaa (Sweden); Pepys, M.B.; Hawkins, P.N. [Immunological Medicine Unit, Department of Medicine, Imperial College School of Medicine, London (United Kingdom)


    Familial amyloid polyneuropathy (FAP) associated with transthyretin (TTR) mutations is the commonest type of hereditary amyloidosis. Plasma TTR is produced almost exclusively in the liver and orthotopic liver transplantation is the only available treatment, although the clinical outcome varies. Serum amyloid P component (SAP) scintigraphy is a method for identifying and quantitatively monitoring amyloid deposits in vivo, but it has not previously been used to study the outcome of visceral amyloid deposits in FAP following liver transplantation. Whole body scintigraphy following injection of iodine-123 labelled SAP was performed in 17 patients with FAP associated with TTR Met30 and in five asymptomatic gene carriers. Follow-up studies were performed in ten patients, eight of whom had undergone orthotopic liver transplantation 1-5 years beforehand. There was abnormal uptake of {sup 123}I-SAP in all FAP patients, including the kidneys in each case, the spleen in five cases and the adrenal glands in three cases. Renal amyloid deposits were also present in three of the asymptomatic carriers. Follow-up studies 1-5 years after liver transplantation showed that there had been substantial regression of the visceral amyloid deposits in two patients and modest improvement in three cases. The amyloid deposits were unchanged in two patients. In conclusion, {sup 123}I-SAP scintigraphy identified unsuspected visceral amyloid in each patient with FAP due to TTR Met30. The universal presence of renal amyloid probably underlies the high frequency of renal failure that occurs in FAP following liver transplantation. The variable capacity of patients to mobilise amyloid deposits following liver transplantation may contribute to their long-term clinical outcome. (orig.) With 2 figs., 2 tabs., 22 refs.

  3. Diversity, biogenesis and function of microbial amyloids



    Amyloid is a distinct β-sheet-rich fold that many proteins can acquire. Frequently associated with neurodegenerative diseases in humans, including Alzheimer’s, Parkinson’s and Huntington’s, amyloids are traditionally considered the product of protein misfolding. However, the amyloid fold is now recognized as a ubiquitous part of normal cellular biology. ‘Functional’ amyloids have been identified in nearly all facets of cellular life, with microbial functional amyloids leading the way. Unlike ...

  4. Shoulder muscle activity and function in common shoulder rehabilitation exercises. (United States)

    Escamilla, Rafael F; Yamashiro, Kyle; Paulos, Lonnie; Andrews, James R


    The rotator cuff performs multiple functions during shoulder exercises, including glenohumeral abduction, external rotation (ER) and internal rotation (IR). The rotator cuff also stabilizes the glenohumeral joint and controls humeral head translations. The infraspinatus and subscapularis have significant roles in scapular plane abduction (scaption), generating forces that are two to three times greater than supraspinatus force. However, the supraspinatus still remains a more effective shoulder abductor because of its more effective moment arm. Both the deltoids and rotator cuff provide significant abduction torque, with an estimated contribution up to 35-65% by the middle deltoid, 30% by the subscapularis, 25% by the supraspinatus, 10% by the infraspinatus and 2% by the anterior deltoid. During abduction, middle deltoid force has been estimated to be 434 N, followed by 323 N from the anterior deltoid, 283 N from the subscapularis, 205 N from the infraspinatus, and 117 N from the supraspinatus. These forces are generated not only to abduct the shoulder but also to stabilize the joint and neutralize the antagonistic effects of undesirable actions. Relatively high force from the rotator cuff not only helps abduct the shoulder but also neutralizes the superior directed force generated by the deltoids at lower abduction angles. Even though anterior deltoid force is relatively high, its ability to abduct the shoulder is low due to a very small moment arm, especially at low abduction angles. The deltoids are more effective abductors at higher abduction angles while the rotator cuff muscles are more effective abductors at lower abduction angles. During maximum humeral elevation the scapula normally upwardly rotates 45-55 degrees, posterior tilts 20-40 degrees and externally rotates 15-35 degrees. The scapular muscles are important during humeral elevation because they cause these motions, especially the serratus anterior, which contributes to scapular upward rotation

  5. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain

    NARCIS (Netherlands)

    Bron, Carel; Dommerholt, J.; Stegenga, Boudewijn; Wensing, M.; Oostendorp, R.A.B.


    Background: Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols.

  6. Gimballed Shoulders for Friction Stir Welding (United States)

    Carter, Robert; Lawless, Kirby


    In a proposed improvement of tooling for friction stir welding, gimballed shoulders would supplant shoulders that, heretofore, have been fixedly aligned with pins. The proposal is especially relevant to self-reacting friction stir welding. Some definitions of terms, recapitulated from related prior NASA Tech Briefs articles, are prerequisite to a meaningful description of the proposed improvement. In friction stir welding, one uses a tool that includes (1) a rotating shoulder on top (or front) of the workpiece and (2) a pin that rotates with the shoulder and protrudes from the shoulder into the depth of the workpiece. In conventional friction stir welding, the main axial force exerted by the tool on the workpiece is reacted through a ridged backing anvil under (behind) the workpiece. When conventional friction stir welding is augmented with an auto-adjustable pin-tool (APT) capability, the depth of penetration of the pin into the workpiece is varied in real time by a position- or forcecontrol system that extends or retracts the pin as needed to obtain the desired effect. In self-reacting (also known as self-reacted) friction stir welding as practiced heretofore, there are two shoulders: one on top (or front) and one on the bottom (or back) of the workpiece. In this case, a threaded shaft protrudes from the tip of the pin to beyond the back surface of the workpiece. The back shoulder is held axially in place against tension by a nut on the threaded shaft. Both shoulders rotate with the pin and remain aligned coaxially with the pin. The main axial force exerted on the workpiece by the tool and front shoulder is reacted through the back shoulder and the threaded shaft into the friction-stir-welding machine head, so that a backing anvil is no longer needed. A key transmits torque between the bottom shoulder and the threaded shaft, so that the bottom shoulder rotates with the shaft. This concludes the prerequisite definitions of terms.

  7. Athletes’ Shoulder Joints Traumas Manual Therapy Rehabilitation

    Directory of Open Access Journals (Sweden)

    A.N. Sykhorychko


    Full Text Available The examination of 60 athletes, aged 18-30, suffering from chronic pains in shoulder joints was conducted. So, 20 women and 20 men were engaged in track and field and team sports, 15 in weightlifting and strength sports, 5 women in strength sports. Shoulder Joints Traumas Manual Therapy enables to reduce pain syndrome, restore shoulder joint flexibility, normalize trophism after trauma and normalize cervicothoracic transition biomechanics.

  8. Stemless shoulder arthroplasty: a literature review




    The design of humeral implants for shoulder arthroplasty has evolved over the years. The new-generation modular shoulder prostheses have an anatomical humeral stem that replicates the three-dimensional parameters of the proximal humerus. An anatomical reconstruction is the best way to restore stability and mobility of the prosthetic shoulder and improve implant durability. However, a perfect anatomical match is not always possible in, for example, patients with post-traumatic osteoarthritis o...

  9. Shoulder joint: overview and clinical evaluation


    Umaña Calderón, Andrés


    The shoulder joint is a complex anatomical unit, in which different structures work together so it can have a great range of motion while maintaining its integrity and stability. Shoulder joint disease is a common consultation reason in emergency and primary care services, thus representing a challenge for health care providers, given its complexity and important anatomical relationships. The purpose of this paper is to present a review of the main anatomical considerations of the shoulder jo...

  10. Shoulder dystocia: risk factors, predictability, and preventability. (United States)

    Mehta, Shobha H; Sokol, Robert J


    Shoulder dystocia remains an unpredictable obstetric emergency, striking fear in the hearts of obstetricians both novice and experienced. While outcomes that lead to permanent injury are rare, almost all obstetricians with enough years of practice have participated in a birth with a severe shoulder dystocia and are at least aware of cases that have resulted in significant neurologic injury or even neonatal death. This is despite many years of research trying to understand the risk factors associated with it, all in an attempt primarily to characterize when the risk is high enough to avoid vaginal delivery altogether and prevent a shoulder dystocia, whose attendant morbidities are estimated to be at a rate as high as 16-48%. The study of shoulder dystocia remains challenging due to its generally retrospective nature, as well as dependence on proper identification and documentation. As a result, the prediction of shoulder dystocia remains elusive, and the cost of trying to prevent one by performing a cesarean delivery remains high. While ultimately it is the injury that is the key concern, rather than the shoulder dystocia itself, it is in the presence of an identified shoulder dystocia that occurrence of injury is most common. The majority of shoulder dystocia cases occur without major risk factors. Moreover, even the best antenatal predictors have a low positive predictive value. Shoulder dystocia therefore cannot be reliably predicted, and the only preventative measure is cesarean delivery.


    Directory of Open Access Journals (Sweden)



    Full Text Available OBJECTIVE: To compare the effectiveness of Triamcinolone acetonide [40mg] and Methylprednisolone acetate [40mg] in 210 patients attending the Outpatient Department of Orthopedics of FAAMCH Barpeta with primary and secondary frozen shoulder. METHODS: A total number o f 210 patients with frozen shoulder who attended the Outpatient clinic of Orthopedics at FAAMCH from Jan 2013 to Jan 2015 were enrolled in our study. The diagnosis of frozen shoulder was made using the guidelines for shoulder complain issued by the Dutch C ollege of General Practitioners. Intra - articular injections of Triamcinolone acetonide [40mg] was used in 110 patients [ M ale - 50, female - 60] and 40mg Methylprednisolone was given to 100 patients [M ale - 35, female 65]. Injection was repeated every 3 weeks [ N o t more than 3 injections] by the posterior route. RESULTS: Triamcinolone acetonide was found to be more effective in diabetic patients with frozen shoulder in comparison to Methyprednisolone acetate. Triamcinolone acetonide was found to be more effective i n those patients presenting with severe grades of frozen shoulder and also these patients required lesser number of injections compared to Methylprednisolone acetate. However both Triamcinolone acatonide and Methyprednisolone were equally effective in prim ary frozen shoulder. CONCLUSION: We conclude that Triamcinolone acetonide and Methylprednisolone acetate are effective in the treatment of painful stiff shoulder; however injection Triamcinolone acetonide is a superior alternative in the treatment of diabe tics with frozen shoulder & resistant cases, with less number of injections.

  12. A shoulder pain score : A comprehensive questionnaire for assessing pain in patients with shoulder complaints

    NARCIS (Netherlands)

    Winters, JC; Sobel, JS; Groenier, KH; Arendzen, JH; MeyboomDeJong, B


    This study describes the validation and application of a comprehensive questionnaire (the shoulder pain score) in assessing pain experienced by patients with shoulder complaints. The shoulder pain score comprised six pain symptom questions selected from the literature, together with a 101-Numerical

  13. [Tendon ruptures of the shoulder]. (United States)

    Habermeyer, P


    Common sports, involving raising the arms above the head, i.e., throwing, racquet games and swimming, often result in rotator cuff tendinitis. During the throwing motion, the humeral head and its overlying biceps tendon and rotator cuff must pass rapidly under the coraco-acromial arch. Damage to these structures can occur by several mechanism. First, an increase in the size of the structures passing underneath the arch may lead to impingement. This can occur either by way of hypertrophy of the musculotendinous cuff or by way of inflammation of the cuff. Second, a decreased space available underneath the arch secondary to osteophyte formation of the acromion and fibrosis of the subacromial space may lead to impingement. Third, weakness or incompetence of the rotator cuff allows the humerus to ride up and impinge on the coracoacromial arch with motion of the shoulder. Tendinitis can be combined with increased laxity of the glenohumeral joint and/or acquired instability due to a labral tear. Prevention of overuse injuries is a cornerstone of our treatment concept. The muscle tendon unit requires passive and neuromuscular facilitated streching after warming-up exercises. Muscular imbalance and weakness are prevented by balanced eccentric strenthening with particular attention to the external rotators and scapular muscles. Knowledge of the mechanics of the pitching motion, tennis serve, swimming stroke, etc. is of paramount importance in the prevention of injuries. As the onset of shoulder problems contributes to a particularly fatiguing situation, extreme fatique performance severity should be avoided. Every effort must be made to apply conservative treatment when overuse problems arise in the athlete's shoulder.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. On the Shoulders of Giants... (United States)


    On the shoulders of giantsI Basil A. Pruitt, Jr., MD and Todd E. Rasmussen, MD I n a letter dated February 5, 1676 (dated 1675 using the Julian...T.E.R.), Fort Sam Houston, San Antonio, TX. Address for reprints: Basil A. Pruitt, Jr, MD, Division of Trauma, Department of Surgery, The University...default.htm. 20. Moore FD. Edward Delos Churchill (1895Y1972). Ann Surg. 1973; 177:507Y508. 21. The Board for the Study of the Severely Wounded. The

  15. The effect of shoulder supporting banding and shoulder pulling banding using elastic bands on shoulder pain and scapular position of a scapular dyskinesis patient with shoulder depression and scapular downward rotation


    Yoo, Won-gyu


    [Purpose] This study developed methods of shoulder supporting banding and shoulder pulling banding using elastic bands for scapular dyskinesis patients with shoulder depression and scapular downward rotation and investigated the effect on shoulder pain and scapular position. [Subject] The subject was a scapular dyskinesis patient with shoulder depression and scapular downward rotation and shoulder pain. [Methods] This study compared the scapular position and upper trapezius pressure pain betw...

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

    Directory of Open Access Journals (Sweden)

    Lacy, Kyle


    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.

  17. Diagnosing patients with longstanding shoulder joint pain

    DEFF Research Database (Denmark)

    Nørregaard, J; Krogsgaard, M R; Lorenzen, T


    OBJECTIVE: To examine the interobserver agreement of commonly used clinical tests and diagnoses in patients with shoulder pain, and the accuracy of these tests and ultrasonographic findings in comparison with arthroscopic findings. METHODS: Eighty six patients with longstanding shoulder joint pain...

  18. [Prediction, prevention and management of shoulder dystocia]. (United States)

    Csorba, Roland


    Shoulder dystocia is one of the most tragic, fatal and unexpected obstetrical events, which is mostly unpredictable and unpreventable. This clinical picture is defined as a delivery that requires additional obstetric maneuvers to release the shoulders after gentle downward traction has failed. Shoulder dystocia occurs when the fetal shoulder impacts on the maternal symphysis or sacral promontory. The incidence of shoulder dystocia is 0.2-0.6%. High perinatal mortality and morbidity is associated with the condition, even when it is managed appropriately. Obstetricians should be aware of the existing risk factors, but should always be alert to the possibility of shoulder dystocia in all labors. Maternal morbidity is also increased, particularly postpartum hemorrhage, rupture of the uterus, injury of the bladder, urethra and the bowels and fourth-degree perineal tears. Complications of the newborn include asphyxia, perinatal mortality, fracture of the clavicula and the humerus. Brachial plexus injuries are one of the most important fetal complications of shoulder dystocia, complicating 4-16% of such deliveries. The purpose of this article is to review the current evidence regarding the possible prediction, prevention and management of shoulder dystocia.

  19. Concept of healing of recurrent shoulder dislocation☆ (United States)

    D’Angelo, Donato


    This paper presents the main surgical techniques applied in the treatment of anterior recurrent shoulder dislocation, aiming the achievement of the normality of articulate movements. This was obtained by combining distinct surgical procedures, which allowed the recovery of a complete functional capacity of the shoulder, without jeopardizing the normality of movement, something that has not been recorded in the case of the tense sutures of the surgical procedures of Putti-Platt, Bankart, Latarjet, Dickson-O’Dell and others. The careful review of the methods applied supports the conclusion that recurrent shoulder dislocation can be cured, since cure has been obtained in 97% of the treated cases. However, some degree of limitation in the shoulder movement has been observed in most of the treated cases. Our main goal was to achieve a complete shoulder functional recovery, by treating simultaneously all of the anatomical–pathological lesions, without considering the so-called essential lesions. The period of post-operatory immobilization only last for the healing of soft parts; this takes place in a position of neutral shoulder rotation, since the use of vascular bone graft eliminates the need for long time immobilization, due to the shoulder stabilization provided by rigid fixation of the coracoid at the glenoid edge, as in the Latarjet's technique. Our procedure, used since 1959, comprises the association of several techniques, which has permitted shoulder healing without movement limitation. That was because of the tension reduction in the sutures of the subescapularis, capsule, and coracobraquialis muscles. PMID:26229839

  20. Towards a Pharmacophore for Amyloid

    Energy Technology Data Exchange (ETDEWEB)

    Landau, Meytal; Sawaya, Michael R.; Faull, Kym F.; Laganowsky, Arthur; Jiang, Lin; Sievers, Stuart A.; Liu, Jie; Barrio, Jorge R.; Eisenberg, David (UCLA)


    Diagnosing and treating Alzheimer's and other diseases associated with amyloid fibers remains a great challenge despite intensive research. To aid in this effort, we present atomic structures of fiber-forming segments of proteins involved in Alzheimer's disease in complex with small molecule binders, determined by X-ray microcrystallography. The fiber-like complexes consist of pairs of {beta}-sheets, with small molecules binding between the sheets, roughly parallel to the fiber axis. The structures suggest that apolar molecules drift along the fiber, consistent with the observation of nonspecific binding to a variety of amyloid proteins. In contrast, negatively charged orange-G binds specifically to lysine side chains of adjacent sheets. These structures provide molecular frameworks for the design of diagnostics and drugs for protein aggregation diseases. The devastating and incurable dementia known as Alzheimer's disease affects the thinking, memory, and behavior of dozens of millions of people worldwide. Although amyloid fibers and oligomers of two proteins, tau and amyloid-{beta}, have been identified in association with this disease, the development of diagnostics and therapeutics has proceeded to date in a near vacuum of information about their structures. Here we report the first atomic structures of small molecules bound to amyloid. These are of the dye orange-G, the natural compound curcumin, and the Alzheimer's diagnostic compound DDNP bound to amyloid-like segments of tau and amyloid-{beta}. The structures reveal the molecular framework of small-molecule binding, within cylindrical cavities running along the {beta}-spines of the fibers. Negatively charged orange-G wedges into a specific binding site between two sheets of the fiber, combining apolar binding with electrostatic interactions, whereas uncharged compounds slide along the cavity. We observed that different amyloid polymorphs bind different small molecules, revealing that a

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

    DEFF Research Database (Denmark)

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


    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...... risk slightly (OR 1.6, 95% CI 1.0-2.6 per unit). CONCLUSIONS: The results indicate that workers with repetitive tasks have increased risk of shoulder tendinitis, which partially can be attributed to force requirements...

  2. Postoperative pectoral swelling after shoulder arthroscopy. (United States)

    Ercin, Ersin; Bilgili, Mustafa Gokhan; Ones, Halil Nadir; Kural, Cemal


    Fluid extravasation is possibly the most common complication of shoulder arthroscopy. Shoulder arthroscopy can lead to major increases in the compartment pressure of adjacent muscles and this phenomenon is significant when an infusion pump is used. This article describes a case of pectoral swelling due to fluid extravasation after shoulder arthroscopy. A 24-year-old male underwent an arthroscopic Bankart repair for recurrent shoulder dislocation. The surgery was performed in the beach chair position and lasted two hours. At the end of the procedure, the patient was found to have left pectoral swelling. A chest radiography showed no abnormality. Pectoral swelling due to fluid extravasation after shoulder arthroscopy has not previously been documented.

  3. Shoulder Ultrasonography: Performance and Common Findings

    Directory of Open Access Journals (Sweden)

    Diana Gaitini


    Full Text Available Ultrasound (US of the shoulder is the most commonly requested examination in musculoskeletal US diagnosis. Sports injuries and degenerative and inflammatory processes are the main sources of shoulder pain and functional limitations. Because of its availability, low cost, dynamic examination process, absence of radiation exposure, and ease of patient compliance, US is the preferred mode for shoulder imaging over other, more sophisticated, and expensive methods. Operator dependence is the main disadvantage of US examinations. Use of high range equipment with high resolution transducers, adhering to a strict examination protocol, good knowledge of normal anatomy and pathological processes and an awareness of common pitfalls are essential for the optimal performance and interpretation of shoulder US. This article addresses examination techniques, the normal sonographic appearance of tendons, bursae and joints, and the main pathological conditions found in shoulder ultrasonography.

  4. Shoulder posture and median nerve sliding

    Directory of Open Access Journals (Sweden)

    Dilley Andrew


    Full Text Available Abstract Background Patients with upper limb pain often have a slumped sitting position and poor shoulder posture. Pain could be due to poor posture causing mechanical changes (stretch; local pressure that in turn affect the function of major limb nerves (e.g. median nerve. This study examines (1 whether the individual components of slumped sitting (forward head position, trunk flexion and shoulder protraction cause median nerve stretch and (2 whether shoulder protraction restricts normal nerve movements. Methods Longitudinal nerve movement was measured using frame-by-frame cross-correlation analysis from high frequency ultrasound images during individual components of slumped sitting. The effects of protraction on nerve movement through the shoulder region were investigated by examining nerve movement in the arm in response to contralateral neck side flexion. Results Neither moving the head forward or trunk flexion caused significant movement of the median nerve. In contrast, 4.3 mm of movement, adding 0.7% strain, occurred in the forearm during shoulder protraction. A delay in movement at the start of protraction and straightening of the nerve trunk provided evidence of unloading with the shoulder flexed and elbow extended and the scapulothoracic joint in neutral. There was a 60% reduction in nerve movement in the arm during contralateral neck side flexion when the shoulder was protracted compared to scapulothoracic neutral. Conclusion Slumped sitting is unlikely to increase nerve strain sufficient to cause changes to nerve function. However, shoulder protraction may place the median nerve at risk of injury, since nerve movement is reduced through the shoulder region when the shoulder is protracted and other joints are moved. Both altered nerve dynamics in response to moving other joints and local changes to blood supply may adversely affect nerve function and increase the risk of developing upper quadrant pain.

  5. Porcine prion protein amyloid. (United States)

    Hammarström, Per; Nyström, Sofie


    Mammalian prions are composed of misfolded aggregated prion protein (PrP) with amyloid-like features. Prions are zoonotic disease agents that infect a wide variety of mammalian species including humans. Mammals and by-products thereof which are frequently encountered in daily life are most important for human health. It is established that bovine prions (BSE) can infect humans while there is no such evidence for any other prion susceptible species in the human food chain (sheep, goat, elk, deer) and largely prion resistant species (pig) or susceptible and resistant pets (cat and dogs, respectively). PrPs from these species have been characterized using biochemistry, biophysics and neurobiology. Recently we studied PrPs from several mammals in vitro and found evidence for generic amyloidogenicity as well as cross-seeding fibril formation activity of all PrPs on the human PrP sequence regardless if the original species was resistant or susceptible to prion disease. Porcine PrP amyloidogenicity was among the studied. Experimentally inoculated pigs as well as transgenic mouse lines overexpressing porcine PrP have, in the past, been used to investigate the possibility of prion transmission in pigs. The pig is a species with extraordinarily wide use within human daily life with over a billion pigs harvested for human consumption each year. Here we discuss the possibility that the largely prion disease resistant pig can be a clinically silent carrier of replicating prions.

  6. Posterior shoulder tightness and rotator cuff strength assessments in painful shoulders of amateur tennis players

    Directory of Open Access Journals (Sweden)

    Freddy B. Marcondes


    Full Text Available BACKGROUND: Previous studies have shown a relationship between shoulder posterior capsule tightness and shoulder pain in overhead athletes. However, this relationship has not been studied in tennis players. OBJECTIVES: Assessment of the shoulder range of motion (ROM, strength and posterior capsule tightness of skilled amateur tennis players who had complaints of dominant shoulder pain in comparison with tennis players without pain. METHOD: Forty-nine skilled amateur tennis players were distributed in 2 groups: Control Group (n=22 and Painful Group (n=27. The first group was composed of asymptomatic subjects, and the second was composed of subjects with shoulder pain on the dominant side. These groups were evaluated to determine the dominant and non-dominant shoulder ROM (internal and external rotation, isometric shoulder strength (internal and external rotation and posterior shoulder tightness by blind evaluators. RESULTS: The ANOVA results indicated significant differences between the groups in the dominant shoulder ROM, posterior capsule tightness, external rotation strength and strength ratio (p<0.05. The intragroup analysis (dominant versus non-dominant in the Painful Group displayed a significant difference for ROM, posterior capsule tightness and external rotation strength (p<0.05. CONCLUSIONS: The tennis players with pain in the dominant shoulder presented greater posterior capsule tightness, internal rotation deficit (ROM, external rotation gain (ROM and deficits in external rotation strength than the tennis players without pain.

  7. UnconStrained ShoUlder arthroplasty

    Institute of Scientific and Technical Information of China (English)


    Objective: To evaluate the results of 36unconstrained shoulder arthroplasties. Methods: In the series, 24 total and 12 hemiarthroplasties of the shoulders were performed with unconstrained shoulder prostheses in 29 patients who suffered from glenohumeral degenerative arthritis, rheumatoid arthritis, avascular necrosis and proximal fracture of humerus, respectively. Follow-up averaged 6.2years. All patients were evaluated pre- and post-operatively using the rating system of the Society of American Shoulder and Elbow Surgeons which assesses the severity of pain,strength of muscles around shoulder, stability, range of motion and functional activities of daily living. Radiolucent line and migration of prostheses were observed postoperatively on X-rays. Results: Postoperatively, the rate of pain relief was 91.3%, and active range of motion increased by 47° inforward flexion, 43° in abduction , 30° in external rotation,and 4 segments in internal rotation. Preoperatively the average points of 6 functional activities patients could perform was 0.8, and postoperatively 3.1. On postoperative X-ray, proximal migration of the humerus was seen in 8 shoulders, 6 of which had either a torn or absent rotator cuff. Radiolucent lines were seen around 1humeral component and 9 glenoid components. Onehumeral and 2 glenoid components loosened. Conclusions: These results suggest that unconstrained shoulder arthroplasty is a satisfactory and safe technique.

  8. Nerve Transfers to Restore Shoulder Function. (United States)

    Leechavengvongs, Somsak; Malungpaishorpe, Kanchai; Uerpairojkit, Chairoj; Ng, Chye Yew; Witoonchart, Kiat


    The restoration of shoulder function after brachial plexus injury represents a significant challenge facing the peripheral nerve surgeons. This is owing to a combination of the complex biomechanics of the shoulder girdle, the multitude of muscles and nerves that could be potentially injured, and a limited number of donor options. In general, nerve transfer is favored over tendon transfer, because the biomechanics of the musculotendinous units are not altered. This article summarizes the surgical techniques and clinical results of nerve transfers for restoration of shoulder function.

  9. [Analysis of clinical symptoms in shoulder arthropathy]. (United States)

    Fabiś, J; Zwierzchowski, H


    Frequency of chosen clinical symptoms has been analyzed in 236 patients aged 10 to 80 years with shoulder pathology. It was found that "impingement syndrome" is characteristic for periarthritis humeroscapularis simplex. Active and passive movement restriction of the shoulder was frequently observed in periarthritis humeroscapularis simplex acuta; passive one greater than 50% was typical for capsulitis adhesiva. Crepitus at the movements, muscle wasting, impingement syndrome pain at the abduction and external rotation against resistance is indicative of periarthritis humeroscapularis destructive. Sonographic assessment of the shoulder is recommended in every case with the biceps long head rupture suspicion.

  10. Management of sequalae of neglected septic shoulder

    Directory of Open Access Journals (Sweden)

    Pawar Uday


    Full Text Available Complex deformities following septic arthritis of the shoulder in infancy are mild and therefore rarely reported. A 12 year old girl presented with shortening of upper extremity right side, with dislocation of shoulder and with entire extremity rotated to 180 degrees. The palm faced posteriorly and the olecranon anteriorly. Arthrodesis of shoulder and unifocal lengthening of humerus was achieved with three 4 mm cannulated cancellous screws and an ilizarov frame. A lengthening of 9 centimeters was achieved and regenerate healed at 12 months. At 10 years follow-up she is able to perfom her activities of daily living.

  11. [Comprehensive arthroscopic management of shoulder osteoarthritis]. (United States)

    Ríos, D; Martetschlager, F; Millett, P J


    Shoulder osteoarthritis has been considered as a cause of severe pain and loss of shoulder function. Many patients with shoulder osteoarthritis are young and have demanding activities, which leads to questioning the choice of arthroplasty. This is why in this paper we describe the comprehensive arthroscopic management (CAM) that combines arthroscopic debridement, capsular release, osteoplasty of the lower humeral head, and auxiliary nerve decompression. In our experience this technique has shown short-term promising results as it decreases pain and allows patients to resume high performance demanding activities.

  12. Imaging of bursae around the shoulder joint

    Energy Technology Data Exchange (ETDEWEB)

    Bureau, N.J. [Department of Radiology, Hotel-Dieu de Montreal Hospital, Montreal, Quebec (Canada); Dussault, R.G. [Department of Radiology, Health Sciences Center, University of Virginia, Charlottesville, Virginia (United States); Keats, T.E. [Department of Radiology, Health Sciences Center, University of Virginia, Charlottesville, Virginia (United States)


    The authors present a review of the anatomy of the major bursae around the shoulder joint and discuss the use of the different imaging modalities which demonstrate their radiologic features. The calcified subacromial-subdeltoid bursa has a characteristic appearance on plain radiographs. When inflamed it can be visualized by ultrasound and magnetic resonance imaging. Calcific bursitis may involve the subcoracoid bursa. This bursa may mimic adhesive capsulitis of the shoulder or complete rotator cuff tear when injected inadvertently during shoulder arthrography. Less well known are three coracoclavicular ligament bursae. These are also subject to calcific bursitis and have a typical radiologic appearance. (orig.). With 6 figs.

  13. Shoulder injuries in soccer goalkeepers: review and development of a FIFA 11+ shoulder injury prevention program (United States)

    Ejnisman, Benno; Barbosa, Gisele; Andreoli, Carlos V; de Castro Pochini, A; Lobo, Thiago; Zogaib, Rodrigo; Cohen, Moises; Bizzini, Mario; Dvorak, Jiri


    In the last years, shoulder injuries have represented an increasing health problem in soccer players. The goalkeepers are more exposed to shoulder disorders than other field players. Injury prevention exercises for upper limbs were cited in few studies involving throwing athletes, but we know that goalkeepers need a specific program. The purpose of this study is to describe the development of an adapted Fédération Internationale de Football Association (FIFA) 11+ program, namely the FIFA 11+ shoulder, which targets the prevention of shoulder injuries in soccer goalkeepers. The FIFA 11+ shoulder program is structured into three parts: general warming-up exercises, exercises to improve strength and balance of the shoulder, elbow, wrist, and finger muscles, and advanced exercises for core stability and muscle control. The exercises were selected based on recommendations from studies demonstrating high electromyographic activity. PMID:27563262

  14. State of the Art Priciples in Shoulder Rehabilitation

    Institute of Scientific and Technical Information of China (English)

    Edward R. Laskowski


    @@ The primary goal of shoulder rehabilitation is to restore optimal pain-free shoulder function. In general terms, shoulder rehabilitation involves control of pain and inflammation,early non-traumatic motion, muscle reactivation, strengthening of shoulder group muscles, and restoration of normal shoulder function within the kinetic-kinematic chain. Finally, sports and activity-specific rehabilitative exercise are essential to maximize function and return the patient to their prior sport or activity without deficit. This discussion will review recent research findings that have expanded our knowledge and understanding of shoulder function and which will serve as guidelines for a state-of-the-art shoulder rehabilitation program.

  15. Stemless shoulder prosthesis versus conventional anatomic shoulder prosthesis in patients with osteoarthritis


    Berth, Alexander; Pap, Géza


    Background The stemless shoulder prosthesis is a new concept in shoulder arthroplasty. To date, only a few studies have investigated the results of this prosthesis. The aim of this study was to investigate the clinical and radiological midterm results of this implant in comparison with a standard anatomic stemmed shoulder prosthesis. Materials and methods The Constant score, the DASH score, the active range of motion (abduction, anteversion, external rotation), and the radiological results we...

  16. Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders. (United States)

    Struyf, Filip; Lluch, Enrique; Falla, Deborah; Meeus, Mira; Noten, Suzie; Nijs, Jo


    Shoulder pain is often a challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. Current evidence clearly emphasizes an incomplete understanding of the nature of shoulder pain. Indeed, the effective diagnosis and treatment of shoulder pain should not only rely upon a detailed knowledge of the peripheral pathologies that may be present in the shoulder, but also on current knowledge of pain neurophysiology. To assess and treat shoulder pain, a comprehensive understanding of the way in which pain is processed is essential. This review reflects modern pain neurophysiology to the shoulder and aims to answer the following questions: why does my shoulder hurt? What is the impact of shoulder pain on muscle function? What are the implications for the clinical examination of the shoulder? And finally, what are the clinical implications for therapy? Despite the increasing amount of research in this area, an in-depth understanding of the bidirectional nociception-motor interaction is still far from being achieved. Many questions remain, especially related to the treatment of nociception-motor interactions.

  17. Functional Amyloid Formation within Mammalian Tissue.

    Directory of Open Access Journals (Sweden)


    Full Text Available Amyloid is a generally insoluble, fibrous cross-beta sheet protein aggregate. The process of amyloidogenesis is associated with a variety of neurodegenerative diseases including Alzheimer, Parkinson, and Huntington disease. We report the discovery of an unprecedented functional mammalian amyloid structure generated by the protein Pmel17. This discovery demonstrates that amyloid is a fundamental nonpathological protein fold utilized by organisms from bacteria to humans. We have found that Pmel17 amyloid templates and accelerates the covalent polymerization of reactive small molecules into melanin-a critically important biopolymer that protects against a broad range of cytotoxic insults including UV and oxidative damage. Pmel17 amyloid also appears to play a role in mitigating the toxicity associated with melanin formation by sequestering and minimizing diffusion of highly reactive, toxic melanin precursors out of the melanosome. Intracellular Pmel17 amyloidogenesis is carefully orchestrated by the secretory pathway, utilizing membrane sequestration and proteolytic steps to protect the cell from amyloid and amyloidogenic intermediates that can be toxic. While functional and pathological amyloid share similar structural features, critical differences in packaging and kinetics of assembly enable the usage of Pmel17 amyloid for normal function. The discovery of native Pmel17 amyloid in mammals provides key insight into the molecular basis of both melanin formation and amyloid pathology, and demonstrates that native amyloid (amyloidin may be an ancient, evolutionarily conserved protein quaternary structure underpinning diverse pathways contributing to normal cell and tissue physiology.

  18. Functional amyloid formation within mammalian tissue.

    Directory of Open Access Journals (Sweden)

    Douglas M Fowler


    Full Text Available Amyloid is a generally insoluble, fibrous cross-beta sheet protein aggregate. The process of amyloidogenesis is associated with a variety of neurodegenerative diseases including Alzheimer, Parkinson, and Huntington disease. We report the discovery of an unprecedented functional mammalian amyloid structure generated by the protein Pmel17. This discovery demonstrates that amyloid is a fundamental nonpathological protein fold utilized by organisms from bacteria to humans. We have found that Pmel17 amyloid templates and accelerates the covalent polymerization of reactive small molecules into melanin-a critically important biopolymer that protects against a broad range of cytotoxic insults including UV and oxidative damage. Pmel17 amyloid also appears to play a role in mitigating the toxicity associated with melanin formation by sequestering and minimizing diffusion of highly reactive, toxic melanin precursors out of the melanosome. Intracellular Pmel17 amyloidogenesis is carefully orchestrated by the secretory pathway, utilizing membrane sequestration and proteolytic steps to protect the cell from amyloid and amyloidogenic intermediates that can be toxic. While functional and pathological amyloid share similar structural features, critical differences in packaging and kinetics of assembly enable the usage of Pmel17 amyloid for normal function. The discovery of native Pmel17 amyloid in mammals provides key insight into the molecular basis of both melanin formation and amyloid pathology, and demonstrates that native amyloid (amyloidin may be an ancient, evolutionarily conserved protein quaternary structure underpinning diverse pathways contributing to normal cell and tissue physiology.

  19. Handball load and shoulder injury rate

    DEFF Research Database (Denmark)

    Møller, M; Nielsen, R O; Attermann, J


    Background Knowledge of injury patterns, an essential step towards injury prevention, is lacking in youth handball. Aim To investigate if an increase in handball load is associated with increased shoulder injury rates compared with a minor increase or decrease, and if an association is influenced...... by scapular control, isometric shoulder strength or glenohumeral range of motion (ROM). Methods 679 players (14-18 years) provided weekly reports on shoulder injury and handball load (training and competition hours) over 31 weeks using the SMS, phone and medical examination system. Handball load in a given...... week was categorised into (1) 60% relative to the weekly average amount of handball load the preceding 4 weeks. Assessment of shoulder isometric rotational and abduction strength, ROM and scapular control...

  20. Subacromial shoulder disorders among baggage handlers

    DEFF Research Database (Denmark)

    Thygesen, Lau Caspar; Mikkelsen, Sigurd; Pedersen, Ellen Bøtker


    PURPOSE: To assess the influence of cumulative employment as baggage handler on the risk of incident subacromial shoulder disorders. Baggage handling is characterized by repetitive work primarily consisting of heavy lifting in awkward positions and time pressure. METHODS: This cohort study is based...... System. The primary exposure was cumulative years of employment as a baggage handler, and the primary outcome was diagnoses and surgical treatment of subacromial shoulder disorders. RESULTS: The cohort contained 3396 baggage handlers and 63,909 workers in the reference group. Baggage handlers with longer...... increased incidence of subacromial shoulder disorders for workers with longer cumulative years of employment. These results support that long-term lifting in awkward positions and time pressure influences the risk of subacromial shoulder disorders....

  1. Total shoulder replacement in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Sneppen, O; Fruensgaard, S; Johannsen, Hans Viggo


    A prospective study of 62 Neer mark II total shoulder arthroplasties performed during the period from 1981 to 1990 on 51 patients with rheumatoid arthritis was undertaken to evaluate factors associated with component loosening and proximal humeral migration. Thirty-two (51%) showed proximal...... migration of the humerus before surgery was performed. The mean follow-up time was 92 months (range 52 to 139 months). The results revealed proximal migration in 55% of the patients (34 shoulders), and 40% (25 shoulders) showed progressive radiographic loosening of the glenoid component. Five of 12 press......-fit humeral components demonstrated progressive radiographic loosening, whereas no signs of loosening were found in 50 cemented humeral components. In spite of progressive component loosening and progressive migration, this study demonstrated good pain relief in 89% of the patients (55 shoulders) and also...

  2. MRI findings in the painful hemiplegic shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Tavora, D.G.F., E-mail: danielgurgel@sarah.b [Department of Radiology, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil); Gama, R.L.; Bomfim, R.C. [Department of Radiology, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil); Nakayama, M. [Department of Radiology, Federal University of Grande Dourados, Dourados (Brazil); Silva, C.E.P. [Department of Statistics, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil)


    Aim: To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients. Materials and methods: Patients with hemiplegia following their first cerebrovascular accident who were admitted to the Sarah Network of Hospitals for Rehabilitation were studied. Forty-five patients with pain in the hemiplegic shoulder and 23 post-stroke patients without shoulder pain were investigated. MRI and radiographic findings of the hemiplegic and contralateral asymptomatic shoulders were evaluated. Results: Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval. Conclusions: Adhesive capsulitis was found to be a possible cause of PHS.

  3. Ipsilateral dislocation of the shoulder and elbow. (United States)

    Khan, M R; Mirdad, T M


    Ipsilateral dislocation of shoulder and elbow joints is a rare injury. Only 2 such cases have been reported in the English literature. We report a case of a 35-year-old man involved in a road traffic accident under the influence of alcohol. He sustained posterior left elbow and anterior left shoulder dislocation with minimally displaced greater tuberosity fracture. He also had partial median nerve palsy. Under intramuscular pethidine and intravenous diazepam, close reduction of elbow followed by shoulder was carried out. At 2 months, median nerve function returned to normal. At 3 months, almost full elbow and shoulder joint movement returned. Although rare and complex, this ipsilateral injury can be treated conservatively.

  4. Dexamethasone for pain after outpatient shoulder surgery

    DEFF Research Database (Denmark)

    Bjørnholdt, K. T.; Mønsted, P. N.; Søballe, Kjeld


    Background Dexamethasone has analgesic properties when given intravenously before surgery, but the optimal dose has not been determined. We hypothesised that a dose of 40 mg dexamethasone would improve analgesia after outpatient shoulder surgery compared with 8 mg. Methods A randomised, double...... a dose–response relationship, increasing the dexamethasone dose from 8 to 40 mg did not improve analgesia significantly after outpatient shoulder surgery....

  5. Diagnostic imaging of shoulder rotator cuff lesions


    Nogueira-Barbosa Marcello Henrique; Volpon José Batista; Elias Jr Jorge; Muccillo Gerson


    Shoulder rotator cuff tendon tears were evaluated with ultrasonography (US) and magnetic resonance imaging (MRI). Surgical or arthroscopical correlation were available in 25 cases. Overall costs were also considered. Shoulder impingement syndrome diagnosis was done on a clinical basis. Surgery or arthroscopy was considered when conservative treatment failure for 6 months, or when rotator cuff repair was indicated. Ultrasound was performed in 22 patients and MRI in 17 of the 25 patients. Sensi...

  6. An atypical mycobacterial infection of the shoulder

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    Christopher L Talbot


    Full Text Available Mycobacterium malmoense is an acid-fast non-tuberculous organism that most commonly causes pulmonary infection. Extrapulmonary infection has also been reported. With an increased emphasis being placed on the clinical importance of this organism, especially within Europe, we report the first case of septic arthritis of the shoulder caused by this organism. We also highlight the importance of considering atypical mycobacterium infection in the differential diagnosis of shoulder infection and issues surrounding the management of this entity.

  7. Concept of healing of recurrent shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Donato D'Angelo


    Full Text Available This paper presents the main surgical techniques applied in the treatment of anterior recurrent shoulder dislocation, aiming the achievement of the normality of articulate movements. This was obtained by combining distinct surgical procedures, which allowed the recovery of a complete functional capacity of the shoulder, without jeopardizing the normality of movement, something that has not been recorded in the case of the tense sutures of the surgical procedures of Putti-Platt, Bankart, Latarjet, Dickson-O'Dell and others.The careful review of the methods applied supports the conclusion that recurrent shoulder dislocation can be cured, since cure has been obtained in 97% of the treated cases. However, some degree of limitation in the shoulder movement has been observed in most of the treated cases.Our main goal was to achieve a complete shoulder functional recovery, by treating simultaneously all of the anatomical–pathological lesions, without considering the so-called essential lesions.The period of post-operatory immobilization only last for the healing of soft parts; this takes place in a position of neutral shoulder rotation, since the use of vascular bone graft eliminates the need for long time immobilization, due to the shoulder stabilization provided by rigid fixation of the coracoid at the glenoid edge, as in the Latarjet's technique.Our procedure, used since 1959, comprises the association of several techniques, which has permitted shoulder healing without movement limitation. That was because of the tension reduction in the sutures of the subescapularis, capsule, and coracobraquialis muscles.

  8. Development of the shoulder girdle musculature. (United States)

    Pu, Qin; Huang, Ruijin; Brand-Saberi, Beate


    The muscles of the shoulder region are important for movements of the upper limbs and for stabilizing the girdle elements by connecting them to the trunk. They have a triple embryonic origin. First, the branchiomeric shoulder girdle muscles (sternocleidomastoideus and trapezius muscles) develop from the occipital lateral plate mesoderm using Tbx1 over the course of this development. The second population of cells constitutes the superficial shoulder girdle muscles (pectoral and latissimus dorsi muscles), which are derived from the wing premuscle mass. This muscle group undergoes a two-step development, referred to as the "in-out" mechanism. Myogenic precursor cells first migrate anterogradely into the wing bud. Subsequently, they migrate in a retrograde manner from the wing premuscle mass to the trunk. SDF-1/CXCR4 signaling is involved in this outward migration. A third group of shoulder muscles are the rhomboidei and serratus anterior muscles, which are referred to as deep shoulder girdle muscles; they are thought to be derived from the myotomes. It is, however, not clear how myotome cells make contact to the scapula to form these two muscles. In this review, we discuss the development of the shoulder girdle muscle in relation to the different muscle groups.

  9. Rugby and Shoulder Trauma: A Systematic Review (United States)

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


    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. PMID:26535182

  10. Electromyographic analysis of the infraspinatus and scapular stabilizing muscles during isometric shoulder external rotation at various shoulder elevation angles


    Uga, Daisuke; Endo, Yasuhiro; Nakazawa, Rie; Sakamoto, Masaaki


    [Purpose] This study aimed to clarify activation of the infraspinatus and scapular stabilizing muscles during shoulder external rotation at various shoulder elevation angles. [Subjects] Twenty subjects participated in this study and all measurements were performed on the right shoulder. [Methods] Isometric shoulder external rotation strength and surface electromyographic data were measured with the shoulder at 0°, 45°, 90°, and 135° elevation in the scapular plane. The electromyographic data ...

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

    NARCIS (Netherlands)

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


    PURPOSE: 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 s

  12. Shoulder-to-Shoulder Research "with" Children: Methodological and Ethical Considerations (United States)

    Griffin, Krista M.; Lahman, Maria K. E.; Opitz, Michael F.


    This paper presents a methodological study with children where two different interview methods were utilized: the "walk-around" (a form of mobile interview) and the "shoulder-to-shoulder." The paper reviews the methodological aspects of the study then provides a brief review of the history of methods employed in research with…

  13. Are Shoulders with A Reverse Shoulder Prosthesis Strong enough? A Pilot Study

    NARCIS (Netherlands)

    Alta, T.D.W.; Veeger, H.E.J.; Janssen, T.W.J.; Willems, W.J.


    Background It has been suggested that limited active ROM of reverse shoulder prostheses relates to lack of strength. However, the postoperative strength has not been quantified. Questions/purposes We therefore measured joint torques in patients with reverse shoulder prostheses and correlated torques

  14. Clinical Outcomes Following Revision Anterior Shoulder Stabilization (United States)

    Frank, Rachel M.; Mellano, Chris; Shin, Jason J.; Feldheim, Terrence F.; Mascarenhas, Randhir; Yanke, Adam Blair; Cole, Brian J.; Nicholson, Gregory P.; Romeo, Anthony A.; Verma, Nikhil N.


    Objectives: The purpose of this study was to determine the clinical outcomes following revision anterior shoulder stabilization performed either via all-arthroscopic soft tissue repair or via Latarjet coracoid transfer. Methods: A retrospective review of prospectively collected data on 91 shoulders undergoing revision anterior shoulder stabilization was performed. All patients underwent prior soft tissue stabilization; those with prior open bone grafting procedures were excluded. For patients with 25% glenoid bone loss, Latarjet was performed (n=28). Patients were queried regarding recurrent instability (subluxation or dislocation). Clinical outcomes were evaluated using validated patient reported outcome questionnaires including the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), visual analog scale (VAS) for pain, and Western Ontario Shoulder Instability Index (WOSI). Results: A total of 63 shoulders in 62 patients (46 males, 16 females) with an average age of 23.2 ± 6.9 years were included in the revision arthroscopy group. At an average follow-up of 46.9 ± 16.8 months (range, 15 to 78), the mean WOSI score was 80.1 (range, 15.0 to 100), and there were significant improvements (pLatarjet group. Thirteen (46%) had more than one previous stabilization attempt. ), the average WOSI score was 71.9, and there were significant improvements (pLatarjet. Conclusion: Both arthroscopic revision stabilization and Latarjet coracoid transfer result in satisfactory outcomes in patients who have failed previous arthroscopic capsulolabral repair. Recurrent instability rates were higher in the all-arthroscopic group (19% versus 7%). Longer-term studies are required to determine whether similar results are maintained over time, and to provide guidance on focused clinical indications for this challenging patient population.

  15. Amyloid deposition in 2 feline thymomas. (United States)

    Burrough, E R; Myers, R K; Hostetter, S J; Fox, L E; Bayer, B J; Felz, C L; Waller, K R; Whitley, E M


    Two cases of feline thymoma with amyloid deposition were encountered between 1982 and 2010. Neoplastic cells were separated by abundant, pale eosinophilic, homogeneous material that was congophilic and birefringent. Ultrastructurally, the neoplastic cells were connected by desmosomes, and the extracellular deposits were composed of nonbranching, hollow-cored fibrils, 8-10 nm in diameter. In the case with sufficient archived tissue for additional sections, the amyloid remained congophilic following potassium permanganate incubation, and the neoplastic cells were immunoreactive for pancytokeratin. The histologic, histochemical, ultrastructural, and immunohistochemical features of both neoplasms are consistent with epithelial-predominant thymoma with the unusual feature of intratumoral amyloid deposition. The affinity of the amyloid for Congo red following potassium permanganate incubation is consistent with non-AA amyloid. The ultrastructural findings were consistent with amyloid production by the neoplastic epithelial cells.

  16. Amyloid Goiter Secondary to Ulcerative Colitis

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    Bunyamin Aydin


    Full Text Available Diffuse amyloid goiter (AG is an entity characterized by the deposition of amyloid in the thyroid gland. AG may be associated with either primary or secondary amyloidosis. Secondary amyloidosis is rarely caused by inflammatory bowel diseases. Secondary amyloidosis is relatively more common in the patients with Crohn’s disease, whereas it is highly rare in patients with ulcerative colitis. Diffuse amyloid goiter caused by ulcerative colitis is also a rare condition. In the presence of amyloid in the thyroid gland, medullary thyroid cancer should be kept in mind in the differential diagnosis. Imaging techniques and biochemical tests are not very helpful in the diagnosis of secondary amyloid goiter and the definitive diagnosis is established based on the histopathologic analysis and histochemical staining techniques. In this report, we present a 35-year-old male patient with diffuse amyloid goiter caused by secondary amyloidosis associated with ulcerative colitis.

  17. The evidenced-based shoulder evaluation. (United States)

    O'Kane, John W; Toresdahl, Brett G


    The physical examination of the shoulder has been studied extensively, but the quality and statistical power of the published research often is lacking. The initial reports of new shoulder examination techniques commonly describe impressive performance. However recent meta-analyses have found that when the majority of these tests are used in isolation, they lack the ability to rule in or rule out the pathology in question, with few exceptions. The diagnostic accuracy of the physical examination improves when the shoulder tests are evaluated in combination, such as positive passive distraction and active compression identifying a superior labral anterior to posterior (SLAP) lesion. The accuracy also can be improved when the shoulder tests are evaluated in conjunction with specific historical findings, such as age greater than 39 years, history of popping or clicking, and a positive painful arc (pain experienced between 60° and 120° of abduction) identifying rotator cuff tendinopathy. The literature on shoulder imaging demonstrates that rotator cuff tears can be ruled in or ruled out by both ultrasound and magnetic resonance imaging. For SLAP lesions, magnetic resonance arthrography can be used to rule out a tear but may not be as accurate as combined physical examinations to rule in a tear.

  18. Amyloid myopathy: a diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Heli Tuomaala


    Full Text Available Amyloid myopathy (AM is a rare manifestation of primary systemic amyloidosis (AL. Like inflammatory myopathies, it presents with proximal muscle weakness and an increased creatine kinase level. We describe a case of AL with severe, rapidly progressive myopathy as the initial symptom. The clinical manifestation and muscle biopsy were suggestive of inclusion body myositis. AM was not suspected until amyloidosis was seen in the gastric mucosal biopsy. The muscle biopsy was then re-examined more specifically, and Congo red staining eventually showed vascular and interstitial amyloid accumulation, which led to a diagnosis of AM. The present case illustrates the fact that the clinical picture of AM can mimic that of inclusion body myositis.

  19. Surgical considerations about amyloid goiter. (United States)

    García Villanueva, Augusto; García Villanueva, María Jesús; García Villanueva, Mercedes; Rojo Blanco, Roberto; Collado Guirao, María Vicenta; Cabañas Montero, Jacobo; Beni Pérez, Rafael; Moreno Montes, Irene


    Amyloidosis is an uncommon syndrome consisting of a number of disorders having in common an extracellular deposit of fibrillary proteins. This results in functional and structural changes in the affected organs, depending on deposit location and severity. Amyloid infiltration of the thyroid gland may occur in 50% and up to 80% of patients with primary and secondary amyloidosis respectively. Amyloid goiter (AG) is a true rarity, usually found associated to secondary amyloidosis. AG may require surgical excision, usually because of compressive symptoms. We report the case of a patient with a big AG occurring in the course of a secondary amyloidosis associated to polyarticular onset juvenile idiopathic arthritis who underwent total thyroidectomy. Current literature is reviewed, an attempt is made to provide action guidelines, and some surgical considerations on this rare condition are given.

  20. Atypical presentation of atypical amyloid. (United States)

    Holanda, Danniele G; Acharya, Veena K; Dogan, Ahmet; Racusen, Lorraine C; Atta, Mohamed G


    Amyloidosis is a group of diseases categorized by precipitation of a group of protein aggregates (amyloid) in tissues, including the kidney, and proteinuria is usually the commonest, though not exclusive, hallmark of clinical presentation. AL and AA are the most commonly recognized forms of amyloidosis involving the kidney, but other forms have been described. We present a case of renal amyloidosis due to a novel amyloidogenic protein, leucocyte cell-derived chemotaxin 2, without proteinuria at presentation or on subsequent follow-up.

  1. Janus faces of amyloid proteins in neuroinflammation. (United States)

    Steinman, Lawrence; Rothbard, Jonathan B; Kurnellas, Michael P


    Amyloid forming molecules are generally considered harmful. In Alzheimer's Disease two amyloid molecules Aβ A4 and tau vie for consideration as the main pathogenic culprit. But molecules obey the laws of chemistry and defy the way we categorize them as humans with our well-known proclivities to bias in our reasoning. We have been exploring the brains of multiple sclerosis patients to identify molecules that are associated with protection from inflammation and degeneration. In 2001 we noted that aB crystallin (cryab) was the most abundant transcript found in MS lesions, but not in healthy brains. Cryab can reverse paralysis and attenuate inflammation in several models of inflammation including experimental autoimmune encephalomyelitis (EAE), and various models of ischemia. Cryab is an amyloid forming molecule. We have identified a core structure common to many amyloids including amyloid protein Aβ A4, tau, amylin, prion protein, serum amyloid protein P, and cryab. The core hexapeptide structure is highly immune suppressive and can reverse paralysis in EAE when administered systemically. Administration of this amyloid forming hexapeptide quickly lowers inflammatory cytokines in plasma like IL-6 and IL-2. The hexapeptide bind a set of proinflammatory mediators in plasma, including acute phase reactants and complement components. The beneficial properties of amyloid forming hexapeptides provide a potential new therapeutic direction. These experiments indicate that amyloid forming molecules have Janus faces, providing unexpected benefit for neuroinflammatory conditions.

  2. Resuscitating the Baby after Shoulder Dystocia

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    Savas Menticoglou


    Full Text Available Background. To propose hypovolemic shock as a possible explanation for the failure to resuscitate some babies after shoulder dystocia and to suggest a change in clinical practice. Case Presentation. Two cases are presented in which severe shoulder dystocia was resolved within five minutes. Both babies were born without a heartbeat. Despite standard resuscitation by expert neonatologists, no heartbeat was obtained until volume resuscitation was started, at 25 minutes in the first case and 11 minutes in the second. After volume resuscitation circulation was restored, there was profound brain damage and the babies died. Conclusion. Unsuspected hypovolemic shock may explain some cases of failed resuscitation after shoulder dystocia. This may require a change in clinical practice. Rather than immediately clamping the cord after the baby is delivered, it is proposed that (1 the obstetrician delay cord clamping to allow autotransfusion of the baby from the placenta and (2 the neonatal resuscitators give volume much sooner.

  3. Kinetic chain abnormalities in the athletic shoulder. (United States)

    Sciascia, Aaron; Thigpen, Charles; Namdari, Surena; Baldwin, Keith


    Overhead activities require the shoulder to be exposed to and sustain repetitive loads. The segmental activation of the body's links, known as the kinetic chain, allows this to occur effectively. Proper muscle activation is achieved through generation of energy from the central segment or core, which then transfers the energy to the terminal links of the shoulder, elbow, and hand. The kinetic chain is best characterized by 3 components: optimized anatomy, reproducible efficient motor patterns, and the sequential generation of forces. However, tissue injury and anatomic deficits such as weakness and/or tightness in the leg, pelvic core, or scapular musculature can lead to overuse shoulder injuries. These injuries can be prevented and maladaptations can be detected with a thorough understanding of biomechanics of the kinetic chain as it relates to overhead activity.

  4. Evaluation and treatment of shoulder pain. (United States)

    Greenberg, Deborah L


    Shoulder pain is a common symptom in the adult population. The most common cause of shoulder pain is SIS, reflecting a problem with the rotator cuff or subacromial bursa. Determining the cause of a patient’s pain is usually a clinical diagnosis based on careful history taking and physical examination. Limited use of imaging studies will be needed in the setting of trauma, possible glenohumeral arthritis, or when a complete tendon tear is suspected. Therapy is based on pain control and therapeutic exercises in almost all cases. Despite the prevalence of shoulder pain, there is no consensus on the best way to achieve pain control or on the type of exercise most likely to achieve speedy recovery.

  5. Cost Analysis in Shoulder Arthroplasty Surgery

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    Matthew J. Teusink


    Full Text Available Cost in shoulder surgery has taken on a new focus with passage of the Patient Protection and Affordable Care Act. As part of this law, there is a provision for Accountable Care Organizations (ACOs and the bundled payment initiative. In this model, one entity would receive a single payment for an episode of care and distribute funds to all other parties involved. Given its reproducible nature, shoulder arthroplasty is ideally situated to become a model for an episode of care. Currently, there is little research into cost in shoulder arthroplasty surgery. The current analyses do not provide surgeons with a method for determining the cost and outcomes of their interventions, which is necessary to the success of bundled payment. Surgeons are ideally positioned to become leaders in ACOs, but in order for them to do so a methodology must be developed where accurate costs and outcomes can be determined for the episode of care.

  6. The Impact of Arthroscopic Capsular Release in Patients with Primary Frozen Shoulder on Shoulder Muscular Strength

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    Michał Waszczykowski


    Full Text Available The aim of this study was to evaluate the impact of arthroscopic capsular release in patients with primary frozen shoulder on muscular strength of nonaffected and treated shoulder after at least two-year follow-up after the surgery. The assessment included twenty-seven patients, who underwent arthroscopic capsular release due to persistent limitation of range of passive and active motion, shoulder pain, and limited function of upper limb despite 6-month conservative treatment. All the patients underwent arthroscopic superior, anteroinferior, and posterior capsular release. After at least two-year follow-up, measurement of muscular strength of abductors, flexors, and external and internal rotators of the operated and nonaffected shoulder, as well as determination of range of motion (ROM and function (ASES in the operated and nonaffected shoulder, was performed. Measurement of muscular strength in the patient group did not reveal statistically significant differences between operated and nonaffected shoulder. The arthroscopic capsular release does not have significant impact on the decrease in the muscular strength of the operated shoulder.

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

    Directory of Open Access Journals (Sweden)

    Aaron Sciascia


    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.

  8. Shoulder injuries in soccer goalkeepers: review and development of a FIFA 11+ shoulder injury prevention program

    Directory of Open Access Journals (Sweden)

    Ejnisman B


    Full Text Available Benno Ejnisman,1 Gisele Barbosa,1 Carlos V Andreoli,1 A de Castro Pochini,1 Thiago Lobo,2 Rodrigo Zogaib,2 Moises Cohen,1 Mario Bizzini,3 Jiri Dvorak3 1Department of Orthopaedics, Federal University of São Paulo, 2Sports Medicine Department, Santos FC, São Paulo, Brazil; 3FIFA-Medical Assessment and Research Centre, Schulthess Clinic, Zurich, Switzerland Abstract: In the last years, shoulder injuries have represented an increasing health problem in soccer players. The goalkeepers are more exposed to shoulder disorders than other field players. Injury prevention exercises for upper limbs were cited in few studies involving throwing athletes, but we know that goalkeepers need a specific program. The purpose of this study is to describe the development of an adapted Fédération Internationale de Football Association (FIFA 11+ program, namely the FIFA 11+ shoulder, which targets the prevention of shoulder injuries in soccer goalkeepers. The FIFA 11+ shoulder program is structured into three parts: general warming-up exercises, exercises to improve strength and balance of the shoulder, elbow, wrist, and finger muscles, and advanced exercises for core stability and muscle control. The exercises were selected based on recommendations from studies demonstrating high electromyographic activity. Keywords: goalkeeper, shoulder, injury prevention, prevention program

  9. The Effect of Fatigued External Rotator Muscles of the Shoulder on the Shoulder Position Sense

    Directory of Open Access Journals (Sweden)

    Naoya Iida


    Full Text Available This study aimed to investigate the effect of fatigue in shoulder external rotator muscles on position sense of shoulder abduction, internal rotation, and external rotation. The study included 10 healthy subjects. Shoulder position sense was measured before and after a fatigue task involving shoulder external rotator muscles. The fatigue task was performed using an isokinetic machine. To confirm the muscle fatigue, electromyography (EMG was recorded, and an integrated EMG and median power frequency (MDF during 3 sec performed target torque were calculated. After the fatigue task, the MDF of the infraspinatus muscle significantly decreased. This indicates that the infraspinatus muscle was involved in the fatigue task. In addition, the shoulder position sense of internal and external rotation significantly decreased after the fatigue task. These results suggest that the fatigue reduced the accuracy of sensory input from muscle spindles. However, no significant difference was observed in shoulder position sense of abduction before and after the fatigue task. This may be due to the fact that infraspinatus muscle did not act as prime movers in shoulder abduction. These results suggest that muscle fatigue decreased position sense during movements in which the affected muscles acted as prime movers.

  10. [Structured electronic consultation letter for shoulder disorders]. (United States)

    Paloneva, Juha; Oikari, Marjo; Ylinen, Jari; Ingalsuo, Minna; Ilkka, Kunnamo; Ilkka, Kiviranta


    Referral to a specialist has a significant influence on management of the patient and costs associated with the treatments. However, development and research of the process by which patients are referred has been almost neglected. Expectations considering the purpose, contents, and timing of the referral of the consulting physician and the consultant do not always meet. A structured, electronic consultation letter was developed to respond this need. Functionality and interactivity are the key elements of the referral, including (1) an electronic referral letter to a specialist, (2) interactive education in clinical examination and management of shoulder disorders, and (3) an instrument of clinical examination and documentation of shoulder disorders.

  11. Muscular imbalance and shoulder pain in volleyball attackers.


    Kugler, A.; Krüger-Franke, M; Reininger, S; Trouillier, H H; Rosemeyer, B


    OBJECTIVE: In overhead sports such as volleyball, baseball, or tennis shoulder problems are very common. The aim of this study was to identify features which may correlate with shoulder problems in volleyball attackers. METHODS: 30 competitive volleyball attackers (mean age 25 years) were included in the study; 15 were suffering from shoulder pain and 15 had no history of shoulder pain. The results were compared with those of a control group of 15 recreational athletes without any overhead sp...

  12. Treatment of 47 Cases of Shoulder Periarthritis with Acupuncture and Tuina

    Institute of Scientific and Technical Information of China (English)

    王文礼; 张伟; 经蕾; 沈卫东; 肖元春


    @@ Shoulder periarthritis is often defined as shoulder pain and confined movement of the shoulder joint due to degeneration and strain of the shoulder joint and its surrounding soft tissues.Patients with shoulder pefiarthritis usually undergo great suffering.During the past two years,we treated 47 shoulder periarthritis cases using acupuncture and tuina.It is now reported as follows.


    Directory of Open Access Journals (Sweden)

    N. A. Shostak


    Full Text Available The paper presents main approaches to the differential diagnosis of shoulder joint pathology and describes the major nosological entities of shoulder diseases. It gives data on the possibility of using nanotechnologies in optimizing the management of a patient with chronic shoulder joint pain syndrome.

  14. Essentials for Acupuncture Treatment of Periarthritis of Shoulder

    Institute of Scientific and Technical Information of China (English)

    Zhang Ping


    @@ Periarthritis of shoulder, also called "congealed shoulder" in TCM, is a disease characterized by progressive pain and movement restriction in the peripheral tissues of the unilateral shoulder joint.Acupuncture can give very good therapeutic effects for this disease. If attention is paid to the following aspects, the therapeutic effect of acupuncture treatment will be much better.

  15. Interobserver reliability of physical examination of shoulder girdle

    NARCIS (Netherlands)

    Nomden, Jettie G.; Slagers, Anton J.; Bergman, Geert; Winters, Jan C.; Kropmans, Thomas J. B.; Dijkstra, Pieter U.


    The object of this study was to assess interobserver reliability in 23 tests concerning physical examination of the shoulder girdle. A physical therapist and a physical therapist/manual therapist independently performed a physical examination of the shoulder girdle in 91 patients with shoulder compl

  16. 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


    ABSTRACT: BACKGROUND: Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions...... 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...

  17. Characterization of Amyloid Cores in Prion Domains (United States)

    Sant’Anna, Ricardo; Fernández, Maria Rosario; Batlle, Cristina; Navarro, Susanna; de Groot, Natalia S.; Serpell, Louise; Ventura, Salvador


    Amyloids consist of repetitions of a specific polypeptide chain in a regular cross-β-sheet conformation. Amyloid propensity is largely determined by the protein sequence, the aggregation process being nucleated by specific and short segments. Prions are special amyloids that become self-perpetuating after aggregation. Prions are responsible for neuropathology in mammals, but they can also be functional, as in yeast prions. The conversion of these last proteins to the prion state is driven by prion forming domains (PFDs), which are generally large, intrinsically disordered, enriched in glutamines/asparagines and depleted in hydrophobic residues. The self-assembly of PFDs has been thought to rely mostly on their particular amino acid composition, rather than on their sequence. Instead, we have recently proposed that specific amyloid-prone sequences within PFDs might be key to their prion behaviour. Here, we demonstrate experimentally the existence of these amyloid stretches inside the PFDs of the canonical Sup35, Swi1, Mot3 and Ure2 prions. These sequences self-assemble efficiently into highly ordered amyloid fibrils, that are functionally competent, being able to promote the PFD amyloid conversion in vitro and in vivo. Computational analyses indicate that these kind of amyloid stretches may act as typical nucleating signals in a number of different prion domains. PMID:27686217

  18. [A strong man with a weak shoulder]. (United States)

    Henket, Marjolijn; Lycklama á Nijeholt, Geert J; van der Zwaal, Peer


    A 47-year-old former olympic athlete had pain and weakness of his left shoulder. There was no prior trauma. He had full range-of-motion and a scapular dyskinesia. There was atrophy of the trapezius and sternocleidomastoideus muscles. He was diagnosed with 'idiopathic neuritis of the accessorius nerve'.

  19. A Simple Technique for Shoulder Arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Berna-Serna, J.D.; Redondo, M.V.; Martinez, F.; Reus, M.; Alonso, J.; Parrilla, A.; Campos, P.A. [Virgen de la Arrixaca Univ. Hospital, El Palmar, Murcia (Spain). Dept. of Radiology


    Purpose: To present a systematic approach to teaching a technique for arthrography of the shoulder. Using an adhesive marker-plate with radiopaque coordinates, precise sites for puncture can be identified and the need for fluoroscopic guidance obviated. Material and Methods: Forty-six glenohumeral arthrograms were performed in 45 patients; in 1 case involving examination of both shoulders. The stages of the technique are described in detail, as are the fundamental aspects of achieving an effective glenohumeral injection. Pain intensity was measured in all patients using a verbal description scale. Results: Shoulder arthrography was successful in all cases. Average time taken for the procedure was 7 min, with no difference in the respective times required by an experienced radiologist and a resident. The procedure was well tolerated by most patients, with slight discomfort being observed in a very few cases. Conclusion: The arthrographic technique used in this study is simple, safe, rapid, and reproducible, and has the advantage of precise localization of the site for puncture without need for fluoroscopic guidance. The procedure described in this study can be of help in teaching residents and can reduce the learning curve for radiologists with no experience in arthrographic methods. It also reduces the time of exposure to fluoroscopy Keywords: Arthrography, joint, shoulder.

  20. 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:; 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)


    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.

  1. Standing on the shoulders of giants. (United States)

    Romanovsky, Andrej A


    In this editorial, the author explains that the journal Temperature stands on the shoulders of giants-prominent scientists of the past and current members of the Temperature community. Temperature also uses the best tools, such as Google Scholar profiles. The editorial includes a new puzzle: why does warm water freeze faster than cold water?

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

    Directory of Open Access Journals (Sweden)

    Mortensen Ole S


    Full Text Available Abstract Background Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions 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 including jobs characterized by intensive computer work. The first 100 positive replies entered the study. Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0-9 scale. Exclusion criteria were cardiovascular disease, trauma, hypertension, or serious chronic disease. Before and after the intervention period the participants replied to a questionnaire about musculoskeletal disorders and work disability, and underwent a standardized clinical examination of the neck and shoulder girdle. Further, on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week. The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results

  3. Amyloid fibrils compared to peptide nanotubes. (United States)

    Zganec, Matjaž; Zerovnik, Eva


    Prefibrillar oligomeric states and amyloid fibrils of amyloid-forming proteins qualify as nanoparticles. We aim to predict what biophysical and biochemical properties they could share in common with better researched peptide nanotubes. We first describe what is known of amyloid fibrils and prefibrillar aggregates (oligomers and protofibrils): their structure, mechanisms of formation and putative mechanism of cytotoxicity. In distinction from other neuronal fibrillar constituents, amyloid fibrils are believed to cause pathology, however, some can also be functional. Second, we give a review of known biophysical properties of peptide nanotubes. Finally, we compare properties of these two macromolecular states side by side and discuss which measurements that have already been done with peptide nanotubes could be done with amyloid fibrils as well.

  4. Ice hockey shoulder pad design and the effect on head response during shoulder-to-head impacts. (United States)

    Richards, Darrin; Ivarsson, B Johan; Scher, Irving; Hoover, Ryan; Rodowicz, Kathleen; Cripton, Peter


    Ice hockey body checks involving direct shoulder-to-head contact frequently result in head injury. In the current study, we examined the effect of shoulder pad style on the likelihood of head injury from a shoulder-to-head check. Shoulder-to-head body checks were simulated by swinging a modified Hybrid-III anthropomorphic test device (ATD) with and without shoulder pads into a stationary Hybrid-III ATD at 21 km/h. Tests were conducted with three different styles of shoulder pads (traditional, integrated and tethered) and without shoulder pads for the purpose of control. Head response kinematics for the stationary ATD were measured. Compared to the case of no shoulder pads, the three different pad styles significantly (p shoulder pads reduced linear head accelerations by an additional 18-21% beyond the other two styles of shoulder pads. The data presented here suggest that shoulder pads can be designed to help protect the head of the struck player in a shoulder-to-head check.

  5. Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder Instabilities. (United States)

    Field, Larry D; Ryu, Richard K N; Abrams, Jeffrey S; Provencher, Matthew


    Arthroscopic shoulder stabilization offers several potential advantages compared with open surgery, including the opportunity to more accurately evaluate the glenohumeral joint at the time of diagnostic assessment; comprehensively address multiple pathologic lesions that may be identified; and avoid potential complications unique to open stabilization, such as postoperative subscapularis failure. A thorough understanding of normal shoulder anatomy and biomechanics, along with the pathoanatomy responsible for anterior, posterior, and multidirectional shoulder instability patterns, is very important in the management of patients who have shoulder instability. The treating physician also must be familiar with diagnostic imaging and physical examination maneuvers that are required to accurately diagnose shoulder instability.

  6. Shoulder Dystocia: Quality, Safety, and Risk Management Considerations. (United States)

    Moni, Saila; Lee, Colleen; Goffman, Dena


    Shoulder dystocia is a term that evokes terror and fear among many physicians, midwives, and health care providers as they recollect at least 1 episode of shoulder dystocia in their careers. Shoulder dystocia can result in significant maternal and neonatal complications. Because shoulder dystocia is an urgent, unanticipated, and uncommon event with potentially catastrophic consequences, all practitioners and health care teams must be well-trained to manage this obstetric emergency. Preparation for shoulder dystocia in a systematic way, through standardization of process, practicing team-training and communication, along with technical skills, through simulation education and ongoing quality improvement initiatives will result in improved outcomes.

  7. Natural polyphenols binding to amyloid: a broad class of compounds to treat different human amyloid diseases. (United States)

    Ngoungoure, Viviane L Ndam; Schluesener, Jan; Moundipa, Paul F; Schluesener, Hermann


    Polyphenols are a large group of phytonutrients found in herbal beverages and foods. They have manifold biological activities, including antioxidative, antimicrobial, and anti-inflammatory properties. Interestingly, some polyphenols bind to amyloid and substantially ameliorate amyloid diseases. Misfolding, aggregation, and accumulation of amyloid fibrils in tissues or organs leads to a group of disorders, called amyloidoses. Prominent diseases are Alzheimer's, Parkinson's, and Huntington's disease, but there are other, less well-known diseases wherein accumulation of misfolded protein is a prominent feature. Amyloidoses are a major burden to public health. In particular, Alzheimer's disease shows a strong increase in patient numbers. Accelerated development of effective therapies for amyloidoses is a necessity. A viable strategy can be the prevention or reduction of protein misfolding, thus reducing amyloid build-up by restoring the cellular aggretome. Amyloid-binding polyphenols affect amyloid formation on various levels, e.g. by inhibiting fibril formation or steering oligomer formation into unstructured, nontoxic pathways. Consequently, preclinical studies demonstrate reduction of amyloid-formation by polyphenols. Amyloid-binding polyphenols might be suitable lead structures for development of imaging agents for early detection of disease and monitoring amyloid deposition. Intake of dietary polyphenols might be relevant to the prevention of amyloidoses. Nutraceutical strategies might be a way to reduce amyloid diseases.

  8. General amyloid inhibitors? A critical examination of the inhibition of IAPP amyloid formation by inositol stereoisomers.

    Directory of Open Access Journals (Sweden)

    Hui Wang

    Full Text Available Islet amyloid polypeptide (IAPP or amylin forms amyloid deposits in the islets of Langerhans; a process that is believed to contribute to the progression of type 2 diabetes and to the failure of islet transplants. An emerging theme in amyloid research is the hypothesis that the toxic species produced during amyloid formation by different polypeptides share common features and exert their effects by common mechanisms. If correct, this suggests that inhibitors of amyloid formation by one polypeptide might be effective against other amyloidogenic sequences. IAPP and Aβ, the peptide responsible for amyloid formation in Alzheimer's disease, are particularly interesting in this regard as they are both natively unfolded in their monomeric states and share some common characteristics. Comparatively little effort has been expended on the design of IAPP amyloid inhibitors, thus it is natural to inquire if Aβ inhibitors are effective against IAPP, especially since no IAPP inhibitors have been clinically approved. A range of compounds inhibit Aβ amyloid formation, including various stereoisomers of inositol. Myo-, scyllo-, and epi-inositol have been shown to induce conformational changes in Aβ and prevent Aβ amyloid fibril formation by stabilizing non-fibrillar β-sheet structures. We investigate the ability of inositol stereoisomers to inhibit amyloid formation by IAPP. The compounds do not induce a conformational change in IAPP and are ineffective inhibitors of IAPP amyloid formation, although some do lead to modest apparent changes in IAPP amyloid fibril morphology. Thus not all classes of Aβ inhibitors are effective against IAPP. This work provides a basis of comparison to work on polyphenol based inhibitors of IAPP amyloid formation and helps provide clues as to the features which render them effective. The study also helps provide information for further efforts in rational inhibitor design.

  9. Painful shoulder. Introduction into fundamental facts and problems

    Energy Technology Data Exchange (ETDEWEB)

    Hartl, P.W.


    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.

  10. Tool Geometry for Friction Stir Welding—Optimum Shoulder Diameter (United States)

    Mehta, M.; Arora, A.; de, A.; Debroy, T.


    The most important geometric parameter in the friction stir welding (FSW) tool design is the shoulder diameter, which is currently estimated by trial and error. Here, we report a combined experimental and theoretical investigation on the influence of shoulder diameter on thermal cycles, peak temperatures, power requirements, and torque during FSW of AA7075-T6. An optimum tool shoulder diameter is identified using a three-dimensional, heat transfer and materials flow model. First, the predictive capability of the model is tested by comparing the computed values of peak temperature, spindle power, and torque requirements for various shoulder diameters against the corresponding experimental data. The change in the values of these variables with shoulder diameter is correctly predicted by the model. The model is then used to identify the optimum tool shoulder diameter that facilitates maximal use of the supplied torque in overcoming interfacial sticking. The tool with optimum shoulder diameter is shown to result in acceptable yield strength (YS) and ductility.

  11. Optimal Design of a Bio-Inspired Anthropocentric Shoulder Rehabilitator

    Directory of Open Access Journals (Sweden)

    S. K. Mustafa


    Full Text Available This paper presents the design of a bio-inspired anthropocentric 7-DOF wearable robotic arm for the purpose of stroke rehabilitation. The proposed arm rehabilitator synergistically utilizes the human arm structure with non-invasive kinematically under-deterministic cable-driven mechanisms to form a completely deterministic structure. It offers the advantages of being lightweight and having high dexterity. Adopting an anthropocentric design concept also allows it to conform to the human anatomical structure. The focus of this paper is on the analysis and design of the 3-DOF-shoulder module, called the shoulder rehabilitator. The design methodology is divided into three main steps: (1 performance evaluation of the cable-driven shoulder rehabilitator, (2 performance requirements of the shoulder joint based on its physiological characteristics and (3 design optimization of the shoulder rehabilitator based on shoulder joint physiological limitations. The aim is to determine a suitable configuration for the development of a shoulder rehabilitator prototype.

  12. Bilateral Traumatic Anterior Dislocation of Shoulder – a rare entity

    Directory of Open Access Journals (Sweden)

    Yashavantha Kumar C


    Full Text Available Introduction: Bilateral shoulder dislocation are most commonly posterior type. These are most commonly due to seizure disorder and electrocution. Anterior shoulder dislocations occurring bilaterally without any predisposing factors are very rare. These types of injuries are due to trauma with a unique mechanism of injury. To best of our knowledge there are only few cases of similar kind are reported in literature. We hereby report a interesting case of posttraumatic, bilateral anterior dislocation of shoulder without associated fracture in a 45 old women without any predisposing pathoanatomy.Case Report: A 45-year-old women presented to casualty with sudden onset of pain and restriction of movement in both shoulders fallowing trauma. Immediately post trauma she had severe pain and restriction of both shoulders. On examination arms were abducted and externally rotated. Bilateral shoulder movements were painful and restricted . There was loss of round contour of shoulder with increased vertical diameter of axilla anteriorly. Radiological examination revealed bilateral anterior dislocation of the shoulders without any associated fractures. Closed reduction done by Milch technique after intraraticular lignocaine injection. MRI of bilateral shoulder showed no pathological lesion. Both shoulders were immobilized with a shoulder immobilizer for three weeks.Conclusion: Most of the bilateral shoulder dislocations are posterior type seen in seizure disorders. Bilateral traumatic anterior shoulder dislocations are rare and are seen as a result of unique mechanism of injury. In our case patient had a fall on her elbows causing forced extension. If diagnosed and treated promptly completely normal function of the shoulders can be restored.

  13. Amyloid Beta as a Modulator of Synaptic Plasticity


    Parihar, Mordhwaj S.; Gregory J. Brewer


    Alzheimer’s disease is associated with synapse loss, memory dysfunction and pathological accumulation of amyloid beta in plaques. However, an exclusively pathological role for amyloid beta is being challenged by new evidence for an essential function of amyloid beta at the synapse. Amyloid beta protein exists in different assembly states in the central nervous system and plays distinct roles ranging from synapse and memory formation to memory loss and neuronal cell death. Amyloid beta is pres...

  14. Dominant vs. non-dominant shoulder morphology in volleyball players and associations with shoulder pain and spike speed. (United States)

    Challoumas, Dimitrios; Artemiou, Andreas; Dimitrakakis, Georgios


    The aims of our study were to compare the dominant (DOM) and non-dominant (NDOM) shoulders of high-level volleyball athletes and identify possible associations of shoulder adaptations with spike speed (SS) and shoulder pathology. A total of 22 male volleyball players from two teams participating in the first division of the Cypriot championship underwent clinical shoulder tests and simple measurements around their shoulder girdle joints bilaterally. SS was measured with the use of a sports speed radar. Compared with the NDOM side, the DOM scapula was more lateralised, the DOM dorsal capsule demonstrated greater laxity, the DOM dorsal muscles stretching ability was compromised, and the DOM pectoralis muscle was more lengthened. Players with present or past DOM shoulder pain demonstrated greater laxity in their DOM dorsal capsule, tightening of their DOM inferior capsule, and lower SS compared with those without shoulder pain. Dorsal capsule measurements bilaterally were significant predictors of SS. None of the shoulder measurements was associated with team roles or infraspinatus atrophy, while scapular lateralisation was more pronounced with increasing years of experience, and scapular antetilting was greater with increasing age. Adaptations of the DOM shoulder may be linked to pathology and performance. We describe simple shoulder measurements that may have the potential to predict chronic shoulder injury and become part of injury prevention programmes. Detailed biomechanical and large prospective studies are warranted to assess the validity of our findings and reach more definitive conclusions.

  15. Hacking the Code of Amyloid Formation (United States)

    Pastor, M Teresa; Esteras-Chopo, Alexandra


    Many research efforts in the last years have been directed towards understanding the factors determining protein misfolding and amyloid formation. Protein stability and amino acid composition have been identified as the two major factors in vitro. The research of our group has been focused on understanding the relationship between amino acid sequence and amyloid formation. Our approach has been the design of simple model systems that reproduce the biophysical properties of natural amyloids. An amyloid sequence pattern was extracted that can be used to detect amyloidogenic hexapeptide stretches in proteins. We have added evidence supporting that these amyloidogenic stretches can trigger amyloid formation by nonamyloidogenic proteins. Some experimental results in other amyloid proteins will be analyzed under the conclusions obtained in these studies. Our conclusions together with evidences from other groups suggest that amyloid formation is the result of the interplay between a decrease of protein stability, and the presence of highly amyloidogenic regions in proteins. As many of these results have been obtained in vitro, the challenge for the next years will be to demonstrate their validity in in vivo systems. PMID:19164912

  16. Neuroinflammation in Lyme neuroborreliosis affects amyloid metabolism

    Directory of Open Access Journals (Sweden)

    Anckarsäter Henrik


    Full Text Available Abstract Background The metabolism of amyloid precursor protein (APP and β-amyloid (Aβ is widely studied in Alzheimer's disease, where Aβ deposition and plaque development are essential components of the pathogenesis. However, the physiological role of amyloid in the adult nervous system remains largely unknown. We have previously found altered cerebral amyloid metabolism in other neuroinflammatory conditions. To further elucidate this, we investigated amyloid metabolism in patients with Lyme neuroborreliosis (LNB. Methods The first part of the study was a cross-sectional cohort study in 61 patients with acute facial palsy (19 with LNB and 42 with idiopathic facial paresis, Bell's palsy and 22 healthy controls. CSF was analysed for the β-amyloid peptides Aβ38, Aβ40 and Aβ42, and the amyloid precursor protein (APP isoforms α-sAPP and β-sAPP. CSF total-tau (T-tau, phosphorylated tau (P-tau and neurofilament protein (NFL were measured to monitor neural cell damage. The second part of the study was a prospective cohort-study in 26 LNB patients undergoing consecutive lumbar punctures before and after antibiotic treatment to study time-dependent dynamics of the biomarkers. Results In the cross-sectional study, LNB patients had lower levels of CSF α-sAPP, β-sAPP and P-tau, and higher levels of CSF NFL than healthy controls and patients with Bell's palsy. In the prospective study, LNB patients had low levels of CSF α-sAPP, β-sAPP and P-tau at baseline, which all increased towards normal at follow-up. Conclusions Amyloid metabolism is altered in LNB. CSF levels of α-sAPP, β-sAPP and P-tau are decreased in acute infection and increase after treatment. In combination with earlier findings in multiple sclerosis, cerebral SLE and HIV with cerebral engagement, this points to an influence of neuroinflammation on amyloid metabolism.

  17. Synovial chondromatosis of the shoulder: imaging findings

    Directory of Open Access Journals (Sweden)

    Carlos Renato Ticianelli Terazaki


    Full Text Available Synovial chondromatosis is a benign condition characterized by synovial proliferation and metaplasia, with development of cartilaginous or osteocartilaginous nodules within a joint, bursa or tendon sheath. In the shoulder, synovial osteochondromatosis may occur within the glenohumeral joint and its recesses (including the tendon sheath of the biceps long head, and in the subacromial-deltoid bursa. Such condition can be identified either by radiography, ultrasonography or magnetic resonance imaging, showing typical features according to each method. Radiography commonly shows ring-shaped calcified cartilages and periarticular soft tissues swelling with erosion of joint margins. Ultrasonography demonstrates hypoechogenic cartilaginous nodules with progressive increase in echogenicity as they become calcified, with development of posterior acoustic shadow in case of ossification. Besides identifying cartilaginous nodules, magnetic resonance imaging can also demonstrate the degree of synovial proliferation. The present study is aimed at describing the imaging findings of this entity in the shoulder.

  18. Frozen shoulder - an effective method of treatment. (United States)

    Warmington, L E


    Although there has been a considerable amount of material published on the pathology and the probable aetiology of the frozen shoulder, the same cannot be said of suggestions for an effective method of physical treatment for all stages of the condition. Some authors claim that exercises mar the recovery process (Cyriax, 1957). Others have found that the condition runs a self-limiting course of anything up to three years, and any physical treatment is "notoriously unsuccessful" in altering this pattern (Crisp and Hume Kendall, 1955). However, all agree that the recovery of frozen shoulders, treated or untreated, is prolonged, and in the acute phase of the condition, physiotherapy plays no part in the treatment of pain (Cyriax, Ibid., Crisp and Hume Kendall, Ibid., Stening, 1961).

  19. Common Shoulder Injuries in American Football Athletes. (United States)

    Gibbs, Daniel B; Lynch, T Sean; Nuber, Erika D; Nuber, Gordon W


    American football is a collision sport played by athletes at high speeds. Despite the padding and conditioning in these athletes, the shoulder is a vulnerable joint, and injuries to the shoulder girdle are common at all levels of competitive football. Some of the most common injuries in these athletes include anterior and posterior glenohumeral instability, acromioclavicular pathology (including separation, osteolysis, and osteoarthritis), rotator cuff pathology (including contusions, partial thickness, and full thickness tears), and pectoralis major and minor tears. In this article, we will review the epidemiology and clinical and radiographic workup of these injuries. We also will evaluate the effectiveness of surgical and nonsurgical management specifically related to high school, collegiate, and professional football athletes.

  20. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain

    Directory of Open Access Journals (Sweden)

    Wensing Michel


    Full Text Available Abstract Background Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment targets through MTrP inactivation. While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain, the percentage of patients who actually have MTrPs remains unclear. The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain. Methods An observational study was conducted. Subjects were recruited from patients participating in a controlled trial studying the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain. Sociodemographic and patient-reported symptom scores, including the Disabilities of the Arm, Shoulder, and Hand (DASH Questionnaire, and Visual Analogue Scales for Pain were compared with other studies. To test for differences in age, gender distribution, and education level between the current study population and the populations from Dutch shoulder studies, the one sample T-test was used. One observer examined all subjects (n = 72 for the presence of MTrPs. Frequency distributions, means, medians, standard deviations, and 95% confidence intervals were calculated for descriptive purposes. The Spearman's rank-order correlation (ρ was used to test for association between variables. Results MTrPs were identified in all subjects. The median number of muscles with MTrPs per subject was 6 (active

  1. Standing on the shoulders of giants

    Institute of Scientific and Technical Information of China (English)

    Peter McDonald


    @@ The cover of this well-illustrated, monochrome book has mini-portraits of eight surgical pioneers that suggest the scope of this coffee table sized hardback. Andreas Vesalius rubs shoulders with Lister, Wangensteen, Pasteur and Ambroise Paré. Indeed this multi-author publication is the most comprehensive tome of the history of what is the core of general surgery (i.e. surgery of the gastrointestinal tract) published to date and browsing through it was an utter delight.

  2. Systematics of shoulder instability; Systematik der Schulterinstabilitaet

    Energy Technology Data Exchange (ETDEWEB)

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


    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

  3. Looking over the shoulders of researchers

    DEFF Research Database (Denmark)

    Nielsen, Kristian Hvidtfelt; Autzen, Charlotte


    The Galathea 3 Expedition from 2006 to 2007 combined research and online news media, allowing journalists literally to “look over the shoulders of researchers.” The authors analyze 781 news articles published online by three media partners of the expedition, all well-established media companies...... and researchers, the authors situate the research-media partnership and their findings in contemporary debates about science and the media....

  4. Severe shoulder tendinopathy associated with levofloxacin. (United States)

    Eyer-Silva, Walter de Araujo; Netto, Henrique de Barros Pinto; Pinto, Jorge Francisco da Cunha; Ferry, Fernando Raphael de Almeida; Neves-Motta, Rogério


    Fluoroquinolone (FQ)-associated tendinopathy and myopathy are uncommon but well recognized complications of the use of this class of antibacterial agents. The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment of community-acquired pneumonia is reported here. Surgical stabilization with suture anchors and subacromial decompression were needed.

  5. Severe shoulder tendinopathy associated with levofloxacin

    Directory of Open Access Journals (Sweden)

    Walter de Araujo Eyer-Silva


    Full Text Available Fluoroquinolone (FQ-associated tendinopathy and myopathy are uncommon but well recognized complications of the use of this class of antibacterial agents. The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment of community-acquired pneumonia is reported here. Surgical stabilization with suture anchors and subacromial decompression were needed.

  6. Adaptation of the AnyBody™ Musculoskeletal Shoulder Model to the Nonconforming Total Shoulder Arthroplasty Context. (United States)

    Sins, Lauranne; Tétreault, Patrice; Hagemeister, Nicola; Nuño, Natalia


    Current musculoskeletal inverse dynamics shoulder models have two limitations to use in the context of nonconforming total shoulder arthroplasty (NC-TSA). First, the ball and socket glenohumeral (GH) joint simplification avoids any humeral head translations. Second, there is no contact at the GH joint to compute the contact area and the center of pressure (COP) between the two components of NC-TSA. In this paper, we adapted the AnyBody™ shoulder model by introducing humeral head translations and contact between the two components of an NC-TSA. Abduction in the scapular plane was considered. The main objective of this study was to adapt the AnyBody™ shoulder model to a NC-TSA context and to compare the results of our model (translations, COP, contact area, GH joint reaction forces (GH-JRFs), and muscular forces) with previous numerical, experimental, and clinical studies. Humeral head translations and contact were successfully introduced in our adapted shoulder model with strong support for our findings by previous studies.

  7. Revision reverse shoulder arthroplasty in failed shoulder arthroplasties for rotator cuff deficiency (United States)



    Purpose the aim of this systematic literature review is to report clinical outcomes of reverse shoulder arthroplasty (RSA) used as a revision surgery following failure of the primary implant due to rotator cuff insufficiency. Methods a systematic review was performed using the following key words: revision, shoulder, rotator cuff deficiency, outcome assessment, treatment outcome, complications. Studies eligible for inclusion in the review were clinical trials investigating patients in whom a primary shoulder arthroplasty implant with an incompetent rotator cuff was replaced with a reverse shoulder prosthesis. Results nine articles were identified and further reviewed. The results refer to a total of 226 shoulders that were treated with RSA as revision surgery. The patients in the studies had a mean age ranging from 64 to 72 years and the longest follow-up was 3.8 years. Improvements in function and reduction of pain were shown by many studies, but the mean Constant score ranged from 44.2 to 56. High complication rates (of up to 62%) were recorded, and a mean reoperation rate of 27.5%. Conclusions RSA as revision surgery for patients with rotator cuff deficiency is a valid option, and often the only solution available, but it should be limited to elderly patients with poor function and severe pain. Level of evidence level IV, systematic review of level I–IV studies. PMID:26151037

  8. Detailed shoulder MRI findings in manual wheelchair users with shoulder pain. (United States)

    Morrow, Melissa M B; Van Straaten, Meegan G; Murthy, Naveen S; Braman, Jonathan P; Zanella, Elia; Zhao, Kristin D


    Shoulder pain and pathology are common in manual wheelchair (MWC) users with paraplegia, and the biomechanical mechanism of injury is largely unknown. Establishing patterns of MRI characteristics in MWC users would help advance understanding of the mechanical etiology of rotator cuff disease, thus improving the logic for prescribed interventions. The purpose of this study was to report detailed shoulder MRI findings in a sample of 10 MWC users with anterolateral shoulder pain. The imaging assessments were performed using our standardized MRI Assessment of the Shoulder (MAS) guide. The tendon most commonly torn was the supraspinatus at the insertion site in the anterior portion in either the intrasubstance or articular region. Additionally, widespread tendinopathy, CA ligament thickening, subacromial bursitis, labral tears, and AC joint degenerative arthrosis and edema were common. Further reporting of detailed shoulder imaging findings is needed to confirm patterns of tears in MWC users regarding probable tendon tear zone, region, and portion. This investigation was a small sample observational study and did not yield data that can define patterns of pathology. However, synthesis of detailed findings from multiple studies could define patterns of pathological MRI findings allowing for associations of imaging findings to risk factors including specific activities.

  9. Detailed Shoulder MRI Findings in Manual Wheelchair Users with Shoulder Pain

    Directory of Open Access Journals (Sweden)

    Melissa M. B. Morrow


    Full Text Available Shoulder pain and pathology are common in manual wheelchair (MWC users with paraplegia, and the biomechanical mechanism of injury is largely unknown. Establishing patterns of MRI characteristics in MWC users would help advance understanding of the mechanical etiology of rotator cuff disease, thus improving the logic for prescribed interventions. The purpose of this study was to report detailed shoulder MRI findings in a sample of 10 MWC users with anterolateral shoulder pain. The imaging assessments were performed using our standardized MRI Assessment of the Shoulder (MAS guide. The tendon most commonly torn was the supraspinatus at the insertion site in the anterior portion in either the intrasubstance or articular region. Additionally, widespread tendinopathy, CA ligament thickening, subacromial bursitis, labral tears, and AC joint degenerative arthrosis and edema were common. Further reporting of detailed shoulder imaging findings is needed to confirm patterns of tears in MWC users regarding probable tendon tear zone, region, and portion. This investigation was a small sample observational study and did not yield data that can define patterns of pathology. However, synthesis of detailed findings from multiple studies could define patterns of pathological MRI findings allowing for associations of imaging findings to risk factors including specific activities.

  10. Amyloid Imaging in Aging and Dementia: Testing the Amyloid Hypothesis In Vivo

    Directory of Open Access Journals (Sweden)

    G. D. Rabinovici


    Full Text Available Amyloid imaging represents a major advance in neuroscience, enabling the detection and quantification of pathologic protein aggregations in the brain. In this review we survey current amyloid imaging techniques, focusing on positron emission tomography (PET with ^{11}carbon-labelled Pittsburgh Compound-B (11C-PIB, the most extensively studied and best validated tracer. PIB binds specifically to fibrillar beta-amyloid (Aβ deposits, and is a sensitive marker for Aβ pathology in cognitively normal older individuals and patients with mild cognitive impairment (MCI and Alzheimer’s disease (AD. PIB-PET provides us with a powerful tool to examine in vivo the relationship between amyloid deposition, clinical symptoms, and structural and functional brain changes in the continuum between normal aging and AD. Amyloid imaging studies support a model in which amyloid deposition is an early event on the path to dementia, beginning insidiously in cognitively normal individuals, and accompanied by subtle cognitive decline and functional and structural brain changes suggestive of incipient AD. As patients progress to dementia, clinical decline and neurodegeneration accelerate and proceed independently of amyloid accumulation. In the future, amyloid imaging is likely to supplement clinical evaluation in selecting patients for anti-amyloid therapies, while MRI and FDG-PET may be more appropriate markers of clinical progression.

  11. Multimedia virtualized environment for shoulder pain rehabilitation (United States)

    Chen, Chih-Chen


    [Purpose] Researchers imported games and virtual reality training to help participants train their shoulders in a relaxed environment. [Subjects and Methods] This study included the use of Kinect somatosensory device with Unity software to develop 3-dimensional situational games. The data collected from this training process can be uploaded via the Internet to a cloud or server for participants to perform self-inspection. The data can be a reference for the medical staff to assess training effectiveness for those with impairments and plan patient rehabilitation courses. [Results] In the training activities, 8 subjects with normal shoulder function demonstrated that the system has good stability and reproducibility. Six subjects with impaired shoulder underwent 6 weeks of training. During the third week of training, average performance stabilized. The t-test comparing 1–2 weeks to 3–4 weeks and 5–6 weeks showed significant differences. [Conclusion] Using games as training methods improved patient concentration, interest in participation and allowed patients to forget about their body discomfort. The equipment utilized in this study is inexpensive, easy to obtain, and the system is easy to install. People can perform simple self-training both at home or in the office. PMID:27190481

  12. Shoulder MRI after surgical treatment of instability

    Energy Technology Data Exchange (ETDEWEB)

    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)


    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.

  13. Effects of irrigation fluid in shoulder arthroscopy (United States)

    Gupta, Surbhi; Manjuladevi, M; Vasudeva Upadhyaya, KS; Kutappa, AM; Amaravathi, Rajkumar; Arpana, J


    Background and Aims: Extravasation of irrigation fluid used in shoulder arthroscopy can lead to life-threatening airway and systemic complications. This study was conducted to assess the effect of irrigation fluid absorption on measurable anthropometric parameters and to identify whether these parameters predict airway/respiratory compromise. Methods: Thirty six American Society of Anaesthesiologists physical status one or two patients aged 15–60 years undergoing shoulder arthroscopy under general anaesthesia were recruited. Measured variables preoperatively (baseline) and at the end of surgery were neck, chest, midarm and midthigh circumferences, weight, haemoglobin and serum sodium. Temperature, endotracheal tube cuff pressure, airway pressure, duration of surgery, amount of irrigation fluid and intravenous fluid used were also noted. Measured parameters were correlated with the duration of surgery and the amount of irrigation fluid used. Results: Postoperatively, the changes in variables showed a significant increase in the mean values (cm) for neck, chest, midarm and midthigh circumference (mean ± standard deviation: 2.35 ± 1.9, P cm, P compared to the baseline. No significant change was found in the serum sodium levels (P = 0.92). No patient experienced airway/respiratory compromise. Conclusion: Regional and systemic absorption of irrigation fluid in arthroscopic shoulder surgery is reflected in the degree of change in the measured anthropometric variables. However, this change was not significant enough to cause airway/respiratory compromise. PMID:27053783

  14. Cine-MR imaging of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Allmann, K.H.; Uhl, M.; Gufler, H.; Kotter, E.; Langer, M. [Univ. Hospital, Freiburg (Germany). Dept. of Diagnostic Radiology; Biebow, N.; Hauer, M.P.; Reichelt, A. [Univ. Hospital, Freiburg (Germany). Dept. of Orthopedic Surgery


    Purpose: Shoulder lesions are usually examined with the joint in only one or two positions. We examined the shoulder with the joint in a variety of positions. We also assessed the application of cine-MR to the detection of instability and impingement. Material and Methods: The cine-MR examinations were performed in 30 patients and 15 healthy volunteers. We used an open 0.2 T system and a closed 1.0 T system. Spoiled gradient echo 2D T1-weighted images and turbo spin-echo T1- and T2-weighted images were obtained with a field of view of 180 mm. The examinations were videotaped and evaluated later. Results: Normal variations of the glenohumeral joint were easy to recognize. Subluxations and luxations of the humeral head as well as rupture of the labrum were identified. It was also possible to identify the labrum with a signal change after arthroscopic refixation. And we were able to objectively assess distances between the osseous structures during dynamic movement. Conclusion: Unlike static MR, cine-MR would appear to be useful in visualizing the capsular ligament complex of the gleno-humeral joint in impingement and instability. It also provides information on dynamic changes and may thus prove to be an important tool for shoulder diagnostics. The method may provide an early diagnosis in the subacromial impingement syndrome. (orig.).

  15. Ironman triathletes: MRI assessment of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Hiller, W.D.; Dierenfield, Laura [North Hawaii Community Hospital, Kamuela, HI (United States); Ainge, George R.; Brown, David W. [North Hawaii Community Hospital, Department of Radiology, Kamuela, HI (United States); Shellock, Frank G. [University of Southern California, Education and Research, Keck School of Medicine, Los Angeles, CA (United States); Crues, John V. [Radnet Inc., Los Angeles, CA (United States); Reuter, Robert M.


    The objective of this paper was to demonstrate the prevalence of shoulder magnetic resonance imaging (MRI) abnormalities, including abnormal bone marrow signal at the acromioclavicular (AC) joint in symptomatic and asymptomatic Ironman Triathletes. The shoulders of 23 Ironman Triathletes, seven asymptomatic (group I) and 16 symptomatic (group II), were studied by MRI. A separate, non-triathlete group was evaluated specifically for AC joint marrow signal abnormalities to compare with the Ironman Triathletes. Partial thickness tears of the rotator cuff, rotator cuff tendinopathy, and AC joint arthrosis were common findings in both groups of triathletes. Tendinopathy was the only finding that was more prevalent in the symptomatic group, but this was not a statistically significant difference (p=0.35). There were no tears of the glenoid labrum seen in group I or II subjects. Of note is that 71% (5/7) of group I subjects and 62% (10/16) of group II subjects had increased signal changes in the marrow of the AC joint (p=0.68). The comparison group showed a lower prevalence (35%, p=0.06) of this finding. No statistically significant difference was found among the findings for group 1, group 2, or the comparison group, although the difference between the comparison group and Ironman Triathletes approached statistical significance when evaluating for AC joint abnormal signal. Shoulder MRI of Ironman Triathletes should be interpreted with an appreciation of the commonly seen findings in asymptomatic subjects. (orig.)

  16. Effects and predictors of shoulder muscle massage for patients with posterior shoulder tightness

    Directory of Open Access Journals (Sweden)

    Yang Jing-lan


    Full Text Available Abstract Background Clinical approaches like mobilization, stretching, and/or massage may decrease shoulder tightness and improve symptoms in subjects with stiff shoulders. We investigated the effect and predictors of effectiveness of massage in the treatment of patients with posterior shoulder tightness. Methods A randomized controlled trial was conducted in a hospital-based outpatient practice (orthopedic and rehabilitation. Forty-three women and 17 men (mean age = 54 years, range 43-73 years with posterior shoulder tightness participated and were randomized into massage and control groups (n = 30 per group. A physical therapist provided the massage on the posterior deltoid, infraspinatus, and teres minor of the involved shoulder for 18 minutes [about 6 minutes for each muscle] two times a week for 4 weeks. For the control group, one therapist applied light hand touch on the muscles 10 minutes two times a week for 4 weeks. Glenohumeral internal rotation ROM, functional status, and muscle tightness were the main outcomes. Additionally, the potential factors on the effectiveness of massage were analyzed by multivariate logistic regression. For this analysis, patients with functional score improvement at least 20% after massage were considered responsive, and the others were considered nonresponsive. Results Fifty-two patients completed the study (29 for the massage and 23 for the control. The overall mean internal rotation ROM increased significantly in the massage group compared to the control (54.9° v.s. 34.9°; P ≤ 0.001. There were 21 patients in the responsive group and 8 in the nonresponsive group. Among the factors, duration of symptoms, functional score, and posterior deltoid tightness were significant predictors of effectiveness of massage. Conclusions Massage was an effective treatment for patients with posterior shoulder tightness, but was less effective in patients with longer duration of symptoms, higher functional limitation

  17. Reverse Shoulder Arthroplasty for Trauma: When, Where, and How. (United States)

    Szerlip, Benjamin W; Morris, Brent J; Edwards, T Bradley


    Reverse shoulder arthroplasty has become increasingly popular for the treatment of complex shoulder injuries, including proximal humerus fractures and fixed glenohumeral dislocation, in the elderly population. The early to midterm results of reverse shoulder arthroplasty for the treatment of proximal humerus fractures are promising compared with the results of unconstrained humeral head replacement, and patients may have more predictable improvement with less dependence on bone healing and rehabilitation. However, long-term follow-up is needed, and surgeons must be familiar with various complications that are specific to reverse shoulder arthroplasty. To achieve optimal patient outcomes for the management of traumatic shoulder injuries, surgeons must have a comprehensive understanding of the current implant options, indications, and surgical techniques for reverse shoulder arthroplasty.

  18. Association of head circumference and shoulder dystocia in macrosomic neonates. (United States)

    Larson, Austin; Mandelbaum, David E


    To determine whether asymmetric macrosomia (disproportionately large body size in comparison to head circumference) could be demonstrated in a population of infants suffering shoulder dystocia during delivery relative to those that did not suffer from shoulder dystocia. A case-control study was conducted as a retrospective chart review over 3 years at a large maternity hospital in an urban setting. Among infants over 4,000 g, those that suffered from shoulder dystocia during delivery had a smaller mean head circumference than infants of a similar size that did not suffer from shoulder dystocia. A statistically significant difference was also present when cases of documented gestational diabetes were excluded. Asymmetric macrosomia is more likely to be present in a population of infants who suffered shoulder dystocia during delivery. This knowledge could be used in designing tools to predict which pregnancies are at highest risk for shoulder dystocia during delivery.

  19. Hybrid Amyloid Membranes for Continuous Flow Catalysis. (United States)

    Bolisetty, Sreenath; Arcari, Mario; Adamcik, Jozef; Mezzenga, Raffaele


    Amyloid fibrils are promising nanomaterials for technological applications such as biosensors, tissue engineering, drug delivery, and optoelectronics. Here we show that amyloid-metal nanoparticle hybrids can be used both as efficient active materials for wet catalysis and as membranes for continuous flow catalysis applications. Initially, amyloid fibrils generated in vitro from the nontoxic β-lactoglobulin protein act as templates for the synthesis of gold and palladium metal nanoparticles from salt precursors. The resulting hybrids possess catalytic features as demonstrated by evaluating their activity in a model catalytic reaction in water, e.g., the reduction of 4-nitrophenol into 4-aminophenol, with the rate constant of the reduction increasing with the concentration of amyloid-nanoparticle hybrids. Importantly, the same nanoparticles adsorbed onto fibrils surface show improved catalytic efficiency compared to the same unattached particles, pointing at the important role played by the amyloid fibril templates. Then, filter membranes are prepared from the metal nanoparticle-decorated amyloid fibrils by vacuum filtration. The resulting membranes serve as efficient flow catalysis active materials, with a complete catalytic conversion achieved within a single flow passage of a feeding solution through the membrane.

  20. Islet Amyloid Polypeptide: Structure, Function, and Pathophysiology

    Directory of Open Access Journals (Sweden)

    Rehana Akter


    Full Text Available The hormone islet amyloid polypeptide (IAPP, or amylin plays a role in glucose homeostasis but aggregates to form islet amyloid in type-2 diabetes. Islet amyloid formation contributes to β-cell dysfunction and death in the disease and to the failure of islet transplants. Recent work suggests a role for IAPP aggregation in cardiovascular complications of type-2 diabetes and hints at a possible role in type-1 diabetes. The mechanisms of IAPP amyloid formation in vivo or in vitro are not understood and the mechanisms of IAPP induced β-cell death are not fully defined. Activation of the inflammasome, defects in autophagy, ER stress, generation of reactive oxygen species, membrane disruption, and receptor mediated mechanisms have all been proposed to play a role. Open questions in the field include the relative importance of the various mechanisms of β-cell death, the relevance of reductionist biophysical studies to the situation in vivo, the molecular mechanism of amyloid formation in vitro and in vivo, the factors which trigger amyloid formation in type-2 diabetes, the potential role of IAPP in type-1 diabetes, the development of clinically relevant inhibitors of islet amyloidosis toxicity, and the design of soluble, bioactive variants of IAPP for use as adjuncts to insulin therapy.

  1. Validation of the Danish version of Oxford Shoulder Score

    DEFF Research Database (Denmark)

    Frich, Lars Henrik; Noergaard, Peter Moensted; Brorson, Stig


    The Oxford Shoulder Score (OSS) is a patient-administered condition-specific questionnaire for patients with degenerative or inflammatory shoulder disease. The purpose of this study was to validate a Danish translation of the OSS and to compare it with the Constant Score (CS).......The Oxford Shoulder Score (OSS) is a patient-administered condition-specific questionnaire for patients with degenerative or inflammatory shoulder disease. The purpose of this study was to validate a Danish translation of the OSS and to compare it with the Constant Score (CS)....

  2. Amyloid β-sheet mimics that antagonize protein aggregation and reduce amyloid toxicity (United States)

    Cheng, Pin-Nan; Liu, Cong; Zhao, Minglei; Eisenberg, David; Nowick, James S.


    The amyloid protein aggregation associated with diseases such as Alzheimer's, Parkinson's and type II diabetes (among many others) features a bewildering variety of β-sheet-rich structures in transition from native proteins to ordered oligomers and fibres. The variation in the amino-acid sequences of the β-structures presents a challenge to developing a model system of β-sheets for the study of various amyloid aggregates. Here, we introduce a family of robust β-sheet macrocycles that can serve as a platform to display a variety of heptapeptide sequences from different amyloid proteins. We have tailored these amyloid β-sheet mimics (ABSMs) to antagonize the aggregation of various amyloid proteins, thereby reducing the toxicity of amyloid aggregates. We describe the structures and inhibitory properties of ABSMs containing amyloidogenic peptides from the amyloid-β peptide associated with Alzheimer's disease, β2-microglobulin associated with dialysis-related amyloidosis, α-synuclein associated with Parkinson's disease, islet amyloid polypeptide associated with type II diabetes, human and yeast prion proteins, and Tau, which forms neurofibrillary tangles.

  3. The Danish Shoulder Arthroplasty Registry: clinical outcome and short-term survival of 2,137 primary shoulder replacements


    Jeppe V Rasmussen; Jakobsen,John; Brorson, Stig; Olsen, Bo S


    The Danish Shoulder Arthroplasty Registry (DSR) was established in 2004. Data are reported electronically by the surgeons. Patient-reported outcome is collected 10–14 months postoperatively using the Western Ontario osteoarthritis of the shoulder index (WOOS). 2,137 primary shoulder arthroplasties (70% women) were reported to the registry between January 2006 and December 2008. Mean age at surgery was 69 years (SD 12). The most common indications were a displaced proximal humeral fracture (54...

  4. The Role of the 14–20 Domain of the Islet Amyloid Polypeptide in Amyloid Formation

    Directory of Open Access Journals (Sweden)

    Sharon Gilead


    Full Text Available The molecular mechanism of amyloid formation by the islet amyloid polypeptide (IAPP has been intensively studied since its identification in the late 1980s. The IAPP(20–29 region is considered to be the central amyloidogenic module of the polypeptide. This assumption is mainly based on the amyloidogenic properties of the region and on the large sequence diversity within this region between the human and mouse IAPP, as the mouse IAPP does not form amyloids. A few years ago, another region within IAPP was identified that seems to be at least as important as IAPP(20–29 in facilitation of molecular recognition that leads to amyloid formation. Here, we reinforce our and others' previous findings by analyzing supporting evidence from the recent literature. Moreover, we provide new proofs to our hypothesis by comparing between the amyloidogenic properties of the two regions derived from the IAPP of cats, which is also known to form amyloid fibrils.

  5. Physical examination of the cervical spine and shoulder girdle in patients with shoulder complaints

    NARCIS (Netherlands)

    Sobel, JS; Winters, JC; Groenier, K; Arendzen, Johan; Meyboom-de Jong, B


    Objective: To look for differences in mobility in randomly selected patients without shoulder complaints depending on age, gender and left- or right-handedness; to investigate in the patient group whether specific differences exist, depending on the diagnosis made or the afflicted side; and to detec

  6. Sorting swimmers shoulders: An observational study on swimmers that presented to a shoulder surgeon

    Directory of Open Access Journals (Sweden)

    Daniel Butler


    Full Text Available Context: It is common for swimmers to suffer shoulder injuries resulting in a wealth of research focusing on the causes and types of injury. However, there is a lack of evidence regarding current management for shoulder injuries in swimmers. Aims: To investigate the diagnosis, subsequent management, and the return to swimming outcomes for swimmers presenting to an orthopedic practice. Settings and Design: Retrospective cohort study of competitive swimmers presenting to an orthopedic practice. Materials and Methods: The diagnosis, subsequent management, and the return to swimming outcomes were analyzed for 14 swimmers whose injuries were managed by a shoulder surgeon. Statistical Analysis Used: Descriptive analysis. Results: No significant association was identified between swimming stroke and type of injury. The majority of swimmers had good scapula rhythm, with no visible dyskinesis, including those with impingement. Swimmers with impingement did not require arthroscopy, and with nonoperative management had a mean time to return to swimming of 1.6 months. All labral tears required arthroscopic labral repair, with these swimmers having a mean time of 2.9 months postsurgery to return to swimming. Conclusion: The study demonstrated that an accurate diagnosis, and appropriate choice of nonoperative and surgical treatments lead to reassuring outcomes for swimmers suffering from shoulder injuries.

  7. Humeral shaft fracture with ipsilateral shoulder dislocation

    Institute of Scientific and Technical Information of China (English)

    Prateek Behera; Vishal Kumar; Sameer Aggarwal


    Although fracture of the humeral shaft or dislocation of the shoulder joint is a common injury,a simutaneous injury is rare.We present such a case combined with head injury which took precedence over the skeletal injuries.The postoperative rehabilitation was slowed down by the head injury.This case report makes us aware of some problems when managing the patient with this rare injury and helps us understand the management options better.Also the need for proper follow-up and rehabilitation is emphasized.

  8. Recoil Considerations for Shoulder-Fired Weapons (United States)


    2012) Steyr 15.2 mm 35 g 1450 m/s 39.6 lb 11.4 Burns (2012) Type 97 (Japanese) 20 mm 162 g 790 m/s 130 lb 28.7 Burns (2012) 12HB00 ( Remington ...shotgun 0.727 in 807 gr (12 × 00) 1225 ft/s 7.0 lb 4.37 Remington (2011) Remington Express 12B0 shotgun 0.727 in 580 gr (12 × 0) 1275 ft/s...7.0 lb 3.28 Remington 5 Table 3. Recoil-related characteristics of selected shoulder-fired weapons cited in table 1. Nomenclature

  9. The Square-Shoulder-Asakura-Oosawa model (United States)

    Fantoni, Riccardo


    A new model for a colloidal size-asymmetric binary mixture is proposed: The Square-Shoulder-Asakura-Oosawa. This belongs to the larger class of non-additive hard-spheres models and has the property that its effective pair formulation is exact whenever the solvent particle fits inside the interstitial region of three touching solute particles. Therefore one can study its properties from the equivalent one-component effective problem. Some remarks on the phase diagram of this new model are also addressed.

  10. Shoulder-elbow exoskeleton as rehabilitation exerciser (United States)

    Ianoşi, A.; Dimitrova, A.; Noveanu, S.; Tătar, O. M.; Mândru, D. S.


    This paper presents a 2 degree of freedom exoskeleton designed for the rehabilitation of the shoulder and elbow movement in the sagittal plane; a semi-portable design strategy was chosen, which enables an easy attachment to a standard medical chair as well as the patient upper limb. A dedicated driver enables the control from a graphical user interface, which also provides the option of customized rehabilitation exercises. The potential of future improvements is assessed, and recommendations of research direction are made in order to broaden the usability of the proposed device.

  11. Humeral shaft fracture with ipsilateral shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Behera Prateek


    Full Text Available 【Abstract】Although fracture of the humeral shaft or dislocation of the shoulder joint is a common injury, a simutaneous injury is rare. We present such a case combined with head injury which took precedence over the skeletal injuries. The postoperative rehabilitation was slowed down by the head injury. This case report makes us aware of some problems when managing the patient with this rare injury and helps us understand the management options better. Also the need for proper follow-up and rehabilitation is emphasized.

  12. Shoulder Injuries in US Astronauts Related to EVA Suit Design (United States)

    Scheuring, R. A.; McCulloch, P.; Van Baalen, Mary; Minard, Charles; Watson, Richard; Blatt, T.


    Introduction: For every one hour spent performing extravehicular activity (EVA) in space, astronauts in the US space program spend approximately six to ten hours training in the EVA spacesuit at NASA-Johnson Space Center's Neutral Buoyancy Lab (NBL). In 1997, NASA introduced the planar hard upper torso (HUT) EVA spacesuit which subsequently replaced the existing pivoted HUT. An extra joint in the pivoted shoulder allows increased mobility but also increased complexity. Over the next decade a number of astronauts developed shoulder problems requiring surgical intervention, many of whom performed EVA training in the NBL. This study investigated whether changing HUT designs led to shoulder injuries requiring surgical repair. Methods: US astronaut EVA training data and spacesuit design employed were analyzed from the NBL data. Shoulder surgery data was acquired from the medical record database, and causal mechanisms were obtained from personal interviews Analysis of the individual HUT designs was performed as it related to normal shoulder biomechanics. Results: To date, 23 US astronauts have required 25 shoulder surgeries. Approximately 48% (11/23) directly attributed their injury to training in the planar HUT, whereas none attributed their injury to training in the pivoted HUT. The planar HUT design limits shoulder abduction to 90 degrees compared to approximately 120 degrees in the pivoted HUT. The planar HUT also forces the shoulder into a forward flexed position requiring active retraction and extension to increase abduction beyond 90 degrees. Discussion: Multiple factors are associated with mechanisms leading to shoulder injury requiring surgical repair. Limitations to normal shoulder mechanics, suit fit, donning/doffing, body position, pre-existing injury, tool weight and configuration, age, in-suit activity, and HUT design have all been identified as potential sources of injury. Conclusion: Crewmembers with pre-existing or current shoulder injuries or certain

  13. Treating Postlaparoscopic Surgery Shoulder Pain with Acupuncture

    Directory of Open Access Journals (Sweden)

    Gur Kreindler


    Full Text Available Objective. The purpose of this study was to examine the effect of acupuncture on postlaparoscopic shoulder pain (PLSP which is a common side effect in patients undergoing abdominal laparoscopic surgery. Methods. Patients with moderate to severe PLSP in spite of analgesic treatment, which were referred by the medical staff to the Complementary-Integrative Surgery Service (CISS at our institution, were provided with acupuncture treatment. The severity of PLSP and of general pain was assessed using a Visual Analogue Scale (VAS from 0 to 10. Pain assessment was conducted prior to and two hours following acupuncture treatment. Acupuncture treatment was individualized based on traditional Chinese medicine diagnosis. Results. A total of 25 patients were evaluated during a 14-month period, from March 2011 to May 2012. A significant reduction in PLSP (mean reduction of 6.4±2.3  P<0.0001 and general pain (mean reduction 6.4±2.1  P<0.0001 were observed, and no significant side effects were reported. Conclusion. Individualized acupuncture treatments according to traditional Chinese medicine principles may improve postlaparoscopic shoulder pain and general pain when used in conjunction with conventional therapy. The primary findings of this study warrant verification in controlled studies.

  14. Diagnostic imaging of shoulder rotator cuff lesions

    Directory of Open Access Journals (Sweden)

    Nogueira-Barbosa Marcello Henrique


    Full Text Available Shoulder rotator cuff tendon tears were evaluated with ultrasonography (US and magnetic resonance imaging (MRI. Surgical or arthroscopical correlation were available in 25 cases. Overall costs were also considered. Shoulder impingement syndrome diagnosis was done on a clinical basis. Surgery or arthroscopy was considered when conservative treatment failure for 6 months, or when rotator cuff repair was indicated. Ultrasound was performed in 22 patients and MRI in 17 of the 25 patients. Sensitivity, specificity and accuracy were 80%, 100% and 90.9% for US and 90%, 100% and 94.12% for MRI, respectively. In 16 cases both US and MRI were obtained and in this subgroup statistical correlation was excellent (p< 0.001. We concluded that both methods are reliable for rotator cuff full thickness tear evaluation. Since US is less expensive, it could be considered as the screening method when rotator cuff integrity is the main question, and when well trained radiologists and high resolution equipment are available.

  15. Isolated Pulmonary Embolism following Shoulder Arthroscopy

    Directory of Open Access Journals (Sweden)

    Nicole H. Goldhaber


    Full Text Available Pulmonary embolism (PE following shoulder arthroscopy is a rare complication. We present a unique case report of a 43-year-old right-hand dominant female who developed a PE 41 days postoperatively with no associated upper or lower extremity DVT. The patient had minimal preoperative and intraoperative risk factors. Additionally, she had no thromboembolic symptoms postoperatively until 41 days following surgery when she developed sudden right-hand swelling, labored breathing, and abdominal pain. A stat pulmonary computed tomography (CT angiogram of the chest revealed an acute PE in the right lower lobe, and subsequent extremity ultrasounds showed no upper or lower extremity deep vein thrombosis. After a thorough review of the literature, we present the first documented isolated PE following shoulder arthroscopy. Although rare, sudden development of an isolated PE is possible, and symptoms such as sudden hand swelling, trouble breathing, and systemic symptoms should be evaluated aggressively with a pulmonary CT angiogram given the fact that an extremity ultrasound may be negative for deep vein thrombosis.

  16. Chirality and chiroptical properties of amyloid fibrils. (United States)

    Dzwolak, Wojciech


    Chirality of amyloid fibrils-linear beta-sheet-rich aggregates of misfolded protein chains-often manifests in morphological traits such as helical twist visible in atomic force microscopy and in chiroptical properties accessible to vibrational circular dichroism (VCD). According to recent studies the relationship between molecular chirality of polypeptide building blocks and superstructural chirality of amyloid fibrils may be more intricate and less deterministic than previously assumed. Several puzzling experimental findings have put into question earlier intuitive ideas on: 1) the bottom-up chirality transfer upon amyloidogenic self-assembly, and 2) the structural origins of chiroptical properties of protein aggregates. For example, removal of a single amino acid residue from an amyloidogenic all-L peptide was shown to reverse handedness of fibrils. On the other hand, certain types of amyloid aggregates revealed surprisingly strong VCD spectra with the sign and shape dependent on the conditions of fibrillation. Hence, microscopic and chiroptical studies have highlighted chirality as one more aspect of polymorphism of amyloid fibrils. This brief review is intended to outline the current state of research on amyloid-like fibrils from the perspective of their structural and superstructural chirality and chiroptical properties.

  17. Appropriate Use Criteria for Amyloid PET (United States)

    Johnson, Keith A.; Minoshima, Satoshi; Bohnen, Nicolaas I.; Donohoe, Kevin J.; Foster, Norman L.; Herscovitch, Peter; Karlawish, Jason H.; Rowe, Christopher C.; Carrillo, Maria C.; Hartley, Dean M.; Hedrick, Saima; Mitchell, Kristi; Pappas, Virginia; Thies, William H.


    Positron Emission Tomography (PET) of brain amyloid-beta is a technology that is becoming more available, but its clinical utility in medical practice requires careful definition. In order to provide guidance to dementia care practitioners, patients and caregivers, the Alzheimer Association and the Society of Nuclear Medicine and Molecular Imaging convened the Amyloid Imaging Taskforce (AIT). The AIT considered a broad range of specific clinical scenarios in which amyloid PET could potentially be appropriately used. Peer-reviewed, published literature was searched to ascertain available evidence relevant to these scenarios, and the AIT developed a consensus of expert opinion. While empirical evidence of impact on clinical outcomes is not yet available, a set of specific Appropriate Use Criteria (AUC) were agreed upon that define the types of patients and clinical circumstances in which amyloid PET could be used. Both appropriate and inappropriate uses were considered and formulated, and are reported and discussed here. Because both dementia care and amyloid PET technology are in active development, these AUC will require periodic reassessment. Future research directions are also outlined, including diagnostic utility and patient-centered outcomes. PMID:23360977

  18. Miniopen coracohumeral ligament release and manipulation for idiopathic frozen shoulder

    Directory of Open Access Journals (Sweden)

    Abdelsalam Eid


    Full Text Available In the management of idiopathic frozen shoulder, manipulation under anaesthesia is known to have serious potential complications including fractures and intra-articular injuries. Arthroscopy is a safer treatment modality but requires special instruments, experience, and involves added cost. The aim of this work was to study the use of miniopen Coracohumeral ligament release and manipulation of the shoulder as a safe and simple method of treating idiopathic frozen shoulder that could be performed as a quick procedure under short duration anaesthesia obtaining a significant improvement of shoulder function while avoiding complications that are feared to occur with the use of manipulation under anaesthesia. Miniopen Coracohumeral ligament release is performed through a 3-cm incision. The Coracohumeral ligament is divided, and then the shoulder is manipulated without undue force. A case series including fifteen patients (19 shoulders with idiopathic frozen shoulder operated by this technique is described. Miniopen Coracohumeral ligament release and manipulation is a quick procedure that may be performed under short duration anaesthesia obtaining a significant improvement of shoulder function meanwhile avoiding complications that are feared to occur with the use of manipulation under anaesthesia.

  19. Association of fetal cranial shape with shoulder dystocia

    NARCIS (Netherlands)

    Belfort, M. A.; White, G. L.; Vermeulen, F. M.


    Objective To evaluate whether fetal cranial shape is related to shoulder dystocia. Methods We compared shoulder dystocia cases (n = 18) with controls (normal vaginal deliveries, n = 18) in a retrospective matched- pairs observational study. Subjects were matched for known maternal and fetal risk fac

  20. Does scapular positioning predict shoulder pain in recreational overhead athletes? (United States)

    Struyf, F; Nijs, J; Meeus, M; Roussel, N A; Mottram, S; Truijen, S; Meeusen, R


    The objective of this prospective study is to investigate possible scapular related risk factors for developing shoulder pain. Therefore, a 2-year follow-up study in a general community sports centre setting was conducted. A sample of convenience of 113 recreational overhead athletes (59 women and 54 men) with a mean age of 34 (17-64; SD 12) years were recruited. At baseline, visual observation for scapular dyskinesis, measured scapular protraction, upward scapular rotation and dynamic scapular control were evaluated. 22% (n=25) of all athletes developed shoulder pain during the 24 months following baseline assessment. The Mean Shoulder Disability Questionnaire (SDQ) score for the painful shoulders was 34.8 (6.3-62.5; SD 17.4). None of the scapular characteristics predicted the development of shoulder pain. However, the athletes that developed shoulder pain demonstrated significantly less upward scapular rotation at 45° (p=0.010) and 90° (p=0.016) of shoulder abduction in the frontal plane at baseline in comparison to the athletes that remained pain-free. In conclusion, although these scapular characteristics are not of predictive value for the development of shoulder pain, this study increases our understanding of the importance of a scapular upward rotation assessment among recreational overhead athletes.

  1. Anatomy and Selected Biomechanical Aspects of the Shoulder. (United States)

    Keene, James S.

    This paper focuses on the anatomy and functions of the shoulder that are relevant to the evaluation and treatment of athletic injuries. A discussion is presented on the four basic components of the shoulder mechanism: (1) super structure--bony components; (2) moving parts--joints involved; (3) motor power--musculature; and (4) communications…

  2. AL amyloid imaging and therapy with a monoclonal antibody to a cryptic epitope on amyloid fibrils.

    Directory of Open Access Journals (Sweden)

    Jonathan S Wall

    Full Text Available The monoclonal antibody 2A4 binds an epitope derived from a cleavage site of serum amyloid protein A (sAA containing a -Glu-Asp- amino acid pairing. In addition to its reactivity with sAA amyloid deposits, the antibody was also found to bind amyloid fibrils composed of immunoglobulin light chains. The antibody binds to synthetic fibrils and human light chain (AL amyloid extracts with high affinity even in the presence of soluble light chain proteins. Immunohistochemistry with biotinylated 2A4 demonstrated positive reaction with ALκ and ALλ human amyloid deposits in various organs. Surface plasmon resonance analyses using synthetic AL fibrils as a substrate revealed that 2A4 bound with a K(D of ∼10 nM. Binding was inhibited in the presence of the -Glu-Asp- containing immunogen peptide. Radiolabeled 2A4 specifically localized with human AL amyloid extracts implanted in mice (amyloidomas as evidenced by single photon emission (SPECT imaging. Furthermore, co-localization of the radiolabeled mAb with amyloid was shown in biodistribution and micro-autoradiography studies. Treatment with 2A4 expedited regression of ALκ amyloidomas in mice, likely mediated by the action of macrophages and neutrophils, relative to animals that received a control antibody. These data indicate that the 2A4 mAb might be of interest for potential imaging and immunotherapy in patients with AL amyloidosis.

  3. The novel amyloid-beta peptide aptamer inhibits intracellular amyloid-beta peptide toxicity

    Institute of Scientific and Technical Information of China (English)

    Xu Wang; Yi Yang; Mingyue Jia; Chi Ma; Mingyu Wang; Lihe Che; Yu Yang; Jiang Wu


    Amyloid β peptide binding alcohol dehydrogenase (ABAD) decoy peptide (DP) can competitively antagonize binding of amyloid β peptide to ABAD and inhibit the cytotoxic effects of amyloid β peptide. Based on peptide aptamers, the present study inserted ABAD-DP into the disulfide bond of human thioredoxin (TRX) using molecular cloning technique to construct a fusion gene that can express the TRX1-ABAD-DP-TRX2 aptamer. Moreover, adeno-associated virus was used to allow its stable expression. Immunofluorescent staining revealed the co-expression of the transduced fusion gene TRX1-ABAD-DP-TRX2 and amyloid β peptide in NIH-3T3 cells, indicating that the TRX1-ABAD-DP-TRX2 aptamer can bind amyloid β peptide within cells. In addition, cell morphology and MTT results suggested that TRX1-ABAD-DP-TRX2 attenuated amyloid β peptide-induced SH-SY5Y cell injury and improved cell viability. These findings confirmed the possibility of constructing TRX-based peptide aptamer using ABAD-DP. Moreover, TRX1-ABAD-DP-TRX2 inhibited the cytotoxic effect of amyloid β peptide.

  4. Clinical Measures of Shoulder Mobility in the Professional Baseball Player. (United States)

    Downar, Jacquelyn M; Sauers, Eric L


    Context: Professional baseball players must achieve a delicate balance between shoulder mobility and stability to attain optimal sports performance. The sport-specific demands of repetitive overhead throwing may result in an altered mobility-stability relationship.Objective: To evaluate clinical measures of shoulder mobility in professional baseball players in order to examine differences between the throwing and the nonthrowing shoulders and to describe chronic adaptations to throwing.Design: Descriptive.Setting: The athletic training room at Maryvale Baseball Park, Phoenix, AZ.Patients or Other Participants: Twenty-seven professional baseball players (20 pitchers, 7 position players; age = 20 +/- 1.6 years, height = 190.5 +/- 4.8 cm, mass = 91.6 +/- 9.6 kg) with no previous history of shoulder or elbow injury.Main Outcome Measure(s): We recorded scapular upward rotation at 4 levels of humeral elevation in the scapular plane (rest, 60 degrees , 90 degrees , 120 degrees ); posterior shoulder tightness; and passive, isolated glenohumeral joint internal and external range of motion.Results: Scapular upward rotation was significantly greater in the throwing shoulder (14.2 +/- 6.5 degrees ) than in the nonthrowing shoulder (10.6 +/- 6.1 degrees ) at 90 degrees of humeral elevation (P = .04). We observed no statistically significant difference in posterior shoulder tightness between the throwing (30.2 +/- 4.6 cm) and the nonthrowing (28.0 +/- 4.8 cm) shoulder (P = .09). In addition, the throwing shoulder exhibited a statistically significant decrease in isolated glenohumeral internal rotation (56.6 +/- 12.5 degrees ) compared with the nonthrowing shoulder (68.6 +/- 12.6 degrees ) (P = .001), with a concomitant increase in isolated glenohumeral external rotation (throwing = 108.9 +/- 9.0 degrees , nonthrowing = 101.9 +/- 5.9 degrees , P = .0014). An analysis of the total arc of motion (internal rotation + external rotation) revealed no statistically significant

  5. Grading of shoulder ulcerations in sows by biopsies

    DEFF Research Database (Denmark)

    Jensen, Henrik Elvang; Dahl-Pedersen, Kirstin; Barington, Krisitane


    Shoulder ulcerations can be graded postmortem from 0 to 4 on a pathoanatomical scale. However, veterinarians and farmers express difficulties evaluating the grade of the lesions antemortem. Accurate grading is needed in order to comply with veterinary instruction in relation to the Danish...... legislation, stating that sows with shoulder ulcers grade 3 or 4 must be kept loose and have access to soft bedding. Thus, the aim of the present study was to evaluate if biopsies from the center of a shoulder ulcer can be used to point out animals for which an intervention must be initiated. Postmortem......, a punch biopsy was sampled from the center of the ulceration or from the tissue overlaying the tuber spina scapula. Afterward, the shoulders were cross-sectioned and evaluated grossly and histologically (“gold standard”). In total, 121 shoulders were included in the study, and the diagnostic value...

  6. The effect of maneuvers for shoulder delivery on perineal trauma

    DEFF Research Database (Denmark)

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


    INTRODUCTION: Approximately 85% of vaginal deliveries are accompanied by perineal trauma. The objective of this trial was to compare the incidence of perineal trauma after primary delivery of either the anterior or posterior shoulder during vaginal delivery. MATERIAL AND METHODS: This was a rando......INTRODUCTION: Approximately 85% of vaginal deliveries are accompanied by perineal trauma. The objective of this trial was to compare the incidence of perineal trauma after primary delivery of either the anterior or posterior shoulder during vaginal delivery. MATERIAL AND METHODS......: 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...... or posterior shoulder. Consequently both maneuvers for shoulder delivery can be used at vaginal delivery, but further trials are warranted before certain methods can be recommended....

  7. Resurfacing shoulder arthroplasty for the treatment of severe rheumatoid arthritis

    DEFF Research Database (Denmark)

    Voorde, Pia C Ten; Rasmussen, Jeppe V; Olsen, Bo S


    BACKGROUND AND PURPOSE: There is no consensus on which type of shoulder prosthesis should be used in patients with rheumatoid arthritis (RA). We describe patients with RA who were treated with shoulder replacement, regarding patient-reported outcome, prosthesis survival, and causes of revision......, and we compare outcome after resurfacing hemi-arthroplasty (RHA) and stemmed hemi-arthroplasty (SHA). PATIENTS AND METHODS: We used data from the national Danish Shoulder Arthroplasty Registry and included patients with RA who underwent shoulder arthroplasty in Denmark between 2006 and 2010. Patient......-reported outcome was obtained 1-year postoperatively using the Western Ontario Osteoarthritis of the Shoulder index (WOOS), and rates of revision were calculated by checking revisions reported until December 2011. The patient-reported outcome of RHA was compared to that of SHA using regression analysis...

  8. Amyloid-β positron emission tomography imaging probes

    DEFF Research Database (Denmark)

    Kepe, Vladimir; Moghbel, Mateen C; Långström, Bengt;


    The rapidly rising prevalence and cost of Alzheimer's disease in recent decades has made the imaging of amyloid-β deposits the focus of intense research. Several amyloid imaging probes with purported specificity for amyloid-β plaques are currently at various stages of FDA approval. However...

  9. The influence of experimentally induced pain on shoulder muscle activity. (United States)

    Diederichsen, Louise Pyndt; Winther, Annika; Dyhre-Poulsen, Poul; Krogsgaard, Michael R; Nørregaard, Jesper


    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 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 (0 degrees -105 degrees) at a speed of approximately 120 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 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 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 that acute pain both subacromially and in the supraspinatus muscle modulates coordination of the shoulder muscles during voluntary movements. During painful conditions, an increased activity was detected in the antagonist (latissimus), which support the idea that localized pain affects muscle activation in a way that protects the painful structure. Further, the changes in muscle activity following subacromial pain induction tend to expand the subacromial space and thereby decrease the load

  10. Fibrillar dimer formation of islet amyloid polypeptides

    Energy Technology Data Exchange (ETDEWEB)

    Chiu, Chi-cheng [Univ. of Chicago, IL (United States); Argonne National Lab. (ANL), Argonne, IL (United States); de Pablo, Juan J. [Univ. of Chicago, IL (United States); Argonne National Lab. (ANL), Argonne, IL (United States)


    Amyloid deposits of human islet amyloid polypeptide (hIAPP), a 37-residue hormone co-produced with insulin, have been implicated in the development of type 2 diabetes. Residues 20 – 29 of hIAPP have been proposed to constitute the amyloidogenic core for the aggregation process, yet the segment is mostly unstructured in the mature fibril, according to solid-state NMR data. Here we use molecular simulations combined with bias-exchange metadynamics to characterize the conformational free energies of hIAPP fibrillar dimer and its derivative, pramlintide. We show that residues 20 – 29 are involved in an intermediate that exhibits transient β-sheets, consistent with recent experimental and simulation results. By comparing the aggregation of hIAPP and pramlintide, we illustrate the effects of proline residues on inhibition of the dimerization of IAPP. The mechanistic insights presented here could be useful for development of therapeutic inhibitors of hIAPP amyloid formation.

  11. Difference in clinical outcome between total shoulder arthroplasty and reverse shoulder arthroplasty used in hemiarthroplasty revision surgery

    NARCIS (Netherlands)

    Hartel, B.P.; Alta, T.D.; Sewnath, M.E.; Willems, W.J.H.


    INTRODUCTION: The increase of shoulder replacements will lead to a higher revision rate of shoulder arthroplasties. The aim of this study is to evaluate the clinical results of revision surgery performed in our hospital, distinguish the differences in clinical outcome according to revision indicatio

  12. Compressive deformation of ultralong amyloid fibrils (United States)

    Paparcone, Raffaella; Cranford, Steven; Buehler, Markus J.


    Involved in various neurodegenerative diseases, amyloid fibrils and plaques feature a hierarchical structure, ranging from the atomistic to the micrometer scale. At the atomistic level, a dense and organized hydrogen bond network is resembled in a beta-sheet rich secondary structure, which drives a remarkable stiffness in the range of 10-20GPa, larger than many other biological nanofibrils, a result confirmed by both experiment and theory. However, the understanding of how these exceptional mechanical properties transfer from the atomistic to the nanoscale remains unknown. Here we report a multiscale analysis that, from the atomistic-level structure of a single fibril, extends to the mesoscale level, reaching size scales of hundreds of nanometers. We use parameters directly derived from full atomistic simulations of A β (1-40) amyloid fibrils to parameterize a mesoscopic coarse-grained model, which is used to reproduce the elastic properties of amyloid fibrils. We then apply our mesoscopic model in an analysis of the buckling behavior of amyloid fibrils with different lengths and report a comparison with predictions from continuum beam theory. An important implication of our results is a severe reduction of the effective modulus due to buckling, an effect that could be important to interpret experimental results of ultra-long amyloid fibrils. Our model represents a powerful tool to mechanically characterize molecular structures on the order of hundreds of nanometers to micrometers on the basis of the underlying atomistic behavior. The work provides insight into structural and mechanical properties of amyloid fibrils and may enable further analysis of larger-scale assemblies such as amyloidogenic bundles or plaques as found in disease states.

  13. Amyloids or prions? That is the question. (United States)

    Sabate, Raimon; Rousseau, Frederic; Schymkowitz, Joost; Batlle, Cristina; Ventura, Salvador


    Despite major efforts devoted to understanding the phenomenon of prion transmissibility, it is still poorly understood how this property is encoded in the amino acid sequence. In recent years, experimental data on yeast prion domains allow to start at least partially decrypting the sequence requirements of prion formation. These experiments illustrate the need for intrinsically disordered sequence regions enriched with a particularly high proportion of glutamine and asparagine. Bioinformatic analysis suggests that these regions strike a balance between sufficient amyloid nucleation propensity on the one hand and disorder on the other, which ensures availability of the amyloid prone regions but entropically prevents unwanted nucleation and facilitates brittleness required for propagation.

  14. Quenched Hydrogen Exchange NMR of Amyloid Fibrils. (United States)

    Alexandrescu, Andrei T


    Amyloid fibrils are associated with a number of human diseases. These aggregatively misfolded intermolecular β-sheet assemblies constitute some of the most challenging targets in structural biology because to their complexity, size, and insolubility. Here, protocols and controls are described for experiments designed to study hydrogen-bonding in amyloid fibrils indirectly, by transferring information about amide proton occupancy in the fibrils to the dimethyl sulfoxide-denatured state. Since the denatured state is amenable to solution NMR spectroscopy, the method can provide residue-level-resolution data on hydrogen exchange for the monomers that make up the fibrils.

  15. Anatomical total shoulder replacement with rotator cuff repair for osteoarthritis of the shoulder. (United States)

    Simone, J P; Streubel, P H; Sperling, J W; Schleck, C D; Cofield, R H; Athwal, G S


    We assessed the clinical results, radiographic outcomes and complications of patients undergoing total shoulder replacement (TSR) for osteoarthritis with concurrent repair of a full-thickness rotator cuff tear. Between 1996 and 2010, 45 of 932 patients (4.8%) undergoing TSR for osteoarthritis underwent rotator cuff repair. The final study group comprised 33 patients with a mean follow-up of 4.7 years (3 months to 13 years). Tears were classified into small (10), medium (14), large (9) or massive (0). On a scale of 1 to 5, pain decreased from a mean of 4.7 to 1.7 (p = shoulders during anatomical TSR, but reverse replacement should be considered for older, less active patients with larger tears.

  16. Posterior shoulder instability following anatomic total shoulder arthroplasty: A case report and review of management

    Directory of Open Access Journals (Sweden)

    Joseph W Galvin


    Full Text Available We report a case of posterior shoulder instability following anatomic total shoulder arthroplasty (TSA. In addition, we present guidelines to aid in the management of posterior instability after TSA. A 50-year-old male underwent anatomic TSA for glenohumeral osteoarthritis. Postoperatively, the patient developed posterior instability secondary to glenoid retroversion. He did not improve despite conservative treatment. He underwent an arthroscopic posterior bone block procedure, 4-month after his index arthroplasty. At 14-month follow-up, the patient had regained near full motion and strength, and radiographs demonstrated osseous integration with no evidence of component loosening. Posterior instability following TSA is a relatively rare complication and challenging to manage. The posterior, arthroscopic iliac crest bone block grafting procedure represents a treatment option for posterior instability in the setting of a stable glenoid prosthesis following TSA.

  17. Designed amyloid fibers as materials for selective carbon dioxide capture. (United States)

    Li, Dan; Furukawa, Hiroyasu; Deng, Hexiang; Liu, Cong; Yaghi, Omar M; Eisenberg, David S


    New materials capable of binding carbon dioxide are essential for addressing climate change. Here, we demonstrate that amyloids, self-assembling protein fibers, are effective for selective carbon dioxide capture. Solid-state NMR proves that amyloid fibers containing alkylamine groups reversibly bind carbon dioxide via carbamate formation. Thermodynamic and kinetic capture-and-release tests show the carbamate formation rate is fast enough to capture carbon dioxide by dynamic separation, undiminished by the presence of water, in both a natural amyloid and designed amyloids having increased carbon dioxide capacity. Heating to 100 °C regenerates the material. These results demonstrate the potential of amyloid fibers for environmental carbon dioxide capture.

  18. [Recurrent instability and luxation of the shoulder]. (United States)

    Sedel, L


    Instability and recurrent dislocation of the shoulder result from injuries affecting the capsule, ligaments or bones. The positive diagnosis rests on careful clinical investigation where a well-oriented questioning plays an essential role. Paraclinical examinations, such as radiography, ultrasonography, CT and MRI, provide a very accurate assessment of the state of relevant structures. Surgical treatment consists of a stabilizing operation which may be Bankart operation (i.e. suture of the detached capsule onto the anterior part of the glenoid labrum), or a Latarget operation (i.e. screwing of a bony buttress) when the anterior part of the glenoid labrum is deformed by a fracture or worn out by frequent passages of the humeral head. When thoughtfully decided and well executed, these operations regularly give excellent results with resumption of previous activities at the same performance level.

  19. Septic Arthritis of the Shoulder Complicating Pregnancy

    Directory of Open Access Journals (Sweden)

    Sara Raiser


    Full Text Available Septic arthropathy leads to rapid joint destruction, impairment, and disability. Staphylococcus can be particularly virulent to bone and joints leading to adverse obstetric events. At 28 of weeks gestation, a patient presented with pyelonephritis and progressive left shoulder pain. Magnetic resonance imaging indicated early clavicular destruction and acromial involvement. Glenohumeral joint aspiration produced Staphylococcus aureus. The patient then had premature rupture of membranes and progressed rapidly to preterm delivery. Placental pathology revealed chorioamnionitis and microabscesses. Treatment of the infected joint required further surgical drainage and bone resection as well as extended antibiotics. It is important to remember that joint pain in pregnancy may indicate infective arthritis, and pyelonephritis can be a source of such an infection. Evaluation includes magnetic resonance imaging and consultation for joint aspiration. Prompt recognition and treatment are necessary to prevent joint destruction.

  20. Shoulder functionality after manual therapy in subjects with shoulder impingement syndrome: a case series. (United States)

    Heredia-Rizo, Alberto Marcos; López-Hervás, Antonia; Herrera-Monge, Patricia; Gutiérrez-Leonard, Ana; Piña-Pozo, Fernando


    The aim of the study was to identify the differences in functionality of the upper limb in subjects suffering from shoulder impingement syndrome after intervention by two manual therapy protocols. Randomized, single-blind study with a sample of 22 subjects (58 ± 10.86 years old) divided into two groups. The conventional-group (n = 11) received mobilizations of the shoulder and the experimental-group (n = 11) was treated with soft tissue techniques in the cervical and upper thoracic regions. These two groups received electrotherapy and postural advices. The treatment lasted three weeks (15 daily sessions of 1 h and 30 min). Both active and passive range of motion (ROM) and self-perceived functionality of the upper limb (DASH questionnaire) were measured. The experimental group showed a significant improvement in the DASH scores and both groups improved mobility in the intra-group comparison pre-intervention versus post-intervention (p .05). Our results suggest that a combined treatment with electrotherapy, postural hygiene and manual therapy, regardless of the protocol, improves shoulder mobility and functionality.

  1. 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)


    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

  2. Effect of reverse shoulder design philosophy on muscle moment arms. (United States)

    Hamilton, Matthew A; Diep, Phong; Roche, Chris; Flurin, Pierre Henri; Wright, Thomas W; Zuckerman, Joseph D; Routman, Howard


    This study analyzes the muscle moment arms of three different reverse shoulder design philosophies using a previously published method. Digital bone models of the shoulder were imported into a 3D modeling software and markers placed for the origin and insertion of relevant muscles. The anatomic model was used as a baseline for moment arm calculations. Subsequently, three different reverse shoulder designs were virtually implanted and moment arms were analyzed in abduction and external rotation. The results indicate that the lateral offset between the joint center and the axis of the humerus specific to one reverse shoulder design increased the external rotation moment arms of the posterior deltoid relative to the other reverse shoulder designs. The other muscles analyzed demonstrated differences in the moment arms, but none of the differences reached statistical significance. This study demonstrated how the combination of variables making up different reverse shoulder designs can affect the moment arms of the muscles in different and statistically significant ways. The role of humeral offset in reverse shoulder design has not been previously reported and could have an impact on external rotation and stability achieved post-operatively.

  3. Clinical Features Associated with Frozen Shoulder Syndrome in Parkinson's Disease. (United States)

    Chang, Ya-Ting; Chang, Wen-Neng; Tsai, Nai-Wen; Cheng, Kuei-Yueh; Huang, Chih-Cheng; Kung, Chia-Te; Su, Yu-Jih; Lin, Wei-Che; Cheng, Ben-Chung; Su, Chih-Min; Chiang, Yi-Fang; Lu, Cheng-Hsien


    Background. Frozen shoulder syndrome is a common musculoskeletal disease of idiopathic Parkinson's disease (PD) that causes long-term pain and physical disability. A better understanding of the associated factors can help identify PD patients who will require prevention to improve their quality of life. Methodology. This prospective study evaluated 60 shoulders of 30 PD patients. Correlation analysis was used to evaluate the relationships between clinical factors and shoulder sonography findings. Results. Frozen shoulder syndrome was found in 14 of 30 PD patients affecting 19 shoulders, including bilateral involvement in five and unilateral involvement in nine. There was a significant positive correlation between the parameters of sonography findings and frozen shoulder syndrome (i.e., thickness of bicipital effusion and tendon thickness of the subscapularis and supraspinatus) and mean ipsilateral Unified Parkinson's Disease Rating Scale (UPDRS) III and its subscores (tremor, rigidity, and bradykinesia scores). Conclusions. Higher ipsilateral UPDRS and subscores are associated with increased effusion around the biceps tendon, with increased tendon thickness of subscapularis and supraspinatus. Preventing frozen shoulder syndrome in the high-risk PD group is an important safety issue and highly relevant for their quality of life.

  4. Lipidic characterization of Santa Inês lamb shoulder

    Directory of Open Access Journals (Sweden)

    Christian Albert Carvalho da Cruz


    Full Text Available The edible portion of the shoulder of 12 castrated and 12 non-castrated Santa Inês lambs slaughtered at different ages (84, 168, 210, 252 days were used. The shoulders were chemically analyzed to determine the quantity of total lipids, cholesterol, and fatty acids composition. Castrated and non-castrated lambs gained body weight (p = 0.0393, p = 0.0017 and half carcass weight (p = 0.0240, p = 0.0017, respectively. The shoulder weight was increased in the carcasses of non-castrated lambs (p = 0.0110. The edible portion of the shoulder of castrated lambs presented higher total lipids (16.09 g.100 g-1. The cholesterol content was influenced by castration (p = 0.0001 reducing with age. Castrated animals presented higher content of C18:1 T11, CLA, and C18:0. The shoulder weight is only increased with increasing age in the carcasses of non-castrated lambs. Castration influences the cholesterol content of the shoulder; however, both castrated and non-castrated lambs had their cholesterol contents reduced with increasing age. Castration and age interfered in the estearic acid concentration of the edible portion of lamb shoulder.

  5. Ultrasound-guided interventional procedures around the shoulder. (United States)

    Messina, Carmelo; Banfi, Giuseppe; Orlandi, Davide; Lacelli, Francesca; Serafini, Giovanni; Mauri, Giovanni; Secchi, Francesco; Silvestri, Enzo; Sconfienza, Luca Maria


    Ultrasound is an established modality for shoulder evaluation, being accurate, low cost and radiation free. Different pathological conditions can be diagnosed using ultrasound and can be treated using ultrasound guidance, such as degenerative, traumatic or inflammatory diseases. Subacromial-subdeltoid bursitis is the most common finding on ultrasound evaluation for painful shoulder. Therapeutic injections of corticosteroids are helpful to reduce inflammation and pain. Calcific tendinopathy of rotator cuff affects up to 20% of painful shoulders. Ultrasound-guided treatment may be performed with both single- and double-needle approach. Calcific enthesopathy, a peculiar form of degenerative tendinopathy, is a common and mostly asymptomatic ultrasound finding; dry needling has been proposed in symptomatic patients. An alternative is represented by autologous platelet-rich plasma injections. Intra-articular injections of the shoulder can be performed in the treatment of a variety of inflammatory and degenerative diseases with corticosteroids or hyaluronic acid respectively. Steroid injections around the long head of the biceps brachii tendon are indicated in patients with biceps tendinopathy, reducing pain and humeral tenderness. The most common indication for acromion-clavicular joint injection is degenerative osteoarthritis, with ultrasound representing a useful tool in localizing the joint space and properly injecting various types of drugs (steroids, lidocaine or hyaluronic acid). Suprascapular nerve block is an approved treatment for chronic shoulder pain non-responsive to conventional treatments as well as candidate patients for shoulder arthroscopy. This review provides an overview of these different ultrasonography-guided procedures that can be performed around the shoulder.

  6. Shoulder girdle elevation during neurodynamic testing: an assessable sign? (United States)

    Coppieters, M W; Stappaerts, K H; Staes, F F; Everaert, D G


    One of the signs advocated for monitoring during neurodynamic testing in the assessment of patients with upper quadrant disorders, is the response of the shoulder girdle. It is stated that a protective rising of the shoulder girdle is present when patients with neurogenic disorders are assessed and that the elevation is absent in asymptomatic subjects. As sensory responses are elicited in the majority of asymptomatic subjects and as the range of motion (ROM) is often limited during neurodynamic testing, it is questionable whether the elevation of the shoulder girdle would be absent in asymptomatic subjects. The aim of this study was to measure the shoulder girdle elevation force during five variants of the neural tissue provocation test for the median nerve. Thirty-five asymptomatic male subjects were assessed. A load cell was used to measure the amount of shoulder girdle elevation force and two electrogoniometers were used to measure the ROM at the elbow and wrist. When the ROM at the end of the test was restricted, a gradual increase in shoulder girdle elevation force could be observed throughout the test. Compared to the initial force at the start of the test, all variants resulted in a significant increase in force. It is concluded that a gradual increase in shoulder girdle elevation force should not be regarded as an abnormal sign in the interpretation of neurodynamic tests.

  7. Platelet-Rich Plasma for Frozen Shoulder: A Case Report

    Directory of Open Access Journals (Sweden)

    Hamidreza Aslani


    Full Text Available Frozen shoulder is a glenohumeral joint disorder that perturbs movement because of adhesion and the existence of fibrosis in the shoulder capsule. Platelet-rich plasma can produce collagen and growth factors, which increases stem cells and consequently enhances the healing. To date, there is no evidence regarding the effectiveness of platelet-rich plasma in frozen shoulder. A 45-year-old man with shoulder adhesive capsulitis volunteered for this treatment. He underwent two consecutive platelet-rich plasma injections at the seventh and eighth month after initiation of symptoms. We measured pain, function, and ROM by the visual analogue scale (VAS, and scores from the Disabilities of the Arm, Shoulder and Hand (DASH questionnaire and goniometer; respectively. After the first injection, the patient reported 60% improvement regarding diurnal shoulder pain, and no night pains. Also, two-fold improvement for ROM and more than 70% improvement for function were reported. This study suggests the use of platelet-rich plasma in frozen shoulder to be tested in randomized trials.


    Directory of Open Access Journals (Sweden)

    L. Min


    Full Text Available Shoulder line is the significant line in hilly area of Loess Plateau in China, dividing the surface into positive and negative terrain (P-N terrains. Due to the point cloud vegetation removal methods of P-N terrains are different, there is an imperative need for shoulder line extraction. In this paper, we proposed an automatic shoulder line extraction method based on point cloud. The workflow is as below: (i ground points were selected by using a grid filter in order to remove most of noisy points. (ii Based on DEM interpolated by those ground points, slope was mapped and classified into two classes (P-N terrains, using Natural Break Classified method. (iii The common boundary between two slopes is extracted as shoulder line candidate. (iv Adjust the filter gird size and repeat step i-iii until the shoulder line candidate matches its real location. (v Generate shoulder line of the whole area. Test area locates in Madigou, Jingbian County of Shaanxi Province, China. A total of 600 million points are acquired in the test area of 0.23km2, using Riegl VZ400 3D Laser Scanner in August 2014. Due to the limit Granted computing performance, the test area is divided into 60 blocks and 13 of them around the shoulder line were selected for filter grid size optimizing. The experiment result shows that the optimal filter grid size varies in diverse sample area, and a power function relation exists between filter grid size and point density. The optimal grid size was determined by above relation and shoulder lines of 60 blocks were then extracted. Comparing with the manual interpretation results, the accuracy of the whole result reaches 85%. This method can be applied to shoulder line extraction in hilly area, which is crucial for point cloud denoising and high accuracy DEM generation.

  9. Point Cloud Oriented Shoulder Line Extraction in Loess Hilly Area (United States)

    Min, Li; Xin, Yang; Liyang, Xiong


    Shoulder line is the significant line in hilly area of Loess Plateau in China, dividing the surface into positive and negative terrain (P-N terrains). Due to the point cloud vegetation removal methods of P-N terrains are different, there is an imperative need for shoulder line extraction. In this paper, we proposed an automatic shoulder line extraction method based on point cloud. The workflow is as below: (i) ground points were selected by using a grid filter in order to remove most of noisy points. (ii) Based on DEM interpolated by those ground points, slope was mapped and classified into two classes (P-N terrains), using Natural Break Classified method. (iii) The common boundary between two slopes is extracted as shoulder line candidate. (iv) Adjust the filter gird size and repeat step i-iii until the shoulder line candidate matches its real location. (v) Generate shoulder line of the whole area. Test area locates in Madigou, Jingbian County of Shaanxi Province, China. A total of 600 million points are acquired in the test area of 0.23km2, using Riegl VZ400 3D Laser Scanner in August 2014. Due to the limit Granted computing performance, the test area is divided into 60 blocks and 13 of them around the shoulder line were selected for filter grid size optimizing. The experiment result shows that the optimal filter grid size varies in diverse sample area, and a power function relation exists between filter grid size and point density. The optimal grid size was determined by above relation and shoulder lines of 60 blocks were then extracted. Comparing with the manual interpretation results, the accuracy of the whole result reaches 85%. This method can be applied to shoulder line extraction in hilly area, which is crucial for point cloud denoising and high accuracy DEM generation.

  10. Islet amyloid polypeptide forms rigid lipid-protein amyloid fibrils on supported phospholipid bilayers. (United States)

    Domanov, Yegor A; Kinnunen, Paavo K J


    Islet amyloid polypeptide (IAPP) forms fibrillar amyloid deposits in the pancreatic islets of Langerhans of patients with type 2 diabetes mellitus, and its misfolding and aggregation are thought to contribute to beta-cell death. Increasing evidence suggests that IAPP fibrillization is strongly influenced by lipid membranes and, vice versa, that the membrane architecture and integrity are severely affected by amyloid growth. Here, we report direct fluorescence microscopic observations of the morphological transformations accompanying IAPP fibrillization on the surface of supported lipid membranes. Within minutes of application in submicromolar concentrations, IAPP caused extensive remodeling of the membrane including formation of defects, vesiculation, and tubulation. The effects of IAPP concentration, ionic strength, and the presence of amyloid seeds on the bilayer perturbation and peptide aggregation were examined. Growth of amyloid fibrils was visualized using fluorescently labeled IAPP or thioflavin T staining. Two-color imaging of the peptide and membranes revealed that the fibrils were initially composed of the peptide only, and vesiculation occurred in the points where growing fibers touched the lipid membrane. Interestingly, after 2-5 h of incubation, IAPP fibers became "wrapped" by lipid membranes derived from the supported membrane. Progressive increase in molecular-level association between amyloid and membranes in the maturing fibers was confirmed by Förster resonance energy transfer spectroscopy.

  11. Diagnosis and clinical assessment of a stiff shoulder. (United States)

    Armstrong, Alison


    The assessment of a stiff shoulder is explored, the necessary investigations to reach a diagnosis are discussed, and the likely causes that can contribute to a frozen shoulder are described. Two flow diagrams are included to help in reaching a conclusion when seeing a patient with a stiff shoulder. The key elements to reaching that conclusion are: carefully listening to the patients story, noting whether there has been a history of trauma, as well as a careful and thorough examination and a plain X-ray with two views.

  12. Prevalence of shoulder pain after stroke and associated factors

    Directory of Open Access Journals (Sweden)

    M.J. Hadianfar


    Full Text Available AbstractBackground and Purpose: Shoulder pain is a common complication from stroke that may cause some rehabilitation limits to achieve functional goals. The information regarding its prevalence and associated factors is limited. This study was conducted to investigate further details pertaining to its associated factors.Materials and Methods: This study was performed on 191 stroke patients at the Physical Medicine and Rehabilitation Ward at Shiraz-Medical School from 2001 to 2004. Each patient was followed up for one year. A questionnaire was prepared containing information about shoulder pain compliant, thorough history and physical examination, previous history of open heart surgery, scoliosis, limited neck range of motion, type of stroke (based on MRI and brain CT, osteoporosis (based on bone mineral density and X ray, shoulder adductor muscles and biceps spasticity (based on ashworth scale. In follow-up visits bi-monthly for one year, the questionnaire was filled out again and if present, shoulder pain was recorded.Results: Most patients developed shoulder pain between 2 and 6 months following their stroke. Forty-nine patients (32.2% developed shoulder pain, 39(79.6% of whom had spastic tone and 8 (16.3% had flaccid tone. In both groups, with shoulder pain and without shoulder pain respectively, 6.7% and 1.9% had a history of open heart surgery, 6.1% and 1% had scoliosis, 67.3% and 35.1% had Intracranial hemorrhage, 73.5% and 23.3% had limited neck range of motion, and 24.5% and 35% had osteopenia.Conclusion: Spasticity was significantly more common in the shoulder pain group, which can be due to capsulitis, soft tissue inflammation (especially ligament and rotator cuff muscle and anteroinferior subluxation of the shoulder. There was a significant statistical correlation between intracranial hemorrhage, reduced neck range of motion, and hemiplegic shoulder pain. It appears that treatment and rehabilitation of spasticity and underlying

  13. Anterior shoulder dislocation with axillary artery and nerve injury. (United States)

    Razif, M A Mohamed; Rajasingam, V


    We report a rare case of left axillary artery injury associated with anterior dislocation of the left shoulder in a 25 yrs old male as a result of a road traffic accident. The shoulder dislocation was reduced. A left upper limb angiogram showed an obstructed left axillary artery. The obstructed segment was surgically reconstructed with a Dacron graft. Six months post operation in follow up, he was found to have good left shoulder function and no neurovascular deficit. This is an injury that could have been easily missed without a simple clinical examination.

  14. A little-known cause of painful shoulder: os acromiale

    Energy Technology Data Exchange (ETDEWEB)

    Granieri, G.F.; Bacarini, L. [Dipartimento di Radiologia Clinica, Ospedale Regionale, Treviso (Italy)


    The incidental discovery of an `os acromiale` might explain some cases of `painful shoulder`: this is what we have observed in three patients. The purpose of our article is to underline the relevance of the axillary roentgenogram of the shoulder for the correct diagnosis of this anomaly. In all patients the radiographic examination was performed using a computed radiography system; moreover we performed a computed tomographic examination of the acromioclavicular portion of the shoulders with three-dimensional reconstructions. (orig.) With 3 figs., 6 refs.

  15. Missed posterior shoulder dislocation with malunited proximal humerus fracture

    Institute of Scientific and Technical Information of China (English)

    Sunil Kumar; Rajesh Kumar Chopra; Abhishek Kashyap; Sumit Arora


    Posterior dislocation of the shoulder may be missed or neglected at initial presentation especially in developing countries.We present a case of 40-year-old Indian man who had 3-month missed posterior dislocation of the right shoulder along with malunited fracture of the anatomical neck of the humerus.Open reduction and stabilization with modified McLaughlin procedure was performed.Rotational osteotomy of proximal humerus had to be performed as supplementary procedure to keep the humeral head stable in glenoid cavity during functional range of movements.The patient had excellent result of the shoulder at 3 years follow-up.


    Directory of Open Access Journals (Sweden)

    Ярослав Николаевич Прощенко


    Full Text Available The article presents an analysis of the treatment of 15 patients with posttraumatic shoulder instability aged 11-17 years, as a result of primary traumatic dislocation and chronic instability. We identified the following causes of chronic shoulder instability: Bankart injury, SLAP-injury; Hill-Sachs defect; fracture of the glenoid, type 3 humeral head-glenoid relation, and retroversion of the humeral head, as well as defects in the treatment of primary shoulder dislocation. Surgical treatment is performed in 7 patients with chronic instability (7 joints. Unsatisfactory result was detected in 1 patient (1 joints, which is caused by a type 3 humeral head-glenoid relation.

  17. Bap: A New Type of Functional Amyloid. (United States)

    Di Martino, Patrick


    Bacteria can build a biofilm matrix scaffold from exopolysaccharides or proteins, and DNA. In a recent report, Taglialegna and colleagues show that pathogenic Staphylococcus aureus produces a protein scaffold based on amyloid assembly of fragments from the biofilm-associated protein. Amyloidogenesis occurs in response to environmental signals.

  18. Serum amyloid P inhibits dermal wound healing (United States)

    The repair of open wounds depends on granulation tissue formation and contraction, which is primarily mediated by myofibroblasts. A subset of myofibroblasts originates from bone-marrow-derived monocytes which differentiate into fibroblast-like cells called fibrocytes. Serum amyloid P (SAP) inhibits ...

  19. Calumenin interacts with serum amyloid P component

    DEFF Research Database (Denmark)

    Vorum, H; Jacobsen, Christian; Honoré, Bent


    with calumenin in the presence of Ca(2+). Amino acid sequencing identified this protein as serum amyloid P component (SAP). Furthermore, we verified and characterized the calumenin-SAP interaction by the surface plasmon resonance technique. The findings indicate that calumenin may participate...

  20. Fibrillar amyloid plaque formation precedes microglial activation.

    Directory of Open Access Journals (Sweden)

    Christian K E Jung

    Full Text Available In Alzheimer's disease (AD, hallmark β-amyloid deposits are characterized by the presence of activated microglia around them. Despite an extensive characterization of the relation of amyloid plaques with microglia, little is known about the initiation of this interaction. In this study, the detailed investigation of very small plaques in brain slices in AD transgenic mice of the line APP-PS1(dE9 revealed different levels of microglia recruitment. Analysing plaques with a diameter of up to 10 μm we find that only the half are associated with clear morphologically activated microglia. Utilizing in vivo imaging of new appearing amyloid plaques in double-transgenic APP-PS1(dE9xCX3CR1+/- mice further characterized the dynamic of morphological microglia activation. We observed no correlation of morphological microglia activation and plaque volume or plaque lifetime. Taken together, our results demonstrate a very prominent variation in size as well as in lifetime of new plaques relative to the state of microglia reaction. These observations might question the existing view that amyloid deposits by themselves are sufficient to attract and activate microglia in vivo.

  1. Graphene oxide strongly inhibits amyloid beta fibrillation

    NARCIS (Netherlands)

    Mahmoudi, Morteza; Akhavan, Omid; Ghavami, Mahdi; Rezaee, Farhad; Ghiasi, Seyyed Mohammad Amin


    Since amyloid beta fibrillation (AbF) plays an important role in the development of neurodegenerative diseases, we investigated the effect of graphene oxide (GO) and their protein-coated surfaces on the kinetics of Ab fibrillation in the aqueous solution. We showed that GO and their protein-covered

  2. A biomechanical model correlating shoulder kinetics to pain in young baseball pitchers. (United States)

    Keeley, David W; Oliver, Gretchen D; Dougherty, Christopher P


    Previous work has postulated that shoulder pain may be associated with increases in both peak shoulder anterior force and peak shoulder proximal force. Unfortunately these relationships have yet to be quantified. Thus, the purpose of this study was to associate these kinetic values with reported shoulder pain in youth baseball pitchers. Nineteen healthy baseball pitchers participated in this study. Segment based reference systems and established calculations were utilized to identify peak shoulder anterior force and peak shoulder proximal force. A medical history questionnaire was utilized to identify shoulder pain. Following collection of these data, the strength of the relationships between both peak shoulder anterior force and peak shoulder proximal force and shoulder pain were analyzed. Although peak anterior force was not significantly correlated to shoulder pain, peak proximal force was. These results lead to the development of a single variable logistic regression model able to accurately predict 84.2% of all cases and 71.4% of shoulder pain cases. This model indicated that for every 1 N increase in peak proximal force, there was a corresponding 4.6% increase in the likelihood of shoulder pain. The magnitude of peak proximal force is both correlated to reported shoulder pain and capable of being used to accurately predict the likelihood of experiencing shoulder pain. It appears that those pitchers exhibiting high magnitudes of peak proximal force are significantly more likely to report experiencing shoulder pain than those who generate lower magnitudes of peak proximal force.

  3. Prevalence of shoulder pain in Swedish flatwater kayakers and its relation to range of motion and scapula stability of the shoulder joint. (United States)

    Johansson, Anette; Svantesson, Ulla; Tannerstedt, Jörgen; Alricsson, Marie


    Few studies have investigated the incidence of injuries in kayakers. The aim was to study the prevalence of shoulder pain in competitive flatwater kayakers and to evaluate any differences in range of motion or scapula stability of the shoulder joint among kayakers with or without the history of shoulder pain. Thirty-one kayakers were participated in the study, and a questionnaire including background data was used. Shoulder range of motion was measured with a goniometer, and the participants were observed for scapula dyskinesis in flexion and abduction. Of the participating kayakers, 54.8% (n = 17) had experienced shoulder pain. Kayakers who had experienced shoulder pain showed a significantly lower degree of internal rotational range of motion versus kayakers with no reported shoulder pain, with a mean degree of internal rotation in the right shoulder 49.3 vs. 60.0 (P = 0.017) and the left shoulder 51.9 vs. 66.0 (P = 0.000). Kayakers who had experienced shoulder pain were also observed with a scapular dyskinesis (n = 15 of 17 kayakers) to a significantly higher degree (P = 0.001) than kayakers with no reported shoulder pain. Findings suggest that screening for scapular dyskinesis and testing for rotational range of motion in the shoulder joint is essential in order to treat and maybe prevent shoulder pain in kayakers.

  4. Exploring the outcomes in studies of primary frozen shoulder

    DEFF Research Database (Denmark)

    Rodgers, Sara; Brealey, Stephen; Jefferson, Laura


    PURPOSE: In our study we explored the need to define a core outcome set for primary frozen shoulder. METHODS: We investigated the outcomes used by studies included in a systematic review of the management of primary frozen shoulder; surveyed which primary outcome measures health care professionals...... considered important; and re-examined papers previously obtained for a systematic review of patients' views of interventions for frozen shoulder to investigate their views on outcomes. RESULTS: Thirty-one studies investigated the outcomes range of movement (28 studies), pain (22), function and disability (22...... in modification of activities) and the emotional impact of frozen shoulder. CONCLUSIONS: We identified a diverse range of outcomes that have been used or are considered to be important. The development of a core outcome set would improve the design and reporting of studies and availability of data for evidence...

  5. Shoulder arthroplasty with the Neer Mark-II prosthesis

    DEFF Research Database (Denmark)

    Frich, Lars Henrik; Møller, B.N.; Sneppen, O.


    Total shoulder joint replacement was used as primary intervention in 50 shoulders--35 with rheumatoid arthritis, eight with osteoarthritis, and seven with traumatic arthritis. Follow-up time was 27 (12-42) months. The primary indication for the operation was chronic severe pain; improvements...... in motion and function were secondary objectives. Relief of pain was obtained in 46 of 50 shoulders. The best results regarding pain, motion, and function were obtained in the osteoarthritic group. The majority of patients with rheumatoid arthritis obtained pain relief and the largest increase in range...... of motion occurred in this group, although full range of motion was never regained. The results in patients with traumatic arthritis seemed unpredictable. Two shoulders were complicated by glenoid loosening, one by humeral subluxation, and one by musculocutaneous nerve palsy....

  6. Shoulder dystocia: simulation and a team-centered protocol. (United States)

    Grobman, William A


    Shoulder dystocia is an obstetric emergency that has been reported to occur in 0.2-3% of all vaginal deliveries. Several characteristics of shoulder dystocia make it a particular challenge to manage effectively. It is relatively infrequent, the diagnosis cannot be made according to a single objective criterion that can be recognized to exist by all members of the care team who are present, it is unpredictable, and there is the need for coordinated actions of all members of the health care team who have come together on the day of the delivery and may not have worked together before or specifically during a shoulder dystocia. In general, there is evidence from different medical disciplines that checklists/protocols and simulation may be used to enhance team performance. There is also some evidence, albeit limited, that such techniques may be used to improve shoulder dystocia outcomes.

  7. Outcomes associated with introduction of a shoulder dystocia protocol. (United States)

    Grobman, William A; Miller, Deborah; Burke, Carol; Hornbogen, Abby; Tam, Karen; Costello, Robert


    The objective of this study was to assess outcomes that are associated with the implementation of a shoulder dystocia protocol that is focused on team response. We identified women who had a shoulder dystocia during 3 time periods: 6 months before (period A), 6 months during (period B), and 6 months after (period C) the institution of a shoulder dystocia protocol. Documentation and health outcomes were compared among the time periods. During the study period, 254 women (77, 100, and 77 in periods A, B, and C, respectively) had a shoulder dystocia. There were no differences among study periods in patient characteristics. However, complete and consistent documentation increased (14% to 50% to 92%; P < .001), and brachial plexus palsy that was diagnosed at delivery (10.1% to 4.0% to 2.6%; P = .03) and at neonatal discharge (7.6% to 3.0% to 1.3%; P = .04) declined.

  8. Shoulder arthroplasty. Part 1: Prosthesis terminology and classification

    Energy Technology Data Exchange (ETDEWEB)

    Sheridan, B.D., E-mail: [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom); Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P. [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom)


    Shoulder arthroplasty is the third most common joint replacement procedure in the UK, and there are a number of different implant options available to surgeons to treat a variety of shoulder disorders. With an increasing burden placed on clinical follow-up, more patients are remaining under the care of their general practitioners and musculoskeletal triage assessment services and are not necessarily being seen by specialists. Referrals to orthopaedic specialists are therefore often prompted by radiological reports describing evidence of implant failure. This article is the first of two reviews on shoulder arthroplasty, concentrating on implant features and the indications for their use. The second article will address the modes of failure of shoulder arthroplasty and describe the relevant associated radiological features.

  9. Spinal accessory neuropathy, droopy shoulder, and thoracic outlet syndrome. (United States)

    Al-Shekhlee, Amer; Katirji, Bashar


    Droopy shoulder has been proposed as a cause of thoracic outlet syndrome. Two patients developed manifestations of neurovascular compression upon arm abduction, associated with unilateral droopy shoulder and trapezius muscle weakness caused by iatrogenic spinal accessory neuropathies following cervical lymph node biopsies. The first patient developed a cold, numb hand with complete axillary artery occlusion when his arm was abducted to 90 degrees. The second patient complained of paresthesias in digits 4 and 5 of the right hand, worsened by elevation of the arm, with nerve conduction findings of right lower trunk plexopathy (low ulnar and medial antebrachial cutaneous sensory nerve action potentials). Spinal accessory nerve grafting (in the first patient) coupled with shoulder strengthening physical exercises in both patients resulted in gradual improvement of symptoms in 2 years. These two cases demonstrate that unilateral droopy shoulder secondary to trapezius muscle weakness may cause compression of the thoracic outlet structures.

  10. Missed posterior shoulder dislocation with malunited proximal humerus fracture

    Directory of Open Access Journals (Sweden)

    Kumar Sunil


    Full Text Available 【Abstract】Posterior dislocation of the shoulder may be missed or neglected at initial presentation especially in developing countries. We present a case of 40-year-old In- dian man who had 3-month missed posterior dislocation of the right shoulder along with malunited fracture of the ana- tomical neck of the humerus. Open reduction and stabiliza- tion with modified McLaughlin procedure was performed. Rotational osteotomy of proximal humerus had to be per- formed as supplementary procedure to keep the humeral head stable in glenoid cavity during functional range of movements. The patient had excellent result of the shoulder at 3 years follow-up. Key words: Shoulder dislocation; Humerus; Osteotomy

  11. Measurement and Quantification of Gross Human Shoulder Motion

    Directory of Open Access Journals (Sweden)

    Jeremy T. Newkirk


    Full Text Available The shoulder girdle plays an important role in the large pointing workspace that humans enjoy. The goal of this work was to characterize the human shoulder girdle motion in relation to the arm. The overall motion of the human shoulder girdle was characterized based on motion studies completed on test subjects during voluntary (natural/unforced motion. The collected data from the experiments were used to develop surface fit equations that represent the position and orientation of the glenohumeral joint for a given humeral pointing direction. These equations completely quantify gross human shoulder girdle motion relative to the humerus. The equations are presented along with goodness-of-fit results that indicate the equations well approximate the motion of the human glenohumeral joint. This is the first time the motion has been quantified for the entire workspace, and the equations provide a reference against which to compare future work.

  12. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique


    MEROLLA, GIOVANNI; Nastrucci, Guglielmo; Porcellini, Giuseppe


    Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid compon...

  13. A role for amyloid in cell aggregation and biofilm formation.

    Directory of Open Access Journals (Sweden)

    Melissa C Garcia

    Full Text Available Cell adhesion molecules in Saccharomyces cerevisiae and Candida albicans contain amyloid-forming sequences that are highly conserved. We have now used site-specific mutagenesis and specific peptide perturbants to explore amyloid-dependent activity in the Candida albicans adhesin Als5p. A V326N substitution in the amyloid-forming region conserved secondary structure and ligand binding, but abrogated formation of amyloid fibrils in soluble Als5p and reduced cell surface thioflavin T fluorescence. When displayed on the cell surface, Als5p with this substitution prevented formation of adhesion nanodomains and formation of large cellular aggregates and model biofilms. In addition, amyloid nanodomains were regulated by exogenous peptides. An amyloid-forming homologous peptide rescued aggregation and biofilm activity of Als5p(V326N cells, and V326N substitution peptide inhibited aggregation and biofilm activity in Als5p(WT cells. Therefore, specific site mutation, inhibition by anti-amyloid peturbants, and sequence-specificity of pro-amyloid and anti-amyloid peptides showed that amyloid formation is essential for nanodomain formation and activation.

  14. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Bjerrum, Flemming; Gögenür, Ismayil


    BACKGROUND: Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholecystolithiasis. Despite the many advantages over open surgery, many patients complain about referred pain to the shoulder during the postoperative course. The purpose of this review was to evaluate...... different intraoperative surgical methods to minimize shoulder pain (SP). METHODS: A search of the literature was conducted using PubMed, Excerpta Medica Database (EMBASE), and Cochrane database of systematic reviews. Eligibility criteria were: randomized clinical trials or meta-analysis evaluating...

  15. Hip and Shoulder Range of Motion in Youth Baseball Pitchers. (United States)

    Oliver, Gretchen D; Weimar, Wendi H


    Oliver, GD and Weimar, WH. Hip and shoulder range of motion in youth baseball pitchers. J Strength Cond Res 30(10): 2823-2827, 2016-Lack of range of motion (ROM) has long been suspected as contributing to injury in baseball pitchers. However, all previous ROM research has focused on collegiate and professional pitchers. It was thus the purpose of this study to measure and evaluate bilateral hip and throwing shoulder rotational passive range of motion (PROM) in youth baseball pitchers. Twenty-six youth baseball pitchers (11.3 ± 1.0 years; 152.4 ± 9.0 cm; 47.5 ± 11.3 kg) with no history of injury participated. Bilateral hip and throwing shoulder rotational PROM was measured. There were no significant side-to-side differences for the hip variables (p ≥ 0.05). Shoulder external rotation (ER) was significantly greater than shoulder internal rotation (IR). And the lead leg hip had significantly greater ER than IR. Shoulder ER revealed significant correlations with both lead and stance hip IR (r = 0.45, p = 0.02 and r = 0.48, p = 0.01, respectively). The youth baseball pitchers in this study displayed similar PROM patterns as collegiate and professional baseball pitchers. Additionally, our youth baseball pitchers also presented strong relationships between hip and shoulder PROM. This study reveals that the PROM patterns displayed by these youth may indicate that their available ROM could survive maturation. It is therefore suggested that clinical focus be directed to maintaining hip and shoulder rotational ROM throughout maturation in attempt to determine a possible relations between injurious mechanisms and performance enhancement.

  16. Mini-Open Latarjet Procedure for Recurrent Anterior Shoulder Instability


    Numa Mercier; Dominique Saragaglia


    Anterior shoulder instability is a common problem. The Latarjet procedure has been advocated as an option for the treatment of anteroinferior shoulder instability. The purpose of this paper is to explain our surgical procedure titled “Mini-open Latarjet Procedure.” We detailed patient positioning, skin incision, subscapularis approach, and coracoid fixation. Then, we reviewed the literature to evaluate the clinical outcomes of this procedure.

  17. Mini-Open Latarjet Procedure for Recurrent Anterior Shoulder Instability

    Directory of Open Access Journals (Sweden)

    Numa Mercier


    Full Text Available Anterior shoulder instability is a common problem. The Latarjet procedure has been advocated as an option for the treatment of anteroinferior shoulder instability. The purpose of this paper is to explain our surgical procedure titled “Mini-open Latarjet Procedure.” We detailed patient positioning, skin incision, subscapularis approach, and coracoid fixation. Then, we reviewed the literature to evaluate the clinical outcomes of this procedure.

  18. Radiotherapy for shoulder impingement; Bestrahlung beim Impingementsyndrom des Schultergelenks

    Energy Technology Data Exchange (ETDEWEB)

    Adamietz, B. [Universitaetsklinikum Erlangen (Germany). Inst. fuer Radiologie; Sauer, R.; Keilholz, L. [Universitaetsklinikum Erlangen (Germany). Strahlentherapeutische Klinik


    Background and Purpose: Up to now, degenerative shoulder diseases were summarized by the term 'periarthritis humeroscapularis'. Actual shoulder diseases can be differentiated etiopathologically according to a primary and secondary impingement syndrome. Narrowing of the subacromial space, which is caused by an osseous shape variant, leads to primary impingement. Secondary impingement develops, when the subacromial space is reduced by swelling tissue below the osseous shoulder roof. This study aimed for the exact diagnosis to indicate therapy and to classify the results according to the Constant score. Patients and Methods: From August 1999 to September 2002, 102 patients with 115 shoulder joint conditions underwent radiation therapy (RT). All joints received two RT series (6 x 0.5 Gy/series) applied in two to three weekly fractions, totaling a dosage of 6.0 Gy (250 kV, 15 mAs, 1-mm Cu filter). The second RT course started 6 weeks after the end of the first. 115 shoulders were examined before RT, 6 weeks after the second RT course and, finally, during the follow-up from January to May 2003. Results: Pain relief was achieved in 94/115 shoulder joints (82%) after 18-month follow-up (median). A significant difference existed between secondary impingement and primary/non-impingement according to response. Tendinosis calcarea, bursitis subdeltoidea, tendovaginitis of the long biceps tendon, and capsulitis adhaesiva responded well to therapy. Conclusion: Shoulder diseases of secondary impingement demonstrate a good response to RT. Less or no benefit was found in primary impingement syndrome or complete rotator cuff disruption and acute shoulder injuries, respectively. (orig.)

  19. Shoulder injuries attributed to resistance training: a brief review. (United States)

    Kolber, Morey J; Beekhuizen, Kristina S; Cheng, Ming-Shun S; Hellman, Madeleine A


    The popularity of resistance training (RT) is evident by the more than 45 million Americans who engage in strength training regularly. Although the health and fitness benefits ascribed to RT are generally agreed upon, participation is not without risk. Acute and chronic injuries attributed to RT have been cited in the epidemiological literature among both competitive and recreational participants. The shoulder complex in particular has been alluded to as one of the most prevalent regions of injury. The purpose of this manuscript is to present an overview of documented shoulder injuries among the RT population and where possible discern mechanisms of injury and risk factors. A literature search was conducted in the PUBMED, CINAHL, SPORTDiscus, and OVID databases to identify relevant articles for inclusion using combinations of key words: resistance training, shoulder, bodybuilding, weightlifting, shoulder injury, and shoulder disorder. The results of the review indicated that up to 36% of documented RT-related injuries and disorders occur at the shoulder complex. Trends that increased the likelihood of injury were identified and inclusive of intrinsic risk factors such as joint and muscle imbalances and extrinsic risk factors, namely, that of improper attention to exercise technique. A majority of the available research was retrospective in nature, consisting of surveys and descriptive epidemiological reports. A paucity of research was available to identify predictive variables leading to injury, suggesting the need for future prospective-based investigations.

  20. Outcomes Study of the TM Reverse Shoulder System Used in Primary or Revision Reverse Total Shoulder Arthroplasty (United States)


    Osteoarthritis; Rheumatoid Arthritis; Post-traumatic Arthritis; Ununited Humeral Head Fracture; Irreducible 3-and 4-part Proximal Humeral Fractures; Avascular Necrosis; Gross Rotator Cuff Deficiency; Failed Total Shoulder Arthroplasty (Both Glenoid and Humeral Components Require Revision

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


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


    Background 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 vir...

  2. 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


    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

  3. Atomic View of a Toxic Amyloid Small Oligomer

    Energy Technology Data Exchange (ETDEWEB)

    Laganowsky, Arthur; Liu, Cong; Sawaya, Michael R.; Whitelegge, Julian P.; Park, Jiyong; Zhao, Minglei; Pensalfini, Anna; Soriaga, Angela B.; Landau, Meytal; Teng, Poh K.; Cascio, Duilio; Glabe, Charles; Eisenberg, David (UCI); (UCLA)


    Amyloid diseases, including Alzheimer's, Parkinson's, and the prion conditions, are each associated with a particular protein in fibrillar form. These amyloid fibrils were long suspected to be the disease agents, but evidence suggests that smaller, often transient and polymorphic oligomers are the toxic entities. Here, we identify a segment of the amyloid-forming protein {alpha}{beta} crystallin, which forms an oligomeric complex exhibiting properties of other amyloid oligomers: {beta}-sheet-rich structure, cytotoxicity, and recognition by an oligomer-specific antibody. The x-ray-derived atomic structure of the oligomer reveals a cylindrical barrel, formed from six antiparallel protein strands, that we term a cylindrin. The cylindrin structure is compatible with a sequence segment from the {beta}-amyloid protein of Alzheimer's disease. Cylindrins offer models for the hitherto elusive structures of amyloid oligomers.

  4. Inhibition of insulin amyloid fibril formation by cyclodextrins. (United States)

    Kitagawa, Keisuke; Misumi, Yohei; Ueda, Mitsuharu; Hayashi, Yuya; Tasaki, Masayoshi; Obayashi, Konen; Yamashita, Taro; Jono, Hirofumi; Arima, Hidetoshi; Ando, Yukio


    Localized insulin-derived amyloid masses occasionally form at the site of repeated insulin injections in patients with insulin-dependent diabetes and cause subcutaneous insulin resistance. Various kinds of insulin including porcine insulin, human insulin, and insulin analogues reportedly formed amyloid fibrils in vitro and in vivo, but the impact of the amino acid replacement in insulin molecules on amyloidogenicity is largely unknown. In the present study, we demonstrated the difference in amyloid fibril formation kinetics of human insulin and insulin analogues, which suggests an important role of the C-terminal domain of the insulin B chain in nuclear formation of amyloid fibrils. Furthermore, we determined that cyclodextrins, which are widely used as drug carriers in the pharmaceutical field, had an inhibitory effect on the nuclear formation of insulin amyloid fibrils. These findings have significant implications for the mechanism underlying insulin amyloid fibril formation and for developing optimal additives to prevent this subcutaneous adverse effect.

  5. Fold modulating function: Bacterial toxins to functional amyloids

    Directory of Open Access Journals (Sweden)

    Adnan Khawaja Syed


    Full Text Available Many bacteria produce cytolytic toxins that target host cells or other competing microbes. It is well known that environmental factors control toxin expression, however recent work suggests that some bacteria manipulate the fold of these protein toxins to control their function. The β-sheet rich amyloid fold is a highly stable ordered aggregate that many toxins form in response to specific environmental conditions. When in the amyloid state, toxins become inert, losing the cytolytic activity they display in the soluble form. Emerging evidence suggest that some amyloids function as toxin storage systems until they are again needed, while other bacteria utilize amyloids as a structural matrix component of biofilms. This amyloid matrix component facilitates resistance to biofilm disruptive challenges. The bacterial amyloids discussed in this review reveal an elegant system where changes in protein fold and solubility dictate the function of proteins in response to the environment.

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

    Directory of Open Access Journals (Sweden)

    Kyle A. R. Kemp


    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.

  7. Copper Promotes the Trafficking of the Amyloid Precursor Protein*


    Acevedo, Karla M.; Hung, Ya Hui; Dalziel, Andrew H.; Li, Qiao-Xin; Laughton, Katrina; Wikhe, Krutika; Rembach, Alan; Roberts, Blaine; Masters, Colin L.; Ashley I. Bush; Camakaris, James


    Accumulation of the amyloid β peptide in the cortical and hippocampal regions of the brain is a major pathological feature of Alzheimer disease. Amyloid β peptide is generated from the sequential protease cleavage of the amyloid precursor protein (APP). We reported previously that copper increases the level of APP at the cell surface. Here we report that copper, but not iron or zinc, promotes APP trafficking in cultured polarized epithelial cells and neuronal cells. In SH-SY5Y neuronal cells ...

  8. An update on the amyloid hypothesis. (United States)

    Eckman, Christopher B; Eckman, Elizabeth A


    Alzheimer's disease (AD) is a devastating neurodegenerative disease. To rationally develop novel therapeutic and/or preventative agents for AD, an understanding of the etiology and pathogenesis of this complex disease is necessary. This article examines the evidence for the amyloid hypothesis of AD pathogenesis and discusses how it relates to the neurological and neuropathological features of AD, the known genetic risk factors and causative mutations, and the heightened risk associated with advanced age.

  9. Traumatic Brain Injury, Microglia, and Beta Amyloid


    Mannix, Rebekah C.; Whalen, Michael J


    Recently, there has been growing interest in the association between traumatic brain injury (TBI) and Alzheimer's Disease (AD). TBI and AD share many pathologic features including chronic inflammation and the accumulation of beta amyloid (A\\(\\beta\\)). Data from both AD and TBI studies suggest that microglia play a central role in A\\(\\beta\\) accumulation after TBI. This paper focuses on the current research on the role of microglia response to A\\(\\beta\\) after TBI.

  10. Contrasting effects of nanoparticle-protein attraction on amyloid aggregation. (United States)

    Radic, Slaven; Davis, Thomas P; Ke, Pu Chun; Ding, Feng


    Nanoparticles (NPs) have been experimentally found to either promote or inhibit amyloid aggregation of proteins, but the molecular mechanisms for such complex behaviors remain unknown. Using coarse-grained molecular dynamics simulations, we investigated the effects of varying the strength of nonspecific NP-protein attraction on amyloid aggregation of a model protein, the amyloid-beta peptide implicated in Alzheimer's disease. Specifically, with increasing NP-peptide attraction, amyloid aggregation on the NP surface was initially promoted due to increased local protein concentration on the surface and destabilization of the folded state. However, further increase of NP-peptide attraction decreased the stability of amyloid fibrils and reduced their lateral diffusion on the NP surface necessary for peptide conformational changes and self-association, thus prohibiting amyloid aggregation. Moreover, we found that the relative concentration between protein and NPs also played an important role in amyloid aggregation. With a high NP/protein ratio, NPs that intrinsically promote protein aggregation may display an inhibitive effect by depleting the proteins in solution while having a low concentration of the proteins on each NP's surface. Our coarse-grained molecular dynamics simulation study offers a molecular mechanism for delineating the contrasting and seemingly conflicting effects of NP-protein attraction on amyloid aggregation and highlights the potential of tailoring anti-aggregation nanomedicine against amyloid diseases.

  11. Functional bacterial amyloid increases Pseudomonas biofilm hydrophobicity and stiffness

    DEFF Research Database (Denmark)

    Zeng, Guanghong; Vad, Brian Stougaard; Dueholm, Morten Simonsen


    The success of Pseudomonas species as opportunistic pathogens derives in great part from their ability to form stable biofilms that offer protection against chemical and mechanical attack. The extracellular matrix of biofilms contains numerous biomolecules, and it has recently been discovered...... that in Pseudomonas one of the components includes β-sheet rich amyloid fibrils (functional amyloid) produced by the fap operon. However, the role of the functional amyloid within the biofilm has not yet been investigated in detail. Here we investigate how the fap-based amyloid produced by Pseudomonas affects biofilm...

  12. Amyloid positron emission tomography and cognitive reserve

    Institute of Scientific and Technical Information of China (English)

    Matteo Bauckneht; Agnese Picco; Flavio Nobili; Silvia Morbelli


    Alzheimer’s disease(AD) is characterized by a nonlinear progressive course and several aspects influence the relationship between cerebral amount of AD pathology and the clinical expression of the disease. Brain cognitive reserve(CR) refers to the hypothesized capacity of an adult brain to cope with brain damage in order to minimize symptomatology. CR phenomenon contributed to explain the disjunction between the degree of neurodegeneration and the clinical phenotype of AD. The possibility to track brain amyloidosis(Aβ) in vivo has huge relevance for AD diagnosis and new therapeutic approaches. The clinical repercussions of positron emission tomography(PET)-assessed Aβ load are certainly mediated by CR thus potentially hampering the prognostic meaning of amyloid PET in selected groups of patients. Similarly, amyloid PET and cerebrospinal fluid amyloidosis biomarkers have recently provided new evidence for CR. The present review discusses the concept of CR in the framework of available neuroimaging studies and specifically deals with the reciprocal influences between amyloid PET and CR in AD patients and with the potential consequent interventional strategies for AD.

  13. Design and Construction of Large Amyloid Fibers

    Directory of Open Access Journals (Sweden)

    Devin M. Ridgley


    Full Text Available Mixtures of “template” and “adder” proteins self-assemble into large amyloid fibers of varying morphology and modulus. Fibers range from low modulus, rectangular cross-sectioned tapes to high modulus, circular cross-sectioned cylinders. Varying the proteins in the mixture can elicit “in-between” morphologies, such as elliptical cross-sectioned fibers and twisted tapes, both of which have moduli in-between rectangular tapes and cylindrical fibers. Experiments on mixtures of proteins of known amino acid sequence show that control of the large amyloid fiber morphology is dependent on the amount of glutamine repeats or “Q-blocks” relative to hydrophobic side chained amino acids such as alanine, isoleucine, leucine, and valine in the adder protein. Adder proteins with only hydrophobic groups form low modulus rectangular cross-sections and increasing the Q-block content allows excess hydrogen bonding on amide groups that results in twist and higher modulus. The experimental results show that large amyloid fibers of specific shape and modulus can be designed and controlled at the molecular level.

  14. Partial Volume Correction in Quantitative Amyloid Imaging (United States)

    Su, Yi; Blazey, Tyler M.; Snyder, Abraham Z.; Raichle, Marcus E.; Marcus, Daniel S.; Ances, Beau M.; Bateman, Randall J.; Cairns, Nigel J.; Aldea, Patricia; Cash, Lisa; Christensen, Jon J.; Friedrichsen, Karl; Hornbeck, Russ C.; Farrar, Angela M.; Owen, Christopher J.; Mayeux, Richard; Brickman, Adam M.; Klunk, William; Price, Julie C.; Thompson, Paul M.; Ghetti, Bernardino; Saykin, Andrew J.; Sperling, Reisa A.; Johnson, Keith A.; Schofield, Peter R.; Buckles, Virginia; Morris, John C.; Benzinger, Tammie. LS.


    Amyloid imaging is a valuable tool for research and diagnosis in dementing disorders. As positron emission tomography (PET) scanners have limited spatial resolution, measured signals are distorted by partial volume effects. Various techniques have been proposed for correcting partial volume effects, but there is no consensus as to whether these techniques are necessary in amyloid imaging, and, if so, how they should be implemented. We evaluated a two-component partial volume correction technique and a regional spread function technique using both simulated and human Pittsburgh compound B (PiB) PET imaging data. Both correction techniques compensated for partial volume effects and yielded improved detection of subtle changes in PiB retention. However, the regional spread function technique was more accurate in application to simulated data. Because PiB retention estimates depend on the correction technique, standardization is necessary to compare results across groups. Partial volume correction has sometimes been avoided because it increases the sensitivity to inaccuracy in image registration and segmentation. However, our results indicate that appropriate PVC may enhance our ability to detect changes in amyloid deposition. PMID:25485714

  15. Kinesio Tape and Shoulder-Joint Position Sense (United States)

    Aarseth, Lindsay M.; Suprak, David N.; Chalmers, Gordon R.; Lyon, Lonnie; Dahlquist, Dylan T.


    Context Joint position sense (JPS) is a key neuromuscular factor for developing and maintaining control of muscles around a joint. It is important when performing specialized tasks, especially at the shoulder. No researchers have studied how Kinesio Tape (KT) application affects JPS. Objective To investigate the effects of KT application and no tape on shoulder JPS at increasing shoulder elevations in athletes. Design Cross-sectional study. Setting University laboratory. Patients or Other Participants A total of 27 healthy athletes who did not participate in overhead sports (age = 20.44 ± 1.05 years, height = 175.02 ± 11.67 cm, mass = 70.74 ± 9.65 kg) with no previous pathologic shoulder conditions volunteered for the study. All participants were from 1 university. Intervention(s) Shoulder JPS was assessed at increasing elevations with and without KT application. Participants attempted to actively replicate 3 target positions with and without the KT and without visual guidance. Main Outcome Measure(s) We examined absolute and variable repositioning errors at increasing shoulder-elevation levels with and without KT application. Results Data revealed an interaction between tape and position for absolute error (F2,52 = 4.07, P = .02); simple effects revealed an increase in error, with KT demonstrating a 2.65° increase in error at 90° of elevation compared with no tape (t26 = 2.65, P = .01). The effect size was medium (ω2 = .135). Variable error showed no interaction of tape and position (F2,52 = .709, P = .50). Further analysis of simple effects was not needed. However, we still calculated the effect size and observed small effect sizes for tape (ω2 = .002), position (ω2 = .072), and tape by position (ω2 = .027). Conclusions At 90° of elevation, shoulder JPS was impaired by the application of KT. PMID:26090707

  16. Ultrasound-guided interventional procedures around the shoulder (United States)

    Messina, Carmelo; Banfi, Giuseppe; Orlandi, Davide; Lacelli, Francesca; Serafini, Giovanni; Mauri, Giovanni; Secchi, Francesco; Silvestri, Enzo


    Ultrasound is an established modality for shoulder evaluation, being accurate, low cost and radiation free. Different pathological conditions can be diagnosed using ultrasound and can be treated using ultrasound guidance, such as degenerative, traumatic or inflammatory diseases. Subacromial–subdeltoid bursitis is the most common finding on ultrasound evaluation for painful shoulder. Therapeutic injections of corticosteroids are helpful to reduce inflammation and pain. Calcific tendinopathy of rotator cuff affects up to 20% of painful shoulders. Ultrasound-guided treatment may be performed with both single- and double-needle approach. Calcific enthesopathy, a peculiar form of degenerative tendinopathy, is a common and mostly asymptomatic ultrasound finding; dry needling has been proposed in symptomatic patients. An alternative is represented by autologous platelet-rich plasma injections. Intra-articular injections of the shoulder can be performed in the treatment of a variety of inflammatory and degenerative diseases with corticosteroids or hyaluronic acid respectively. Steroid injections around the long head of the biceps brachii tendon are indicated in patients with biceps tendinopathy, reducing pain and humeral tenderness. The most common indication for acromion–clavicular joint injection is degenerative osteoarthritis, with ultrasound representing a useful tool in localizing the joint space and properly injecting various types of drugs (steroids, lidocaine or hyaluronic acid). Suprascapular nerve block is an approved treatment for chronic shoulder pain non-responsive to conventional treatments as well as candidate patients for shoulder arthroscopy. This review provides an overview of these different ultrasonography-guided procedures that can be performed around the shoulder. PMID:26313499

  17. Clinically relevant magnetic resonance imaging (MRI findings in elite swimmers’ shoulders

    Directory of Open Access Journals (Sweden)

    Arno Celliers


    Full Text Available Background: Shoulder pain is the most common and well-documented site of musculoskeletal pain in elite swimmers. Structural abnormalities on magnetic resonance imaging (MRI of elite swimmers’ symptomatic shoulders are common. Little has been documented about the association between MRI findings in the asymptomatic shoulder versus the symptomatic shoulder.Objective: To assess clinically relevant MRI findings in the shoulders of symptomatic and asymptomatic elite swimmers.Method: Twenty (aged 16–23 years elite swimmers completed questionnaires on their swimming training, pain and shoulder function. MRI of both shoulders (n = 40 were performed and all swimmers were given a standardised clinical shoulder examination. Results: Both shoulders of 11 male and 9 female elite swimmers (n = 40 were examined. Eleven of the 40 shoulders were clinically symptomatic and 29 were asymptomatic. The most common clinical finding in both the symptomatic and asymptomatic shoulders was impingement during internal rotation, with impingement in 54.5% of the symptomatic shoulders and in 31.0% of the asymptomatic shoulders. The most common MRI findings in the symptomatic and asymptomatic shoulders were supraspinatus tendinosis (45.5% vs. 20.7%, subacromial subdeltoid fluid (45.5% vs. 34.5%, increased signal in the AC Joint (45.5% vs. 37.9% and AC joint arthrosis (36.4% vs. 34.5%. Thirty-nine (97.5% of the shoulders showed abnormal MRI features.Conclusion: MRI findings in the symptomatic and asymptomatic shoulders of young elite swimmers are similar and care should be taken when reporting shoulder MRIs in these athletes. Asymptomatic shoulders demonstrate manifold MRI abnormalities that may be radiologically significant but appear not to be clinically significant.

  18. Correlation between MRI and Arthroscopy in Diagnosis of Shoulder Pathology (United States)

    Bhonsle, Sachin; Mehta, Sonu


    Introduction Shoulder pain can cause significant pain, discomfort and reduce the ability to perform activities of daily living, thus making it the third most common cause of musculoskeletal consultation. The current gold standard diagnostic investigation is arthroscopy. MRI is a proved sensitive and accurate non-invasive tool in investigating shoulder pathology, but false and misleading results are equally reported. Aim The aim of the study is to compare the efficacy of MRI in diagnosing shoulder pathologies in comparison to arthroscopy, considering arthroscopy as the gold standard. Materials and Methods Thirty nine consecutive patients, between 18-80 years of age, presenting with chronic shoulder pain or instability of more than 6 weeks, or with clinical signs of impingement or tear were included in the study. MRI of the shoulder joint was done followed by shoulder arthroscopy. The data collected was analysed for the significant correlation between MRI of shoulder and arthroscopic findings by kappa statistics. Results Out of 39 patients, Rotator cuff (RC) tear was the most common pathology. MRI showed excellent sensitivity in the diagnosis of rotator cuff tears (0.91) and osteochondral defects (OCD), very good sensitivity for Bankart’s lesion (0.8) and had poor sensitivity to detect SLAP tear (0.15). MRI was specific for all shoulder pathologies. MRI detected RC tears with kappa score of 0.73, Bankart’s tear and OCD’s with kappa score of 0.83 and 1.0 respectively and SLAP lesion with kappa score of 0.14. The accuracy of MRI was highest in diagnosing OCD’s (1.0), followed by RC tear (0.9), Bankart’s tear (0.9) and accuracy was least in diagnosing SLAP lesion (0.7). False negative results were more than false positives. Conclusion The present study supports that MRI is effective in diagnosing rotator cuff tears, Bankart’s tear and ostechondral defects but was not found to be helpful in diagnosing SLAP lesions. MRI and arthroscopy have complimentary roles

  19. Shoulder skin and muscle hemodynamics during backpack carriage. (United States)

    Mao, Clifford P; Macias, Brandon R; Hargens, Alan R


    The purpose of this study was to quantify the effects of loaded backpacks on shoulder muscle oxygenation, skin blood flow, and pain. We hypothesized that backpack load carriage is associated with lower shoulder muscle oxygenation and skin microvascular flow. Near-infrared spectroscopy quantified shoulder tissue oxygenation and laser Doppler flow measured skin microvascular flow. Eight adult volunteers donned a standard backpack without added load, 5 kg load, and 10 kg load for 5 min while standing. An 8 min rest period before each backpack donning condition ensured that all measured parameters returned to baseline. Data were analyzed using a repeated measures ANOVA and significance set at p backpack significantly reduced shoulder muscle oxygenation by 22 ± 23% as compared to the empty backpack control condition (p = 0.023). In addition, a 10 kg backpack load reduced skin microvascular flow by 82 ± 22%, as compared to the empty backpack control condition (p = 0.024). Perceived pain was significantly higher when wearing the 10 kg backpack (level 4 on a 10-maximal pain scale) as compared to the empty backpack (0, 0-no pain) (p backpack loads of 10 kg decrease shoulder muscle oxygenation and skin microvascular flow.

  20. The role of sensitization in musculoskeletal shoulder pain

    Directory of Open Access Journals (Sweden)

    John Borstad


    Full Text Available Introduction: Peripheral and central sensitization are neurophysiological processes that can prolong painful conditions. Painful shoulder conditions are often persistent, perhaps due to the presence of sensitization.Method:This manuscript summarizes six studies that have evaluated those with musculoskeletal shoulder pain for the presence of sensitization.Results:All six manuscripts report evidence of peripheral sensitization, while central sensitization was described in five of the studies. The chronicity of symptoms in subjects who were included in the studies is probably influencing this finding. The primary somatosensory test used to assess sensitization in these studies was Pressure Pain Threshold, a test for lowered nociceptive thresholds.Discussion:It appears that peripheral sensitization manifests consistently in those with musculoskeletal shoulder pathology, probably due to the inflammatory processes related to tissue injury. Central sensitization, while not universally present, was reported in a majority of the manuscripts. Because central sensitization is thought to be a key step on the pathway to chronic pain, evidence for its presence in those with shoulder pain is significant. Clinicians should expect the presence of sensitization with shoulder pathology and make appropriate choices about interventions so as not to exacerbate pain.

  1. Web Page Content and Quality Assessed for Shoulder Replacement. (United States)

    Matthews, John R; Harrison, Caitlyn M; Hughes, Travis M; Dezfuli, Bobby; Sheppard, Joseph


    The Internet has become a major source for obtaining health-related information. This study assesses and compares the quality of information available online for shoulder replacement using medical (total shoulder arthroplasty [TSA]) and nontechnical (shoulder replacement [SR]) terminology. Three evaluators reviewed 90 websites for each search term across 3 search engines (Google, Yahoo, and Bing). Websites were grouped into categories, identified as commercial or noncommercial, and evaluated with the DISCERN questionnaire. Total shoulder arthroplasty provided 53 unique sites compared to 38 websites for SR. Of the 53 TSA websites, 30% were health professional-oriented websites versus 18% of SR websites. Shoulder replacement websites provided more patient-oriented information at 48%, versus 45% of TSA websites. In total, SR websites provided 47% (42/90) noncommercial websites, with the highest number seen in Yahoo, compared with TSA at 37% (33/90), with Google providing 13 of the 33 websites (39%). Using the nonmedical terminology with Yahoo's search engine returned the most noncommercial and patient-oriented websites. However, the quality of information found online was highly variable, with most websites being unreliable and incomplete, regardless of search term.

  2. Obesity-Related Adipokines Predict Patient-Reported Shoulder Pain

    Directory of Open Access Journals (Sweden)

    Rajiv Gandhi


    Full Text Available Background/Aims: Increasingly, an inflammatory modulating effect of adipokines within synovial joints is being recognized. To date, there has been no work examining a potential association between the presence of adipokines in the shoulder and patient-reported outcomes. This study undertakes an investigation assessing these potential links. Methods: 50 osteoarthritis patients scheduled for shoulder surgery completed a pre-surgery questionnaire capturing demographic information including validated, patient-reported function (Disabilities of the Arm, Shoulder, and Hand questionnaire and pain (Short Form McGill Pain Questionnaire measures. Synovial fluid (SF samples were analyzed for leptin, adiponectin, and resistin levels using Milliplex MAP assays. Linear regression modeling was used to assess the association between adipokine levels and patient-reported outcomes, adjusted for age, sex, BMI, and disease severity. Results: 54% of the cohort was female (n = 27. The mean age (SD of the sample was 62.9 (9.9 years and the mean BMI (SD was 28.1 (5.4 kg/m2. From regression analyses, greater SF leptin and adiponectin levels, but not regarding resistin, were found to be associated with greater pain (p Conclusions: The identified association between shoulder-derived SF leptin and adiponectin and shoulder pain is likely explained by the pro-inflammatory characteristics of the adipokines and represents potentially important therapeutic targets.

  3. Nationwide trends in total shoulder arthroplasty and hemiarthroplasty for osteoarthritis. (United States)

    Trofa, David; Rajaee, Sean S; Smith, Eric L


    Recent literature reports an increase in the rate of shoulder arthroplasties, particularly total shoulder arthroplasties (TSAs), being performed in the United States. However, the national epidemiology of use of hemiarthroplasty (HA) and TSA as treatments for glenohumeral osteoarthritis has not been elucidated. We conducted a study to analyze trends in using HA and TSA as treatments for glenohumeral osteoarthritis from 2000 to 2010, and to compare patient characteristics and inpatient complications. US Nationwide Inpatient Sample patients with a primary inpatient diagnosis of shoulder arthritis and a principal procedure of HA or TSA were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedural codes. From 2000 to 2010 the nationally adjusted population rate of shoulder arthroplasty performed for osteoarthritis increased 3.7-fold. Specifically, the population rate of TSA increased 5.0-fold, and that of HA increased 1.9-fold. In 2010, 80.3% of patients having shoulder arthroplasty for arthritis underwent TSA. TSA patients were older (P < .0001) and had a higher mean number of chronic illnesses (P = .034). TSA-associated discharges had a higher rate of surgical and medical care complications (P = .011) and blood transfusions (P = .041) after adjusting for comorbidities.

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

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


    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 Shoulder abductor strength was significantly higher during condition 3 than during condition 1 (p shoulder abduction and increasing shoulder abductor strength.

  5. Regional brain hypometabolism is unrelated to regional amyloid plaque burden (United States)

    Altmann, Andre; Ng, Bernard; Landau, Susan M.; Jagust, William J.


    See Sorg and Grothe (doi:10.1093/brain/awv302) for a scientific commentary on this article. In its original form, the amyloid cascade hypothesis of Alzheimer’s disease holds that fibrillar deposits of amyloid are an early, driving force in pathological events leading ultimately to neuronal death. Early clinicopathological investigations highlighted a number of inconsistencies leading to an updated hypothesis in which amyloid plaques give way to amyloid oligomers as the driving force in pathogenesis. Rather than focusing on the inconsistencies, amyloid imaging studies have tended to highlight the overlap between regions that show early amyloid plaque signal on positron emission tomography and that also happen to be affected early in Alzheimer’s disease. Recent imaging studies investigating the regional dependency between metabolism and amyloid plaque deposition have arrived at conflicting results, with some showing regional associations and other not. We extracted multimodal neuroimaging data from the Alzheimer’s disease neuroimaging database for 227 healthy controls and 434 subjects with mild cognitive impairment. We analysed regional patterns of amyloid deposition, regional glucose metabolism and regional atrophy using florbetapir (18F) positron emission tomography, 18F-fluordeoxyglucose positron emission tomography and T1-weighted magnetic resonance imaging, respectively. Specifically, we derived grey matter density and standardized uptake value ratios for both positron emission tomography tracers in 404 functionally defined regions of interest. We examined the relation between regional glucose metabolism and amyloid plaques using linear models. For each region of interest, correcting for regional grey matter density, age, education and disease status, we tested the association of regional glucose metabolism with (i) cortex-wide florbetapir uptake; (ii) regional (i.e. in the same region of interest) florbetapir uptake; and (iii) regional florbetapir uptake

  6. Three-dimensional scapular kinematics and scapulohumeral rhythm in patients with glenohumeral osteoarthritis or frozen shoulder. (United States)

    Fayad, Fouad; Roby-Brami, Agnès; Yazbeck, Chadi; Hanneton, Sylvain; Lefevre-Colau, Marie-Martine; Gautheron, Vincent; Poiraudeau, Serge; Revel, Michel


    We aimed to describe 3D scapular kinematics and scapulohumeral rhythm (SHR) in glenohumeral (GH) osteoarthritis shoulders compared to unaffected shoulders and to compare the abnormal scapular kinematic schema for GH osteoarthritis with that for frozen shoulder. Thirty-two patients with stiff shoulder (16 with GH osteoarthritis and 16 with frozen shoulder) performed maximal arm elevation in two planes, sagittal and frontal. Scapular rotations and humeral elevation of the affected and unaffected shoulders were measured by the Polhemus Fastrak electromagnetic system. Patients with GH osteoarthritis were older, had longer disease duration (pshoulders except for arm elevation in the frontal plane in the GH osteoarthritis group. Furthermore, protraction was lower with frozen shoulder than GH osteoarthritis during arm elevation in the frontal plane. Scapular lateral rotation and SHR were significantly higher for the affected shoulders in both groups whatever the plane of elevation. SHR showed a fair to moderate negative correlation with maximal humeral elevation in both groups and appears to be higher with frozen shoulder than GH osteoarthritis. In addition, SHR of the affected shoulder showed a fair to moderate correlation with disease duration only with GH osteoarthritis. Scapular tilt did not differ between affected and unaffected sides and was not influenced by type of disease. In conclusion, the increased scapular lateral rotation described in frozen shoulder is also observed in GH osteoarthritis. SHR of the affected shoulder is inversely related to severity of limitation of shoulder range of motion, which suggests a compensatory pattern.

  7. What is the effect of a shoulder-strengthening program to prevent shoulder pain among junior female team handball players?

    Directory of Open Access Journals (Sweden)

    Sommervold M


    Full Text Available Maria Sommervold, Håvard Østerås Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU, Trondheim, Norway Background: Excessively high stresses are applied to the shoulder joint of handball players, mainly caused by overhead throwing. Shoulder pain is a significant problem among junior female team handball players and both male and female top-level team handball players in Norway.Method: A randomized selection was performed among the best female junior teams (J 16 in the Trøndelag region of Norway in the 2014–2015 season. Three teams were randomized to the intervention group and three teams to the control group. Players in the intervention group (n=53 participated in a seven-month, three-times-a-week shoulder-muscle strength-training program, while those in the control group (n=53 participated in a comparable handball training, but did not conduct any specific strength training during the season. Results: A strength-training program had no effect on the prevention of shoulder pain. Overall, the players reported shoulder pain, but graded the pain low on visual analog scale (VAS. Both the intervention group and the control group reported pain under 1 on VAS at baseline and posttest, and there was no significant difference within or between the groups when it came to the intensity of pain reported on VAS. A significant difference (p<0.048 was found between the groups on the sport-specific part of the quick-Disability of the Arm, Shoulder and Hand (DASH form, but it did not fulfill the minimal demand to change and the players scored it low, something that indicates little functional problems when it comes to team handball. The intervention group was significantly stronger (p<0.008 on the push-ups test compared to the control group on the posttest. The intervention group increased the number of push-ups from 3.1 to 6.4, while the control group went from 2.3 to 3.6. Aside from this, there were no

  8. Is it feasible to merge data from national shoulder registries?

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe V; Brorson, Stig; Hallan, Geir


    BACKGROUND: The Nordic Arthroplasty Register Association was initiated in 2007, and several papers about hip and knee arthroplasty have been published. Inspired by this, we aimed to examine the feasibility of merging data from the Nordic national shoulder arthroplasty registries by defining...... a common minimal data set. METHODS: A group of surgeons met in 2014 to discuss the feasibility of merging data from the national shoulder registries in Denmark, Norway, and Sweden. Differences in organization, definitions, variables, and outcome measures were discussed. A common minimal data set...... of arthroplasties for osteoarthritis have increased in the study period. The most common arthroplasty type was total shoulder arthroplasty (34%) for osteoarthritis and stemmed hemiarthroplasty (90%) for acute fractures. CONCLUSION: We were able to merge data from the Nordic national registries into 1 common data...

  9. Wearable IMU for Shoulder Injury Prevention in Overhead Sports

    Directory of Open Access Journals (Sweden)

    Samir A. Rawashdeh


    Full Text Available Body-worn inertial sensors have enabled motion capture outside of the laboratory setting. In this work, an inertial measurement unit was attached to the upper arm to track and discriminate between shoulder motion gestures in order to help prevent shoulder over-use injuries in athletics through real-time preventative feedback. We present a detection and classification approach that can be used to count the number of times certain motion gestures occur. The application presented involves tracking baseball throws and volleyball serves, which are common overhead movements that can lead to shoulder and elbow overuse injuries. Eleven subjects are recruited to collect training, testing, and randomized validation data, which include throws, serves, and seven other exercises that serve as a large null class of similar movements, which is analogous to a realistic usage scenario and requires a robust estimator.

  10. [New options in the treatment of painful shoulder syndrome]. (United States)

    Esparza Miñana, J M; Londoño Parra, M; Villanueva Pérez, V L; De Andrés Ibáñez, J


    Shoulder pain is a common complaint in clinical practice in Primary Care and affects 20% of the general population. The usual form of treatment is based on NSAIDs, rest, rehabilitation and, as an alternative, a local injection into the joint. There are also radiofrequency techniques on the suprascapular nerve in the cases of refractory pain to these therapies. Radiofrequency can be used in two ways: Conventional Radiofrequency, using high temperatures to the target tissue with the aim of producing a thermal neurolysis and Pulsed Radiofrequency where the temperatures are lower and produces a temporary non-destructive blockage; the latter being the most common technique in the management of shoulder pain. Although the analgesic mechanism of action of Radiofrequency is unknown, recent studies have shown that it is safe, effective and Lasting. Radiofrequency of the suprascapular nerve is a valid, effective and with few complications in the treatment of shoulder pain refractory to other therapies.

  11. Morphology of the shoulder muscles in Sapajus apella (Primates: Cebidae

    Directory of Open Access Journals (Sweden)

    Mariana Oliveira Lima


    Full Text Available The study of nonhuman primates has been very important, due to the similarities with the human species. Many animal species, especially primates, have been used in medical and biological researches. Sapajus apella is a species with usual and abundant incidence in the Southeastern Region. This paper aimed to study the stabilizing muscles of the shoulder in the tufted capuchin monkey and compare them to those in human beings, with the purpose of providing information to anatomical and functional interpretations which will be useful for further studies on comparative anatomy. Four specimens of S. apella from the Human Anatomy Laboratory of Universidade Federal de Uberlandia were used. The specimens were prepared through dissection of the stabilizing muscles of the shoulder and preserved in formaldehyde solution. It was observed that the shoulder stabilizing muscles of the S. apella present morphological similarities, regarding origin and branching, with those found in human beings, as well as in other primates.

  12. On the homology of the shoulder girdle in turtles. (United States)

    Nagashima, Hiroshi; Sugahara, Fumiaki; Takechi, Masaki; Sato, Noboru; Kuratani, Shigeru


    The shoulder girdle in turtles is encapsulated in the shell and has a triradiate morphology. Due to its unique configuration among amniotes, many theories have been proposed about the skeletal identities of the projections for the past two centuries. Although the dorsal ramus represents the scapular blade, the ventral two rami remain uncertain. In particular, the ventrorostral process has been compared to a clavicle, an acromion, and a procoracoid based on its morphology, its connectivity to the rest of the skeleton and to muscles, as well as with its ossification center, cell lineage, and gene expression. In making these comparisons, the shoulder girdle skeleton of anurans has often been used as a reference. This review traces the history of the debate on the homology of the shoulder girdle in turtles. And based on the integrative aspects of developmental biology, comparative morphology, and paleontology, we suggest acromion and procoracoid identities for the two ventral processes.

  13. Shoulder physical activity, functional disability and task difficulties in patients with stiff shoulders: interpretation from RT3 accelerator. (United States)

    Yang, Jing-Lan; Lin, Jiu-Jenq; Huang, Han-Yi; Huang, Tsun-Shun; Chao, Yu Wen


    We determined whether the degree of symptom-related functional disability was related to daily physical activity of the shoulder in subjects with stiff shoulders (SSs). Responsiveness and a clinically meaningful level of discrimination between improvement and non-improvement for shoulder physical activity (SPA) were determined. Twenty-six subjects with SSs participated. Shoulder physical activity was assessed by RT3 accelerometers fixed on the humerus during daily 14-h data collection periods twice a week for 2 weeks. A moderate correlation coefficient was found between SPA and functional disability (β = .47). Based on our cohort design and sample, we suggest that SPA (higher than 101.8 counts, hard-moderate or hard tasks) during daily activity are associated with (with at least 83% probability) non-improvement in an individual with SS. Compared to the non-improvement group, the improvement group had less duration of sedentary activity, less frequency and duration of hard tasks, and more frequency and duration of easy tasks (p physical activities for subjects with SS is important to consider in rehabilitation strategies for these subjects. In our sample, a hard level of shoulder physical activity and sedentary activity should be cautious for these subjects. Further study is needed to validate therapeutic effect of physical activity on the course of patient improvement in subjects with SSs.

  14. Cardiac resynchronization therapy in a patient with amyloid cardiomyopathy. (United States)

    Zizek, David; Cvijić, Marta; Zupan, Igor


    Cardiac involvement in systemic light chain amyloidosis carries poor prognosis. Amyloid deposition in the myocardium can alter regional left ventricular contraction and cause dyssynchrony. Cardiac resynchronization therapy (CRT) is an effective treatment strategy for patients with advanced heart failure and echocardiographic dyssynchrony. We report a clinical and echocardiographic response of a patient with amyloid cardiomyopathy, treated with a combination of chemotherapy and CRT.

  15. The Effect of Glycosaminoglycans (GAGs on Amyloid Aggregation and Toxicity

    Directory of Open Access Journals (Sweden)

    Clara Iannuzzi


    Full Text Available Amyloidosis is a protein folding disorder in which normally soluble proteins are deposited extracellularly as insoluble fibrils, impairing tissue structure and function. Charged polyelectrolytes such as glycosaminoglycans (GAGs are frequently found associated with the proteinaceous deposits in tissues of patients affected by amyloid diseases. Experimental evidence indicate that they can play an active role in favoring amyloid fibril formation and stabilization. Binding of GAGs to amyloid fibrils occurs mainly through electrostatic interactions involving the negative polyelectrolyte charges and positively charged side chains residues of aggregating protein. Similarly to catalyst for reactions, GAGs favor aggregation, nucleation and amyloid fibril formation functioning as a structural templates for the self-assembly of highly cytotoxic oligomeric precursors, rich in β-sheets, into harmless amyloid fibrils. Moreover, the GAGs amyloid promoting activity can be facilitated through specific interactions via consensus binding sites between amyloid polypeptide and GAGs molecules. We review the effect of GAGs on amyloid deposition as well as proteins not strictly related to diseases. In addition, we consider the potential of the GAGs therapy in amyloidosis.

  16. Structural network alterations and neurological dysfunction in cerebral amyloid angiopathy

    NARCIS (Netherlands)

    Reijmer, Yael D.; Fotiadis, Panagiotis; Martinez-Ramirez, Sergi; Salat, David H.; Schultz, Aaron; Shoamanesh, Ashkan; Ayres, Alison M.; Vashkevich, Anastasia; Rosas, Diana; Schwab, Kristin; Leemans, Alexander; Biessels, Geert Jan; Rosand, Jonathan; Johnson, Keith A.; Viswanathan, Anand; Gurol, M. Edip; Greenberg, Steven M.


    Cerebral amyloid angiopathy is a common form of small-vessel disease and an important risk factor for cognitive impairment. The mechanisms linking small-vessel disease to cognitive impairment are not well understood. We hypothesized that in patients with cerebral amyloid angiopathy, multiple small s

  17. Native human serum amyloid P component is a single pentamer

    DEFF Research Database (Denmark)

    Sørensen, Inge Juul; Andersen, Ove; Nielsen, EH;


    Serum amyloid P component (SAP) and C-reactive protein (CRP) are members of the pentraxin protein family. SAP is the precursor protein to amyloid P component present in all forms of amyloidosis. The prevailing notion is that SAP in circulation has the form of a double pentameric molecule (decamer...

  18. Specific Triazine Herbicides Induce Amyloid-beta(42) Production

    NARCIS (Netherlands)

    Portelius, Erik; Durieu, Emilie; Bodin, Marion; Cam, Morgane; Pannee, Josef; Leuxe, Charlotte; Mabondzo, Aloise; Oumata, Nassima; Galons, Herve; Lee, Jung Yeol; Chang, Young-Tae; Stuber, Kathrin; Koch, Philipp; Fontaine, Gaelle; Potier, Marie-Claude; Manousopoulou, Antigoni; Garbis, Spiros D.; Covaci, Adrian; Van Dam, Debby; De Deyn, Peter; Karg, Frank; Flajolet, Marc; Omori, Chiori; Hata, Saori; Suzuki, Toshiharu; Blennow, Kaj; Zetterberg, Henrik; Meijer, Laurent


    Proteolytic cleavage of the amyloid-beta protein precursor (A beta PP) ecretases leads to extracellular release of amyloid-beta (A beta) peptides. Increased production of A beta(42) over A beta(40) and aggregation into oligomers and plaques constitute an Alzheimer's disease (AD) hallmark. Identifyin

  19. Unraveling the mystery of protein-amyloid binding mechanisms

    NARCIS (Netherlands)

    Beringer, D.


    There are several diseases which are caused by amyloid, a deposit of aggregated protein. Examples of these diseases are Alzheimer’s disease, caused by the aggregation of the peptide Aβ, and Diabetes type 2, caused by hIAPP aggregates. A large number of proteins interact with these amyloid fibrils, s

  20. Definitive Treatment of Infected Shoulder Arthroplasty With a Cement Spacer. (United States)

    Mahure, Siddharth A; Mollon, Brent; Yu, Stephen; Kwon, Young W; Zuckerman, Joseph D


    Infection in the setting of shoulder arthroplasty can result in significant pain, loss of function, and the need for additional surgery. As the use of shoulder arthroplasty increases, the medical and economic burdens of periprosthetic joint infection increase as well. The ideal management of infected shoulder prostheses has not been established. This report describes 9 patients from a single institution who had an infected shoulder arthroplasty that was definitively managed with a cement spacer. All patients had a minimum of 2 years of follow-up. Of the 9 patients in this study, 6 were men. Mean age was 73±9 years. Of the study patients, 1 had diabetes, 2 presented with Parkinson's disease, and 5 had a history of tobacco use. Average body mass index was 27.9±7 kg/m(2). After mean follow-up of 4 years, none of the patients had clinical or radiographic evidence of infection. Functional outcomes, as measured by American Shoulder and Elbow Surgeons scores, were good or fair in 89% of patients, and the average American Shoulder and Elbow Surgeons score was 57. A review of recent literature suggested that the current findings were similar to those in studies reporting 1- or 2-stage revision procedures. Although cement spacers are typically used as part of a 2-stage revision procedure, the current findings suggest that cement spacers can be used effectively to eradicate infection and allow for acceptable functional recovery and range of motion in patients who have severe medical comorbidities and cannot tolerate additional surgery. [Orthopedics. 2016; 39(5):e924-e930.].

  1. The Relation between Calcium Supplement Consumption and Calcific Shoulder Tendonitis

    Directory of Open Access Journals (Sweden)

    Alireza Rouhani


    Full Text Available Background: Calcific tendonitis is a common cause of non-traumatic shoulder pain. Previous studies have suggested a relation between minerals and endocrine and calcium deposition. Thus, hypercalcemia is probably related to calcific tendonitis. This study aims at evaluating the relation found between calcium supplement consumption and calcific shoulder tendonitis. Methods: This analytical-descriptive study was conducted on 250 patients with shoulder pain referring to clinics and emergency department of Shohada Orthopedics Hospital during one year for considering calcific shoulder tendonitis and calcium supplement consumption. Patients with calcific tendonitis were treated and their functional ability was evaluated using DASH questionnaire, pain severity and range of motion (ROM before and after treatment and their correlation with calcium supplement consumption. Results: Calcific tendonitis and calcium consumption were generally seen in 30 (12% and 73 (29.2% cases, respectively. Calcium consumption frequency in patients with calcific tendonitis was significantly higher than the patients who did not consume calcium supplements (76.7% vs. 22.7%. Patients with calcific tendonitis who did not consume calcium supplements suffered from significantly longer periods of shoulder pain. All patients having consumed calcium supplement were female. The group who consumed calcium supplement had significantly severe pain and higher DASH score before and after treatment, while there was no significant difference in number of impaired ROM before and after treatment. Also, there was a negative correlation between calcium supplement consumption, pain severity and DASH score before and after treatment. Conclusion: Calcium supplement consumption is related to calcific tendonitis and is also accompanied with more pain and lower functional ability in patients with calcific tendonitis.    Keywords: Calcific tendonitis; Shoulder; Calcium supplement; Pain

  2. Hemiplegic shoulder pain: evidence of a neuropathic origin. (United States)

    Zeilig, Gabi; Rivel, Michal; Weingarden, Harold; Gaidoukov, Evgeni; Defrin, Ruth


    Hemiplegic shoulder pain (HSP) is common after stroke. Whereas most studies have concentrated on the possible musculoskeletal factors underlying HSP, neuropathic aspects have hardly been studied. Our aim was to explore the possible neuropathic components in HSP, and if identified, whether they are specific to the shoulder or characteristic of the entire affected side. Participants included 30 poststroke patients, 16 with and 14 without HSP, and 15 healthy controls. The thresholds of warmth, cold, heat-pain, touch, and graphesthesia were measured in the intact and affected shoulder and in the affected lower leg. They were also assessed for the presence of allodynia and hyperpathia, and computed tomography/magnetic resonance imaging scans of the brain were reviewed. In addition, chronic pain was characterized. Participants with HSP exhibited higher rates of parietal lobe damage (P<0.05) compared to those without HSP. Both poststroke groups exhibited higher sensory thresholds than healthy controls. Those with HSP had higher heat-pain thresholds in both the affected shoulder (P<0.001) and leg (P<0.01), exhibited higher rates of hyperpathia in both these regions (each P<0.001), and more often reported chronic pain throughout the affected side (P<0.001) than those without HSP. The more prominent sensory alterations in the shoulder region suggest that neuropathic factors play a role in HSP. The clinical evidence of damage to the spinothalamic-thalamocortical system in the affected shoulder and leg, the presence of chronic pain throughout the affected side, and the more frequent involvement of the parietal cortex all suggest that the neuropathic component is of central origin.

  3. Simple self-reduction method for anterior shoulder dislocation

    Institute of Scientific and Technical Information of China (English)

    Reiner Wirbel; Martin Ruppert; Elmar Schwarz; Bernhard Zapp


    Objective:To demonstrate and evaluate a modified simple method about self-reduction of anterior shoulder dislocation for significance in the emergency room. Methods:TheBoss-Holzach-Matter method for self-reduction of anterior shoulder disloaction is described.Patients with an anterior shoulder dislocation were retrospectively analysed concerning age, gender, type of anterior shoulder dislocation, occurrence of associated fractures, time between injury and reduction, reduction time, and method of reduction with its respective success rate. Results:Eighty-six patients(52 men,34 women, mean age49 years) were treated fromJanuary 2010 toJune2014.The reduction time ranged between20 seconds and6 min(mean1.5 min). Subcoracoid type of shoulder dislocation was seen in72 cases(84%), subglenoid type in14 cases(16%).Associated factures were seen in20 cases, proportionally more often in subgleboid dislocations,12 at the greater tuberosity,6 at the inferior rim of the glenoid fossa and2 at both localizations.TheBoss-Holzach-Matter method was used in35 cases with a success rate of 71.5%; dieKocher method and traction/countertraction method with premedication were used in 14 cases and17 cases with success rates of64% and70%, respectively.All other cases and the failed primary attempts required hyponotic medication.All patients older than70(n=16) were not able to perform the self reducing procedure. Conclusion:The presentedBoss-Holzach-Matter method for reduction of anterior shoulder dislocation is a simple method without the need of anaesthesia, but cooperation from patients is crucial.The successful rate is comparable with other established methods.

  4. Shoulder arthroplasty in complex acute and chronic proximal humeral fractures

    DEFF Research Database (Denmark)

    Frich, Lars Henrik; Søjbjerg, J.O.; Sneppen, O.


    From 1983 to 1988, 42 shoulder arthroplasties were performed on comminuted acute or chronic proximal humeral fractures. Patients were categorized according to the post-fracture operative delay; there were 15 four-part fractures, with median post-fracture delay of 13 days (range: 7 to 21), and 27...... instability were seen in shoulders formerly treated with osteosynthesis (one acute and four chronic cases). Two of these cases developed an infection. Good results can be expected after prosthetic replacement in acute proximal humeral fractures. Failed primary treatment reduces the possibility of a good...

  5. Shoulder arthroplasty. Part 2: Normal and abnormal radiographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Sheridan, B.D., E-mail: [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom); Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P. [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom)


    Frequently, the decision made by general practitioners or musculoskeletal triage assessment services to refer patients for specialist review is initiated by a radiological report. Following shoulder arthroplasty it is important to ensure that any patient with asymptomatic evidence of a failing prosthesis is referred for review so that revision surgery can be contemplated and planned before the situation becomes unsalvageable. The first paper in this series described the various types of shoulder arthroplasty and indications for each. This follow-up paper will concentrate on their modes of failure and the associated radiographic features, and is aimed at radiology trainees and non-musculoskeletal specialist radiologists.

  6. Calcifying tendinitis of the shoulder: advances in imaging and management. (United States)

    Gosens, Taco; Hofstee, Dirk-Jan


    Calcifying tendonitis of the shoulder is a common, acute or chronic, painful disorder characterized by calcifications in the rotator cuff tendons. A natural cycle exists during which the tendon repairs itself. In chronic calcific tendonitis, however, this cycle is blocked at one of the healing stages. Because chronic presentation with exacerbations is usual, initial treatment should be conservative, including rest, physical therapy, nonsteroidal anti-inflammatory drugs, and, in later stages, subacromial infiltration with corticosteroids. Surgery is recommended when conservative treatment fails. This article discusses advances in imaging and medical, physical, and surgical management, as well as current evidence for the treatment of calcifying tendonitis of the shoulder.

  7. Intertester reliability of shoulder complaints diagnoses in primary health care (United States)

    Storheil, Benny; Klouman, Elise; Holmvik, Stian; Emaus, Nina; Fleten, Nils


    Objective Shoulder complaints are frequently encountered in general practice, but precise diagnosing is challenging. This study investigated agreement of shoulder complaints diagnoses between clinicians in a primary health care setting. Design Cross-sectional study. Setting Four primary health care clinicians used patients’ history and functional examination of the shoulder by selective tissue tension techniques (STTs), to diagnose shoulder complaints. Subjects 62 patients, aged 18–75 years. Main outcome measure Reliability of diagnoses was assessed by observed intertester agreement and Cohen’s kappa. A total of 372 diagnostic pairs were available for intertester comparisons. Results Six diagnoses were assigned by all clinicians; supraspinatus-, infraspinatus-, subscapularis-tendinopathies; chronic subacromial bursitis; glenohumeral capsulitis, and acromioclavicular joint lesion. The observed agreement on these diagnoses ranged from 0.84 for glenohumeral capsulitis to 0.97 for acromioclavicular joint lesion. Kappa scores were 0.46 (95% CI 0.33, 0.58) for chronic subacromial bursitis; 0.53 (95% CI 0.34, 0.68), 0.59 (95% CI 0.47, 0.70), and 0.68 (95% CI 0.53, 0.82) for infraspinatus -, supraspinatus -, and subscapularis-tendinopathy, respectively. For glenohumeral capsulitis and acromioclavicular lesion kappa scores were 0.66 (95% CI 0.57, 0.73) and 0.78 (95% CI 0.61, 0.90). Kappa scores were higher for individual diagnoses than for individual tests, except for limitation in passive abduction (0.70, 95% CI 0.62, 0.78) and passive lateral rotation (0.66, 95% CI 0.57, 0.73). Conclusions Although experienced clinicians showed substantial intertester agreement, precise diagnoses of shoulder complaints in primary health care remain a challenge. The present results call for further research on refined diagnoses of shoulder complaints. Key Points Based on medical history and a systematic functional examination by selective tissue tension techniques (STTs), we

  8. Contractile dysfunction of the shoulder (rotator cuff tendinopathy): an overview. (United States)

    Littlewood, Chris


    It is now over a decade since the features defining a contractile dysfunction of the shoulder were first reported. Since this time, some progress has been made to better understand this mechanical syndrome. In response to these developments, this narrative review will explore current understanding in relation to pathology, diagnosis, treatment, and prognosis of this syndrome with reference to literature specifically relating to contractile dysfunction but also literature relating to rotator cuff tendinopathy where necessary. The review not only identifies the strengths of the mechanical diagnosis and therapy approach with reference to a contractile dysfunction of the shoulder but also identifies where further progress needs to be made.

  9. Anterior dislocation of shoulder in eclampsia:a case report

    Institute of Scientific and Technical Information of China (English)

    Seema Rawat; Sanjay Meena; Shreesh Kumar Gangari; Lalit Kumar Lohia


    This case report presents a 25-year-old female patient with anterior dislocation of right shoulder secondary to seizures as a complication of eclampsia.This is an unusual mechanism of injury,but similar to other uncontrolled muscular contractions caused by electroconvulsive therapy,etc.To the best of our knowledge only one such case has been reported in the English literature.Closed reduction under general anaesthesia was successfully achieved.High suspicion in patients complaining of pain over shoulder joint is necessary for early diagnosis of this condition.

  10. Laser-induced propagation and destruction of amyloid beta fibrils. (United States)

    Yagi, Hisashi; Ozawa, Daisaku; Sakurai, Kazumasa; Kawakami, Toru; Kuyama, Hiroki; Nishimura, Osamu; Shimanouchi, Toshinori; Kuboi, Ryoichi; Naiki, Hironobu; Goto, Yuji


    The amyloid deposition of amyloid beta (Abeta) peptides is a critical pathological event in Alzheimer disease (AD). Preventing the formation of amyloid deposits and removing preformed fibrils in tissues are important therapeutic strategies against AD. Previously, we reported the destruction of amyloid fibrils of beta(2)-microglobulin K3 fragments by laser irradiation coupled with the binding of amyloid-specific thioflavin T. Here, we studied the effects of a laser beam on Abeta fibrils. As was the case for K3 fibrils, extensive irradiation destroyed the preformed Abeta fibrils. However, irradiation during spontaneous fibril formation resulted in only the partial destruction of growing fibrils and a subsequent explosive propagation of fibrils. The explosive propagation was caused by an increase in the number of active ends due to breakage. The results not only reveal a case of fragmentation-induced propagation of fibrils but also provide insights into therapeutic strategies for AD.

  11. Prevalence of cerebral amyloid pathology in persons without dementia

    DEFF Research Database (Denmark)

    Jansen, Willemijn J; Ossenkoppele, Rik; Knol, Dirk L;


    IMPORTANCE: Cerebral amyloid-β aggregation is an early pathological event in Alzheimer disease (AD), starting decades before dementia onset. Estimates of the prevalence of amyloid pathology in persons without dementia are needed to understand the development of AD and to design prevention studies....... OBJECTIVE: To use individual participant data meta-analysis to estimate the prevalence of amyloid pathology as measured with biomarkers in participants with normal cognition, subjective cognitive impairment (SCI), or mild cognitive impairment (MCI). DATA SOURCES: Relevant biomarker studies identified...... for amyloid positivity. DATA EXTRACTION AND SYNTHESIS: Individual records were provided for 2914 participants with normal cognition, 697 with SCI, and 3972 with MCI aged 18 to 100 years from 55 studies. MAIN OUTCOMES AND MEASURES: Prevalence of amyloid pathology on positron emission tomography...

  12. Amyloid-like protein inclusions in tobacco transgenic plants.

    Directory of Open Access Journals (Sweden)

    Anna Villar-Piqué

    Full Text Available The formation of insoluble protein deposits in human tissues is linked to the onset of more than 40 different disorders, ranging from dementia to diabetes. In these diseases, the proteins usually self-assemble into ordered β-sheet enriched aggregates known as amyloid fibrils. Here we study the structure of the inclusions formed by maize transglutaminase (TGZ in the chloroplasts of tobacco transplastomic plants and demonstrate that they have an amyloid-like nature. Together with the evidence of amyloid structures in bacteria and fungi our data argue that amyloid formation is likely a ubiquitous process occurring across the different kingdoms of life. The discovery of amyloid conformations inside inclusions of genetically modified plants might have implications regarding their use for human applications.

  13. Preparation of Amyloid Fibrils Seeded from Brain and Meninges. (United States)

    Scherpelz, Kathryn P; Lu, Jun-Xia; Tycko, Robert; Meredith, Stephen C


    Seeding of amyloid fibrils into fresh solutions of the same peptide or protein in disaggregated form leads to the formation of replicate fibrils, with close structural similarity or identity to the original fibrillar seeds. Here we describe procedures for isolating fibrils composed mainly of β-amyloid (Aβ) from human brain and from leptomeninges, a source of cerebral blood vessels, for investigating Alzheimer's disease and cerebral amyloid angiopathy. We also describe methods for seeding isotopically labeled, disaggregated Aβ peptide solutions for study using solid-state NMR and other techniques. These methods should be applicable to other types of amyloid fibrils, to Aβ fibrils from mice or other species, tissues other than brain, and to some non-fibrillar aggregates. These procedures allow for the examination of authentic amyloid fibrils and other protein aggregates from biological tissues without the need for labeling the tissue.

  14. Development of [F-18]-Labeled Amyloid Imaging Agents for PET

    Energy Technology Data Exchange (ETDEWEB)

    Mathis, CA


    The applicant proposes to design and synthesize a series of fluorine-18-labeled radiopharmaceuticals to be used as amyloid imaging agents for positron emission tomography (PET). The investigators will conduct comprehensive iterative in vitro and in vivo studies based upon well defined acceptance criteria in order to identify lead agents suitable for human studies. The long term goals are to apply the selected radiotracers as potential diagnostic agents of Alzheimer's disease (AD), as surrogate markers of amyloid in the brain to determine the efficacy of anti-amyloid therapeutic drugs, and as tools to help address basic scientific questions regarding the progression of the neuropathology of AD, such as testing the "amyloid cascade hypothesis" which holds that amyloid accumulation is the primary cause of AD.

  15. Is it possible to reduce obstetrical brachial plexus palsy by optimal management of shoulder dystocia? (United States)

    Doumouchtsis, Stergios K; Arulkumaran, Sabaratnam


    Obstetrical brachial plexus palsies (OBPP) have been historically attributed to the impaction of the fetal shoulder behind the symphysis pubis and to excessive lateral traction of the fetal head during maneuvers to deliver the fetal shoulders in shoulder dystocia. Shoulder dystocia is indeed a major risk factor as it increases the risk for OBPP 100-fold. The incidence of OBPP following shoulder dystocia varies widely from 4% to 40%. However, a significant proportion of OBPPs are secondary to in utero injury. The propulsive forces of labor, intrauterine maladaptation, and compression of the posterior shoulder against the sacral promontory as well as uterine anomalies are possible intrauterine causes of OBPP. Many risk factors for OBPP may be unpredictable. Early identification of risk factors for shoulder dystocia, as well as appropriate management when it occurs, may improve our ability to prevent the occurrence of OBPP in those cases that are caused by shoulder dystocia.

  16. 78 FR 36307 - Proposed Information Collection (Shoulder and Arm Conditions Disability Benefits Questionnaire... (United States)


    ... AFFAIRS Proposed Information Collection (Shoulder and Arm Conditions Disability Benefits Questionnaire... Disability Benefits Questionnaire)'' in any correspondence. During the comment period, comments may be viewed.... SUPPLEMENTARY INFORMATION: Title: Shoulder and Arm Conditions Disability Benefits Questionnaire, VA Form...

  17. 78 FR 65451 - Agency Information Collection (Shoulder and Arm Conditions Disability Benefits Questionnaire... (United States)


    ... AFFAIRS Agency Information Collection (Shoulder and Arm Conditions Disability Benefits Questionnaire... Disability Benefits Questionnaire)'' in any correspondence. FOR FURTHER INFORMATION CONTACT: Crystal Rennie... (Shoulder and Arm Conditions Disability Benefits Questionnaire).'' SUPPLEMENTARY INFORMATION:...

  18. Idiopathic snapping scapula in a Moroccan patient: A rare cause of shoulder pain

    Directory of Open Access Journals (Sweden)

    Kona Kaut Irène


    Conclusion: Our case illustrates a new case of a jumped shoulder blade of unknown origin after completion of all etiological imaging. Further analysis of clinical events is needed to better understand this type of jumped shoulder blade.

  19. Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome

    DEFF Research Database (Denmark)

    Storgaard, Filip Holst; Pedersen, Christina Gravgaard; Jensen, Majbritt Lykke

    Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome.......Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome....

  20. Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy (United States)

    Dierksen, Gregory; Betensky, Rebecca; Gidicsin, Christopher; Halpin, Amy; Becker, Alex; Carmasin, Jeremy; Ayres, Alison; Schwab, Kristin; Viswanathan, Anand; Salat, David; Rosand, Jonathan; Johnson, Keith A.; Greenberg, Steven M.


    Objective: We aimed to determine whether amyloid imaging can help predict the location and number of future hemorrhages in cerebral amyloid angiopathy (CAA). Methods: We performed a longitudinal cohort study of 11 patients with CAA without dementia who underwent serial brain MRIs after baseline amyloid imaging with Pittsburgh compound B (PiB). Mean distribution volume ratio (DVR) of PiB was determined at the sites of new micro/macrobleeds identified on follow-up MRI and compared with PiB retention at “simulated” hemorrhages, randomly placed in the same subjects using a probability distribution map of CAA-hemorrhage location. Mean PiB retention at the sites of observed new bleeds was also compared to that in shells concentrically surrounding the bleeds. Finally the association between number of incident bleeds and 3 regional amyloid measures were obtained. Results: Nine of 11 subjects had at least one new microbleed on follow-up MRI (median 4, interquartile range [IQR] 1–9) and 2 had 5 new intracerebral hemorrhages. Mean DVR was greater at the sites of incident bleeds (1.34, 95% confidence interval [CI] 1.23–1.46) than simulated lesions (1.14, 95% CI 1.07–1.22, p < 0.0001) in multivariable models. PiB retention decreased with increasing distance from sites of observed bleeds (p < 0.0001). Mean DVR in a superior frontal/parasagittal region of interest correlated independently with number of future hemorrhages after adjustment for relevant covariates (p = 0.003). Conclusions: Our results provide direct evidence that new CAA-related hemorrhages occur preferentially at sites of increased amyloid deposition and suggest that PiB-PET imaging may be a useful tool in prediction of incident hemorrhages in patients with CAA. PMID:22786597

  1. Stability and cytotoxicity of crystallin amyloid nanofibrils (United States)

    Kaur, Manmeet; Healy, Jackie; Vasudevamurthy, Madhusudan; Lassé, Moritz; Puskar, Ljiljana; Tobin, Mark J.; Valery, Celine; Gerrard, Juliet A.; Sasso, Luigi


    Previous work has identified crystallin proteins extracted from fish eye lenses as a cheap and readily available source for the self-assembly of amyloid nanofibrils. However, before exploring potential applications, the biophysical aspects and safety of this bionanomaterial need to be assessed so as to ensure that it can be effectively and safely used. In this study, crude crystallin amyloid fibrils are shown to be stable across a wide pH range, in a number of industrially relevant solvents, at both low and high temperatures, and in the presence of proteases. Crystallin nanofibrils were compared to well characterised insulin and whey protein fibrils using Thioflavin T assays and TEM imaging. Cell cytotoxicity assays suggest no adverse impact of both mature and fragmented crystallin fibrils on cell viability of Hec-1a endometrial cells. An IR microspectroscopy study supports long-term structural integrity of crystallin nanofibrils.Previous work has identified crystallin proteins extracted from fish eye lenses as a cheap and readily available source for the self-assembly of amyloid nanofibrils. However, before exploring potential applications, the biophysical aspects and safety of this bionanomaterial need to be assessed so as to ensure that it can be effectively and safely used. In this study, crude crystallin amyloid fibrils are shown to be stable across a wide pH range, in a number of industrially relevant solvents, at both low and high temperatures, and in the presence of proteases. Crystallin nanofibrils were compared to well characterised insulin and whey protein fibrils using Thioflavin T assays and TEM imaging. Cell cytotoxicity assays suggest no adverse impact of both mature and fragmented crystallin fibrils on cell viability of Hec-1a endometrial cells. An IR microspectroscopy study supports long-term structural integrity of crystallin nanofibrils. Electronic supplementary information (ESI) available: ThT fluorescence graphs of buffers and solvents used for

  2. Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty


    Booker, Simon; Alfahad, Nawaf; Scott, Martin; Gooding, Ben; Wallace, W. Angus


    To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from pati...

  3. Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain



    Abstract Background Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Methods Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with ...

  4. Counterrotating-Shoulder Mechanism for Friction Stir Welding (United States)

    Nunes, Arthur C., Jr.


    A counterrotating-shoulder mechanism has been proposed as an alternative to the mechanism and fixtures used in conventional friction stir welding. The mechanism would internally react most or all of the forces and torques exerted on the workpiece, making it unnecessary to react the forces and torques through massive external fixtures. In conventional friction stir welding, a rotating pin tool is inserted into, and moved along, a weld seam. As the pin tool moves, it stirs together material from the opposite sides of the seam to form the weld. A large axial plunge force must be exerted upon the workpiece through and by the pin tool and a shoulder attached above the pin tool in order to maintain the pressure necessary for the process. The workpiece is secured on top of an anvil, which supports the workpiece against the axial plunge force and against the torque exerted by the pin tool and shoulder. The anvil and associated fixtures must be made heavy (and, therefore, are expensive) to keep the workpiece stationary. In addition, workpiece geometries must be limited to those that can be accommodated by the fixtures. The predecessor of the proposed counterrotating-shoulder mechanism is a second-generation, self-reacting tool, resembling a bobbin, that makes it possible to dispense with the heavy anvil. This tool consists essentially of a rotating pin tool with opposing shoulders. Although the opposing shoulders maintain the necessary pressure without need to externally apply or react a large plunge force, the torque exerted on the workpiece remains unreacted in the absence of a substantial external fixture. Depending on the RPM and the thickness of the workpiece, the torque can be large. The proposed mechanism (see figure) would include a spindle attached to a pin tool with a lower shoulder. The spindle would be coupled via splines to the upper one of three bevel gears in a differential drive. The middle bevel gear would be the power-input gear and would be coupled to the

  5. 46 CFR 160.031-4 - Equipment for shoulder gun type line-throwing appliance. (United States)


    ... 46 Shipping 6 2010-10-01 2010-10-01 false Equipment for shoulder gun type line-throwing appliance... Appliance, Shoulder Gun Type (and Equipment) § 160.031-4 Equipment for shoulder gun type line-throwing... the gun. The line canister shall be secured by clamps or brackets below the barrel of the gun. (c)...

  6. Incidence of shoulder pain after neck dissection : A clinical explorative study for risk factors

    NARCIS (Netherlands)

    Dijkstra, PU; van Wilgen, PC; Brendeke, W; de Goede, CJT; Kerst, A; Koolstra, M; Marinus, J; Schoppink, EM; Stuiver, MM; van de Velde, CF; Roodenburg, JLN


    Background. It is the purpose of this study to determine the incidence of shoulder pain and restricted range of motion of the shoulder after neck dissection, and to identify risk factors for the development of shoulder pain and restricted range of motion. Methods. Clinical patients who underwent a n

  7. Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain

    DEFF Research Database (Denmark)

    Andersen, Lars L; Hansen, Klaus; Mortensen, Ole S;


    Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults...... with nonspecific neck/shoulder pain....

  8. The role of experimentally-induced subacromial pain on shoulder strength and throwing accuracy. (United States)

    Wassinger, Craig A; Sole, Gisela; Osborne, Hamish


    Shoulder injuries often comprise two separate yet related components, structural tissue damage and pain. The role of each of these components on shoulder function is difficult to ascertain. Experimental pain models allow the assessment of consequences of localized pain when applied to healthy individuals. By understanding the role of pain on shoulder function, clinicians will be able to more efficiently assess and treat shoulder injuries. The objective of the study was to evaluate the role of experimentally-induced sub-acromial pain on shoulder isokinetic rotational strength and throwing accuracy. This was a block counterbalanced, crossover, repeated measures study design utilizing 20 individuals without self-reported shoulder or cervical pathology. Shoulder function was measured with and without experimental pain injection (2 mL of 5% hypertonic saline) in the sub-acromial space. Functional tasks consisted of shoulder rotational strength utilizing isokinetic testing and throwing accuracy via the functional throwing performance index. The hypertonic saline induced moderate pain levels in all participants (4.3-5.1/10). Normalized shoulder internal (t = 3.76, p = 0.001) and external (t = 3.12, p = 0.006) rotation strength were both diminished in the painful condition compared to the pain free condition. Throwing accuracy was also reduced while the participants experienced pain (t = 3.99, p = 0.001). Moderate levels of experimental shoulder pain were sufficient to negatively influence shoulder strength and throwing accuracy in participants without shoulder pathology.

  9. Musculoskeletal ultrasonographic findings of the affected and unaffected shoulders in hemiplegic patients

    Directory of Open Access Journals (Sweden)

    Fatma Ali


    Conclusion Hemiplegic stroke Results in injury to the affected shoulder and the shoulder on the unaffected side. Musculoskeletal ultrasonography is an essential method in the evaluation of poststroke painful hemiplegic shoulder. However, the US grades did not correlate with the stages of motor recovery.

  10. Treatment of myofascial trigger points in patients with chronic shoulder pain : a randomized, controlled trial

    NARCIS (Netherlands)

    Bron, Carel; de Gast, Arthur; Dommerholt, Jan; Stegenga, Boudewijn; Wensing, Michel; Oostendorp, Rob A. B.


    Background: Shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. Myofascial trigger points (MTrPs) cause shoulder pain and are prevalent in patients with shoulder pain. However, few studies have focused on MTrP therapy. The aim of this study was to assess the effecti

  11. Episodical CO2 emission during shoulder seasons in the arctic

    DEFF Research Database (Denmark)

    Friborg, Thomas; Elberling, Bo; Hansen, Birger

    and the driving processes behind winter time exchange of CO2 are not fully understood. Here we present two very different examples of CO2 exchange from shoulder seasons in the Arctic. In an example from NE Greenland, eddy covariance measurements show that the snow cover has a significant effect on the release...

  12. A review of national shoulder and elbow joint replacement registries

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe V; Olsen, Bo S; Fevang, Bjørg-Tilde S


    The aim was to review the funding, organization, data handling, outcome measurements, and findings from existing national shoulder and elbow joint replacement registries; to consider the possibility of pooling data between registries; and to consider wether a pan european registry might be feasible....

  13. Pseudoseptic arthritis of the shoulder following pneumococcal vaccination. (United States)

    Floyd, Mark W; Boyce, Brandon M; Castellan, Robert M; McDonough, E Barry


    Pseudoseptic arthritis is primarily described in rheumatoid arthritis and other systemic inflammatory conditions. To our knowledge, only 1 case report of pseudoseptic arthritis associated with intra-articular injection of a pneumococcal polyvalent vaccine (PPV) has been published. Here, a second case is presented in which a patient presented with swelling, pain, and erythema of the affected shoulder. A 59-year-old woman presented to the emergency department with a 3-day history of severe pain and decreased mobility of her left shoulder after receiving a PPV vaccination. Her clinical and laboratory workup was suspicious for septic arthritis; however, magnetic resonance imaging of the affected shoulder with and without contrast showed only a partial thickness tear of the rotator cuff, fluid in the subacromial/subdeltoid bursa, and subcutaneous edema without evidence of an abscess. Based on the clinical and laboratory data, she underwent arthroscopic debridement. There was inflammatory tissue throughout the shoulder but no obvious purulent material. She did well postoperatively with a supervised range of motion rehabilitation protocol. Her cultures remained negative. At 12 weeks, she was discharged from follow-up. We suspect that the vaccination was inadvertently injected into the glenohumeral joint directly through the rotator cuff given the lack of a full-thickness tear and the patient's thin body habitus, which could explain her aseptic inflammatory arthritis.

  14. Effects of manual therapy on shoulder pain in office workers (United States)

    Go, Seong-Uk; Lee, Byoung-Hee


    [Purpose] The purpose of this study was to determine the effects of manual therapy on shoulder pain in office workers. [Subjects and Methods] Subjects included 38 office workers who were randomly divided into two groups: a manual therapy group of 19 subjects and a shoulder stabilization exercise group of 19 subjects. All subjects underwent evaluation of the pressure pain threshold in the splenius capitis and upper, middle, and lower trapezius muscles on both sides. The manual therapy used in the study was designed to include soft-tissue mobilization, prone thoracic mobilization, prone selected thoracic mobilization, cervical mobilization, and thoracic manipulation. Both groups underwent training of two 40-minute sessions per week for 6 weeks. [Results] After the intervention, both groups showed significantly increased pressure pain thresholds in the splenius capitis and upper, middle, and lower trapezius muscles on both sides. The manual therapy group showed greater improvements than did the shoulder stabilization exercise group in the splenius capitis on both sides, left upper trapezius, middle trapezius on both sides, and right lower trapezius. [Conclusion] The results of this study suggest that manual therapy for shoulder pain is feasible and suitable for office workers and may be useful in clinical rehabilitation. PMID:27799661

  15. Shoulder strength imbalances as injury risk in handball. (United States)

    Edouard, P; Degache, F; Oullion, R; Plessis, J-Y; Gleizes-Cervera, S; Calmels, P


    This study was conducted to analyze whether internal (IR) and external (ER) rotator shoulder muscles weakness and/or imbalance collected through a preseason assessment could be predictors of subsequent shoulder injury during a season in handball players. In preseason, 16 female elite handball players (HPG) and 14 healthy female nonathletes (CG) underwent isokinetic IR and ER strength test with use of a Con-Trex® dynamometer in a seated position with 45° shoulder abduction in scapular plane, at 60, 120 and 240°/s in concentric and at 60°/s in eccentric, for both sides. An imbalanced muscular strength profile was determined using -statistically selected cut-offs from CG values. For HPG, all newly incurred shoulder injuries were reported during the season. There were significant differences between HPG and CG only for dominant eccentric IR strength, ER/IR ratio at 240°/s and for IRecc/ERcon ratio. In HPG, IR and ER strength was higher, and ER/IR ratios lower for dominant than for nondominant side. The relative risk was 2.57 (95%CI: 1.60-3.54; Pmuscle strength increases on the dominant side without ER/IR imbalances; and higher injury risk was associated with imbalanced muscular strength profile.

  16. Orthopedic evaluation and surgical treatment of the spastic shoulder. (United States)

    Namdari, Surena; Baldwin, Keith; Horneff, John G; Keenan, Mary Ann


    The spastic shoulder can often result from brain injury that causes disruption in the upper motor neuron inhibitory pathways. Patients develop dyssynergic muscle activation, muscle weakness, and contractures and often present with fixed adduction and internal rotation deformity to the limb. This article reviews the importance of a comprehensive preoperative evaluation and discusses appropriate treatment strategies based on preoperative evaluation.

  17. Measurement of active shoulder proprioception: dedicated system and device. (United States)

    Lubiatowski, Przemyslaw; Ogrodowicz, Piotr; Wojtaszek, Marcin; Kaniewski, Ryszard; Stefaniak, Jakub; Dudziński, Witold; Romanowski, Leszek


    Proprioception is an essential part of shoulder stability and neuromuscular control. The purpose of the study was the development of a precise system of shoulder proprioception assessment in the active mode (Propriometr). For that purpose, devices such as the electronic goniometer and computer software had been designed. A pilot study was carried out on a control group of 27 healthy subjects, the average age being 23.8 (22-29) in order to test the system. The result of the assessment was the finding of the error of active reproduction of the joint position (EARJP). EARJP was assessed for flexion, abduction, external and internal rotation. For every motion, reference positions were used at three different angles. The results showed EARJP to range in 3-6.1°. The proprioception evaluation system (propriometr) allows a precise measurement of active joint position sense. The designed system can be used to assess proprioception in both shoulder injuries and treatment. In addition, all achieved results of normal shoulders may serve as reference to be compared with the results of forthcoming studies.

  18. Red-shouldered hawk nesting habitat preference in south Texas (United States)

    Strobel, Bradley N.; Boal, Clint W.


    We examined nesting habitat preference by red-shouldered hawks Buteo lineatus using conditional logistic regression on characteristics measured at 27 occupied nest sites and 68 unused sites in 2005–2009 in south Texas. We measured vegetation characteristics of individual trees (nest trees and unused trees) and corresponding 0.04-ha plots. We evaluated the importance of tree and plot characteristics to nesting habitat selection by comparing a priori tree-specific and plot-specific models using Akaike's information criterion. Models with only plot variables carried 14% more weight than models with only center tree variables. The model-averaged odds ratios indicated red-shouldered hawks selected to nest in taller trees and in areas with higher average diameter at breast height than randomly available within the forest stand. Relative to randomly selected areas, each 1-m increase in nest tree height and 1-cm increase in the plot average diameter at breast height increased the probability of selection by 85% and 10%, respectively. Our results indicate that red-shouldered hawks select nesting habitat based on vegetation characteristics of individual trees as well as the 0.04-ha area surrounding the tree. Our results indicate forest management practices resulting in tall forest stands with large average diameter at breast height would benefit red-shouldered hawks in south Texas.

  19. Change in neck circumference after shoulder arthroscopy: An observational study

    Directory of Open Access Journals (Sweden)

    Shrividya Chellam


    Full Text Available Background and Aims: Shoulder arthroscopy requires fluid irrigation, which causes soft-tissue oedema around chest, neck, and arm intraoperatively, leading to postoperative airway complications. We decided to study the incidence of increase in the neck circumference in shoulder arthroscopy and its effects on the airway. Methods: We studied 32 cases of shoulder arthroscopies over a period of 1-year, performed under general anaesthesia with interscalene block. The neck circumference of patients before and after the procedure was measured along with other parameters. The endotracheal tube cuff was deflated at the end of surgery to determine air leak around the tube. The negative leak test suggested airway oedema. Results: Thirty out of 32 patients showed positive air leak test. The average change in neck circumference was 1.17 ± 1.16 cm and all could be extubated uneventfully. Two showed negative leak test with an increase in neck circumference by 4.5 and 6.4 cm and were not extubated. Multiple regression analysis for risk factors showed intraoperative hypertension as a single predictor for an increase in neck circumference. Conclusion: Change in the neck circumference beyond 4 cm may suggest airway compromise and below 4 cm, airway compromise is unlikely even in the presence of extensive soft-tissue oedema around the shoulder, upper arm and chest.

  20. Suprascapular nerve block for the treatment of frozen shoulder

    Directory of Open Access Journals (Sweden)

    Korhan Ozkan


    Full Text Available Aims: The aim of our study was to compare the effects of suprascapular nerve block in patients with frozen shoulder and diabetes mellitus unresponsive to intraarticular steroid injections. Settings and Design: Ten patients without improvement of sign and symptoms after intraarticular injections were made a suprascapular nerve block. Methods: Pain levels and active range of movement of patients were recorded at initial attendance and after 1, 4, and 12 weeks. All patients′ simple pain scores, total pain scores, and range of motion of their shoulders were improved significantly after suprascapular nerve block. Statistical Analysis: In this study, the statistical analyses were performed by using the SPSS 8.0 program (SPSS Software, SPSS Inc., USA. To compare pre- and post-injection results of simple pain score, total pain score, shoulder abduction and external rotation, Wilcoxon test was used. Results: Patient′s simple pain scores, total pain scores also abduction, external rotation and internal rotation angles were improved significantly after suprascapular nerve block. Conclusion: Effective results after suprascapular nerve blockage was obtained for the treatment of refractory frozen shoulder cases.

  1. Modern Treatment Methods of Habitual Shoulder Dislocation (Literature Review

    Directory of Open Access Journals (Sweden)

    Dlyasin N.G.


    Full Text Available In the literature review the groups of the most applicable surgical interventions in treatment of patients with habitual shoulder dislocation are cited. The tendency to increase an application of arthroscopic operations seek to eliminate some realizing factors of dislocation of the humeral head is observed

  2. Cutaneous Manifestations of Familial Transthyretin Amyloid Polyneuropathy. (United States)

    Lanoue, Julien; Wei, Nancy; Gorevic, Peter; Phelps, Robert G


    Familial amyloid polyneuropathy (FAP) is a rare inherited autosomal dominant form of systemic amyloidosis, which classically presents with severe motor, sensory, and autonomic dysfunction. Cutaneous involvement does not become clinically apparent until late stage symptomatic disease and is rarely reported in modern literature. Here, the authors review the clinical and histologic cutaneous findings of FAP previously described in the literature and report on 3 patients with unique genetic mutations (Thr60Ala and Gly6Ser; Trp41Leu; Glu89Gln) for which cutaneous involvement has not previously been described. Histologically, our patients showed variable amyloid deposition in the subcutaneous adipose tissue, papillary dermis, and dermal blood vessel walls. A review of the literature suggests cutaneous transthyretin deposition is an underrecognized feature of FAP that occurs early on in disease, even before neural involvement and related symptoms as seen in one of our patients. As such, a cutaneous punch biopsy can serve as quick, easy, and relatively noninvasive diagnostic tool in suspected cases.

  3. Copernicus revisited: amyloid beta in Alzheimer's disease. (United States)

    Joseph, J; Shukitt-Hale, B; Denisova, N A; Martin, A; Perry, G; Smith, M A


    The beta-amyloid hypothesis of Alzheimer's Disease (AD) has dominated the thinking and research in this area for over a decade and a half. While there has been a great deal of effort in attempting to prove its centrality in this devastating disease, and while an enormous amount has been learned about its properties (e.g., putative toxicity, processing and signaling), Abeta has not proven to be both necessary and sufficient for the development, neurotoxicity, and cognitive deficits associated with this disease. Instead, the few treatments that are available have emerged from aging research and are primarily directed toward modification of acetylcholine levels. Clearly, it is time to rethink this position and to propose instead that future approaches should focus upon altering the age-related sensitivity of the neuronal environment to insults involving such factors as inflammation and oxidative stress. In other words "solve the problems of aging and by extension those of AD will also be reduced." This review is being submitted as a rather Lutherian attempt to "nail an alternative thesis" to the gate of the Church of the Holy Amyloid to open its doors to the idea that aging is the most pervasive element in this disease and Abeta is merely one of the planets.

  4. Magnetite nanoparticle interactions with insulin amyloid fibrils (United States)

    Chen, Yun-Wen; Chang, Chiung-Wen; Hung, Huey-Shan; Kung, Mei-Lang; Yeh, Bi-Wen; Hsieh, Shuchen


    Accumulation of amyloid fibrils is one of the likely key factors leading to the development of Alzheimer’s disease and other amyloidosis associated diseases. Magnetic nanoparticles (NPs) have been developed as promising medical materials for many medical applications. In this study, we have explored the effects of Fe3O4 NPs on the fibrillogenesis process of insulin fibrils. When Fe3O4 NPs were co-incubated with insulin, Fe3O4 NPs had no effect on the structural transformation into amyloid-like fibrils but had higher affinity toward insulin fibrils. We demonstrated that the zeta potential of insulin fibrils and Fe3O4 NPs were both positive, suggesting the binding forces between Fe3O4 NPs and insulin fibrils were van der Waals forces but not surface charge. Moreover, a different amount of Fe3O4 NPs added had no effect on secondary structural changes of insulin fibrils. These results propose the potential use of Fe3O4 NPs as therapeutic agents against diseases related to protein aggregation or contrast agents for magnetic resonance imaging.

  5. Immune functions of serum amyloid A. (United States)

    Eklund, Kari K; Niemi, K; Kovanen, P T


    Serum amyloid A (SAA) is a highly conserved, acute-phase protein synthesized predominantly by the liver. After secretion into the circulation, it associates with high-density lipoprotein (HDL) particles. During acute inflammation, serum SAA levels may rise up to 1000-fold, and under these conditions, SAA displaces apolipoprotein A-I from HDL, thus becoming the major apolipoprotein of circulating HDL3. SAA exhibits significant immunological activity by, for example, inducing the synthesis of several cytokines and by being chemotactic for neutrophils and mast cells. It exerts many of its immunological activities by binding and activating cell-surface receptors, including Toll-like receptor (TLR) 2 and TLR4, formyl peptide receptor-like 1 (FPRL1), class B scavenger receptor CD36, and the ATP receptor P2X7. SAA also recently has been shown to activate the inflammasome cascade, which has a key role in immune activation, thus further stressing the unique role of SAA in immunomodulation. Traditionally, SAA has been considered to have a key role in the pathogenesis of amyloid A-type amyloidosis, but we now understand that it may also participate in the pathogenesis of chronic inflammatory diseases, such as rheumatoid arthritis and atherosclerosis. Thus, SAA is one potential target in the treatment of diseases associated with chronic inflammation. The purpose of this review is to shed light on SAA as an immunologically active protein. We also focus on the recent findings implicating SAA in the regulation of the inflammasome cascade.

  6. Coracoid syndrome: a neglected cause of anterior shoulder pain (United States)



    Purpose the present prospective open-label study was designed to gain further insights into a condition thought to constitute a neglected but not uncommon syndrome characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process, not related to rotator cuff or pectoralis minor tendinopathy, long head of the biceps tendon disorders, or instability. The aim was to clarify its prevalence, clinical characteristics, differential diagnosis and response to corticosteroid injections. Methods patients with primary anterior shoulder pain precisely reproduced by deep pressure on the apex of the coracoid process were recruited. Patients with clinical or instrumental signs of other shoulder disorders were excluded. Patients were given an injection of triamcinolone acetonide 40 mg/ml 1 ml at the coracoid trigger point. They were evaluated after 15, 30 and 60 days and at 2 years using Equal Visual Analog Scale (EQ-VAS) and the Italian version of the Simple Shoulder Test (SST). Results between January 1 and December 31 2010, we treated 15 patients aged 26–66 years. The majority were women (86.67%). At 15 days, 6 (40%) patients reported complete resolution of their symptoms, while 9 (60%) complained of residual symptoms and received another injection. At 30 days, 14 (93.33%) patients were pain-free and very satisfied. At 2 years, the 14 patients who had been asymptomatic at 30 days reported that they had experienced no further pain or impaired shoulder function. The analysis of variance for repeated measures showed a significant effect of time on EQ-VAS and SST scores. Conclusions the present study documents the existence, and characteristics, of a “coracoid syndrome” characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process and showed that the pain is usually amenable to steroid treatment. This syndrome should be clearly distinguished from anterior shoulder pain due to other causes, in

  7. SERF Protein Is a Direct Modifier of Amyloid Fiber Assembly

    Directory of Open Access Journals (Sweden)

    S. Fabio Falsone


    Full Text Available The inherent cytotoxicity of aberrantly folded protein aggregates contributes substantially to the pathogenesis of amyloid diseases. It was recently shown that a class of evolutionary conserved proteins, called MOAG-4/SERF, profoundly alter amyloid toxicity via an autonomous but yet unexplained mode. We show that the biological function of human SERF1a originates from its atypical ability to specifically distinguish between amyloid and nonamyloid aggregation. This inherently unstructured protein directly affected the aggregation kinetics of a broad range of amyloidogenic proteins in vitro, while being inactive against nonamyloid aggregation. A representative biophysical analysis of the SERF1a:α-synuclein (aSyn complex revealed that the amyloid-promoting activity resulted from an early and transient interaction, which was sufficient to provoke a massive increase of soluble aSyn amyloid nucleation templates. Therefore, the autonomous amyloid-modifying activity of SERF1a observed in living organisms relies on a direct and dedicated manipulation of the early stages in the amyloid aggregation pathway.

  8. Amyloid plaque imaging in vivo: current achievement and future prospects

    Energy Technology Data Exchange (ETDEWEB)

    Nordberg, Agneta [Karolinska University Hospital Huddinge, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Alzheimer Neurobiology, Stockholm (Sweden); Karolinska University Hospital Huddinge, Department of Geriatric Medicine, Stockholm (Sweden)


    Alzheimer's disease (AD) is a very complex neurodegenerative disorder, the exact cause of which is still not known. The major histopathological features, amyloid plaques and neurofibrillary tangles, already described by Alois Alzheimer, have been the focus in research for decades. Despite a probable whole cascade of events in the brain leading to impairment of cognition, amyloid is still the target for diagnosis and treatment. The rapid development of molecular imaging techniques now allows imaging of amyloid plaques in vivo in Alzheimer patients by PET amyloid ligands such as Pittsburgh compound B (PIB). Studies so far have revealed high {sup 11}C-PIB retention in brain at prodromal stages of AD and a possibility to discriminate AD from other dementia disorders by {sup 11}C-PIB. Ongoing studies are focussing to understand the relationship between brain and CSF amyloid processes and cognitive processes. In vivo imaging of amyloid will be important for early diagnosis and evaluation of new anti-amyloid therapies in AD. (orig.)

  9. Using bacterial inclusion bodies to screen for amyloid aggregation inhibitors

    Directory of Open Access Journals (Sweden)

    Villar-Piqué Anna


    Full Text Available Abstract Background The amyloid-β peptide (Aβ42 is the main component of the inter-neuronal amyloid plaques characteristic of Alzheimer's disease (AD. The mechanism by which Aβ42 and other amyloid peptides assemble into insoluble neurotoxic deposits is still not completely understood and multiple factors have been reported to trigger their formation. In particular, the presence of endogenous metal ions has been linked to the pathogenesis of AD and other neurodegenerative disorders. Results Here we describe a rapid and high-throughput screening method to identify molecules able to modulate amyloid aggregation. The approach exploits the inclusion bodies (IBs formed by Aβ42 when expressed in bacteria. We have shown previously that these aggregates retain amyloid structural and functional properties. In the present work, we demonstrate that their in vitro refolding is selectively sensitive to the presence of aggregation-promoting metal ions, allowing the detection of inhibitors of metal-promoted amyloid aggregation with potential therapeutic interest. Conclusions Because IBs can be produced at high levels and easily purified, the method overcomes one of the main limitations in screens to detect amyloid modulators: the use of expensive and usually highly insoluble synthetic peptides.

  10. The amyloid stretch hypothesis: Recruiting proteins toward the dark side (United States)

    Esteras-Chopo, Alexandra; Serrano, Luis; de la Paz, Manuela López


    A detailed understanding of the molecular events underlying the conversion and self-association of normally soluble proteins into amyloid fibrils is fundamental to the identification of therapeutic strategies to prevent or cure amyloid-related disorders. Recent investigations indicate that amyloid fibril formation is not just a general property of the polypeptide backbone depending on external factors, but that it is strongly modulated by amino acid side chains. Here, we propose and address the validation of the premise that the amyloidogenicity of a protein is indeed localized in short protein stretches (amyloid stretch hypothesis). We demonstrate that the conversion of a soluble nonamyloidogenic protein into an amyloidogenic prone molecule can be triggered by a nondestabilizing six-residue amyloidogenic insertion in a particular structural environment. Interestingly enough, although the inserted amyloid sequences clearly cause the process, the protease-resistant core of the fiber also includes short adjacent sequences from the otherwise soluble globular domain. Thus, short amyloid stretches accessible for intermolecular interactions trigger the self-assembly reaction and pull the rest of the protein into the fibrillar aggregate. The reliable identification of such amyloidogenic stretches in proteins opens the possibility of using them as targets for the inhibition of the amyloid fibril formation process. PMID:16263932

  11. Habitat suitability index models: Black-shouldered kite

    Energy Technology Data Exchange (ETDEWEB)

    Faanes, C.A.; Howard, R.J.


    The black-shouldered kite inhabits a disjunct range extending from California, Texas, and south intermittently to Chile and Argentina (American Ornithologists' Union 1983). Prior to the 1960's, this species occurred in low numbers across much of its range. Populations of black-shouldered kite have changed considerably within the limited area of its US range. Although considered common and widespread in California in the late 1800's, the species was largely extirpated from much of the state by the early 1900's. Since 1960, the population status and range of this raptor in North America have improved markedly. Today the black-shouldered kite in California is a common species of open and cultivated bottomland. The black-shouldered kite habitat suitability index (HSI) model is intended for use with the habitat evaluation procedures (HEP) developed by the US Fish and Wildlife Service (1980) for impact assessment and habitat management. The model was developed from a review and synthesis of existing information, and includes unpublished information that reflects the opinions of persons familiar with black-shouldered kite ecology. It is scaled to produce an index of habitat suitability between 0 (unsuitable habitat) and 1.0 (optimally suitable habitat). Assumptions used to develop the HSI model and guidelines for model application, including techniques for measuring model variables, are described. Model documentation is provided. This model is a hypothesis of species-habitat relations, not a statement of proven cause and effect. The model has not been field tested. 33 refs., 3 tabs.

  12. Mechanical deformation mechanisms and properties of amyloid fibrils. (United States)

    Choi, Bumjoon; Yoon, Gwonchan; Lee, Sang Woo; Eom, Kilho


    Amyloid fibrils have recently received attention due to their remarkable mechanical properties, which are highly correlated with their biological functions. We have studied the mechanical deformation mechanisms and properties of amyloid fibrils as a function of their length scales by using atomistic simulations. It is shown that the length of amyloid fibrils plays a role in their deformation and fracture mechanisms in such a way that the competition between shear and bending deformations is highly dependent on the fibril length, and that as the fibril length increases, so does the bending strength of the fibril while its shear strength decreases. The dependence of rupture force for amyloid fibrils on their length is elucidated using the Bell model, which suggests that the rupture force of the fibril is determined from the hydrogen bond rupture mechanism that critically depends on the fibril length. We have measured the toughness of amyloid fibrils, which is shown to depend on the fibril length. In particular, the toughness of the fibril with its length of ∼3 nm is estimated to be ∼30 kcal mol(-1) nm(-3), comparable to that of a spider silk crystal with its length of ∼2 nm. Moreover, we have shown the important effect of the pulling rate on the mechanical deformation mechanisms and properties of amyloid fibril. It is found that as the pulling rate increases, so does the contribution of the shear effect to the elastic deformation of the amyloid fibril with its length of deformation mechanism of the amyloid fibril with its length of >15 nm is almost independent of the pulling rate. Our study sheds light on the role of the length scale of amyloid fibrils and the pulling rate in their mechanical behaviors and properties, which may provide insights into how the excellent mechanical properties of protein fibrils can be determined.

  13. Influence of frequency and duration of strength training for effective management of neck and shoulder pain

    DEFF Research Database (Denmark)

    Andersen, Christoffer H; Andersen, Lars Louis; Gram, Bibi


    training (REF). Primary outcome was self-reported neck and shoulder pain (scale 0-9) and secondary outcome work disability (Disability in Arms, Shoulders and Hands (DASH)). RESULTS: The intention-to-treat analysis showed reduced neck and right shoulder pain in the training groups after 20 weeks compared......BACKGROUND: Specific strength training can reduce neck and shoulder pain in office workers, but the optimal combination of exercise frequency and duration remains unknown. This study investigates how one weekly hour of strength training for the neck and shoulder muscles is most effectively...

  14. Placement of the stemless humeral component in the Total Evolutive Shoulder System (TESS). (United States)

    Geurts, Ghislain F; van Riet, Roger P; Jansen, Nick; Declercq, Geert


    Humeral implant design in shoulder arthroplasty has evolved over the years. The third generation shoulder prostheses have an anatomic humeral stem that replicates the 3-dimensional parameters of the proximal humerus. The overall complication rate has decreased as a result of these changes in implant design. In contrast, the rate of periprosthetic humeral fractures has increased. To avoid stem-related complications while retaining the advantages of the third generation of shoulder implants, the stemless total evolutive shoulder system has been developed. The indications, the surgical technique, and the complications of this humeral implant in shoulder arthroplasty will be described.

  15. Difference in clinical outcome between total shoulder arthroplasty and reverse shoulder arthroplasty used in hemiarthroplasty revision surgery

    Directory of Open Access Journals (Sweden)

    Bas Pieter Hartel


    Conclusions: In this study, revision surgery showed poor to reasonable postoperative results and better clinical outcome for TSA. When a revision after HA was needed, and the soft-tissue component of the shoulder was intact, a TSA proved to be a preferable solution.

  16. Ligand-binding sites in human serum amyloid P component

    DEFF Research Database (Denmark)

    Heegaard, N.H.H.; Heegaard, Peter M. H.; Roepstorff, P.;


    Amyloid P component (AP) is a naturally occurring glycoprotein that is found in serum and basement membranes, AP is also a component of all types of amyloid, including that found in individuals who suffer from Alzheimer's disease and Down's syndrome. Because AP has been found to bind strongly...... of 25 mu M, while the IC50 of AP-(27-38)-peptide and AP-(33-38)-peptide are 10 mu M and 2 mu M, respectively, The understanding of the structure and function of active AP peptides will be useful for development of amyloid-targeted diagnostics and therapeutics....

  17. Aluminium, beta-amyloid and non-enzymatic glycosylation. (United States)

    Exley, C; Schley, L; Murray, S; Hackney, C M; Birchall, J D


    The non-enzymatic glycosylation of beta-amyloid is implicated in the aetiology of Alzheimer's disease. However, controversy surrounds the nature of any involvement and a potential mechanism has not been fully elucidated. We present evidence of an aluminium-induced aggregation of the A beta P(25-35) peptide and speculate that the mechanism of formation of our ordered beta-amyloid aggregates might involve non-enzymatic glycosylation and/or site-specific crosslinking of beta-amyloid fibrils by atomic aluminium.

  18. Amyloid-β and Astrocytes Interplay in Amyloid-β Related Disorders

    Directory of Open Access Journals (Sweden)

    Yazan S. Batarseh


    Full Text Available Amyloid-β (Aβ pathology is known to promote chronic inflammatory responses in the brain. It was thought previously that Aβ is only associated with Alzheimer’s disease and Down syndrome. However, studies have shown its involvement in many other neurological disorders. The role of astrocytes in handling the excess levels of Aβ has been highlighted in the literature. Astrocytes have a distinctive function in both neuronal support and protection, thus its involvement in Aβ pathological process may tip the balance toward chronic inflammation and neuronal death. In this review we describe the involvement of astrocytes in Aβ related disorders including Alzheimer’s disease, Down syndrome, cerebral amyloid angiopathy, and frontotemporal dementia.

  19. Eugenol prevents amyloid formation of proteins and inhibits amyloid-induced hemolysis (United States)

    Dubey, Kriti; Anand, Bibin G.; Shekhawat, Dolat Singh; Kar, Karunakar


    Eugenol has attracted considerable attention because of its potential for many pharmaceutical applications including anti-inflammatory, anti-tumorigenic and anti-oxidant properties. Here, we have investigated the effect of eugenol on amyloid formation of selected globular proteins. We find that both spontaneous and seed-induced aggregation processes of insulin and serum albumin (BSA) are significantly suppressed in the presence of eugenol. Isothermal titration calorimetric data predict a single binding site for eugenol-insulin complex confirming the affinity of eugenol for native soluble insulin species. We also find that eugenol suppresses amyloid-induced hemolysis. Our findings reveal the inherent ability of eugenol to stabilize native proteins and to delay the conversion of protein species of native conformation into β-sheet assembled mature fibrils, which seems to be crucial for its inhibitory effect.

  20. Shoulder muscle recruitment patterns during a kayak stroke performed on a paddling ergometer. (United States)

    Trevithick, Beverley A; Ginn, Karen A; Halaki, Mark; Balnave, Ronald


    Precise muscle co-ordination is required to maintain normal shoulder function and alterations in synchrony between shoulder muscles can result in loss of full range of movement and pain. Although shoulder pain in kayakers is high with 53% of elite international paddlers reporting shoulder injuries, little information is available regarding the pattern of shoulder muscle recruitment during paddling. The aim of this study was to investigate the normal recruitment pattern of shoulder muscles during the kayak stroke. Nine recreational paddlers without shoulder pain were examined. EMG data from eight shoulder muscles of the dominant arm were collected simultaneously with video data during simulated paddling on an ergometer. EMG data was normalized to time and peak amplitude. Intersubject consistency was evaluated using Pearson correlation analysis. The results of this study indicated a fair to high correlation in at least one phase of the kayak stroke in five of the muscles examined: upper trapezius, supraspinatus, latissimus dorsi, serratus anterior and rhomboid major. This normative data will enable comparisons with the shoulder muscle recruitment patterns in kayakers with shoulder pain in order to determine the role of altered motor control in the painful kayaking shoulder.

  1. Atrophy of muscles surrounding the shoulder in hemiplegia. Analysis with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Fukuda, Fumio; Kobayashi, Tsunesaburo; Matsumoto, Shinichi [Fukushima Rosai Hospital, Iwaki (Japan)


    Decrease of range of motion and subluxation of shoulders are common secondary dysfunctions after the stroke. The purpose of this study is to evaluate the atrophy of muscles surrounding shoulders in hemiplegic patients and to delineate the correlations between those atrophies and shoulder functions. MRI studies were done on bilateral shoulders in 13 hemiplegic patients with shoulder pain. The cross sectional areas of muscles surrounding shoulder, i.e., subscapularis, supraspinatus, infraspinatus, teres minor and deltoid muscle were measured on those images obtained. The degree of atrophies were evaluated by dividing cross-sectional area of the muscle on affected shoulder by that of non-affected shoulder, that is muscle atrophy ratio [MAR], for each muscle in every case. Also, the range of movements [ROM], the degree of subluxation and muscle strength of shoulder flexion were evaluated. All muscle cross-sectional areas on the affected side were significantly smaller than those of muscles on the unaffected side (p<0.01). The means of MARs were 0.68, 0.69, 0.86, 0.72 and 0.69 for subscapularis, supraspinatus, infraspinatus, teres minor and deltoid muscle. The pattern of muscle atrophies, however, varies from case to case. Both correlations of ROM versus supraspinatus MAR and degree of shoulder subluxation versus deltoid MAR were statistically significant (p<0.05). These results indicate the contribution of muscle atrophy to the shoulder dysfunction in hemiplegic patients. (author).

  2. Interaction of amyloid inhibitor proteins with amyloid beta peptides: insight from molecular dynamics simulations.

    Directory of Open Access Journals (Sweden)

    Payel Das

    Full Text Available Knowledge of the detailed mechanism by which proteins such as human αB- crystallin and human lysozyme inhibit amyloid beta (Aβ peptide aggregation is crucial for designing treatment for Alzheimer's disease. Thus, unconstrained, atomistic molecular dynamics simulations in explicit solvent have been performed to characterize the Aβ17-42 assembly in presence of the αB-crystallin core domain and of lysozyme. Simulations reveal that both inhibitor proteins compete with inter-peptide interaction by binding to the peptides during the early stage of aggregation, which is consistent with their inhibitory action reported in experiments. However, the Aβ binding dynamics appear different for each inhibitor. The binding between crystallin and the peptide monomer, dominated by electrostatics, is relatively weak and transient due to the heterogeneous amino acid distribution of the inhibitor surface. The crystallin-bound Aβ oligomers are relatively long-lived, as they form more extensive contact surface with the inhibitor protein. In contrast, a high local density of arginines from lysozyme allows strong binding with Aβ peptide monomers, resulting in stable complexes. Our findings not only illustrate, in atomic detail, how the amyloid inhibitory mechanism of human αB-crystallin, a natural chaperone, is different from that of human lysozyme, but also may aid de novo design of amyloid inhibitors.

  3. Yeast and Fungal Prions: Amyloid-Handling Systems, Amyloid Structure, and Prion Biology. (United States)

    Wickner, R B; Edskes, H K; Gorkovskiy, A; Bezsonov, E E; Stroobant, E E


    Yeast prions (infectious proteins) were discovered by their outré genetic properties and have become important models for an array of human prion and amyloid diseases. A single prion protein can become any of many distinct amyloid forms (called prion variants or strains), each of which is self-propagating, but with different biological properties (eg, lethal vs mild). The folded in-register parallel β sheet architecture of the yeast prion amyloids naturally suggests a mechanism by which prion variant information can be faithfully transmitted for many generations. The yeast prions rely on cellular chaperones for their propagation, but can be cured by various chaperone imbalances. The Btn2/Cur1 system normally cures most variants of the [URE3] prion that arise. Although most variants of the [PSI+] and [URE3] prions are toxic or lethal, some are mild in their effects. Even the most mild forms of these prions are rare in the wild, indicating that they too are detrimental to yeast. The beneficial [Het-s] prion of Podospora anserina poses an important contrast in its structure, biology, and evolution to the yeast prions characterized thus far.

  4. Interaction between amyloid beta peptide and an aggregation blocker peptide mimicking islet amyloid polypeptide.

    Directory of Open Access Journals (Sweden)

    Nasrollah Rezaei-Ghaleh

    Full Text Available Assembly of amyloid-beta peptide (Aβ into cytotoxic oligomeric and fibrillar aggregates is believed to be a major pathologic event in Alzheimer's disease (AD and interfering with Aβ aggregation is an important strategy in the development of novel therapeutic approaches. Prior studies have shown that the double N-methylated analogue of islet amyloid polypeptide (IAPP IAPP-GI, which is a conformationally constrained IAPP analogue mimicking a non-amyloidogenic IAPP conformation, is capable of blocking cytotoxic self-assembly of Aβ. Here we investigate the interaction of IAPP-GI with Aβ40 and Aβ42 using NMR spectroscopy. The most pronounced NMR chemical shift changes were observed for residues 13-20, while residues 7-9, 15-16 as well as the C-terminal half of Aβ--that is both regions of the Aβ sequence that are converted into β-strands in amyloid fibrils--were less accessible to solvent in the presence of IAPP-GI. At the same time, interaction of IAPP-GI with Aβ resulted in a concentration-dependent co-aggregation of Aβ and IAPP-GI that was enhanced for the more aggregation prone Aβ42 peptide. On the basis of the reduced toxicity of the Aβ peptide in the presence of IAPP-GI, our data are consistent with the suggestion that IAPP-GI redirects Aβ into nontoxic "off-pathway" aggregates.

  5. Tensile deformation and failure of amyloid and amyloid-like protein fibrils (United States)

    Solar, Max; Buehler, Markus J.


    Here we report a series of full atomistic molecular dynamics simulations of six amyloid or amyloid-like protein fibrils in order to systematically understand the effect of different secondary structure motifs on the mechanical tensile and failure response of cross-\\beta protein fibrils. We find a similar failure behavior across the six structures; an initial failure event occurs at small strains involving cooperative rupture of a group of hydrogen bonds, followed by a slow one-by-one hydrogen bond rupture process as the remaining \\beta -sheets peel off with very low applied stress. We also find that the ultimate tensile strength of the protein fibrils investigated scales directly with the number of hydrogen bonds per unit area which break in the initial rupture event. Our results provide insights into structure-property relationships in protein fibrils important for disease and engineering applications and lay the groundwork for the development of materials selection criteria for the design of de novo amyloid-based functional biomaterials.

  6. Bapineuzumab alters aβ composition: implications for the amyloid cascade hypothesis and anti-amyloid immunotherapy.

    Directory of Open Access Journals (Sweden)

    Alex E Roher

    Full Text Available The characteristic neuropathological changes associated with Alzheimer's disease (AD and other lines of evidence support the amyloid cascade hypothesis. Viewing amyloid deposits as the prime instigator of dementia has now led to clinical trials of multiple strategies to remove or prevent their formation. We performed neuropathological and biochemical assessments of 3 subjects treated with bapineuzumab infusions. Histological analyses were conducted to quantify amyloid plaque densities, Braak stages and the extent of cerebral amyloid angiopathy (CAA. Amyloid-β (Aβ species in frontal and temporal lobe samples were quantified by ELISA. Western blots of amyloid-β precursor protein (AβPP and its C-terminal (CT fragments as well as tau species were performed. Bapineuzumab-treated (Bapi-AD subjects were compared to non-immunized age-matched subjects with AD (NI-AD and non-demented control (NDC cases. Our study revealed that Bapi-AD subjects exhibited overall amyloid plaque densities similar to those of NI-AD cases. In addition, CAA was moderate to severe in NI-AD and Bapi-AD patients. Although histologically-demonstrable leptomeningeal, cerebrovascular and neuroparenchymal-amyloid densities all appeared unaffected by treatment, Aβ peptide profiles were significantly altered in Bapi-AD subjects. There was a trend for reduction in total Aβ42 levels as well as an increase in Aβ40 which led to a corresponding significant decrease in Aβ42:Aβ40 ratio in comparison to NI-AD subjects. There were no differences in the levels of AβPP, CT99 and CT83 or tau species between Bapi-AD and NI-AD subjects. The remarkable alteration in Aβ profiles reveals a dynamic amyloid production in which removal and depositional processes were apparently perturbed by bapineuzumab therapy. Despite the alteration in biochemical composition, all 3 immunized subjects exhibited continued cognitive decline.

  7. The cost of shoulder pain at work : variation in work tasks and good job opportunities are essential for prevention

    NARCIS (Netherlands)

    Bongers, P.M.


    Shoulder pain is widespread and imposes a considerable burden on the affected person and society. Women seem to have more shoulder problems than men, and the frequency of shoulder pain increases with age. Smoking and previous trauma are associated with shoulder pain. A recent systematic review of th

  8. Arthroscopic Shoulder Surgery in Female Professional Tennis Players (United States)

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


    Objectives: Recent publications have highlighted the relatively poor outcome of other overhead athletes, particularly baseball players, with regard to return to sports at the same or higher level after shoulder surgery. However, true assessment of their ability when returning to sport is not as clear. Further, ability to return to other overhead sports has not been reported. Our objective was to assess outcome and time to return to previous level of function following shoulder surgery in professional tennis players. Methods: 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. Details of the surgery including date, procedures performed, and complications were recorded. The primary outcomes were 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. Pre and post-operative singles rankings were used to determine rate and completeness of return to preoperative function. Their highest ranking pre-injury, post operatively, and the time to return to pre-injury ranking were evaluated. Results: During the study period eight professional women tennis players from the WTA underwent shoulder surgery on their dominant arm. All surgery was performed arthroscopically, 7 out of 8 players had more than one procedure performed during the surgery. In total, 3 players underwent debridement of a partial rotator cuff tear and 2 players underwent repair of a complete supraspinatus tear. Three players had an anterior labral repair or reconstruction for anterior instability, and one player underwent repair of a SLAP lesion. Two players underwent neurolysis of a suprascapular nerve, and three players in total underwent a subacromial decompression. All players (100%) returned to professional play. The mean

  9. Immunotherapy against amyloid pathology in Alzheimer's disease. (United States)

    Galimberti, Daniela; Ghezzi, Laura; Scarpini, Elio


    The first drugs developed for Alzheimer's disease (AD), anticholinesterase inhibitors (AchEI), increase acetylcholine levels, previously demonstrated to be reduced in AD. To date, four AchEI are approved for the treatment of mild to moderate AD. A further therapeutic option available for moderate to severe AD is memantine. These treatments are symptomatic, whereas drugs under development are supposed to modify pathological steps leading to AD, thus acting on the evolution of the disease. For this reason they are currently termed "disease modifying" drugs. To block the progression of the disease, they have to interfere with pathogenic steps at the basis of clinical symptoms, including the deposition of extracellular amyloid beta (Aβ) plaques and of intracellular neurofibrillary tangles. The most innovative approach is represented by the vaccination and passive immunization against Aβ peptide. In this article, current knowledge about concluded and ongoing clinical trials with both vaccination with different antigens and passive immunization will be reviewed and discussed.

  10. Cerebral microvascular amyloid beta protein deposition induces vascular degeneration and neuroinflammation in transgenic mice expressing human vasculotropic mutant amyloid beta precursor protein.

    NARCIS (Netherlands)

    Miao, J.; Xu, F.; Davis, J.; Otte-Holler, I.; Verbeek, M.M.; Nostrand, W.E. van


    Cerebral vascular amyloid beta-protein (Abeta) deposition, also known as cerebral amyloid angiopathy, is a common pathological feature of Alzheimer's disease. Additionally, several familial forms of cerebral amyloid angiopathy exist including the Dutch (E22Q) and Iowa (D23N) mutations of Abeta. Incr

  11. Amyloid A amyloidosis secondary to rheumatoid arthritis: pathophysiology and treatments. (United States)

    Nakamura, Tadashi


    The introduction of biological therapies targeting specific inflammatory mediators revolutionised the treatment of rheumatoid arthritis (RA). Targeting key components of the immune system allows efficient suppression of the pathological inflammatory cascade that leads to RA symptoms and subsequent joint destruction. Reactive amyloid A (AA) amyloidosis, one of the most severe complications of RA, is a serious, potentially life-threatening disorder caused by deposition of AA amyloid fibrils in multiple organs. These AA amyloid fibrils derive from the circulatory acute-phase reactant serum amyloid A protein (SAA), and may be controlled by treatment. New biologics may permit AA amyloidosis secondary to RA to become a treatable, manageable disease. Rheumatologists, when diagnosing and treating patients with AA amyloidosis secondary to RA, must understand the pathophysiology and clinical factors related to development and progression of the disease, including genetic predisposition and biological versatility of SAA.

  12. Amyloid detection using a Peltier-based device. (United States)

    Cabrera, Miguel A; Ferreyra, Martin G; Cortez, Leonardo; Grupalli, Silvina A; Alvarez, L Leguina; Chehin, Rosana


    Amyloid aggregation of polypeptides is related to a growing number of pathologic states known as amyloid disorders. At present, it is clear that any proteins submitted to appropriate physicochemical environment can acquire fibrilar conformation. Fourier transform infrared spectroscopy (FTIR) has been a widely used technique to study temperature- induced amyloid-fibrils formation in vitro. In this way, strict changes and temperature controls are required to characterize the physicochemical basis of the amyloid-fibrils formation. In this article, the development of a highly efficient and accurate Peltier-based system to improve FTIR measurements is presented (see An Old Physics Phenomenon Applied to a Serious Biomedical Pathology. The accuracy of the thermostatic control was tested with biophysical parameters on biological samples probing its reproducibility. The design of the present device contributes to maintain the FTIR environment stable, which represents a real contribution to improve the spectral quality and thus, the reliability of the results.

  13. Tau/Amyloid Beta 42 Peptide Test (Alzheimer Biomarkers) (United States)

    ... Was this page helpful? Also known as: Alzheimer Biomarkers Formal name: Tau Protein and Amyloid Beta 42 ... being researched for their potential use as AD biomarkers. If someone has symptoms of dementia , a health ...

  14. Phosphorylation modifies the molecular stability of β-amyloid deposits (United States)

    Rezaei-Ghaleh, Nasrollah; Amininasab, Mehriar; Kumar, Sathish; Walter, Jochen; Zweckstetter, Markus


    Protein aggregation plays a crucial role in neurodegenerative diseases. A key feature of protein aggregates is their ubiquitous modification by phosphorylation. Little is known, however, about the molecular consequences of phosphorylation of protein aggregates. Here we show that phosphorylation of β-amyloid at serine 8 increases the stability of its pathogenic aggregates against high-pressure and SDS-induced dissociation. We further demonstrate that phosphorylation results in an elevated number of hydrogen bonds at the N terminus of β-amyloid, the region that is critically regulated by a variety of post-translational modifications. Because of the increased lifetime of phosphorylated β-amyloid aggregates, phosphorylation can promote the spreading of β-amyloid in Alzheimer pathogenesis. Our study suggests that regulation of the molecular stability of protein aggregates by post-translational modifications is a crucial factor for disease progression in the brain.

  15. Binuclear ruthenium(II) complexes for amyloid fibrils recognition

    Energy Technology Data Exchange (ETDEWEB)

    Hanczyc, Piotr, E-mail:


    Highlights: • Interactions of binuclear ruthenium(II) complexes with amyloid fibrils. • Dimer ruthenium(II) compounds are sensitive amyloid fibrils biomarkers. • Recognition of amyloid-chromophore adducts by two-photon excited emission. - Abstract: Metal–organic compounds represent a unique class of biomarkers with promising photophysical properties useful for imaging. Here interactions of insulin fibrils with two binuclear complexes [μ-(11,11′-bidppz)(phen){sub 4}Ru{sub 2}]{sup 4+} (1) and [μ-C4(cpdppz)(phen){sub 4}Ru{sub 2}]{sup 4+} (2) are studied by linear dichroism (LD) and fluorescence. These ruthenium(II) compounds could provide a new generation of amyloid binding chromophores with long lived lifetimes, good luminescence quantum yields for the bound molecules and photo-stability useful in multiphoton luminescence imaging.

  16. Prion Diseases of Yeast: Amyloid Structure and Biology


    Reed B Wickner; Edskes, Herman K.; Kryndushkin, Dmitry; McGlinchey, Ryan; Bateman, David; Kelly, Amy


    Prion “variants” or “strains” are prions with the identical protein sequence, but different characteristics of the prion infection: e.g. different incubation period for scrapie strains or different phenotype intensity for yeast prion variants. We have shown that infectious amyloids of the yeast prions [PSI+], [URE3] and [PIN+] each have an in-register parallel β-sheet architecture. Moreover, we have pointed out that this amyloid architecture can explain how one protein can faithfully transmit...

  17. Amyloid fibrils composed of hexameric peptides attenuate neuroinflammation. (United States)

    Kurnellas, Michael P; Adams, Chris M; Sobel, Raymond A; Steinman, Lawrence; Rothbard, Jonathan B


    The amyloid-forming proteins tau, αB crystallin, and amyloid P protein are all found in lesions of multiple sclerosis (MS). Our previous work established that amyloidogenic peptides from the small heat shock protein αB crystallin (HspB5) and from amyloid β fibrils, characteristic of Alzheimer's disease, were therapeutic in experimental autoimmune encephalomyelitis (EAE), reflecting aspects of the pathology of MS. To understand the molecular basis for the therapeutic effect, we showed a set of amyloidogenic peptides composed of six amino acids, including those from tau, amyloid β A4, major prion protein (PrP), HspB5, amylin, serum amyloid P, and insulin B chain, to be anti-inflammatory and capable of reducing serological levels of interleukin-6 and attenuating paralysis in EAE. The chaperone function of the fibrils correlates with the therapeutic outcome. Fibrils composed of tau 623-628 precipitated 49 plasma proteins, including apolipoprotein B-100, clusterin, transthyretin, and complement C3, supporting the hypothesis that the fibrils are active biological agents. Amyloid fibrils thus may provide benefit in MS and other neuroinflammatory disorders.

  18. Structural properties of Gerstmann-Straussler-Scheinker disease amyloid protein. (United States)

    Salmona, Mario; Morbin, Michela; Massignan, Tania; Colombo, Laura; Mazzoleni, Giulia; Capobianco, Raffaella; Diomede, Luisa; Thaler, Florian; Mollica, Luca; Musco, Giovanna; Kourie, Joseph J; Bugiani, Orso; Sharma, Deepak; Inouye, Hideyo; Kirschner, Daniel A; Forloni, Gianluigi; Tagliavini, Fabrizio


    Prion protein (PrP) amyloid formation is a central feature of genetic and acquired forms of prion disease such as Gerstmann-Sträussler-Scheinker disease (GSS) and variant Creutzfeldt-Jakob disease. The major component of GSS amyloid is a PrP fragment spanning residues approximately 82-146. To investigate the determinants of the physicochemical properties of this fragment, we synthesized PrP-(82-146) and variants thereof, including entirely and partially scrambled peptides. PrP-(82-146) readily formed aggregates that were partially resistant to protease digestion. Peptide assemblies consisted of 9.8-nm-diameter fibrils having a parallel cross-beta-structure. Second derivative of infrared spectra indicated that PrP-(82-146) aggregates are primarily composed of beta-sheet (54%) and turn (24%) which is consistent with their amyloid-like properties. The peptide induced a remarkable increase in plasma membrane microviscosity of primary neurons. Modification of the amino acid sequence 106-126 caused a striking increase in aggregation rate, with formation of large amount of protease-resistant amorphous material and relatively few amyloid fibrils. Alteration of the 127-146 region had even more profound effects, with the inability to generate amyloid fibrils. These data indicate that the intrinsic properties of PrP-(82-146) are dependent upon the integrity of the C-terminal region and account for the massive deposition of PrP amyloid in GSS.

  19. Complexation of amyloid fibrils with charged conjugated polymers. (United States)

    Ghosh, Dhiman; Dutta, Paulami; Chakraborty, Chanchal; Singh, Pradeep K; Anoop, A; Jha, Narendra Nath; Jacob, Reeba S; Mondal, Mrityunjoy; Mankar, Shruti; Das, Subhadeep; Malik, Sudip; Maji, Samir K


    It has been suggested that conjugated charged polymers are amyloid imaging agents and promising therapeutic candidates for neurological disorders. However, very less is known about their efficacy in modulating the amyloid aggregation pathway. Here, we studied the modulation of Parkinson's disease associated α-synuclein (AS) amyloid assembly kinetics using conjugated polyfluorene polymers (PF, cationic; PFS, anionic). We also explored the complexation of these charged polymers with the various AS aggregated species including amyloid fibrils and oligomers using multidisciplinary biophysical techniques. Our data suggests that both polymers irrespective of their different charges in the side chains increase the fibrilization kinetics of AS and also remarkably change the morphology of the resultant amyloid fibrils. Both polymers were incorporated/aligned onto the AS amyloid fibrils as evident from electron microscopy (EM) and atomic force microscopy (AFM), and the resultant complexes were structurally distinct from their pristine form of both polymers and AS supported by FTIR study. Additionally, we observed that the mechanism of interactions between the polymers with different species of AS aggregates were markedly different.

  20. Amyloid diseases of yeast: prions are proteins acting as genes. (United States)

    Wickner, Reed B; Edskes, Herman K; Bateman, David A; Kelly, Amy C; Gorkovskiy, Anton; Dayani, Yaron; Zhou, Albert


    The unusual genetic properties of the non-chromosomal genetic elements [URE3] and [PSI+] led to them being identified as prions (infectious proteins) of Ure2p and Sup35p respectively. Ure2p and Sup35p, and now several other proteins, can form amyloid, a linear ordered polymer of protein monomers, with a part of each molecule, the prion domain, forming the core of this β-sheet structure. Amyloid filaments passed to a new cell seed the conversion of the normal form of the protein into the same amyloid form. The cell's phenotype is affected, usually from the deficiency of the normal form of the protein. Solid-state NMR studies indicate that the yeast prion amyloids are in-register parallel β-sheet structures, in which each residue (e.g. Asn35) forms a row along the filament long axis. The favourable interactions possible for aligned identical hydrophilic and hydrophobic residues are believed to be the mechanism for propagation of amyloid conformation. Thus, just as DNA mediates inheritance by templating its own sequence, these proteins act as genes by templating their conformation. Distinct isolates of a given prion have different biological properties, presumably determined by differences between the amyloid structures. Many lines of evidence indicate that the Saccharomyces cerevisiae prions are pathological disease agents, although the example of the [Het-s] prion of Podospora anserina shows that a prion can have beneficial aspects.

  1. Switchable photooxygenation catalysts that sense higher-order amyloid structures (United States)

    Taniguchi, Atsuhiko; Shimizu, Yusuke; Oisaki, Kounosuke; Sohma, Youhei; Kanai, Motomu


    Proteins can misfold into amyloid structures that are associated with diseases; however, the same proteins often have important biological roles. To degrade selectively the amyloid form without affecting the fraction of functional protein is, therefore, an attractive goal. Here we report target-state-dependent photooxygenation catalysts that are active only when bound to the cross-β-sheet structure that is characteristic of pathogenic aggregated amyloid proteins. We show these catalysts can selectively oxygenate the amyloid form of amyloid β-protein (Aβ) 1-42 in the presence of non-amyloid off-target substrates. Furthermore, photooxygenation with a catalyst that bears an Aβ-binding peptide attenuated the Aβ pathogenicity in the presence of cells. We also show that selective photooxygenation is generally applicable to other amyloidogenic proteins (amylin, insulin, β2-microglobulin, transthyretin and α-synuclein) and does not affect the physiologically functional non-aggregate states of these proteins. This is the first report of an artificial catalyst that can be selectively and reversibly turned on and off depending on the structure and aggregation state of the substrate protein.

  2. Force generation by the growth of amyloid aggregates. (United States)

    Herling, Therese W; Garcia, Gonzalo A; Michaels, Thomas C T; Grentz, Wolfgang; Dean, James; Shimanovich, Ulyana; Gang, Hongze; Müller, Thomas; Kav, Batuhan; Terentjev, Eugene M; Dobson, Christopher M; Knowles, Tuomas P J


    The generation of mechanical forces are central to a wide range of vital biological processes, including the function of the cytoskeleton. Although the forces emerging from the polymerization of native proteins have been studied in detail, the potential for force generation by aberrant protein polymerization has not yet been explored. Here, we show that the growth of amyloid fibrils, archetypical aberrant protein polymers, is capable of unleashing mechanical forces on the piconewton scale for individual filaments. We apply microfluidic techniques to measure the forces released by amyloid growth for two systems: insulin and lysozyme. The level of force measured for amyloid growth in both systems is comparable to that observed for actin and tubulin, systems that have evolved to generate force during their native functions and, unlike amyloid growth, rely on the input of external energy in the form of nucleotide hydrolysis for maximum force generation. Furthermore, we find that the power density released from growing amyloid fibrils is comparable to that of high-performance synthetic polymer actuators. These findings highlight the potential of amyloid structures as active materials and shed light on the criteria for regulation and reversibility that guide molecular evolution of functional polymers.

  3. Toxic species in amyloid disorders: Oligomers or mature fibrils

    Directory of Open Access Journals (Sweden)

    Meenakshi Verma


    Full Text Available Protein aggregation is the hallmark of several neurodegenerative disorders. These protein aggregation (fibrillization disorders are also known as amyloid disorders. The mechanism of protein aggregation involves conformation switch of the native protein, oligomer formation leading to protofibrils and finally mature fibrils. Mature fibrils have long been considered as the cause of disease pathogenesis; however, recent evidences suggest oligomeric intermediates formed during fibrillization to be toxic. In this review, we have tried to address the ongoing debate for these toxic amyloid species. We did an extensive literature search and collated information from Pubmed ( and Google search using various permutations and combinations of the following keywords: Neurodegeneration, amyloid disorders, protein aggregation, fibrils, oligomers, toxicity, Alzheimer′s Disease, Parkinson′s Disease. We describe different instances showing the toxicity of mature fibrils as well as oligomers in Alzheimer′s Disease and Parkinson′s Disease. Distinct structural framework and morphology of amyloid oligomers suggests difference in toxic effect between oligomers and fibrils. We highlight the difference in structure and proposed toxicity pathways for fibrils and oligomers. We also highlight the evidences indicating that intermediary oligomeric species can act as potential diagnostic biomarker. Since the formation of these toxic species follow a common structural switch among various amyloid disorders, the protein aggregation events can be targeted for developing broad-range therapeutics. The therapeutic trials based on the understanding of different protein conformers (monomers, oligomers, protofibrils and fibrils in amyloid cascade are also described.

  4. Insulin amyloid at injection sites of patients with diabetes. (United States)

    Nilsson, Melanie R


    The formation of insulin amyloid can dramatically impact glycemic control in patients with diabetes, making it an important therapeutic consideration. In addition, the cost associated with the excess insulin required by patients with amyloid is estimated to be $3K per patient per year, which adds to the growing financial burden of this disease. Insulin amyloid has been observed with every mode of therapeutic insulin administration (infusion, injection and inhalation), and the number of reported cases has increased significantly since 2002. The new cases represent a much broader demographic, and include many patients who have used exclusively human insulin and human insulin analogs. The reason for the increase in case reports is unknown, but this review explores the possibility that changes in patient care, improved differential diagnosis and/or changes in insulin type and insulin delivery systems may be important factors. The goal of this review is to raise key questions that will inspire proactive measures to prevent, identify and treat insulin amyloid. Furthermore, this comprehensive examination of insulin amyloid can provide insight into important considerations for other injectable drugs that are prone to form amyloid deposits.

  5. Effect of bone loss in anterior shoulder instability (United States)

    Garcia, Grant H; Liu, Joseph N; Dines, David M; Dines, Joshua S


    Anterior shoulder instability with bone loss can be a difficult problem to treat. It usually involves a component of either glenoid deficiency or a Hill-Sachs lesion. Recent data shows that soft tissue procedures alone are typically not adequate to provide stability to the shoulder. As such, numerous surgical procedures have been described to directly address these bony deficits. For glenoid defects, coracoid transfer and iliac crest bone block procedures are popular and effective. For humeral head defects, both remplissage and osteochondral allografts have decreased the rates of recurrent instability. Our review provides an overview of current literature addressing these treatment options and others for addressing bone loss complicating anterior glenohumeral instability. PMID:26085984


    Directory of Open Access Journals (Sweden)



    Full Text Available Shoulder pain is a common problem with an estimated prevalence of 4% to 26%. 1 Pathology may originate from the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, and other soft tissues around the shoulder girdle. Suprascapular nerve entrapment at spinoglenoid notch is rare but well documented. Kopell and Thompson 2 are credited with providing the first description of the suprascapular nerve entrapment syndrome . 3 This condition is largely underreported, meta - analysis revealed only 88 published reports on suprascapular nerve compression syndrome from 1959 through 2001. We report a case of suprascapular nerve compression at suprascapular foramen the cause of which was not the spinoglenoid cys t or any tumorous swelling like neuroma but a narrow canal at suprascapular foramen, the symptoms of which were relieved after surgical release of transverse scapular ligament.

  7. Acromioclavicular osteoarthritis: a common cause of shoulder pain. (United States)

    Menge, Travis J; Boykin, Robert E; Bushnell, Brandon D; Byram, Ian R


    Osteoarthritis of the acromioclavicular joint is a frequent cause of shoulder pain and can result in significant debilitation. It is the most common disorder of the acromioclavicular joint and may arise from a number of pathologic processes, including primary (degenerative), posttraumatic, inflammatory, and septic arthritis. Patients often present with nonspecific complaints of pain located in the neck, shoulder, and/or arm, further complicating the clinical picture. A thorough understanding of the pertinent anatomy, disease process, patient history, and physical examination is crucial to making the correct diagnosis and formulating a treatment plan. Initial nonoperative management is aimed at relieving pain and restoring function. Typical treatments include anti-inflammatory medications, physical therapy, and injections. Patients who continue to exhibit symptoms after appropriate nonsurgical treatment may be candidates for operative resection of the distal clavicle through either open or arthroscopic techniques.

  8. Elite swimmers with and without unilateral shoulder pain: mechanical hyperalgesia and active/latent muscle trigger points in neck-shoulder muscles. (United States)

    Hidalgo-Lozano, A; Fernández-de-las-Peñas, C; Calderón-Soto, C; Domingo-Camara, A; Madeleine, P; Arroyo-Morales, M


    Our aim was to investigate the presence of mechanical hypersensitivity and active trigger points (TrPs) in the neck-shoulder muscles in elite swimmers with/without unilateral shoulder pain. Seventeen elite swimmers with shoulder pain; 18 swimmers without shoulder pain; and 15 elite athletes matched controls were recruited. Pressure pain thresholds (PPT) were assessed over the levator scapulae, sternocleidomastoid, upper trapezius, infraspinatus, scalene, subscapularis and tibialis anterior muscles. TrPs in the levator scapulae, upper trapezius, infraspinatus, scalene, sternocleidomastoid and subscapularis muscles were also explored. Swimmers with shoulder pain showed significant lower PPT in all muscles compared with controls (Ppain, underlining widespread mechanical hypersensitivity. The mean number of TrPs for elite swimmer with and without shoulder pain was, respectively, 4.7 ± 1 (2.1 ± 1.5 active; 2.6 ± 1.4 latent) and 4.7 ± 1.3 (1.3 ± 1.3 active; 3.4 ± 1.5 latent), whereas healthy athletes only showed latent TrPs (2.4 ± 1.2). Elite swimmers with shoulder pain showed higher number of active TrPs than swimmers without pain, whereas it was the opposite for the number of latent muscle TrP (Pmechanical hypersensitivity suggests that active TrPs play a role in the development of shoulder pain in elite swimmers.

  9. Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life

    NARCIS (Netherlands)

    Renzenbrink, Gerbert J.; IJzerman, Maarten J.


    Objective: To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia. Design: Prospective, open label design. Setting: The outpatient services of a large teachin

  10. Inadvertent intraosseous gadolinium injection during pediatric shoulder MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Pack, Jason R.; Jordanov, Martin I.; Block, John J. [Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN (United States)


    A variety of problems can arise while performing MR arthrography of the shoulder. These have been well documented in the literature and range from improper patient selection to errors in technique or in the choice of imaging sequences. We present a rare case of inadvertent, painless intraosseous injection of dilute gadolinium into the proximal humeral epiphysis of a 13-year-old male athlete. The clinical relevance is discussed and technical recommendations are offered. (orig.)



    Malone, Terry; Hazle, Charles


    The diagnostic capabilities of advanced imaging have increasingly enabled clinicians to delineate between structural alterations and injuries more efficiently than ever before. These impressive gains have unfortunately begun to provide a reliance on imaging at the loss of quality in the clinical examination. Ideally, imaging of the shoulder complex is performed to confirm the provisional diagnosis developed from the history and clinical exam rather than to create such. This clinical commentar...

  12. The painful shoulder: when to inject and when to refer. (United States)

    Codsi, Michael J


    Physicians can usually diagnose the cause of shoulder pain by performing a focused history and physical examination and ordering anteroposterior and lateral radiographs. Treatment depends on the cause and can include physical therapy, injections of corticosteroids into the joint space or bursa, and surgery. This paper reviews the diagnosis and treatment of impingement syndrome, adhesive capsulitis, rotator cuff tears, and arthritis of the glenohumeral joint and acromioclavicular (AC) joint.

  13. Efficacy of exercise combined with elecrotherapy in painful shoulder syndromes



    One of the most common causes of shoulder pain is the "impingement syndrome". After evaluation by physical examination and radiologic tecniques, 15 patients with diagnoses of impingement syndrome, admitted to Physical Therapy and Rehabilitation and Orthopedics and Traumatology Department of Trakya University were included in this study. Accoding to Neer Classificahon 5 patients (33.3%) were identified as Stage I and 10 patients (66. 7%) as Stage II. After aplication of diatermy therapy combin...

  14. Extracorporeal shock wave therapy in calcific tendinitis of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Peters, Jutta [Bethanien Krankenhaus, Department of Radiology, Frankfurt am Main (Germany); University Hospital Frankfurt, Department of Radiology, Frankfurt am Main (Germany); Luboldt, Wolfgang; Schwarz, Wolfram; Jacobi, Volkmar; Herzog, Christopher; Vogl, Thomas J. [University Hospital Frankfurt, Department of Radiology, Frankfurt am Main (Germany)


    To investigate clinical (pain, mobility) and radiological (resolution of calcium deposits) efficacy of different energy levels of extracorporeal shock wave therapy (ESWT) in calcific tendinitis of the shoulder. There were 90 study subjects with radiographically verified calcific tendinitis of one shoulder, mean age 52{+-}6 years (range 29 - 65 years; females:males=55:35), all of whom had had symptoms for at least 6 months and substantial restriction of shoulder mobility and pain that required taking anti-inflammatory drugs. Calcium deposits were of type I or type II (clearly circumscribed and dense) and ranged from 1 cm to 3 cm in diameter. Subjects were divided into three groups to receive ESWT at one of two energy levels (E{sub 1}=0.15 mJ/mm{sup 2}, E{sub 2}=0.44 mJ/mm{sup 2}) or sham treatment. Treatment was given at 6 weekly intervals until symptoms resolved, five treatments had been given or the subject dropped out of the programme. All subjects in groups E{sub 1} and E{sub 2} completed the programme. Those in group E{sub 1} had significantly less pain during treatment but more treatments than those in group E{sub 2}, and at 6 month follow-up had residual calcification and recurrence of pain (87%). Subjects in group E{sub 2} had no residual calcification or recurrence of pain. Sham treatment had no effect. There were no side effects except a small number of haematomas (2 in E{sub 1}, 6 in E{sub 2}; maximum size 2 cm). ESWT in calcific tendinitis of the shoulder is very effective. It does not have significant side effects at an energy level of E=0.44 mJ/mm{sup 2}, which can therefore be recommended. (orig.)

  15. MRI of Little Leaguer's shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Hatem, Stephen F.; Recht, Michael P. [Division of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio (United States); Profitt, Brad [PLLC, Profitt Chiropractic, Ashland, KY (United States)


    The MRI appearance of 'Little Leaguer's shoulder' has not been previously reported in the radiology literature. Purported etiologies include proximal humeral epiphyseolysis, osteochondrosis of the proximal humeral epiphysis, stress fracture of the proximal humeral epiphyseal plate, and rotational stress fracture of the proximal humeral epiphyseal plate. We describe magnetic resonance imaging findings in four patients and review the literature. (orig.)

  16. An 80-Year-Old Woman with Left Shoulder Pain


    Khoo, SB


    This case history illustrates the real life experience and dilemma of an 80-year-old woman in pursuit of medical care for her left shoulder pain. Points for discussion range from clinical features of Pancoast tumor, importance of pain management, good principles of Family Medicine and Palliative care to ethical issues of conspiracy of silence, limited treatment plan and palliative versus curative radiotherapy treatment without a known biopsy report. This paper provides opportunity for analysi...

  17. Shoulder injuries in overhead sports; Schultergelenkverletzungen bei Ueberkopfsportarten

    Energy Technology Data Exchange (ETDEWEB)

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


    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

  18. Anticoagulant-induced hemarthrosis presenting as anterior shoulder dislocation. (United States)

    Davis, Christine B; Nowak, Richard M


    This is a case of nontraumatic shoulder pain initially diagnosed on x-ray as an anterior dislocation. The patient was on anticoagulants and, in actuality, had severe hemarthrosis that caused the subluxation. Attempts to reduce the dislocation in this situation might have resulted in worsening of the intra-articular bleed. There has been only 1 similar reported case in the European Journal of Emergency Medicine in 2013 of a 53-year-old woman who was thought to have a nontraumatic anterior shoulder dislocation, and attempts were unsuccessful at reduction. Definitive therapy involved hemarthrosis aspiration. Others have reported spontaneous hemarthrosis due to anticoagulants; however, only 1 has reported an initial mistaken joint dislocation diagnosis. Nontraumatic hemarthrosis do occur in patients on anticoagulant therapy, and it is important to recognize that this can be misdiagnosed as a joint dislocation requiring reduction. In a patient who is on anticoagulants presenting with nontraumatic joint pain and anterior shoulder or possibly other dislocations on plain radiographs, it is pertinent to consider hemarthrosis.

  19. Shoulder impingement syndrome : evaluation of the causes with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yong Ho; Song, In Sup; Chung, Hun Young; Yoon, Sang Jin; Kim, Yang Soo; Shim, Hyung Jin; Choi, Young Hee; Lee, Jong Beum; Lee, Yong Chul; Kim, Kun Sang [Chungang Univ. College of Medicine, Seoul (Korea, Republic of); Choi, Yun Sun [Eulji Hospital, College of Medicine, Seoul (Korea, Republic of)


    Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69% of patients, the condition was due to more than one cause.

  20. Kinetic strategies of patients with shoulder impingement syndrome. (United States)

    Doiron, Yan; Delacroix, Sébastien; Denninger, Marc; Simoneau, Martin


    Our aim was to determine whether subjects with shoulder impingement syndrome (SIS) have abnormal multijoint torque patterns compared to healthy subjects during normalized isometric force along specific directions. Subjects had to generate an isometric force corresponding to 40% of the maximal pain-free force. Eight targets were displayed on a monitor (0, 45, 90, 135, 180, 225, 270, and 315 degrees ). We calculated shoulder and elbow torques (kinetic strategies) using a biomechanical model. Regardless of the target location, the SIS group succeeded in reaching the target; however, when compared to the healthy subjects, they needed more time to do so, suggesting that SIS may slow down the execution of the kinetic strategies. Moreover, the SIS group produced lower shoulder external/internal torque to reach the targets located at 0 degrees and 225 degrees, and they generated greater abduction/adduction torque for targets located at 0, 135, and 180 degrees. In addition, they had lower elbow extension/flexion torque for the target located at 315 degrees. The investigation of atypical kinetic strategies is essential to provide an understanding of the pathomechanics of the SIS and to develop more effective treatment strategies.

  1. Shoulder hemiarthroplasty for the treatment of complex proximal humeral fractures

    Institute of Scientific and Technical Information of China (English)

    YANG Shu-hua; WANG Jing; XU Wei-hua; LI Jin; LIU Guo-hui; YANG Can; YE Shu-nan; YE Zhe-wei; LIU Yong


    Objective: To investigate the indication, perioperative announcements, selection of prosthesis and clinical results of shoulder hemiarthroplasty for the treatment of complex proximal humeral fractures.Methods: A total of 55 patients who suffered from com-plex proximal humeral fractures were treated by shoulder hemiarthroplasty. The mean age was 55.6 years and mean follow-up period was 25.1 months. The scoring system modi-fication for hemiarthroplasty (SSMH) had been adopted for evaluation at the latest follow-up.Results: The pain was obviously relieved in all patients. Fifty patients were painless and 5 patients had slight pain. The mean range of motion was 100°(90°-110°) in abduction, 95°(80°-100°) in forward flexion, 35°(30°-40°) in extemal rotation and internal rotation was confined at L2 level (L1-L3). The mean SSMH score was 27.9 (24-29). Fifty patients (90.1%) were satisfied with the clinical outcome.Conclusions: Shoulder hemiarthroplasty is an effective method to treat complex proximal humeral fractures. The proper selection of patients and prosthesis, good operation skill and enough functional exercise are the key points of successful treatment.

  2. Shoulder height, body mass and shape of proboscideans

    Directory of Open Access Journals (Sweden)

    Asier Larramendi


    Full Text Available In recent decades there has been a growing interest in proboscideans’ body size, given that mass is highly correlated with biological functions. Different allometric equations have been proposed in the recent decades to estimate their body masses, based on a large number of living examples. However, the results obtained by these formulae are not accurate because extinct animals often had different body proportions and some were outside the size range of extant samples. Here the body mass of a large number of extinct proboscideans has been calculated by the Graphic Double Integration volumetric method which is based on technical restorations from graphical reconstructions of fossils employing photos, measurements and comparative anatomy of extant forms. The method has been tested on extant elephants with highly accurate results. The reconstructions necessary to apply this method give important information such as body proportions. On the other hand, equations to calculate the skeletal shoulder height have been developed, with a large number of published shoulder heights being recalculated. From the shoulder heights, several equations were created to find out the body mass of a series of extant and extinct species. A few of the largest proboscideans, namely Mammut borsoni and Palaeoloxodon namadicus, were found out to have reached and surpassed the body size of the largest indricotheres. Bearing this in mind, the largest land mammal that ever existed seems to be within the order of Proboscidea, contrary to previous understanding.

  3. Shoulder and elbow joint angle tracking with inertial sensors. (United States)

    El-Gohary, Mahmoud; McNames, James


    Wearable inertial systems have recently been used to track human movement in and outside of the laboratory. Continuous monitoring of human movement can provide valuable information relevant to individuals' level of physical activity and functional ability. Traditionally, orientation has been calculated by integrating the angular velocity from gyroscopes. However, a small drift in the measured velocity leads to increasing integration error over time. To compensate that drift, complementary data from accelerometers are normally fused into tracking systems using the Kalman or extended Kalman filter. In this study, we combine kinematic models designed for control of robotic arms with state-space methods to continuously estimate the angles of human shoulder and elbow using two wearable inertial measurement units. We use the unscented Kalman filter to implement the nonlinear state-space inertial tracker. Shoulder and elbow joint angles obtained from 8 subjects using our inertial tracker were compared to the angles obtained from an optical-tracking reference system. On average, there was an RMS angle error of less than 8° for all shoulder and elbow angles. The average correlation coefficient for all movement tasks among all subjects was r ≥ 0.95 . This agreement between our inertial tracker and the optical reference system was obtained for both regular and fast-speed movement of the arm. The same method can be used to track movement of other joints.


    Directory of Open Access Journals (Sweden)

    Jacob Isaac Jason


    Full Text Available Objective: The purpose of this study was to conduct a systematic review on various physiotherapy management for adhesive capsulitis of shoulder. Methods: A search of the literature was conducted using Clinical Key, ProQuest and PEDro databases up to September 2015. Search limits included the English language and human studies. Search terms included adhesive capsulitis, frozen shoulder, Physical therapy, Physiotherapy etc. Inclusion criteria: Systematic reviews and randomised controlled trials (RCTs in English language were included if they fulfilled the following criteria: (a patients with adhesive capsulitis were included, (b results on pain and function were reported, and (c a study period of at least two weeks was reported. Articles were assessed using the Jadad (1 scale and Physiotherapy Evidence Database (PEDro scale. ‘High-quality’ was defined as a “yes” score of 50% in Jadad scale and a PEDro rating of 5 out of 10. Totally 17 studies were selected for this systematic review. Conclusion: This study has found sufficient level of evidence for physiotherapy in the treatment of adhesive capsulitis the shoulder. In particular, manual treatment must be combined with commonly indicated exercise or conventional physiotherapy, as it remains the standard care.

  5. MR arthrography of the shoulder: Do we need local anesthesia?

    Energy Technology Data Exchange (ETDEWEB)

    Spick, Claudio, E-mail: [Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna (AKH), Waehringer-Guertel 18-20, 1090 Vienna (Austria); Szolar, Dieter H.M.; Reittner, Pia; Preidler, Klaus W.; Tillich, Manfred [Diagnostikum Graz-Südwest, Weblinger Guertel 25, 8054 Graz (Austria)


    Purpose: To assess pain intensity with and without subcutaneous local anesthesia prior to intraarticular administration of contrast medium for magnetic resonance arthrography (MRa) of the shoulder. Materials and methods: This single-center study was conducted after an IRB waiver of authorization, between January 2010 and December 2012. All patients provided written, informed consent for the procedure. Our prospectively populated institutional database was searched, based on our inclusion criteria. There were 249 outpatients (178 men and 71 women; mean age, 44.4 years ± 14.6; range, 15–79) who underwent MRa and were enrolled in this study. Patients were excluded if they had received surgery of the shoulder before MRa, had undergone repeated MRa of the same shoulder, and/or had undergone MRa of both shoulders on the same day. Patients were randomly assigned into one of three groups. Patients in group A (n = 61) received skin infiltration with local anesthesia. Patients in control group B (n = 92) and group C (n = 96) did not receive local anesthesia. Pain levels were immediately assessed after the injection for MRa using a horizontal visual analog scale (VAS) that ranged from 0 to 10. To compare the pain scores of the three groups for male and female patients, a two-way analysis of variance was used. A p-value equal to or less than 0.05 was considered to indicate a significant result. Results: Patients who received local anesthesia (group A) showed a mean pain level on the VAS of 2.6 ± 2.3. In patients who did not receive local anesthetics (groups B and C), a mean pain level on the VAS of 2.6 ± 2.2 and 2.7 ± 2.4 were detected, respectively. Between the three groups, no statistically significant difference in pain intensity was detected (p = .960). There were significant differences in subjective pain perception between men and women (p = .009). Moreover, the sex difference in all three groups was equal (p = .934). Conclusion: Local anesthesia is not required to

  6. Interactions between amyloid-β and hemoglobin: implications for amyloid plaque formation in Alzheimer's disease.

    Directory of Open Access Journals (Sweden)

    Jia-Ying Chuang

    Full Text Available Accumulation of amyloid-β (Aβ peptides in the brain is one of the central pathogenic events in Alzheimer's disease (AD. However, why and how Aβ aggregates within the brain of AD patients remains elusive. Previously, we demonstrated hemoglobin (Hb binds to Aβ and co-localizes with the plaque and vascular amyloid deposits in post-mortem AD brains. In this study, we further characterize the interactions between Hb and Aβ in vitro and in vivo and report the following observations: 1 the binding of Hb to Aβ required iron-containing heme; 2 other heme-containing proteins, such as myoglobin and cytochrome C, also bound to Aβ; 3 hemin-induced cytotoxicity was reduced in neuroblastoma cells by low levels of Aβ; 4 Hb was detected in neurons and glial cells of post-mortem AD brains and was up-regulated in aging and APP/PS1 transgenic mice; 5 microinjection of human Hb into the dorsal hippocampi of the APP/PS1 transgenic mice induced the formation of an envelope-like structure composed of Aβ surrounding the Hb droplets. Our results reveal an enhanced endogenous expression of Hb in aging brain cells, probably serving as a compensatory mechanism against hypoxia. In addition, Aβ binds to Hb and other hemoproteins via the iron-containing heme moiety, thereby reducing Hb/heme/iron-induced cytotoxicity. As some of the brain Hb could be derived from the peripheral circulation due to a compromised blood-brain barrier frequently observed in aged and AD brains, our work also suggests the genesis of some plaques may be a consequence of sustained amyloid accretion at sites of vascular injury.

  7. Laser therapy of painful shoulder and shoulder-hand syndrome in treatment of patients after the stroke. (United States)

    Karabegović, Azra; Kapidzić-Duraković, Suada; Ljuca, Farid


    The common complication after stroke is pain and dysfunction of shoulder of paralyzed arm, as well as the swelling of the hand. The aim of this study was to determine the effects of LASER therapy and to correlate with electrotherapy (TENS, stabile galvanization) in subjects after stroke. We analyzed 70 subjects after stroke with pain in shoulder and oedema of paralyzed hand. The examinees were divided in two groups of 35, and they were treated in the Clinic for Physical Medicine and Rehabilitation in Tuzla during 2006 and 2007. Experimental group (EG) had a treatment with LASER, while the control group (CG) was treated with electrotherapy. Both groups had kinesis therapy and ice massage. All patients were examined on the admission and discharge by using the VAS, DASH, Barthel index and FIM. The pain intensity in shoulder was significantly reduced in EG (p<0,0001), swelling is lowered in EG (p=0,01). Barthel index in both groups was significant higher (p<0,01). DASH was significantly improved after LASER therapy in EG (p<0,01). EG had higher level of independency (p<0,01). LASER therapy used on EG shows significantly better results in reducing pain, swelling, disability and improvement of independency.

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

    Energy Technology Data Exchange (ETDEWEB)

    Tirman, P.F.J. [San Francisco Magnetic Resonance Center, San Francisco, CA (United States); Steinbach, L.S. [Department of Radiology, University of California, San Francisco, CA (United States); Feller, J.F. [Department of Veterans Affairs, David Grant USAF Medical Center, Travis Air Force Base, CA (United States); Stauffer, A.E. [Radiologic Imaging Associates, Mission Viejo, CA (United States)


    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.

  9. Shoulder disorders related to work organization and other occupational factors among supermarket cashiers. (United States)

    Niedhammer, I; Landre, M F; LeClerc, A; Bourgeois, F; Franchi, P; Chastang, J F; Marignac, G; Mereau, P; Quinton, D; Du Noyer, C R; Schmaus, A; Vallayer, C


    The study was designed to examine, in 210 supermarket cashiers, the cross-sectional relationships between shoulder disorders according to location and chronicity of pain as well as personal and occupational factors and store and workstation characteristics. The factors associated with shoulder disorders differed for the right and left sides. Age and psychological disorders were significant risk factors. Among occupational factors, duration of employment, job control, wage dependence on efficiency, exposure to cold, movements and postures such as stooping, working with arms above shoulder level and holding heavy loads in position, and using a laser scanner were associated with shoulder disorders, especially on the left. These results confirm the multifactorial origin of shoulder disorders, and show the importance of psychosocial work factors, movements and postures, and the laser scanner as occupational risk factors, and the need to consider right and left shoulder disorders in cashiers separately.

  10. The association between Generalized Joint Hypermobility and shoulder mobility in young, competitive swimmers

    DEFF Research Database (Denmark)

    Junge, Tina; Henriksen, P; Knudsen, H K;


    risk factors for shoulder injuries (Pink et al., 2000, Zemek et al., 1995). An association between GJH and shoulder mobility among young, competitive swimmers has not been studied. The aim of this study was firstly to evaluate the association between GJH and horizontal shoulder abduction (HSA) in young...... mobility was measured as HSA using an inclinometer in a standardized protocol format. A multiple regression analysis was used to reveal associations between GJH and horizontal shoulder abduction, adjusted for sex and age. Results Overall, significant associations between GJH and HSA were found. An increase....... Conclusion In this study, a significant association was observed between GJH and HSA, as the horizontal shoulder abduction increased with increasing BT scores. The predictive validity of GJH and HSA with respect to shoulder injuries must be assessed in future studies...

  11. Physical mechanisms underlying the strain-rate-dependent mechanical behavior of kangaroo shoulder cartilage (United States)

    Thibbotuwawa, Namal; Oloyede, Adekunle; Li, Tong; Singh, Sanjleena; Senadeera, Wijitha; Gu, YuanTong


    Due to anatomical and biomechanical similarities to human shoulder, kangaroo was chosen as a model to study shoulder cartilage. Comprehensive enzymatic degradation and indentation tests were applied on kangaroo shoulder cartilage to study mechanisms underlying its strain-rate-dependent mechanical behavior. We report that superficial collagen plays a more significant role than proteoglycans in facilitating strain-rate-dependent behavior of the kangaroo shoulder cartilage. By comparing the mechanical properties of degraded and normal cartilages, it was noted that proteoglycan and collagen degradation significantly compromised strain-rate-dependent mechanical behavior of the cartilage. Superficial collagen contributed equally to the tissue behavior at all strain-rates. This is different to the studies reported on knee cartilage and confirms the importance of superficial collagen on shoulder cartilage mechanical behavior. A porohyperelastic numerical model also indicated that collagen disruption would lead to faster damage of the shoulder cartilage than when proteoglycans are depleted.

  12. Development of a Finite Element Model of the Human Shoulder to Investigate the Mechanical Responses and Injuries in Side Impact (United States)

    Iwamoto, Masami; Miki, Kazuo; Yang, King H.

    Previous studies in both fields of automotive safety and orthopedic surgery have hypothesized that immobilization of the shoulder caused by the shoulder injury could be related to multiple rib fractures, which are frequently life threatening. Therefore, for more effective occupant protection, it is important to understand the relationship between shoulder injury and multiple rib fractures in side impact. The purpose of this study is to develop a finite element model of the human shoulder in order to understand this relationship. The shoulder model included three bones (the humerus, scapula and clavicle) and major ligaments and muscles around the shoulder. The model also included approaches to represent bone fractures and joint dislocations. The relationships between shoulder injury and immobilization of the shoulder are discussed using model responses for lateral shoulder impact. It is also discussed how the injury can be related to multiple rib fractures.

  13. Risk of surgery for subacromial impingement syndrome in relation to neck-shoulder complaints and occupational biomechanical exposures

    DEFF Research Database (Denmark)

    Svendsen, Susanne Wulff; Dalbøge, Annett; Andersen, JH


    OBJECTIVES: The aim of this longitudinal study was to evaluate the risk of surgery for subacromial impingement syndrome (SIS) in relation to neck-shoulder complaints and occupational biomechanical shoulder exposures. METHODS: The study was based on the Musculoskeletal Research Database...... at the Danish Ramazzini Centre. We linked baseline questionnaire information from 1993-2004 on neck-shoulder complaints, job titles, psychosocial work factors, body mass index, and smoking with register information on first-time surgery for SIS from 1996-2008. Biomechanical exposure measures were obtained from....... Using no neck-shoulder complaints and low shoulder load at baseline as a reference, no neck-shoulder complaints and high shoulder load showed an adjusted hazard ratio (HR adj) of 2.55 [95% confidence interval (95% CI) 1.59-4.09], while neck-shoulder complaints in combination with high shoulder load...

  14. Do Astronauts Havbe a Higher Rate of Orthopedic Shoulder Conditions Than a Cohort of Working Professionals (United States)

    Laughlin, M. S.; Murray, J. D.; Young, M.; Wear, M. L.; Van Baalen, M.; Tarver, W. J.


    Occupational surveillance of astronaut shoulder injuries began with operational concerns at the Neutral Buoyancy Laboratory (NBL) during Extra Vehicular Activity (EVA) training. Orthopedic shoulder injury and surgery rates were calculated [1], but classifying the rates as normal, high or low was highly dependent on the comparison group. Thus, the purpose of this study was to identify a population of working professionals and compare orthopedic shoulder consultation and surgery rates.

  15. Combined single photon emission computerized tomography and conventional computerized tomography: Clinical value for the shoulder surgeons?

    Directory of Open Access Journals (Sweden)

    Michael T Hirschmann


    Full Text Available With the cases described, we strive to introduce single photon emission computerized tomography in combination with conventional computer tomography (SPECT/CT to shoulder surgeons, illustrate the possible clinical value it may offer as new diagnostic radiologic modality, and discuss its limitations. SPECT/CT may facilitate the establishment of diagnosis, process of decision making, and further treatment for complex shoulder pathologies. Some of these advantages were highlighted in cases that are frequently seen in most shoulder clinics.

  16. Shoulder Impingement, An Uncommon Complication of Distal Clavicle Fracture Treated Arthroscopically: A Case Report

    Directory of Open Access Journals (Sweden)

    CS Wang


    Full Text Available Clavicle fracture is commonly treated conservatively. However uncommon complication can arise causing impingement. We report a patient who sustained distal clavicle fracture and was treated conservatively. However he developed persistent shoulder pain that affected his daily life. Shoulder impingement was diagnosed and arthroscopic subacromioclavicular decompression was done. Following early physiotherapy the early recovery was good with full range of motion of the shoulder.

  17. Radiological Projection for Diagnosis of Shoulder Subluxation in Patients with Post-Stroke Hemiplegia

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Kwang Ho [Dept. of Radiological Science, Catholic University of Daegu, Daegu (Korea, Republic of); Kang, Yeong Han [Dept. of Radiology, Daegu Catholic University Hospital, Daegu (Korea, Republic of)


    The purpose of this study was to find out useful radiological projection of shoulder subluxation in patients with post-stroke hemiplegia. A total of 33 patients with post-stroke hemiplegia were included(20 men and 13 women, mean age 62.3 years) and having the subluxed shoulder over one finger breath. The shoulder subluxation was determined as the ratio of the radiographic vertical and horizontal distance. The vertical distance was determined by measuring the distance between the most inferolateral point of the acromion and the central point of the humeral head. The horizontal distance was determined by measuring the distance between the central point of the glenoid fossa and the central point of the humeral head. To measure of the shoulder subluxation, the shoulder AP, axial and transthoracic lateral projections were taken on both affected and unaffected shoulders. We analyzed the difference of subluxation distance by t-test. When patients was in sitting position, the average time of being shoulder subluxation was 123 second. There was significant difference between supine(49.90{+-}13.6 mm) and sitting position(60.72{+-}16.3 mm) in the vertical distance of shoulder anterior-posterior projection. Also, there was significant difference on transthoracic lateral projections, Affected 35.92{+-}6.2 mm, Unaffected 28.76{+-}5.4 mm. But in case of shoulder axial projection(supine position), there was no significant difference (Unaffected and affected was 23.01{+-}9.0 mm, 22.45{+-}8.2 mm each). Radiological projection of shoulder subluxation has diagnostic value when it goes after check out the process of subluxation through finger breadth test. For this, patients must be in sitting and shoulder neutral position about 2 minutes. In addition, Shoulder anterior-posterior and transthoracic projection were significant to diagnose subluxation. But in axial projection, there wasn't meaningful differences.

  18. Effect of brief daily resistance training on rapid force development in painful neck and shoulder muscles

    DEFF Research Database (Denmark)

    Jay, Kenneth; Schraefel, Mc; Andersen, Christoffer H


    OBJECTIVE: To determine the effect of small daily amounts of progressive resistance training on rapid force development of painful neck/shoulder muscles. METHODS: 198 generally healthy adults with frequent neck/shoulder muscle pain (mean: age 43.1 years, computer use 93% of work time, 88% women...... relationship existed between changes in rapid force development and pain (r = 0.27, Pneck/shoulder pain increases rapid force development and...

  19. "Wet diapers--dry patients": an effective dressing for patients undergoing arthroscopic shoulder surgery. (United States)

    Kapila, Atul; Bhargava, Amit; Funk, Len; Copeland, Stephen; Levy, Ofer


    Shoulder arthroscopy is very commonly associated with postoperative leakage of irrigation fluid. This causes apprehension to patients and their relatives and leads to frequent change of dressings. We describe a simple and effective diaper dressing for patients undergoing arthroscopic shoulder surgery. It is highly absorbent, cost-effective, and easy to apply. We have used this dressing successfully in more than 1,500 shoulder arthroscopies over the last 3 years with no adverse reaction.

  20. Overhead shoulder press – In-front of the head or behind the head?

    Directory of Open Access Journals (Sweden)

    Mark R. McKean


    Conclusion: Shoulder ROM was within passive ROM for all measures except external rotation for males with the behind the head technique. To avoid possible injury passive ROM should be increased prior to behind the head protocol. Females showed greater spine movements, suggesting trunk strengthening may assist overhead pressing techniques. For participants with normal trunk stability and ideal shoulder ROM, overhead pressing is a safe exercise (for the shoulder and spine when performed either in-front of or behind the head.

  1. Management in non-traumatic arm, neck and shoulder complaints: differences between diagnostic groups



    textabstractArm, neck and/or shoulder complaints are common in western societies. In the Netherlands, general practice guidelines are issued on shoulder pain and epicondylitis only. Little is known about actual management of the total range of diagnoses. The objectives of the study are: to determine management in patients consulting the GP with a new episode of non-traumatic arm neck and shoulder complaints up to 6 months after the first consultation. To evaluate differences in management bet...

  2. Endogenously generated amyloid β increases membrane fluidity in neural 2a cells

    Institute of Scientific and Technical Information of China (English)

    NIU Ying; SHENG BaiYang; SONG Bo; LIU LingLing; ZHANG XiuFang; ZHAO NanMing; GONG YanDao


    The effect of endogenously generated amyloid β on membrane fluidity was investigated in Neural 2a cells stably expressing Swedish mutant amyloid precursor protein (APPswe). Membrane fluidity was studied by fluorescence polarizability using 1,6-Diphenyl-1,3,5-Hexatriene (DPH) as the fluorescence probe. It was found that the membrane fluidity in APPswe cells was significantly higher than that in its wild type counterparts. Alleviating the effect of amyloid β either by y secretase activity inhibition or by amyloid antibody treatment decreased membrane fluidity, which indicated an important role of amyloid β in increasing membrane fluidity. Treatment using amyloid β channel blocker, tromethamine and NA4 suggested that channel formed by amyloid β on the cell membrane is a way through which amyloid β takes its membrane fluidizing effect.

  3. Identification of a Common Binding Mode for Imaging Agents to Amyloid Fibrils from Molecular Dynamics Simulations

    DEFF Research Database (Denmark)

    Skeby, Katrine Kirkeby; Sørensen, Jesper; Schiøtt, Birgit


    Amyloid diseases are characterized by the misfolding and deposition of proteins in the body in the form of insoluble amyloid fibrils. Alzheimer’s disease and type 2 diabetes mellitus are two examples of amyloid diseases which are closely related both with respect to the atomic structures of the a......Amyloid diseases are characterized by the misfolding and deposition of proteins in the body in the form of insoluble amyloid fibrils. Alzheimer’s disease and type 2 diabetes mellitus are two examples of amyloid diseases which are closely related both with respect to the atomic structures...... of the amyloid fibrils and the disease pathology. Alzheimer’s disease is very difficult to diagnose, and much research is being performed to develop noninvasive diagnostic methods, such as imaging with small-molecule agents. The interactions between amyloid fibrils and imaging agents are challenging to examine...

  4. Characterizing Structural Stability of Amyloid Motif Fibrils Mediated by Water Molecules. (United States)

    Choi, Hyunsung; Chang, Hyun Joon; Lee, Myeongsang; Na, Sungsoo


    In biological systems, structural confinements of amyloid fibrils can be mediated by the role of water molecules. However, the underlying effect of the dynamic behavior of water molecules on structural stabilities of amyloid fibrils is still unclear. By performing molecular dynamics simulations, we investigate the dynamic features and the effect of interior water molecules on conformations and mechanical characteristics of various amyloid fibrils. We find that a specific mechanism induced by the dynamic properties of interior water molecules can affect diffusion of water molecules inside amyloid fibrils, inducing their different structural stabilities. The conformation of amyloid fibrils induced by interior water molecules show the fibrils' different mechanical features. We elucidate the role of confined and movable interior water molecules in structural stabilities of various amyloid fibrils. Our results offer insights not only in further understanding of mechanical features of amyloids as mediated by water molecules, but also in the fine-tuning of the functional abilities of amyloid fibrils for applications.

  5. Nonequilibrium and generalized-ensemble molecular dynamics simulations for amyloid fibril

    Energy Technology Data Exchange (ETDEWEB)

    Okumura, Hisashi [Research Center for Computational Science, Institute for Molecular Science, Okazaki, Aichi 444-8585 (Japan); Department of Structural Molecular Science, The Graduate University for Advanced Studies, Okazaki, Aichi 444-8585 (Japan)


    Amyloids are insoluble and misfolded fibrous protein aggregates and associated with more than 20 serious human diseases. We perform all-atom molecular dynamics simulations of amyloid fibril assembly and disassembly.

  6. Odontogenic fibroma, including amyloid and ossifying variants. (United States)

    Eversole, Lewis R


    Sixty-five cases of odontogenic fibroma (OdonF) are herein presented having been segregated into peripheral, extra bony tumors (n = 40) and tumors arising in bone or centrally (n = 25). All cases were characterized microscopically by a fibrous proliferation that varied within and between cases in cellularity and collagen fibril diameter, with intermixed odontogenic epithelial islands and cords. All central lesions presented as well demarcated radiolucencies and resorption of contiguous tooth roots was a common finding. These intraosseous lesions were of the WHO type; the so-called nonWHO type was excluded as all lesions with this diagnosis were devoid of an epithelial component and could be reclassified as other soft tissue fibrogenic tumors. Neither the central tumors nor the peripheral lesions recurred following enucleation/curettage, with a mean follow-up of 4 and 3.4 years respectively. Three distinct microscopic variations were encountered in this series: (1) two cases of OdonF with giant cell reaction, (2) two instances of OdonF with ossifying fibroma; and (3) four instances of OdonF with odontogenic ameloblast-associated protein (ODAM), an amyloid-like protein found deposited adjacent to epithelial cords plus CD1a+/S-100+ Langerhans dendritic cells entwined around the epithelial element. A single instance of the odontogenic fibroma-like hamartoma/enamel hypoplasia syndrome has been included in this series.

  7. The activity pattern of shoulder muscles in subjects with and without subacromial impingement

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Nørregaard, Jesper; Dyhre-Poulsen, Poul


    in patients with SI. The aim of the study was to determine and compare the activity pattern of the shoulder muscles in subjects with and without SI. Twenty-one subjects with SI and 20 healthy controls were included. Electromyography (EMG) was assessed from eight shoulder muscles from both shoulders during...... motion. In the symptomatic shoulder, there was a significantly greater EMG activity during abduction in the supraspinatus and latissimus muscles and less activity in serratus anterior compared to the healthy subjects. During external rotation, there was significantly less activity of the infraspinatus...

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

    Energy Technology Data Exchange (ETDEWEB)

    Carroll, K.W. [Radiology Regional Center, Naples, FL (United States); Helms, C.A. [Duke University Medical Center, Department of Radiology, Durham, NC (United States)


    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.)

  9. Metastatic gastric cancer presenting with shoulder-hand syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Massarotti Marco


    Full Text Available Abstract Introduction Shoulder-hand syndrome is a relatively rare clinical entity classified as a complex regional pain syndrome type 1 and consisting essentially of a painful 'frozen shoulder' with disability, swelling, vasomotor or dystrophic changes in the homolateral hand. The pathophysiology is not completely clear but a predominant 'sympathetic' factor affecting the neural and vascular supply to the affected parts seems to be involved. Shoulder-hand syndrome has been related to many surgical, orthopedic, neurological and medical conditions; it is more often seen after myocardial infarction, hemiplegia and painful conditions of neck and shoulder, such as trauma, tumors, cervical discogenic or intraforaminal diseases and shoulder calcific tendinopathy, but has also been associated with herpetic infections, brain and lung tumors, thoracoplasty and drugs including phenobarbitone and isoniazid. The diagnosis of shoulder-hand syndrome is primarily clinical, but imaging studies, particularly bone scintigraphy, may be useful to exclude other disorders. Case presentation We report the case of a 67-year-old woman who presented with shoulder-hand syndrome as the initial manifestation of gastric cancer which had metastasized to bone. Conclusion Wider investigations are advisable in patients with atypical shoulder-hand syndrome. To the best of the authors' knowledge this is the first case of shoulder-hand syndrome associated with metastatic gastric cancer.


    Directory of Open Access Journals (Sweden)

    S. Lakshmi Narayana


    Full Text Available AIMS AND OBJECTIVES To study the efficacy of hydraulic distension under local anaesthesia in the management of frozen shoulder. To study the age and sex distribution of frozen shoulder. MATERIALS AND METHODS 50 Patients with 54 shoulders of frozen shoulder syndrome, 4 cases with bilateral shoulder involvement were studied. A detailed history was elicited with particular reference to frozen shoulder (as shown in the proforma. A preliminary general physical examination was done. RESULTS Fifty patients with 54 shoulders of frozen shoulder syndrome were treated with hydraulic distension under local anaesthesia. The maximum and minimum age in this study was found to be 85 years and 41 years respectively. The average age of the patients in this study was calculated as 54.16 years. Out of 50 patients followed up, 32 were females and 18 were males. The Female: Male ratio was 1.77:1. In this series, 4 patients had bilateral involvement. In 17 patients, side involved was the dominant that is right arm. In 29 cases, the left arm that is non-dominant arm was involved. Associated conditions in this series are 7 patients had diabetes mellitus, 4 patients had hypertension, 5 patients had osteoarthritis of knee, 2 had peptic ulcer, 1 pulmonary Koch’s and 1 had bilateral cataract. CONCLUSION Concomitant home exercises program is a must and is the hallmark of success following hydraulic distension. Hydraulic distension is a safe, reliable, cost effective without requiring specialised equipment in the management of frozen shoulder.

  11. Driving Simulator Study of Effect of Inside Shoulder on Vehicle Operation

    Directory of Open Access Journals (Sweden)

    Han Ding


    Full Text Available According to the Chinese Design Specification for Highway Alignment (JTG D20-2006, eight-lane expressways should be paved with an inside shoulder of 2.5 m; however, this regulation is rarely obeyed in engineering practice. On the basis of driving simulator experiment, this research examined the impacts of inside shoulder on vehicle operation with and without the speed limitation. A virtual scenario, consisting of five expressways with different inside shoulder widths, was created and displayed in driving simulator, and vehicle operational data—speed and lane position—were recorded. Authors used analysis of variance (ANOVA and contrast analysis to examine whether inside shoulder width had statistically significant effects on travel speed and lane position. Analytical results indicated that there is a kind of quadratic relationship between inside shoulder width and driver's speed choice, while driver's speed choice is not significantly affected by inside shoulder width. What is more, inside shoulder width has statistically significant effects on vehicle's lane positions, and vehicle's lane position is negatively correlated to inside shoulder width. Specifically, the vehicle can be maintained at the center of lane when the inside shoulder width is 2.5 m.

  12. Total shoulder arthroplasty outcome for treatment of osteoarthritis: a multicenter study using a contemporary implant. (United States)

    Wright, Thomas W; Flurin, Pierre-Henri; Crosby, Lynn; Struk, Aimee M; Zuckerman, Joseph D


    In this article, we present clinical results of primary total shoulder arthroplasty for osteoarthritis using an implant that provides dual eccentricity and variable neck and version angles for reconstruction of proximal humeral anatomy. Two hundred one patients with symptomatic osteoarthritis underwent 218 total shoulder arthroplasties with a fourth-generation anatomical shoulder and a replicator plate at 4 centers between August 1, 2006, and December 31, 2010. Fourth-generation implants allow for varying humeral neck and version angles and have dual eccentricity so as to be consistently able to cover the humeral head cut. At a mean follow-up of 3 years (minimum, 2 years), there was an 81% follow-up rate. At final follow-up, 3 objective measures were significantly (P Shoulder Pain and Disability Index (pre, 86; post, 20), Simple Shoulder Test (pre, 3.3; post, 10), UCLA Shoulder Rating Scale (pre, 13; post, 31), and American Shoulder and Elbow Surgeons Shoulder Assessment (pre, 33; post, 85). Complications were noted in 11% of the shoulders. The most common complications were rotator cuff failure (13, 6%) and infection (5, 2%).

  13. Amyloid PET in European and North American cohorts; and exploring age as a limit to clinical use of amyloid imaging

    Energy Technology Data Exchange (ETDEWEB)

    Chiotis, Konstantinos [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); Carter, Stephen F. [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); University of Manchester, Wolfson Molecular Imaging Centre, Institute of Brain, Behaviour and Mental Health, Manchester (United Kingdom); Farid, Karim [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); APHP, Hotel-Dieu Hospital, Department of Nuclear Medicine, Paris (France); Savitcheva, Irina [Karolinska University Hospital Huddinge, Department of Radiology, Stockholm (Sweden); Nordberg, Agneta [Karolinska Institutet, Department of NVS, Center for Alzheimer Research, Translational Alzheimer Neurobiology, Stockholm (Sweden); Karolinska University Hospital Huddinge, Department of Geriatric Medicine, Stockholm (Sweden); Collaboration: for the Diagnostic Molecular Imaging (DiMI) network and the Alzheimer' s Disease Neuroimaging Initiative


    Several radiotracers that bind to fibrillar amyloid-beta in the brain have been developed and used in various patient cohorts. This study aimed to investigate the comparability of two amyloid positron emission tomography (PET) tracers as well as examine how age affects the discriminative properties of amyloid PET imaging. Fifty-one healthy controls (HCs), 72 patients with mild cognitive impairment (MCI) and 90 patients with Alzheimer's disease (AD) from a European cohort were scanned with [11C]Pittsburgh compound-B (PIB) and compared with an age-, sex- and disease severity-matched population of 51 HC, 72 MCI and 84 AD patients from a North American cohort who were scanned with [18F]Florbetapir. An additional North American population of 246 HC, 342 MCI and 138 AD patients with a Florbetapir scan was split by age (55-75 vs 76-93 y) into groups matched for gender and disease severity. PET template-based analyses were used to quantify regional tracer uptake. The mean regional uptake patterns were similar and strong correlations were found between the two tracers across the regions of interest in HC (ρ = 0.671, p = 0.02), amyloid-positive MCI (ρ = 0.902, p < 0.001) and AD patients (ρ = 0.853, p < 0.001). The application of the Florbetapir cut-off point resulted in a higher proportion of amyloid-positive HC and a lower proportion of amyloid-positive AD patients in the older group (28 and 30 %, respectively) than in the younger group (19 and 20 %, respectively). These results illustrate the comparability of Florbetapir and PIB in unrelated but matched patient populations. The role of amyloid PET imaging becomes increasingly important with increasing age in the diagnostic assessment of clinically impaired patients. (orig.)

  14. Failure of perivascular drainage of β-amyloid in cerebral amyloid angiopathy. (United States)

    Hawkes, Cheryl A; Jayakody, Nimeshi; Johnston, David A; Bechmann, Ingo; Carare, Roxana O


    In Alzheimer's disease, amyloid-β (Aβ) accumulates as insoluble plaques in the brain and deposits in blood vessel walls as cerebral amyloid angiopathy (CAA). The severity of CAA correlates with the degree of cognitive decline in dementia. The distribution of Aβ in the walls of capillaries and arteries in CAA suggests that Aβ is deposited in the perivascular pathways by which interstitial fluid drains from the brain. Soluble Aβ from the extracellular spaces of gray matter enters the basement membranes of capillaries and drains along the arterial basement membranes that surround smooth muscle cells toward the leptomeningeal arteries. The motive force for perivascular drainage is derived from arterial pulsations combined with the valve effect of proteins present in the arterial basement membranes. Physical and biochemical changes associated with arteriosclerosis, aging and possession of apolipoprotein E4 genotype lead to a failure of perivascular drainage of soluble proteins, including Aβ. Perivascular cells associated with arteries and the lymphocytes recruited in the perivenous spaces contribute to the clearance of Aβ. The failure of perivascular clearance of Aβ may be a major factor in the accumulation of Aβ in CAA and may have significant implications for the design of therapeutics for the treatment of Alzheimer's disease.

  15. Polymerizing the fibre between bacteria and host cells: the biogenesis of functional amyloid fibres



    Amyloid fibres are proteinaceous aggregates associated with several human diseases, including Alzheimer’s, Huntington’s and Creutzfeldt Jakob’s. Disease-associated amyloid formation is the result of proteins that misfold and aggregate into β sheet-rich fibre polymers. Cellular toxicity is readily associated with amyloidogenesis, although the molecular mechanism of toxicity remains unknown. Recently, a new class of ‘functional’ amyloid fibres was discovered that demonstrates that amyloids can ...

  16. Amyloid Structure and Assembly: Insights from Scanning Transmission Electron Microscopy

    Energy Technology Data Exchange (ETDEWEB)

    Goldsbury, C.; Wall, J.; Baxa, U.; Simon, M. N.; Steven, A. C.; Engel, A.; Aebi, U.; Muller, S. A.


    Amyloid fibrils are filamentous protein aggregates implicated in several common diseases such as Alzheimer's disease and type II diabetes. Similar structures are also the molecular principle of the infectious spongiform encephalopathies such as Creutzfeldt-Jakob disease in humans, scrapie in sheep, and of the so-called yeast prions, inherited non-chromosomal elements found in yeast and fungi. Scanning transmission electron microscopy (STEM) is often used to delineate the assembly mechanism and structural properties of amyloid aggregates. In this review we consider specifically contributions and limitations of STEM for the investigation of amyloid assembly pathways, fibril polymorphisms and structural models of amyloid fibrils. This type of microscopy provides the only method to directly measure the mass-per-length (MPL) of individual filaments. Made on both in vitro assembled and ex vivo samples, STEM mass measurements have illuminated the hierarchical relationships between amyloid fibrils and revealed that polymorphic fibrils and various globular oligomers can assemble simultaneously from a single polypeptide. The MPLs also impose strong constraints on possible packing schemes, assisting in molecular model building when combined with high-resolution methods like solid-state nuclear magnetic resonance (NMR) and electron paramagnetic resonance (EPR).

  17. Prediction of Peptide and Protein Propensity for Amyloid Formation.

    Directory of Open Access Journals (Sweden)

    Carlos Família

    Full Text Available Understanding which peptides and proteins have the potential to undergo amyloid formation and what driving forces are responsible for amyloid-like fiber formation and stabilization remains limited. This is mainly because proteins that can undergo structural changes, which lead to amyloid formation, are quite diverse and share no obvious sequence or structural homology, despite the structural similarity found in the fibrils. To address these issues, a novel approach based on recursive feature selection and feed-forward neural networks was undertaken to identify key features highly correlated with the self-assembly problem. This approach allowed the identification of seven physicochemical and biochemical properties of the amino acids highly associated with the self-assembly of peptides and proteins into amyloid-like fibrils (normalized frequency of β-sheet, normalized frequency of β-sheet from LG, weights for β-sheet at the window position of 1, isoelectric point, atom-based hydrophobic moment, helix termination parameter at position j+1 and ΔG° values for peptides extrapolated in 0 M urea. Moreover, these features enabled the development of a new predictor (available at capable of accurately and reliably predicting the amyloidogenic propensity from the polypeptide sequence alone with a prediction accuracy of 84.9 % against an external validation dataset of sequences with experimental in vitro, evidence of amyloid formation.

  18. Lipid raft disruption protects mature neurons against amyloid oligomer toxicity. (United States)

    Malchiodi-Albedi, Fiorella; Contrusciere, Valentina; Raggi, Carla; Fecchi, Katia; Rainaldi, Gabriella; Paradisi, Silvia; Matteucci, Andrea; Santini, Maria Teresa; Sargiacomo, Massimo; Frank, Claudio; Gaudiano, Maria Cristina; Diociaiuti, Marco


    A specific neuronal vulnerability to amyloid protein toxicity may account for brain susceptibility to protein misfolding diseases. To investigate this issue, we compared the effects induced by oligomers from salmon calcitonin (sCTOs), a neurotoxic amyloid protein, on cells of different histogenesis: mature and immature primary hippocampal neurons, primary astrocytes, MG63 osteoblasts and NIH-3T3 fibroblasts. In mature neurons, sCTOs increased apoptosis and induced neuritic and synaptic damages similar to those caused by amyloid beta oligomers. Immature neurons and the other cell types showed no cytotoxicity. sCTOs caused cytosolic Ca(2+) rise in mature, but not in immature neurons and the other cell types. Comparison of plasma membrane lipid composition showed that mature neurons had the highest content in lipid rafts, suggesting a key role for them in neuronal vulnerability to sCTOs. Consistently, depletion in gangliosides protected against sCTO toxicity. We hypothesize that the high content in lipid rafts makes mature neurons especially vulnerable to amyloid proteins, as compared to other cell types; this may help explain why the brain is a target organ for amyloid-related diseases.

  19. On the adsorption of magnetite nanoparticles on lysozyme amyloid fibrils. (United States)

    Majorosova, Jozefina; Petrenko, Viktor I; Siposova, Katarina; Timko, Milan; Tomasovicova, Natalia; Garamus, Vasil M; Koralewski, Marceli; Avdeev, Mikhail V; Leszczynski, Błażej; Jurga, Stefan; Gazova, Zuzana; Hayryan, Shura; Hu, Chin-Kun; Kopcansky, Peter


    An adsorption of magnetic nanoparticles (MNP) from electrostatically stabilized aqueous ferrofluids on amyloid fibrils of hen egg white lysozyme (HEWL) in 2mg/mL acidic dispersions have been detected for the MNP concentration range of 0.01-0.1vol.%. The association of the MNP with amyloid fibrils has been characterized by transmission electron microscopy (TEM), small-angle X-ray scattering (SAXS) and magneto-optical measurements. It has been observed that the extent of adsorption is determined by the MNP concentration. When increasing the MNP concentration the formed aggregates of magnetic particles repeat the general rod-like structure of the fibrils. The effect is not observed when MNP are mixed with the solution of lysozyme monomers. The adsorption has been investigated with the aim to clarify previously found disaggregation activity of MNP in amyloid fibrils dispersions and to get deeper insight into interaction processes between amyloids and MNP. The observed effect is also discussed with respect to potential applications for ordering lysozyme amyloid fibrils in a liquid crystal phase under external magnetic fields.

  20. New Insights in the Amyloid-Beta Interaction with Mitochondria

    Directory of Open Access Journals (Sweden)

    Carlos Spuch


    Full Text Available Biochemical and morphological alterations of mitochondria may play an important role in the pathogenesis of Alzheimer’s disease (AD. Particularly, mitochondrial dysfunction is a hallmark of amyloid-beta-induced neuronal toxicity in Alzheimer’s disease. The recent emphasis on the intracellular biology of amyloid-beta and its precursor protein (APP has led researchers to consider the possibility that mitochondria-associated and mitochondrial amyloid-beta may directly cause neurotoxicity. Both proteins are known to localize to mitochondrial membranes, block the transport of nuclear-encoded mitochondrial proteins to mitochondria, interact with mitochondrial proteins, disrupt the electron transport chain, increase reactive oxygen species production, cause mitochondrial damage, and prevent neurons from functioning normally. In this paper, we will outline current knowledge of the intracellular localization of amyloid-beta. Moreover, we summarize evidence from AD postmortem brain as well as animal AD models showing that amyloid-beta triggers mitochondrial dysfunction through a number of pathways such as impairment of oxidative phosphorylation, elevation of reactive oxygen species production, alteration of mitochondrial dynamics, and interaction with mitochondrial proteins. Thus, this paper supports the Alzheimer cascade mitochondrial hypothesis such as the most important early events in this disease, and probably one of the future strategies on the therapy of this neurodegenerative disease.

  1. Modeling the Aggregation Propensity and Toxicity of Amyloid-β Variants

    DEFF Research Database (Denmark)

    Tiwari, Manish Kumar; Kepp, Kasper Planeta


    Protein aggregation is a hallmark of many neurodegenerative disorders. Alzheimer’s disease (AD) is directly linked to deposits of amyloid-β (Aβ) derived from the amyloid-β protein precursor (AβPP), and multiple experimental studies have investigated the aggregation behavior of these amyloids...

  2. Amyloid-beta Positron Emission Tomography Imaging Probes : A Critical Review

    NARCIS (Netherlands)

    Kepe, Vladimir; Moghbel, Mateen C.; Langstrom, Bengt; Zaidi, Habib; Vinters, Harry V.; Huang, Sung-Cheng; Satyamurthy, Nagichettiar; Doudet, Doris; Mishani, Eyal; Cohen, Robert M.; Hoilund-Carlsen, Poul F.; Alavi, Abass; Barrio, Jorge R.


    The rapidly rising prevalence and cost of Alzheimer's disease in recent decades has made the imaging of amyloid-beta deposits the focus of intense research. Several amyloid imaging probes with purported specificity for amyloid-beta plaques are currently at various stages of FDA approval. However, a

  3. Trifluoroethanol modulates α-synuclein amyloid-like aggregate formation, stability and dissolution

    DEFF Research Database (Denmark)

    Di Carlo, Maria Giovanna; Vetri, Valeria; Buscarino, Gianpiero


    The conversion of proteins into amyloid fibrils and other amyloid-like aggregates is closely connected to the onset of a series of age-related pathologies. Upon changes in environmental conditions, amyloid-like aggregates may also undergo disassembly into oligomeric aggregates, the latter being r...

  4. Whole body amyloid deposition imaging by 123I-SAP scintigraphy

    NARCIS (Netherlands)

    van Rheenen, Ronald; Glaudemans, Andor; Hazenberg, Bouke


    Amyloidosis is the name of a group of diseases characterized by extracellular deposition of amyloid fibrils. Deposition of amyloid can be localized or systemic. The 123I-SAP-scan can be used to image extent and distribution of amyloid deposition in patients with systemic AA, AL and ATTR amyloidosis.

  5. Genetic determinants of white matter hyperintensities and amyloid angiopathy in familial Alzheimer's disease

    NARCIS (Netherlands)

    Ryan, Natalie S.; Biessels, Geert Jan; Kim, Lois; Nicholas, Jennifer M.; Barber, Philip A.; Walsh, Phoebe; Gami, Priya; Morris, Huw R.; Bastos-Leite, António J.; Schott, Jonathan M.; Beck, Jon; Mead, Simon; Chavez-Gutierrez, Lucia; de Strooper, Bart; Rossor, Martin N.; Revesz, Tamas; Lashley, Tammaryn; Fox, Nick C.


    Familial Alzheimer's disease (FAD) treatment trials raise interest in the variable occurrence of cerebral amyloid angiopathy (CAA); an emerging important factor in amyloid-modifying therapy. Previous pathological studies reported particularly severe CAA with postcodon 200 PSEN1 mutations and amyloid

  6. Reverse Total Shoulder Arthroplasty and Work-Related Outcomes. (United States)

    Garcia, Grant H; Taylor, Samuel A; Mahony, Gregory T; DePalma, Brian J; Grawe, Brian M; Nguyen, Joseph; Dines, Joshua S; Dines, David M; Warren, Russell F; Craig, Edward V; Gulotta, Lawrence V


    The average retirement age is increasing, and the indications for reverse total shoulder arthroplasty (RTSA) are being broadened. The goal of the current study was to determine objective findings for rate of return to work and time to return to work after RTSA. The authors performed retrospective data collection for consecutive patients who underwent RTSA at their institution between 2007 and 2013. All patients were asked to complete a questionnaire about their work history and their ability to participate in work-related activities. A total of 40 patients reported working before surgery. Average patient age was 74.7 years (range, 56-82 years). Average follow-up was 2.6 years (range, 1-4.7 years). Average American Shoulder and Elbow Surgeons score improved from 34.0 to 81.7 (P<.001). Average visual analog scale pain score decreased from 6.5 to 0.7 (P<.001). Most patients (65.4%) classified their job as sedentary, 34.6% classified their job as light work, and no patients classified their job as heavy work. Of patients who worked preoperatively, 65% (n=26) returned to work after RTSA. Only a previous diagnosis of heart disease affected return to work (P=.04). Overall, average time to return to work was 2.3 months (range, 0.5-11 months). Patients with sedentary jobs returned to work more quickly (1.4 months) than those with light work (4.0 months). A total of 96.2% of patients reported good to excellent surgical outcomes. Of patients who worked before RTSA, 65% were still working at final follow-up. Only 5% of patients retired for reasons attributed to the operated shoulder. On average, patients returned to work less than 3 months after surgery.

  7. Artifacts and pitfalls in shoulder magnetic resonance imaging. (United States)

    Marcon, Gustavo Felix; Macedo, Tulio Augusto Alves


    Magnetic resonance imaging has revolutionized the diagnosis of shoulder lesions, in many cases becoming the method of choice. However, anatomical variations, artifacts and the particularity of the method may be a source of pitfalls, especially for less experienced radiologists. In order to avoid false-positive and false-negative results, the authors carried out a compilation of imaging findings that may simulate injury. It is the authors' intention to provide a useful, consistent and comprehensive reference for both beginner residents and skilled radiologists who work with musculoskeletal magnetic resonance imaging, allowing for them to develop more precise reports and helping them to avoid making mistakes.

  8. Occipital condyle fracture as a rare cause of shoulder pain

    Directory of Open Access Journals (Sweden)

    Anil Yalcin


    Full Text Available Occipital condyle fractures (OCFs usually occur due to high energy trauma and are often associated with serious injuries, particularly in the brain. Because it is difficult to determine this fracture on plain radiographs, it can easily be misdiagnosed. In this report, we present a patient admitted to our emergency department with one and only complaint of shoulder pain following a motor vehicle accident. We aimed to underline the importance of physician’s elaboration and attention in the diagnosis of this rare entity.


    Hazle, Charles


    The diagnostic capabilities of advanced imaging have increasingly enabled clinicians to delineate between structural alterations and injuries more efficiently than ever before. These impressive gains have unfortunately begun to provide a reliance on imaging at the loss of quality in the clinical examination. Ideally, imaging of the shoulder complex is performed to confirm the provisional diagnosis developed from the history and clinical exam rather than to create such. This clinical commentary will provide the framework for both basic and advanced uses of imaging as well as discussion of evolving modalities. Level of Evidence: 5 PMID:24175143

  10. Síndrome de hombro doloroso Painful Shoulder Syndrome

    Directory of Open Access Journals (Sweden)

    Galia Constanza Fonseca-Portilla


    paciente cumple las normas internacionales mínimas propuestas, aunque es recomendable protocolizar.Aim: A painful shoulder is between the ten most frequent causes of consultation to a physiatrist. It affects a large percent of the economically active population. 5.74% of the new cases referred to the physiatrist of a metropolitan clinic during the year 2008, corresponded with a painful shoulder. The aim of this study was to investigate how the painful shoulder appears in this population. This includes the study of the demographic variables of the consulting population and the treatments that were used Methods: We reviewed 171 medical clinical records retrospectively of patients that consulted for a painful for shoulder shoulder syndrome during 2008 in the physiatry service of a Metropolitan health clinic that serves a population of 400 000 inhabitants from rural, urban marginal and urban areas with a second level of medical attention (specialized medical attention. Indicators like demographic variables were registered together with diagnostic and clinical evaluations, diagnostic imaging and treatments used. Results: The average age of the patients was 55 years, 74.3% were females and in 45% the right side was involved. Frequent associated diseases were diabetes (20.9% and psychiatric diseases (15%. A relationship between shoulder pain and fibromyalgia was found (4.3%. Treatment accomplished quality goals with prescription of exercise, non-steroidal anti-inflammatory drugs and infiltration as proposed by other authors. Conclusion: This population followed demographic and clinic characteristics described by other authors for shoulder pain (age, gender, shoulder side. This is the first national research that shows a relationship between fibromyalgia and shoulder pain. Physical examination register could improve. Quality treatment follows international parameters.

  11. Comorbid functional shoulder pain and zolpidem dependence treated with pramipexole

    Directory of Open Access Journals (Sweden)

    Dhiraj Kandre


    Full Text Available Pramipexole is a dopamine agonist with higher affinity for D3 receptors. Treatment with pramipexole in clinical conditions such as restless legs syndrome, fibromyalgia, and parkinsonism has been found to significantly improve measures of pain and sleep along with the other symptoms. There is no research data available that explores the usefulness of pramipexole in somatoform/functional pain syndromes. We report a case of a 65-year-old male with bilateral functional shoulder pain associated with insomnia and zolpidem dependence effectively treated with pramipexole.

  12. Registro de artroplastias do ombro Shoulder arthroplasty records

    Directory of Open Access Journals (Sweden)

    Geraldo Motta Filho


    Full Text Available OBJETIVO: Determinar as características clínico-cirúrgicas referentes a 145 artroplastias do ombro realizadas no período entre julho de 2004 a dezembro de 2006. MÉTODOS: No período de estudo foram realizadas 145 artroplastias de ombro. Através de protocolo prospectivo, informações demográficas, da anamnese, exame físico e exame radiográfico foram armazenadas em um banco de dados. Os dados coletados foram organizados em três grandes grupos: doenças articulares degenerativas, fraturas e seqüelas traumáticas. Esses dados foram correlacionados a fim de definir o perfil epidemiológico dos pacientes, das lesões e artroplastias. RESULTADOS: Das 145 artroplastias de ombro realizadas 37% foram por seqüelas traumáticas, 30% por doença articular degenerativa e 33% com diagnóstico de fratura. Foram 12% artroplastias totais e 88% parciais. Ocorreram cinco complicações no pós-operatório recente. CONCLUSÃO: As artroplastias de ombro tornaram-se um procedimento frequente na prática ortopédica. Registros cirúrgicos são importantes a fim de demonstrar essa evolução progressiva e permitir avaliações de resultados clínicos no futuro.OBJECTIVE: The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. METHODOLOGY: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. RESULTS: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus

  13. Diagnosis of shoulder impingement syndrome; Diagnostik des Schulterimpingementsyndroms

    Energy Technology Data Exchange (ETDEWEB)

    Hodler, J. [Orthopaedische Universitaetsklinik Balgrist, Zuerich (Switzerland)


    This article reviews the pathogenesis and clinical and imaging findings in shoulder impingement syndrome. Different stages of impingement syndrome are described. Stage I relates to edema and hemorrhage of the supraspinatus tendon. Stage II is characterized by bursal inflammation and fibrosis, as well as tendinopathy. In stage III there is a tear of the rotator cuff. Clinical signs many overlap. Moreover, calcifying tendinitis, fractures and pain originating from the cervical spine may mimic shoulder impingement syndrome. Imaging is important for the exact diagnosis. Standard radiographs are the basis of imaging in shoulder impingement syndrome. They may demonstrate subchondral sclerosis of the major tuberosity, subacromial spurs, and form anomalies of the acromion. They are also important in the differential diagnosis of shoulder impingement syndrome and demonstrate calcifying tendinitis, fractures and neoplasm. Ultrasonography has found acceptance as a screening tool and even as a final diagnostic method by many authors. However, there is a high interobserver variability in the demonstration of rotator cuff tears. Its usefulness has therefore been questioned. MR imaging is probably the method of choice in the evaluation of the rotator cuff and surrounding structures. Several investigations have demonstrated that differentiation of early findings, such as tendinopathy versus partial tears, may be difficult with MR imaging. However, reproducibility for fullthickness tears appears to be higher than for sonography. Moreover, specificity appears to be superior to sonography. MR arthrography is not universally accepted. However, it allows for more exact differentiation of discrete findings and may be indicated in preoperative planning. Standard arthrography and CT have a limited role in the current assessment of the rotator cuff. (orig.) [Deutsch] Grundlage des Impingementsyndroms ist eine Kompression des Supraspinatus am akromioklavikularen Bogen vor allem bei Flexion

  14. Modified axillary radiograph of the shoulder: a new position. (United States)

    Senna, Luís Filipe; Pires E Albuquerque, Rodrigo


    Obtaining axillary radiographs of the shoulder in acute trauma is not always feasible. The authors present a new modification of this radiographic view, in order to assess the anatomic relationship between the humeral head and the glenoid cavity. The incidence is performed with the patient sitting on X-ray table, with the affected limb supported thereon. The authors describe the case of a 28-year-old male who suffered an anterior glenohumeral dislocation that was clearly evidenced by this modified radiograph. The concentric relationship between the humeral head and the glenoid cavity was also easily confirmed by obtaining such radiograph after the reduction maneuver.


    Directory of Open Access Journals (Sweden)

    Balteanu Veronica


    Full Text Available The rehabilitation of the posttraumatic shoulder requires a complex treatment, which demands the implication of several specialists (specialized physician, radiologist, kinesiotherapist. The patient himself plays an important role: he has to be cooperative, active; he must understand the therapeutic act and respect all the indications of the specialists. The upper limb often suffers traumatisms, more serious and more frequent in certain sports branches.The functional rehabilitation – through adequate kinesiotherapeutic means and methods, methodically and systematically applied, within an optimal time frame – will recover the patient’s usual gestures for the respective segment; his social and professional reintegration will also occur as soon as possible.

  16. Comparison between ultrasound and plain X-ray in evaluating the cause of shoulder pain. (United States)

    Salek, K M; Mannan, M; Chowdhury, A Z; Haque, M A; Kaiser, M S; Nabi, S; Ferdousee, R A; Paul, B K; Ahmed, S M; Khan, M; Begum, M


    Painful shoulder is a common painful condition among patients. Apart from acute traumatic lesions such as fractures, dislocations, contusions, sprains and ruptured tendons, 85 to 90% of painful shoulders are due to adhesive capsulitis, acute or chronic calcific tendinitis, bursitis, bicipital tendinitis and lesions of the musculotendinous cuff. Arthritis is the cause of less than 5% of painful shoulders. For evaluating conditions of shoulder joint, X-ray has been regarded as only method of choice for long time. Magnetic resonance imaging (MRI) is an alternative procedure but the cost limits its utilization especially in Bangladesh. Ultrasonography is an effective imaging modality in the evaluation of both rotator and non-rotator cuff disorders. Because of low cost and availability, it can be an alternative procedure for the diagnosis of painful shoulder. The present study was conducted to assess ultrasonography as a useful modality in evaluating cases of shoulder pain and to compare the findings with X-ray findings. Thirty two patients with shoulder pain were evaluated by X-ray and Ultrasonography (USG). Clinical diagnosis was done for correlation. To identify the cause of shoulder pain, 100% patients were found normal in plain X-ray. On Ultrasonography (USG) 12.5% patients had displaced long head of biceps, 21.9% had biceps tendinitis, and 3.1% had bursitis. In the assessment of shoulder pathology, USG had a sensitivity of 73.3%, specificity of 88.2%, Positive predictive value (PPV) of 84.6%, Negative predictive value (NPV) of 78.9% and an accuracy of 81.3%. USG is a useful modality for evaluation the shoulder joint in case of painful shoulder even plain X-ray is non conclusive.

  17. Analysis of amyloid fibrils in the cheetah (Acinonyx jubatus). (United States)

    Bergström, Joakim; Ueda, Mitsuharu; Une, Yumi; Sun, Xuguo; Misumi, Shogo; Shoji, Shozo; Ando, Yukio


    Recently, a high prevalence of amyloid A (AA) amyloidosis has been documented among captive cheetahs worldwide. Biochemical analysis of amyloid fibrils extracted from the liver of a Japanese captive cheetah unequivocally showed that protein AA was the main fibril constituent. Further characterization of the AA fibril components by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and Western blot analysis revealed three main protein AA bands with approximate molecular weights of 8, 10 and 12 kDa. Mass spectrometry analysis of the 12-kDa component observed in SDS-PAGE and Western blotting confirmed the molecular weight of a 12,381-Da peak. Our finding of a 12-kDa protein AA component provides evidence that the cheetah SAA sequence is longer than the previously reported 90 amino acid residues (approximately 10 kDa), and hence SAA is part of the amyloid fibril.

  18. Alzheimer's disease: the amyloid hypothesis and the Inverse Warburg effect

    KAUST Repository

    Demetrius, Lloyd A.


    Epidemiological and biochemical studies show that the sporadic forms of Alzheimer\\'s disease (AD) are characterized by the following hallmarks: (a) An exponential increase with age; (b) Selective neuronal vulnerability; (c) Inverse cancer comorbidity. The present article appeals to these hallmarks to evaluate and contrast two competing models of AD: the amyloid hypothesis (a neuron-centric mechanism) and the Inverse Warburg hypothesis (a neuron-astrocytic mechanism). We show that these three hallmarks of AD conflict with the amyloid hypothesis, but are consistent with the Inverse Warburg hypothesis, a bioenergetic model which postulates that AD is the result of a cascade of three events—mitochondrial dysregulation, metabolic reprogramming (the Inverse Warburg effect), and natural selection. We also provide an explanation for the failures of the clinical trials based on amyloid immunization, and we propose a new class of therapeutic strategies consistent with the neuroenergetic selection model.

  19. Atomic-resolution structures of prion AGAAAAGA amyloid fibrils

    CERN Document Server

    Zhang, Jiapu


    To the best of the author's knowledge, there is little structural data available on the AGAAAAGA palindrome in the hydrophobic region (113-120) of prion proteins due to the unstable, noncrystalline and insoluble nature of the amyloid fibril, although many experimental studies have shown that this region has amyloid fibril forming properties and plays an important role in prion diseases. In view of this, the present study is devoted to address this problem from computational approaches such as local optimization steepest descent, conjugate gradient, discrete gradient and Newton methods, global optimization simulated annealing and genetic algorithms, canonical dual optimization theory, and structural bioinformatics. The optimal atomic-resolution structures of prion AGAAAAGA amyloid fibils reported in this Chapter have a value to the scientific community in its drive to find treatments for prion diseases or at least be useful for the goals of medicinal chemistry.

  20. Molecular dynamics simulations of amyloid fibrils: an in silico approach

    Institute of Scientific and Technical Information of China (English)

    Wei Ye; Wei Wang; Cheng Jiang; Qingfen Yu; Haifeng Chen


    Amyloid fibrils play causal roles in the pathogenesis of amyloid-related degenerative diseases such as Alzheimer's disease,type Ⅱ diabetes mellitus,and the prion-related transmissible spongiform encephalopathies.The mechanism of fibril formation and protein aggregation is still hotly debated and remains an important open question in order to develop therapeutic method of these diseases.However,traditional molecular biological and crystallographic experiments could hardly observe atomic details and aggregation process.Molecular dynamics (MD) simulations could provide explanations for experimental results and detailed pathway of protein aggregation.In this review,we focus on the applications of MD simulations on several amyloidogenic protein systems.Furthermore,MD simulations could help us to understand the mechanism of amyloid aggregation and how to design the inhibitors.

  1. Destroying activity of magnetoferritin on lysozyme amyloid fibrils

    Energy Technology Data Exchange (ETDEWEB)

    Kopcansky, Peter; Siposova, Katarina [Institute of Experimental Physics, SAS, Watsonova 47, 040 01 Kosice (Slovakia); Melnikova, Lucia, E-mail: [Institute of Experimental Physics, SAS, Watsonova 47, 040 01 Kosice (Slovakia); Bednarikova, Zuzana [Institute of Experimental Physics, SAS, Watsonova 47, 040 01 Kosice (Slovakia); Institute of Chemical Sciences, Faculty of Sciences, Safarik University, Kosice (Slovakia); Timko, Milan; Mitroova, Zuzana; Antosova, Andrea [Institute of Experimental Physics, SAS, Watsonova 47, 040 01 Kosice (Slovakia); Garamus, Vasil M. [Helmholtz-Zentrum Geesthacht: Centre for Materials and Coastal Research, Max-Planck-Street 1, 21502 Geesthacht (Germany); Petrenko, Viktor I. [Joint Institute for Nuclear Research, Joliot-Curie 6, Dubna, 141980 Moscow Region (Russian Federation); Kyiv Taras Shevchenko National University, Volodymyrska Street 64, Kyiv 01033 (Ukraine); Avdeev, Mikhail V. [Joint Institute for Nuclear Research, Joliot-Curie 6, Dubna, 141980 Moscow Region (Russian Federation); Gazova, Zuzana [Institute of Experimental Physics, SAS, Watsonova 47, 040 01 Kosice (Slovakia); Department of Medical and Clinical Biochemistry and LABMED, Tr. SNP 1, 040 11 Kosice (Slovakia)


    Presence of protein amyloid aggregates (oligomers, protofilaments, fibrils) is associated with many diseases as diabetes mellitus or Alzheimer's disease. The interaction between lysozyme amyloid fibrils and magnetoferritin loaded with different amount of iron atoms (168 or 532 atoms) has been investigated by small-angle X-rays scattering and thioflavin T fluorescence measurements. Results suggest that magnetoferritin caused an iron atom-concentration dependent reduction of lysozyme fibril size. - Highlights: • The interaction between lysozyme amyloid fibrils and magnetoferritin loaded with different amount of iron atoms (168 or 532 atoms) has been investigated by small-angle X-rays scattering and thioflavin T fluorescence measurements. • Results suggest that magnetoferritin caused an iron atom-concentration dependent reduction of lysozyme fibril size.

  2. Atomic Resolution Structure of Monomorphic Aβ42 Amyloid Fibrils. (United States)

    Colvin, Michael T; Silvers, Robert; Ni, Qing Zhe; Can, Thach V; Sergeyev, Ivan; Rosay, Melanie; Donovan, Kevin J; Michael, Brian; Wall, Joseph; Linse, Sara; Griffin, Robert G


    Amyloid-β (Aβ) is a 39-42 residue protein produced by the cleavage of the amyloid precursor protein (APP), which subsequently aggregates to form cross-β amyloid fibrils that are a hallmark of Alzheimer's disease (AD). The most prominent forms of Aβ are Aβ1-40 and Aβ1-42, which differ by two amino acids (I and A) at the C-terminus. However, Aβ42 is more neurotoxic and essential to the etiology of AD. Here, we present an atomic resolution structure of a monomorphic form of AβM01-42 amyloid fibrils derived from over 500 (13)C-(13)C, (13)C-(15)N distance and backbone angle structural constraints obtained from high field magic angle spinning NMR spectra. The structure (PDB ID: 5KK3 ) shows that the fibril core consists of a dimer of Aβ42 molecules, each containing four β-strands in a S-shaped amyloid fold, and arranged in a manner that generates two hydrophobic cores that are capped at the end of the chain by a salt bridge. The outer surface of the monomers presents hydrophilic side chains to the solvent. The interface between the monomers of the dimer shows clear contacts between M35 of one molecule and L17 and Q15 of the second. Intermolecular (13)C-(15)N constraints demonstrate that the amyloid fibrils are parallel in register. The RMSD of the backbone structure (Q15-A42) is 0.71 ± 0.12 Å and of all heavy atoms is 1.07 ± 0.08 Å. The structure provides a point of departure for the design of drugs that bind to the fibril surface and therefore interfere with secondary nucleation and for other therapeutic approaches to mitigate Aβ42 aggregation.

  3. BETASCAN: probable beta-amyloids identified by pairwise probabilistic analysis.

    Directory of Open Access Journals (Sweden)

    Allen W Bryan


    Full Text Available Amyloids and prion proteins are clinically and biologically important beta-structures, whose supersecondary structures are difficult to determine by standard experimental or computational means. In addition, significant conformational heterogeneity is known or suspected to exist in many amyloid fibrils. Recent work has indicated the utility of pairwise probabilistic statistics in beta-structure prediction. We develop here a new strategy for beta-structure prediction, emphasizing the determination of beta-strands and pairs of beta-strands as fundamental units of beta-structure. Our program, BETASCAN, calculates likelihood scores for potential beta-strands and strand-pairs based on correlations observed in parallel beta-sheets. The program then determines the strands and pairs with the greatest local likelihood for all of the sequence's potential beta-structures. BETASCAN suggests multiple alternate folding patterns and assigns relative a priori probabilities based solely on amino acid sequence, probability tables, and pre-chosen parameters. The algorithm compares favorably with the results of previous algorithms (BETAPRO, PASTA, SALSA, TANGO, and Zyggregator in beta-structure prediction and amyloid propensity prediction. Accurate prediction is demonstrated for experimentally determined amyloid beta-structures, for a set of known beta-aggregates, and for the parallel beta-strands of beta-helices, amyloid-like globular proteins. BETASCAN is able both to detect beta-strands with higher sensitivity and to detect the edges of beta-strands in a richly beta-like sequence. For two proteins (Abeta and Het-s, there exist multiple sets of experimental data implying contradictory structures; BETASCAN is able to detect each competing structure as a potential structure variant. The ability to correlate multiple alternate beta-structures to experiment opens the possibility of computational investigation of prion strains and structural heterogeneity of amyloid

  4. [Carpal tunnel syndrome, amyloid tenosynovitis and periodic hemodialysis]. (United States)

    Clanet, M; Mansat, M; Durroux, R; Testut, M F; Guiraud, B; Rascol, A; Conte, J


    Since 1975, various entrapment neuropathies have been reported in patients undergoing periodic haemodialysis, the most frequent being the carpal tunnel syndrome. Ten patients on chronic haemodialysis developing 15 carpal tunnel syndromes (5 unilateral and 5 bilateral) are reported. Various causes for the renal failure were present and clinical signs of the carpal tunnel syndrome developed at a late stage. The arteriovenous fistula required for extrarenal epuration was antebrachial and of the laterolateral type, except in one case when it was lateroterminal. The carpal tunnel syndrome was always on the same side as the fistula, developing at a later stage on th contralateral side in the 5 cases of bilateral disorders. Lesions were severe, in 11 of the 15 cases. Some patients noted fluctuations in pain symptoms during haemodialysis, either improving or becoming worse. Gross pathological findings during operation (13 cases) were tenosynovitis with epineural hypervascularisation on the opposite side. In 9 cases, however, atypical hypertrophic tenosynovitis was observed. Histological examination in 12 cases demonstrated typical tenosynovitis in 3 patients, but granulomatous tenosynovitis with amyloid deposits was reported in 9 patients. Lesions were bilateral in 2 cases thus present, on the side opposite to the fistula. Ultrastructural study confirmed the amyloid nature of the deposits in 3 cases, the microfibrillary appearance (80 to 100 A) being characteristic of amyloid substance. This rare complication does not represent a common carpal tunnel syndrome, and three mechanisms may be involved in its induction : peripheral uraemic neuropathy, haemodynamic modifications resulting from the antebrachial arteriovenous shunt, and amyloid formation in the flexor synovial sheaths. In the latter case, the type of amyloid disease may be a primary systemic amyloidosis not previously detected, or an elective amyloid process localised to the tenosynovial and periarticular tissues.

  5. Quantitative amyloid imaging using image-derived arterial input function.

    Directory of Open Access Journals (Sweden)

    Yi Su

    Full Text Available Amyloid PET imaging is an indispensable tool widely used in the investigation, diagnosis and monitoring of Alzheimer's disease (AD. Currently, a reference region based approach is used as the mainstream quantification technique for amyloid imaging. This approach assumes the reference region is amyloid free and has the same tracer influx and washout kinetics as the regions of interest. However, this assumption may not always be valid. The goal of this work is to evaluate an amyloid imaging quantification technique that uses arterial region of interest as the reference to avoid potential bias caused by specific binding in the reference region. 21 participants, age 58 and up, underwent Pittsburgh compound B (PiB PET imaging and MR imaging including a time-of-flight (TOF MR angiography (MRA scan and a structural scan. FreeSurfer based regional analysis was performed to quantify PiB PET data. Arterial input function was estimated based on coregistered TOF MRA using a modeling based technique. Regional distribution volume (VT was calculated using Logan graphical analysis with estimated arterial input function. Kinetic modeling was also performed using the estimated arterial input function as a way to evaluate PiB binding (DVRkinetic without a reference region. As a comparison, Logan graphical analysis was also performed with cerebellar cortex as reference to obtain DVRREF. Excellent agreement was observed between the two distribution volume ratio measurements (r>0.89, ICC>0.80. The estimated cerebellum VT was in line with literature reported values and the variability of cerebellum VT in the control group was comparable to reported variability using arterial sampling data. This study suggests that image-based arterial input function is a viable approach to quantify amyloid imaging data, without the need of arterial sampling or a reference region. This technique can be a valuable tool for amyloid imaging, particularly in population where reference

  6. Quantitative amyloid imaging using image-derived arterial input function. (United States)

    Su, Yi; Blazey, Tyler M; Snyder, Abraham Z; Raichle, Marcus E; Hornbeck, Russ C; Aldea, Patricia; Morris, John C; Benzinger, Tammie L S


    Amyloid PET imaging is an indispensable tool widely used in the investigation, diagnosis and monitoring of Alzheimer's disease (AD). Currently, a reference region based approach is used as the mainstream quantification technique for amyloid imaging. This approach assumes the reference region is amyloid free and has the same tracer influx and washout kinetics as the regions of interest. However, this assumption may not always be valid. The goal of this work is to evaluate an amyloid imaging quantification technique that uses arterial region of interest as the reference to avoid potential bias caused by specific binding in the reference region. 21 participants, age 58 and up, underwent Pittsburgh compound B (PiB) PET imaging and MR imaging including a time-of-flight (TOF) MR angiography (MRA) scan and a structural scan. FreeSurfer based regional analysis was performed to quantify PiB PET data. Arterial input function was estimated based on coregistered TOF MRA using a modeling based technique. Regional distribution volume (VT) was calculated using Logan graphical analysis with estimated arterial input function. Kinetic modeling was also performed using the estimated arterial input function as a way to evaluate PiB binding (DVRkinetic) without a reference region. As a comparison, Logan graphical analysis was also performed with cerebellar cortex as reference to obtain DVRREF. Excellent agreement was observed between the two distribution volume ratio measurements (r>0.89, ICC>0.80). The estimated cerebellum VT was in line with literature reported values and the variability of cerebellum VT in the control group was comparable to reported variability using arterial sampling data. This study suggests that image-based arterial input function is a viable approach to quantify amyloid imaging data, without the need of arterial sampling or a reference region. This technique can be a valuable tool for amyloid imaging, particularly in population where reference normalization may

  7. Validity of Ultrasonography and Measures of Adult Shoulder Function and Reliability of Ultrasonography in Detecting Shoulder Synovitis in Patients With Rheumatoid Arthritis Using Magnetic Resonance Imaging as a Gold Standard

    NARCIS (Netherlands)

    Bruyn, G. A. W.; Pineda, C.; Hernandez-Diaz, C.; Ventura-Rios, L.; Moya, C.; Garrido, J.; Groen, H.; Pena, A.; Espinosa, R.; Moeller, I.; Filippucci, E.; Iagnocco, A.; Balint, P. V.; Kane, D.; D'Agostino, M-A; Angulo, M.; Ponte, R.; Fernandez-Gallardo, J. M.; Naredo, E.; Moller, I.


    Objective. To assess the intra- and interobserver reproducibility of musculoskeletal ultrasonography (US) in detecting inflammatory shoulder changes in patients with rheumatoid arthritis, and to determine the agreement between US and the Shoulder Pain and Disability Index (SPADI) and the Disabilitie

  8. Serum amyloid a in clinical practice

    Directory of Open Access Journals (Sweden)

    Jovanović Dijana B.


    Full Text Available Serum amyloid A (SAA is an acute phase first class protein discovered a quarter of the century ago. Its concentration depends on clinical findings of the patient, illness activity and the therapy applied. SAA increases moderately to markedly (100-1000 mg/l in bacterial and fungal infections, invasive malignant diseases, tissue injuries in the acute myocardial infarction and autoimmune diseases such as rheumatoid arthritis and vasculitis. Mild elevation (10-100 mg/l is often seen in viral infections, systemic lupus erythematosus and localized inflammation or tissue injuries in cystitis and cerebral infarction. SAA as sensitive, non-invasive parameter is used in organ transplantation where early and correct diagnosis is needed as well as where prompt therapy is required. Besides acute kidney allograft rejection, SAA is used in the diagnosis of rejection after liver transplantation, simultaneous pancreas and kidney transplantation and also in bone marrow transplantation (acute „graft vs. host disease". Simultaneous determination of C-reactive protein (CRP and SAA may point to acute kidney allograft rejection. Standard immunosuppressive therapy with cyclosporine A and prednisolone significantly suppresses the acute phase CRP reaction both in operation itself and acute rejection, but not in infection. On the other hand, SAA rejection in operation, acute allograft rejection and infection is present in spite of cyclosporine A and steroids therapy. Different reaction of SAA and CRP in transplant patients to cyclosporine A therapy helps in differentiation between the infection and rejection. Although CRP and SAA are sensitive and acute phase reactants, their serum concentrations cannot be valued as prognostic and diagnostic criteria without creatinine serum concentration and clinical findings. In addition, they offer important information for clinical diagnosis as well as the kind of therapy.

  9. A population study on differences in the determinants of a specific shoulder disorder versus nonspecific shoulder pain without clinical findings. (United States)

    Miranda, Helena; Viikari-Juntura, Eira; Heistaro, Sami; Heliövaara, Markku; Riihimäki, Hilkka


    Musculoskeletal pain frequently occurs without particular clinical findings. Pain per se may be determined by factors other than those indicating a clinical disorder. The authors examined the prevalence and determinants of clinically diagnosed chronic rotator cuff tendinitis and self-reported nonspecific shoulder pain. The Health 2000 survey, carried out in 2000-2001 in Finland, included a nationally representative sample of 8,028 persons aged 30 years or more. In the present study, analyses were restricted to subjects aged 30-64 years who had held a job during the preceding 12 months. The prevalences of chronic rotator cuff tendinitis and nonspecific shoulder pain were 2.0% (78 of 3,909 subjects) and 12% (410 of 3,525 subjects), respectively. Nonspecific pain was related to burnout (adjusted odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.4, 2.2), depression (among women, the adjusted OR was 1.8 (95% CI: 1.1, 2.9) for mild depression and 3.0 (95% CI: 1.6, 5.6) for severe depression), and inability to express one's feelings (alexithymia) (adjusted OR = 1.6, 95% CI: 1.1, 2.5). However, these factors were not associated with chronic rotator cuff tendinitis, determinants of which were work-related cumulative loading on the shoulder, age, and insulin-dependent diabetes mellitus (adjusted OR = 8.8, 95% CI: 1.9, 40.3). The determinants of specific musculoskeletal disorders differ from those of subjective complaints without clinical findings. Such complaints may be indicators of adverse psychological and psychosocial factors rather than the presence of an underlying pathologic condition.

  10. Biotechnologically engineered protein binders for applications in amyloid diseases. (United States)

    Haupt, Christian; Fändrich, Marcus


    The aberrant self-assembly of polypeptide chains into amyloid structures is a common phenomenon in several neurodegenerative diseases, systemic amyloidosis, and 'normal' aging. Improvements in laboratory-scale detection of these structures, their clinical diagnosis, and the treatment of disease likely depend on the advent of new molecules that recognize particular states or induce their clearance in vivo. This review will describe what biotechnology can do to generate proteinaceous amyloid-binders, explain their molecular recognition mechanisms, and summarize possibilities to functionalize further these ligands for specific applications.

  11. Structural network alterations and neurological dysfunction in cerebral amyloid angiopathy (United States)

    Reijmer, Yael D.; Fotiadis, Panagiotis; Martinez-Ramirez, Sergi; Salat, David H.; Schultz, Aaron; Shoamanesh, Ashkan; Ayres, Alison M.; Vashkevich, Anastasia; Rosas, Diana; Schwab, Kristin; Leemans, Alexander; Biessels, Geert-Jan; Rosand, Jonathan; Johnson, Keith A.; Viswanathan, Anand; Gurol, M. Edip


    Cerebral amyloid angiopathy is a common form of small-vessel disease and an important risk factor for cognitive impairment. The mechanisms linking small-vessel disease to cognitive impairment are not well understood. We hypothesized that in patients with cerebral amyloid angiopathy, multiple small spatially distributed lesions affect cognition through disruption of brain connectivity. We therefore compared the structural brain network in patients with cerebral amyloid angiopathy to healthy control subjects and examined the relationship between markers of cerebral amyloid angiopathy-related brain injury, network efficiency, and potential clinical consequences. Structural brain networks were reconstructed from diffusion-weighted magnetic resonance imaging in 38 non-demented patients with probable cerebral amyloid angiopathy (69 ± 10 years) and 29 similar aged control participants. The efficiency of the brain network was characterized using graph theory and brain amyloid deposition was quantified by Pittsburgh compound B retention on positron emission tomography imaging. Global efficiency of the brain network was reduced in patients compared to controls (0.187 ± 0.018 and 0.201 ± 0.015, respectively, P < 0.001). Network disturbances were most pronounced in the occipital, parietal, and posterior temporal lobes. Among patients, lower global network efficiency was related to higher cortical amyloid load (r = −0.52; P = 0.004), and to magnetic resonance imaging markers of small-vessel disease including increased white matter hyperintensity volume (P < 0.001), lower total brain volume (P = 0.02), and number of microbleeds (trend P = 0.06). Lower global network efficiency was also related to worse performance on tests of processing speed (r = 0.58, P < 0.001), executive functioning (r = 0.54, P = 0.001), gait velocity (r = 0.41, P = 0.02), but not memory. Correlations with cognition were independent of age, sex, education level, and other magnetic resonance imaging

  12. Native human serum amyloid P component is a single pentamer

    DEFF Research Database (Denmark)

    Sørensen, Inge Juul; Andersen, Ove; Nielsen, EH;


    Serum amyloid P component (SAP) and C-reactive protein (CRP) are members of the pentraxin protein family. SAP is the precursor protein to amyloid P component present in all forms of amyloidosis. The prevailing notion is that SAP in circulation has the form of a double pentameric molecule (decamer...... by rocket immunoelectrophoresis and electron microscopy. Thus, electron micrographs of purified SAP showed a predominance of decamers. However, the decamer form of SAP reversed to single pentamers when purified SAP was incorporated into SAP-depleted serum....

  13. [Salmon-pink colored conjunctival tumor with amyloid deposits]. (United States)

    Müller, P L; Loeffler, K U; Holz, F G; Fischer, H-P; Herwig, M C


    An 82-year-old male patient presented with a salmon-pink colored conjunctival tumor of the left eye. A circumscribed, dense and whitish portion was detected by clinical examination. The histophological and immunhistochemical examination of the biopsy tissue revealed a CD20+ marginal zone lymphoma of the conjunctiva with amyloid deposits. Extranodal marginal zone lymphoma at this site is the most common lymphoma of the ocular adnexa and accounts for 5-10% of malignant diseases. An association with amyloid production is very rare and according to the current state of knowledge has no known impact on the outcome.

  14. Feasibility of shoulder use for highway work zone optimization

    Directory of Open Access Journals (Sweden)

    Bo Du


    Full Text Available Highway maintenance, often requiring lane closure, is very expensive in terms of the costs associated with transportation agencies (i. e. work zone setups and road users (i. e. delay. Longer work zones tend to increase the user delay but will be efficient because of fewer repeated setups. To increase road capacity and mitigate congestion impact for a short-term work zone, temporary shoulder use may be applied. This study develops an analytical model to optimize work zone length on a multi-lane highway considering time-varying traffic volume and road capacity affected by light condition, heavy vehicle percentage, and lane width. The results can be used to evaluate the work zone impact (i. e. delay and cost and assist engineers/planners to prepare and develop a cost-effective highway maintenance plan. A case study for a highway work zone in New Jersey has been conducted, in which the optimized solution is found. A guideline of using road shoulder under various circumstances is developed.

  15. Simultaneous Bilateral Anterior Shoulder Dislocation Occurred During Sleepwalking

    Directory of Open Access Journals (Sweden)

    fevzi yilmaz


    A 17-years-old male presented to our emergency department with a complaint of bilateral shoulder pain and motion restriction. His past medical history was unremarkable for epilepsy or major trauma. His family members said that he was a sleepwalker since he was 5 or 6 years old and sometimes he was going to another place from his bed and when they saw him there were abrasions especially on his face and extremities. It was learned that he left the drugs given by the doctors for his complaint after using a short time. On his physical examination in the emergency department he appeared to be good, he was concious, cooperative and oriented to person, time and place. His vital signs and neurological examination were normal. His extremity examination revealed that his arms were slightly in abduction and external rotation. There was epaulet sign bilateral on his shoulders and his peripheral neurological examination was otherwise normal. The radiological evaluation revealed bilateral subchorocoidal anterior dislocation without signs of fracture (Figure 1.

  16. Extracorporeal shock wave therapy for calcifying tendinitis of the shoulder. (United States)

    Hsu, Chin-Jung; Wang, Der-Yean; Tseng, Kuo-Fung; Fong, Yi-Chin; Hsu, Horng-Chaung; Jim, Yick-Fung


    We prospectively studied extracorporeal shock wave therapy (ESWT) for calcific tendinitis of the shoulder in 46 consecutive patients. All patients were randomly divided into 2 groups: treatment and control. The 33 patients in the treatment group received 2 courses of ESWT at the energy density of 0.55 mJ/mm(2) (1000 impulses). The control group underwent sham treatment with a dummy electrode (13 patients). Evaluation included the Constant score, pain scale, and radiographs. The ESWT results were good to excellent in 87.9% of shoulders (29/33) and fair in 12.1% (4/33), and the control results were fair in 69.2% (9/13) and poor in 30.1% (4/13). Among ESWT patients, calcium deposits were completely eliminated in 7 cases (21.2%), partially eliminated in 11 (36.3%), and unchanged in 15 (45.4%). In contrast, elimination was partial in 2 control patients (15.3%) and unchanged in 11 (84.7%). There was no significant difference between Gärtner type I and type II groups in the Constant score (P > .05). ESWT shows promise for pain relief and functional restoration of calcific tendinitis with negligible complications.

  17. Osseous Defects Seen in Patients with Anterior Shoulder Instability (United States)

    Itoi, Eiji


    Shoulder surgeons need to be aware of the critical size of the glenoid or humeral osseous defects seen in patients with anterior shoulder instability, since the considerable size of osseous defect is reported to cause postoperative instability. Biomechanical studies have identified the size of the osseous defect which affects stability. Since engagement always occurs between a Hill-Sachs lesion and the glenoid rim, when considering the critical size of the Hill-Sachs lesion, we have to simultaneously consider the size of the glenoid osseous defect. With the newly developed concept of the glenoid track, we are able to evaluate whether a large Hill-Sachs lesion is an "on-track" or "off-track" lesion, and to consider both osseous defects together. In case of an off-track Hill-Sachs lesion, if the glenoid defect is less than 25%, no treatment is required. In this case, the Latarjet procedure or arthroscopic remplissage procedure can be a treatment option. However, if the glenoid defect is more than 25%, treatment such as bone grafting is required. This will convert an off-track lesion to an on-track lesion. After the bone graft or Latarjet procedure, if the Hill-Sachs lesion persists as off-track, then further treatment is necessitated. In case with an on-track Hill-Sachs lesion and a less than 25% glenoid defect, arthroscopic Bankart repair alone is enough. PMID:26640623

  18. Shoulder tip pain: an under-reported complication of ventriculoperitoneal shunt.

    LENUS (Irish Health Repository)

    Lim, C


    Ventriculoperitoneal (VP) shunt insertion is the commonest form of treatment for hydrocephalus. Shoulder tip pain after VP shunt insertion is unusual and has only recently been reported. We present a case of excruciating shoulder tip pain due to diaphragmatic irritation after VP shunt insertion.

  19. Trajectories of musculoskeletal shoulder pain after spinal cord injury : Identification and predictors

    NARCIS (Netherlands)

    Eriks-Hoogland, Inge E.; Hoekstra, Trynke; de Groot, Sonja; Stucki, Gerold; Post, Marcel W.; van der Woude, Lucas H.


    Objective/Background: Although shoulder pain is a problem in up to 86% of persons with a spinal cord injury (SCI), so far, no studies have empirically identified longitudinal patterns (trajectories) of musculoskeletal shoulder pain after SCI. The objective of this study was: (1) to identify distinct

  20. 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;


    supervision or to a control group. At baseline and at follow-up the participants were tested for maximum isometric shoulder strength by a blinded tester. Further, once a week participants reported pain intensity of the neck/shoulder during the previous week. RESULTS: In intention-to-treat analysis neck...